Chondrosarcoma is a rare type of sarcoma of the bone. The information here should ideally be read with our general information about primary bone cancer.
We hope this section answers your questions. If you have any further questions, you can ask your doctor or nurse at the hospital where you are having your treatment.
Sarcomas are rare types of cancer that develop in the supporting tissues of the body. There are two main types, bone sarcomas and soft tissue sarcomas.
Bone sarcomas, such as chondrosarcoma, can develop in any of the bones of the body, but may also develop in the soft tissue near bones.
Soft tissue sarcomas can develop in muscle, fat, blood vessels, or any of the other tissues that support, surround and protect the organs of the body.
Primary bone cancers are cancers that start in the bone. They are rare, with only about 530 new cases each year in the UK. There are several different types of bone cancer. Chondrosarcoma is one of the more common types.
Chondrosarcoma is a cancer of the cartilage, which is the tough covering on the ends of the bones. Chondrosarcoma usually grows in a bone or on its surface. This type of cancer can occur at any age but is more common in people over the age of 40. It’s slightly more common in men.
It's usually a slow-growing tumour. The most common sites affected are the:
upper arms (humerus)
shoulder blades (scapula)
There are several subtypes of chondrosarcoma, including de-differentiated, clear cell and mesenchymal.
Causes of chondrosarcoma
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The exact causes of primary bone cancer are unknown. People who have had a chondroma or an osteochondroma, which are rare types of non-cancerous (benign) bone tumours, have a very slightly increased risk of developing a chondrosarcoma. Another rare condition called Ollier’s disease (also called enchondromatosis) can also increase this risk. People with rare genetic conditions called hereditary multiple exostoses (HME) and Maffucci syndrome are slightly more likely to develop a chondrosarcoma.
Signs and symptoms of chondrosarcoma
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Pain is the most common symptom of bone cancer. However, symptoms may vary depending on the position of the cancer in the body and its size. There may be some swelling in the affected area and it may become tender to touch.
Primary bone cancer is sometimes discovered when a bone that has been weakened by cancer breaks after a minor fall or accident.
These symptoms can be caused by many things other than cancer. However, any persistent bone pain, particularly if it occurs at night, or any swelling, should be checked by your doctor.
How chondrosarcoma is diagnosed
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Usually you begin by seeing your GP, who will examine you and may arrange any necessary tests or x-rays. If a chondrosarcoma is suspected, you should be referred directly to a specialist hospital or bone tumour centre for further investigation. Many of the specific tests for diagnosing bone tumours, such as bone biopsies, need to be done by an experienced team using specialist techniques.
The doctor at the hospital will ask you about your general health and any previous medical problems. They will examine you, which will include an examination of the painful bone to check for any swelling or tenderness. You will probably have a blood test to check your general health.
A variety of other tests and investigations may be needed to diagnose a chondrosarcoma. An x-ray of the painful part of the bone usually shows the tumour. A small piece of the tumour may be removed and looked at under a microscope (a biopsy). Other tests are done to check whether the cancer has spread elsewhere.
This uses x-rays to build up a picture of the bone.
The doctor will take a sample of cells (a biopsy) to be examined by a pathologist (a doctor that specialises in cell types). If your doctor thinks you have bone cancer, the biopsy should be done at a specialist bone cancer centre.
A small sample of the tumour is taken from the affected bone using a needle. You will be given a local anaesthetic to numb the area. Sometimes a general anaesthetic is used.
Open or surgical biopsy
This type of biopsy is not often used, as the needle biopsy is much quicker and simpler. In an open biopsy, a small piece of bone is removed during a minor operation while you are under a general anaesthetic. It may be necessary to do this if a needle biopsy can’t be done or doesn’t give a clear diagnosis.
MRI (magnetic resonance imaging) scan
This test uses magnetism instead of x-rays to build up cross-sectional pictures of your body. During the test, you will be asked to lie very still on a couch inside a large metal cylinder that is open at both ends.
The whole test may take up to an hour. It can be slightly uncomfortable and some people feel a bit claustrophobic during the scan. It's very noisy, but you'll be given earplugs or headphones. You'll be able to hear, and speak to, the person operating the scanner.
