What is Chondrosarcoma?
It is a form of primary bone cancer, meaning it originates in the bones. The cells that transform and produce cartilage are mainly affected by this condition. The tumor usually arises in the leg, arm, shoulder and pelvis bones. However, it can also be found in other areas in the body such as the proximal parts of humerus, tibia and femur, the chest wall as well as sternum. This type of Sarcoma can occur on healthy bones as well as on benign bone tumors. In some rare cases, it grows within the muscles adjacent to the bones.
Bone cancers are usually very rare. Chondrosarcoma is ranked the second most frequent bone cancer with Osteosarcoma (another similar cancer) being the most common. This cancer can also occur in animals such as cats and dogs.
Chondrosarcoma Types
The condition is classified into several categories depending on the appearance of the tumor under the microscope. These are:
- Conventional
- Extraskeletal Myxoid
- Mesenchymal
- Clear Cell
- Dedifferentiated
- Juxtacortical
- Periosteal
- Synovial
Chondrosarcoma Causes
As is the case with many other types of bone cancer, the exact causes responsible for the occurrence of this condition are unknown. People with the rare benign bone tumors called chondroma or osteochondroma are slightly more likely to develop the cancer compared to healthy individuals. Enchondromatosis or Ollier’s disease is another risk factor for the disorder. The rare hereditary diseases such as Maffucci’s syndrome and Multiple Exostoses (HME) may also increase the risk of developing Chondrosarcoma.
Chondrosarcoma Symptoms
The symptoms of this disorder can vary from one patient to another. Following are the common symptoms of the condition:
- Mild to severe pain around the area of the tumor
- Redness and swelling at the site of cancer
- Pain that tends to increase with activity
- Enlargement of an existing exostosis (bone enlargement)
- Decreased limb movement in the affected area
- Limping
- Abnormal urinary frequency or urinary obstruction (especially in pelvic tumors)
Chondrosarcoma Prevention
It is not possible to prevent the growth of these cancerous tumors because of their unknown etiology. Researches are being carried out to establish some preventive measures for this disorder.
Physicians believe that various bone-related disorders can increase the risk of developing the bone cancer. Some studies suggest a possible connection between the tumor and an injury to the area involved. However, it is still not known whether these traumas cause the condition or just draw attention to a previously undetected cancer.
Chondrosarcoma Diagnosis
Doctors perform a detailed physical examination and study the medical history of patients for any previous bone trauma in the affected area. The signs and symptoms of a patient are also studied carefully. The sufferer is asked various questions regarding his or her health habits as well as the history of serious illnesses and their treatment. Various diagnostic tests are also used for making the diagnosis:
X-rays
This test uses high-energy radiation for taking images of the affected internal parts. It is very useful for observing the size, shape and location of the tumor.
Bone Scan
A scanner and a low-level radioactive material are used in bone scans to detect any cancer cell in bones.
CT (Computed Tomography) scans
In this imaging test, a rotating camera uses x-rays to take cross-sectional images of organs and tissues.
MRI (Magnetic Resonance Imaging)
It is used for taking detailed images of the internal affected area using radio waves and a powerful magnet.
PET (Positron Emission Tomography) and PET/CT scans
Radioactive positrons (positively charged particles) are used for detecting any slight change in the chemical activities and metabolism of the body. The particles then produce images showing the functioning of the body, rather than its internal structures.
Biopsy
This test involves removing a tissue sample from the tumor to be examined in laboratory. The diagnostician may use a needle or make an incision in skin to collect the sample.
Blood Tests
Blood tests are not very useful for making the diagnosis of this disease. However, they can be used for ruling out other types of cancers.
Radiographic Findings
Radiographic exams can suggest the presence of Chondrosarcoma by detecting a chondroid matrix mineralization (which represents the enchondral ossification) along with fast-growing features of soft-tissue extension and deep endosteal scalloping. The mineralized chondroid matrix detected by the exam has a distinctive “ring and arc” calcification pattern.
Chondrosarcoma Grading and Staging System
Grading of the tumor is done on the basis of the appearance of the cancerous cells under the microscope. This helps to estimate the time likely to be taken by the tumor to progress into cancer. Low-grades represent almost normal-looking and slow growing tumors that have lower chances of spreading. The cells in high-grade tumors have extremely abnormal appearance and are expected to grow quickly, spreading to adjoining areas.
This type of bone tumors are graded in three categories, with a grade 1 tumor denoting low-grade cancer and the 3rd grade meaning a serious cancer.
Staging the bone tumor means determining its size and stage of metastasis beyond the original site. Staging helps the doctor to determine the most suitable treatment option for the disorder. Chondrosarcomas can be staged in the following manner:
Stage 1A
It denotes a low-grade cancer which has not spread outside the affected bone.
Stage 1B
A cancer in this stage is considered low-grade, but has extended into the soft tissues containing blood vessels and nerves.
