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 400 new cases each year in the UK. There are several different types of bone cancer. Chondrosarcoma is the second most common type, with about 90 new cases each year in the UK.
Chondrosarcoma is a cancer of the cartilage, which is the tough covering found on the ends of the bones. Chondrosarcoma usually grows within 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, and the most common sites affected are the pelvic bones, the shoulder bones, the upper parts of the arms and legs, and the ribs. 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, 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 accident.
The symptoms described 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 may be referred directly to a specialist hospital or bone tumour centre for tests. 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 take your full medical history before doing a physical examination. This 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. Other tests are often done to check whether the cancer has spread elsewhere.
Further tests for chondrosarcoma
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This involves the use of x-rays to build up a picture of the bone.
For this test, a small sample of the tumour is taken from the affected bone. The doctor looks at the sample under a microscope to identify the exact type of tumour you have.
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, pacemakers or metal in the eye from previous accidents or trauma) 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
A CT 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.
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’.
In some people with chondrosarcoma, the cancer may spread to the lungs. A chest x-ray is usually done to check for this.
Grading of chondrosarcoma
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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 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 chondrosarcoma
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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 decide on the most appropriate treatment.
Most patients are staged 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 is contained within the bone.
The cancer is low-grade and extends outside the bone into the soft tissue spaces which contain nerves and blood vessels.
The cancer is high-grade and is contained within the bone.
The cancer is high-grade and extends outside the bone into the soft tissue spaces which contain nerves and blood vessels.
The cancer can be low-grade or high-grade and found either within the bone or outside it. The cancer has also spread to other parts of the body, or to other bones not directly connected to the bone where the tumour started.
If the cancer comes back after initial treatment, this is known as recurrent cancer or relapse.
Treatment for chondrosarcoma
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As chondrosarcomas are very rare, they are usually treated by a team of doctors and other health professionals at a specialist hostpital. 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, however, 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 special 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.
Research into new ways of treating chondrosarcoma is going on all the time. 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.
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 specially trained staff, and some of the nurses on the ward will have received training in counselling. You may feel more comfortable talking to a counsellor outside the hospital environment or to a member of your religious faith.
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.
Sarcoma UK is a support and information website for people affected by sarcomas.
This section has been compiled using a number of reliable sources, including:
European Society of Medical Oncology (ESMO). Bone sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of oncology. Volume 23: Issue Supplement 7. 2012.
Gelderblom, et al. Chondrosarcoma [online] Available from: http://www.uptodate.com/contents/chondrosarcoma [accessed November 2012]
Kuwahara, et al. Maffucci syndrome. Medscape Reference. Available from: http://emedicine.medscape.com/article/1111804-overview [accessed November 2012]
Raghavan, et al. Textbook of Uncommon Cancer. 3rd edition. Wiley Publishers. 2006.
Tobias J and Hochhauser D. Cancer & its management. 6th edition. Wiley Blackwell. 2010.
With thanks to Dr Beatrice Seddon, Consultant Clinical Oncologist.
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