[Alarm symptoms of spinal metastases in patients with cancer]

Recently, the evidence-based guideline 'Spinal metastasis' produced by the Dutch National Working Group on Neuro-Oncology appeared. This guideline applies to patients with spinal metastases and spinal localizations of haematological malignancies, with or without epidural extension. Timely diagnosis and treatment of spinal metastases is essential in order to reduce pain and neurological deficit in particular. An important aim of this guideline is to reduce both patient and doctor delay by providing information to high-risk patients and their general practitioners and to give clear advice on the organization of care. In this case report we describe two patients with spinal metastases in order to illustrate the difficulties in providing a timely diagnosis and optimal treatment for symptomatic spinal metastases. Furthermore, we provide advice to all health care professionals involved to secure the highest possible quality of life for patients with spinal metastases.