Episode 17: When Cancer Spreads to the Spine. A Conversation with Dr. Mark Bilsky

Dr. Maxwell Boakye
March 1, 2022

One of oncology’s greatest challenges in treating cancer is when it spreads to a different part of the body. When cancer spreads to the spine, it presents unique challenges for doctors creating a successful treatment plan. On this episode, I have the pleasure of interviewing the chief of Oncology at Sloan Kettering, and one of my mentors, Dr. Mark Bilsky. We’ll discuss the logistics of his practice, surgical and non-surgical treatment strategies, as well as recent advances in the field of spinal oncology.

You will want to hear this episode if you are interested in…

Getting to know Dr. Mark Bilsky and his practice [0:56]
Why Dr. Bilsky decided to focus on spinal oncology [4:18]
The epidemiology of spinal cancer, the role surgery plays in treatment, and how surgical techniques and equipment have changed over time [6:45]
How Dr. Bilsky evaluates spinal metastases at his center and the logistics of his practice [18:03]
Examining advances in radiosurgery and the systems Dr. Bilsky uses at Sloan Kettering [23:51]
Treating instability in spinal cancer patients [25:48]
Rapid-fire updates on modeling management for various types of tumors [28:42]
The magic wand question [33:19]

Classifying metastatic tumors

A critical part of treating tumors on the spine is knowing how to classify them. As with most oncological solutions, treating tumors that have metastasized to the spine requires either surgical or non-surgical intervention. With that knowledge, the classification of metastatic tumors can be broken down into those two categories. Metastasized spine tumors that often need surgery are non-small cell lung, colon, renal cell, and melanomas. It’s the hormone-driven tumors like breast and prostate that usually respond better to a non-surgical approach, even after spreading to the spine. Thankfully, Dr. Bilsky created the NOMS assessment to create a more individualized approach to determining patient treatment plans. Listen to this episode for more info on NOMS!

Treating spinal instability caused by cancer

When cancer spreads to the spine, patients are often plagued with a multitude of painful symptoms. Compression on the spine caused by metastatic tumors can lead to spinal fractures and spinal instability. Surgical intervention is almost guaranteed when these things occur or if the tumor is radioresistant. Spinal instability is often treated through surgical procedures known as vertebroplasty and kyphoplasty. While both methods use image guidance to inject a cement mixture into the fractured bone through a hollow needle, kyphoplasty first inserts a balloon into the fractured bone through the hollow needle to create enough space for the cement after it’s inflated and removed.

Moving towards a minimally invasive future

I love asking my magic wand question because it always gives me a good indication of where an expert’s field is heading. Dr. Bilsky’s answer is no exception. He believes that the next great frontier of spinal oncology will focus on making its treatments more minimally invasive and tolerable for patients. Long surgeries with a great deal of blood loss do nothing to help improve patient outcomes. Right now, minimally invasive procedures such as tubular decompressions lead the way in mitigating patient risk, however, Dr. Bilsky feels that achieving meaningful tumor decompression through endoscopic resections should be one of the field’s major goals in the future. For more information on treating metastatic tumors, listen to this episode!

Download the transcript of this conversation