What is chondrosarcoma?
The second most common type of bone cancer, chondrosarcoma begins in the bone cells and results in abnormal bone and/or cartilage growth. Of the 2,500 new cases of bone cancer diagnosed each year in the United States, about 25 percent are chondrosarcoma. When chondrosarcoma is treated effectively prior to spreading, the five-year survival rate is 80 to 90 percent.
Who is likely to have chondrosarcoma?
Chondrosarcoma most often affects adults between age 20 and 75, but it can occur at any age. Others more susceptible to chondrosarcoma include individuals, especially children, who have received radiation therapy or treatment with certain anti-cancer drugs and people with Paget disease of the bone. Also at high risk are individuals who have had certain hereditary conditions that produce benign bone tumors, such as Ollier’s disease, Maffucci syndrome, multiple hereditary exostoses (or osteochondromatoses), and Wilms’ tumor. The risk of chondrosarcoma is especially high for these individuals if they experience sudden growth spurts or increases in hormone production, such as during pregnancy.
What characterizes chondrosarcoma?
Chondrosarcoma is usually found in the pelvis, rib cage, arms, shoulder, and legs, although any bone can be affected. If this cancer spreads, it usually spreads to the lungs.
Pain is the most common symptom. Pain may occur at night or with activity at first and then become gradually more severe over time. Also, sometimes swelling, a mass, or a lump may form either on the bone or in the tissue around the bone, and this swelling may inhibit joint function or movement. Chondrosarcoma can weaken bones and cause them to fracture with little or no stress or trauma. Fever, chills, night sweats, and weight loss are less common but can occur, usually after the cancer spreads beyond its original location.
How does the pathologist make the diagnosis?
The pathologist reviews the results of a personal and family medical history, physical examination, and diagnostic tests performed or ordered by the primary care physician. Depending upon the symptoms and other factors, these diagnostic tests may include an x-ray, bone scan, computed tomography (CT) scan, magnetic resonance imaging (MRI) scan, or positron emission tomography (PET) scan. These tests allow the pathologist to review the clinical and radiological evidence to determine the source of pain or the presence of cancer cells.
What else does the pathologist look for?
If a tumor is found, the primary physician may arrange to obtain a biopsy specimen–a sample of the tumor’s cells–for the pathologist to examine under a microscope for the presence of cancer cells. The pathologist may also perform tests looking for chromosome or gene changes in the tumor cells to aid in treatment planning. A physician experienced in the treatment of bone cancer should obtain the biopsy. To obtain the biopsy sample, the physician uses either a small needle (needle biopsy) or makes a surgical incision (open biopsy) through the skin.
What is meant by the grade and stage of the cancer?
Chondrosarcomas are classified as high-grade, intermediate-grade, or low-grade by the pathologist. High-grade tumors grow and spread faster than low-grade tumors. The pathologist and primary care doctor also determine the cancer’s stage to plan the best treatment. According to the Surgical Staging System, Stage I chondrosarcomas are low-grade and localized, or confined to their original location. Stage II tumors are high-grade and localized. Metastatic tumors are more likely to be grade III.
How do doctors determine what treatment will be necessary?
The recommended treatment will depend on the grade and stage of the tumor, its size and location, and the patient’s age and general health. The pathologist consults with the primary care physician or specialist. Together, using their combined experience and knowledge, they determine treatment options most appropriate for the patient’s condition. It’s important to learn as much as possible about the treatment options and make the decision that’s right for you.
What kinds of treatments are available for chondrosarcoma?
Treatment for chondrosarcoma includes surgery and sometimes radiation therapy or other adjunct treatments. Chemotherapy is used to treat only rare types of chondrosarcoma.
The usual surgical treatment for chondrosarcoma involves the surgeon removing the entire tumor along with a margin of cancer-free tissue surrounding the tumor. In most cases, surgeons are able to avoid the removal of an entire limb. In some cases, reconstructive surgery or limb-salvaging surgery is required for the patient to continue to have limb function. Depending on the amount of bone removed, the surgeon may use bone cement, a bone graft or metal implants to maintain limb function.
If the entire tumor cannot be removed due to its location, or if there is too small a margin of cancer-free tissue surrounding the removed tumor, radiation therapy or other adjunct treatments will be used to attack the remaining cancer cells.
Radiation therapy uses pinpointed, high-energy beams to kill cancer cells and can be used in addition to surgery or for patients who refuse or cannot have surgery. Radiation therapy can reduce the risk of cancer spreading to tissue surrounding the tumor and can relieve pain and other symptoms.
Adjunct treatments used in the treatment of chondrosarcoma include the organic compound phenol and cryotherapy, which uses liquid nitrogen. Both treatments destroy cancer cells remaining after surgery.
In addition, people with bone cancer may receive other treatments to control pain and other symptoms, to relieve side effects or to ease emotional problems. Many patients also require rehabilitation to adapt to reconstructed or salvaged limbs or new prosthetic devices.
Chondrosarcoma sometimes spreads or comes back, and people with bone cancer are also more likely to develop another type of cancer. For these reasons, follow-up treatment is necessary. The type of follow-up treatment depends on the grade and stage of chondrosarcoma. Regular blood tests and x-rays or other imaging tests are usually necessary, and patients must be vigilant about reporting any unusual symptoms.
Clinical trials of new treatments for chondrosarcoma may be found at www.cancer.gov/clinicaltrials. These treatments are highly experimental in nature but may be an option for advanced cancers. For more information about clinical trials, talk to your doctor or call the National Cancer Institute’s Cancer Information Service at 1–800–4–CANCER.
What kinds of questions should I ask my doctors?
Ask any question you want. There are no questions you should be reluctant to ask. Here are a few to consider:
DEFINITION OF TERMS
Cartilage: A dense connective tissue found in the joints; rib cage; ear, nose and throat; and between spinal vertebrae.
Metastatic: Spreading beyond the original tumor location to other parts of the body.
Pathologist: A physician who examines tissues and fluids to diagnose disease in order to assist in making treatment decisions.
Sarcoma: A cancer–usually malignant–arising from bone, muscle, or other connective tissue.
This information was developed by the College of American Pathologists’ Public Affairs Committee in conjunction with the College’s Cancer Committee and Council on Scientific Affairs. The College is providing this information to help you better understand your health. Ultimately any decisions you make about your health, however, should be between you and your doctor.