If you have any metal implants (such as surgical clips or a pacemaker), it will not be possible for you to have this test. In this situation, another type of scan may be used.
CT (computerised tomography) scan
In some people with chondrosarcoma, the cancer may spread to the lungs. A CT scan may be done to check for this. The scan takes a series of x-rays that build up a three-dimensional picture of the inside of the body. The scan is painless and takes just a few minutes. A CT scan uses small amounts of radiation, which is very unlikely to harm you or anyone you come into contact with. You may be asked not to eat or drink for at least four hours before the scan.
You may be given a drink or an injection of dye that allows particular areas to be seen more clearly. For a few minutes this may make you feel hot all over. If you are allergic to iodine or have asthma, you could have a more serious reaction to the injection, so it's important to let your doctor know beforehand.
You'll probably be able to go home as soon as the scan is over.
We have a video about having a CT scan at macmillan.org.uk/testsandscans
This is a more sensitive test than the bone x-ray and shows up any abnormal areas of bone more clearly. For this test, a small amount of a mildly radioactive substance is injected into a vein, usually in your arm. Abnormal bone absorbs more radioactivity than normal bone, so these areas are highlighted and picked up by the scanner as ‘hot spots’.
Waiting for test results can be an anxious time for you. It may help to talk about your worries with a relative or friend. You could also speak to one of our cancer support specialists.
Grading of bone sarcomas
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Grading refers to the appearance of cancer cells under a microscope and gives an idea of how quickly a cancer may grow and develop. Low-grade means that the cancer cells look very much like normal cells. They are usually slow-growing and less likely to spread. In high-grade tumours, the cells look very abnormal, are likely to grow more quickly, and are more likely to spread.
Chondrosarcomas are graded from 1 to 3, with grade 1 being low-grade cancer and grade 3 being high-grade. Higher-grade chondrosarcomas are more likely to recur (come back) and may spread to other parts of the body. Most chondrosarcomas are low-grade.
Chondrosarcoma can occasionally develop into a more aggressive type of bone cancer known as de-differentiated chondrosarcoma.
Staging of bone sarcomas
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The stage of a cancer is a term used to describe its size and whether it has spread beyond its original site. Knowing the particular type and the stage of the cancer helps the doctors plan the most appropriate treatment.
Most patients are grouped depending on whether cancer is found in only one part of the body (localised disease) or whether the cancer has spread from one part of the body to another (metastatic disease).
The cancer is low-grade and less than 8cm across.
The cancer is low-grade and either bigger than 8cm across or in more than one place in the same bone.
The cancer is high-grade and less than 8cm across.
The cancer is high-grade and bigger than 8cm across.
The cancer is high-grade and is in more than one place in the bone where it started.
The cancer is of any grade and has spread to the lung.
The cancer is of any grade. It has spread to lymph nodes and/or other parts of the body other than the lungs.
If the cancer comes back after initial treatment, this is known as recurrent or relapsed cancer.
Treatment for chondrosarcoma
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As chondrosarcomas are very rare, they are usually treated by a team of doctors and other health care professionals at a specialist hospital. This means that you may have to travel some distance to have your treatment.
The type of treatment you are given will depend on a number of things, including the position and size of the cancer, whether it has spread, the grade of the cancer, and your general health.
Some people with a chondrosarcoma will need to have a combination of different treatments. The treatments that might be used are surgery (where this is possible), chemotherapy and radiotherapy. However, chemotherapy and radiotherapy are not very effective for most chondrosarcomas and therefore surgery is the main treatment.
Major improvements have been made in surgery for bone cancer. In the past, it was often necessary to remove (amputate) the affected limb if chondrosarcoma was found. Now it's often possible just to remove the affected part of the bone and some of the healthy tissue around it. The bone is then replaced with a specially designed metal replacement (prosthesis) or a bone graft (bone taken from another part of the body). If the cancer affects a bone in or near a joint, the whole joint can often be replaced with an artificial one. These operations are known as limb-sparing surgery.
Unfortunately, it's not always possible to use limb-sparing surgery and, occasionally, an amputation may be the only way to treat the cancer. This is often the case when the cancer cells have spread from the bone into the nerves and blood vessels around it.