Stage 2A
This stage includes high-grade cancers that have not spread outside the hard coating of the bone.
Stage 2B
It denotes a high-grade cancer that has already extended into the soft tissues surrounding the bone.
Stage 3
The cancers in this stage can be either low-grade or high-grade, located inside or outside the bone. However, they have already metastasized to other bones and body parts not directly connected with the original site of the tumors.
Chondrosarcoma Differential Diagnosis
The differential diagnosis of this disorder includes ensuring the absence of the following diseases, which give rise to identical signs and symptoms:
- Chondroblastoma
- Paget Sarcoma
- Chondroma
- Fibrous Dysplasia
- Osteosarcoma
- Fibrosarcoma
- Chordoma
- Metastatic Carcinoma
- Chondromyxoid Fibroma
- Fibrous Histiocytoma
- Synovial Chondromatosis
Chondrosarcoma Treatment
The treatment of the disease depends on a number of factors such as the stage, location and size of the tumor as well as the age and the overall health of the patient. There are different treatment options available for the condition.
Surgery
Surgical removal of the tumor is considered to be the most effective treatment option. Some of the surrounding healthy tissues are also removed along with the tumor during surgery. The different types of surgery include:
Limb-sparing surgery
In this surgery, the cancerous cartilage and bone is removed, along with some surrounding muscle. Metal prosthesis or bone transplant may be performed to replace the affected bone. In most cases, the patient needs proper rehabilitation for regaining complete use of the affected limb.
Amputation
Amputation involves complete or partial removal of the affected limb. The removed limb is temporarily replaced with an artificial one and later with a permanent prosthesis.
Another surgical procedure named the gamma knife surgery has been used to treat some patients with a considerable success rate. But its usefulness is still under evaluation.
Proton Therapy
It is another useful treatment option that uses various drugs for destroying the cancerous cells. In this treatment, it is possible to control the amount of medicine reaching the tumor and the surrounding tissues of different body parts like the spinal cord and brain stem. This means high dosages of the drugs are delivered to the tumors to kill the damaged cells while the surrounding tissues are reasonably safe.
Radiotherapy
High-energy rays are used in radiotherapy for destroying the cancer cells. The healthy cells surrounding the tumor are also damaged to some extent. However, a therapist tries to keep the damage as low as possible. This treatment option is generally not very appropriate for treating the cancer. However, it may be helpful for managing certain situations.
Chemotherapy
In chemotherapy, the doctor uses certain drugs to destroy the cancerous cells. It is a common treatment option for various types of cancers. However, it is very rarely used for treating this type of sarcoma.
Physical Therapy
Exercise and physical therapy may be useful for regaining the use of the affected limb after surgery.
Chondrosarcoma Follow-up Care
Regular check-ups after the completion of treatment are very important for individuals with this type of bone cancer. X-rays are used to study their internal structures for detecting any early sign of recurrence. These follow-up examinations are carried out for several years. It is advisable to immediately contact a doctor if the patients notice any abnormal symptoms during this time.
Chondrosarcoma Prognosis
The outcome of the treatment primarily depends on the combination of the tumor’s grade and the success rate of the tumor-removal surgery. The lower grade tumors generally have positive prognoses, while the prognoses for higher graded tumors are usually poor.
Chondrosarcoma Survival Rate
The life expectancy of patients varies according to the tumor grades they are affected by. Grade 1 tumors of this type are associated with a survival rate around 90% while the survival rate for the grade 2 tumors ranges between 60% and 70%. The survival rate for grade 3 tumors ranges from 30% to 50%.
Chondrosarcoma Incidence
It is a rare condition despite being the second most frequent type of bone cancer. The condition affects 1 out of every 200,000 people every year all over the world. This form of sarcoma typically occurs in individuals over 40 years of age. However, it can affect young adults aged above 20 years as well as older people around 60 years of age. Men are more likely to be affected as compared to women. It can sometimes occur in children as well.
Chondrosarcoma Support Groups
A number of forums and foundations have been established to provide information and treatment guidelines to help patients fight the condition. The most notable among these include:
Sarcoma Foundation of America
9884 Main Street
Damascus, MD 20872
USA
Tel: (301)253-8687
Fax: (301)253-8690
Email: mailto:info@curesarcoma.org
Website: http://www.curesarcoma.org
American Cancer Society, Inc.
1599 Clifton Road NE
Atlanta, Georgia 30329
United States
Tel: (404)320-3333, (800)227-2345
Website: http://www.cancer.org
National Coalition for Cancer Survivorship
1010 Wayne Avenue
7th Floor
Silver Spring, Maryland 20910
Tel: (301)650-9127
Fax: (301)565-9670
Email: info@canceradvocacy.org
Website: http:// www.canceradvocacy.org
Chondrosarcoma is a potentially life threatening condition requiring early diagnosis along with prompt treatment. Early and proper management allows its sufferers to live a long and normal life.