Scottish referral guidelines for suspected cancer: quick reference guide

Malignant Spinal Cord Compression ( MSCC)

Many patients with cancer are at risk of MSCC but particularly those with lung, breast, prostate cancer or multiple myeloma.

Some health boards have specific pathways for suspected MSCC with arrangements for direct referral via an MSCC Coordinator.

Seek immediate advice as an emergency from Duty Clinical Oncologist or MSCC Coordinator on patients with cancer and symptoms or signs suggestive of spinal metastases or MSCC:

• Radicular pain.
• Limb weakness or difficulty in walking.
• Sensory loss (including perineal or saddle paraesthesia).
• Bladder or bowel dysfunction.

Refer urgently (within 24 hours) to MSCC Coordinator
or Duty Clinical Oncologist to discuss the care of patients with cancer and any of the following symptoms suggestive of spinal metastases:

• Pain in the middle (thoracic) or upper (cervical) spine.
• Progressive lower (lumbar) spinal pain.
• Severe unremitting lower spinal pain.
• Spinal pain aggravated by straining (e.g at stool, or when coughing or sneezing).
• Localised spinal tenderness.
• Nocturnal spinal pain preventing sleep.

Perform frequent clinical reviews of patients with cancer who develop lower spinal pain that is clinically thought to be of degenerative or non-specific origin (i.e. not progressive, severe or aggravated by straining and has no accompanying neurological symptoms).