The type of surgery you have will depend on a number of factors. Your surgeon will discuss the different types of surgery with you in more detail before you have to make any decision about your treatment.
It's often helpful to talk to someone who has had the same operation you are going to have. The medical and nursing staff will be able to arrange this for you. On some wards, a counsellor may be available to discuss any of your worries.
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. This type of treatment is not commonly used for chondrosarcoma. However, it may be helpful in certain situations.
Chemotherapy can make you feel better by relieving the symptoms of the cancer, but it can sometimes have unpleasant side effects. Any side effects that do occur can often be well controlled with medicines.
Radiotherapy treats cancer by using high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells. Radiotherapy is rarely used to treat chondrosarcomas, although it is sometimes helpful in certain situations.
Radiotherapy can cause side effects such as skin redness (erythema) and tiredness (fatigue). These side effects can be mild or more troublesome, depending on the strength of the radiotherapy dose and the length of your treatment. The radiotherapist will be able to advise you on what to expect.
Clinical trials for chondrosarcoma
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Research into new ways of treating chondrosarcoma is going on all the time. New treatments that are carried out on patients are known as clinical trials. These are especially important for finding improvements in treatment for rare cancers. Your specialist can tell you more about trials that may be relevant for you.
Before any trial is allowed to take place, it must be approved by an ethics committee, which protects the interests of the patients taking part.
Your doctor or a research nurse will discuss the treatment with you, so that you fully understand the trial and what it means to take part. You may decide not to take part or to withdraw from the trial at any stage. You will then receive the best standard treatment available.
Follow-up for chondrosarcoma
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After your treatment is completed, you will have regular check-ups and x-rays. Your specialist will advise you on how frequently you need to be seen. Follow-up will continue for several years. If you have any problems, or notice any new symptoms in between your regular appointments, let your doctor know as soon as possible.
You may have many different emotions, including anger, resentment, guilt, anxiety and fear. You may find yourself tearful, restless and unable to sleep. Or you may have feelings of hopelessness and depression. These are all normal reactions but it can be difficult and distressing to admit to them.
The need for support will vary from person to person and may depend on the treatment you receive and any side effects this causes. Your specialist will tell you about any potential side effects and how to deal with them before you begin any treatment.
Some hospitals have their own emotional support services with trained staff, and some of the nurses on the ward will have had training in counselling. You may feel more comfortable talking to a counsellor outside the hospital environment or to a member of your religious faith, if you are religious.
Everyone has their own way of coping with difficult situations. Some people find it helpful to talk to family or friends, while others prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is available if you need it. Our cancer support specialists can give you information and support to help you cope.
Cancer52 is an alliance of more than 50 organisations working to address the inequalities that exist in policy, services and research into the less common cancers and to improve outcomes for people with these highly challenging diseases.
Rarer Cancers Foundation
Rarer Cancers Foundation (RCF) is a UK charity that offers general advice and information about rare and less common cancers, facilitates supportive networking between patients and carers, and works to improve services for people with rarer cancers.
Sarcoma UK provides information and support to anyone affected by sarcoma, and aims to achieve the best possible standard of treatment and care for people with sarcoma.
This section has been compiled using a number of reliable sources, including:
DeVita V, et al. DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology (9th edition). 2011. Lippincott, Williams & Wilkins. Philadelphia.
Grimer R, et al. UK Guidelines for the Management of Soft Tissue Sarcomas. British Sarcoma Group. 2010.
European Society of Medical Oncology (ESMO). Bone sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2012. Volume 23: Issue Supplement 7.
National Institute for Health and Clinical Excellence (NICE). Improving outcomes for people with sarcoma. March 2006.
National Cancer Intelligence Network (NCIN). Bone and Soft Tissue Sarcomas: UK Incidence and Survival 1996 to 2010. November 2013.
Gelderblom A, Bovée J. Chondrosarcoma. UpToDate. 2013 (accessed March 2014).
Raghavan D, et al. Textbook of Uncommon Cancer (3rd edition). 2006. Wiley.
Tobias J, Hochhauser D. Cancer and its management (6th edition). 2010. WileyBlackwell.
Thank you to Dr Beatrice Seddon, Consultant Clinical Oncologist; and the people affected by cancer who reviewed this information.
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