Chondrosarcoma

Chondrosarcoma is a rare type of bone cancer. It affects the tough covering on the ends of bones called cartilage. It is usually a slow-growing tumour found in a bone or on its surface. The most common sites affected are the:

  • upper arms (humerus)
  • thighs (femur)
  • pelvis
  • shoulder blades (scapula)
  • ribs.

Pain is the most common symptom. The area may also be swollen and tender to touch.

An x-ray of the bone usually shows the tumour. A small piece of the tumour is removed and looked at under a microscope (a biopsy). This tells your doctors the type of bone tumour it is and how slowly or quickly it grows (grade). Scans are done to find out if the cancer has spread anywhere else in the body (staging).

Surgery is usually the main treatment. Some people may need a combination of treatments. Chemotherapy and radiotherapy may sometimes be used. Your team will discuss your treatment plan with you before you make any decisions.

This information is best read with our general information about bone cancer.

What is chondrosarcoma?

Primary bone cancers are rare cancers that start in the bone. There are different types of bone cancer. Chondrosarcoma is one of the more common types.

Chondrosarcoma is a cancer of the cartilage cells. Cartilage is a tough, flexible material that covers the ends of the bones and allows them to move freely at the joints. 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 is slightly more common in men.

Chondrosarcoma is usually a slow-growing tumour. The most common sites affected are the:

  • upper arms (humerus)
  • thighs (femur)
  • pelvis
  • shoulder blades (scapula)
  • ribs.

There are several sub-types of chondrosarcoma, including de-differentiated, clear cell and mesenchymal. These different types can be treated differently.


Causes of chondrosarcoma

The exact causes of primary bone cancer are unknown.

People who have had rare types of non-cancerous (benign) bone tumours called a chondroma or an osteochondroma have a very slightly increased risk of developing a chondrosarcoma.

Another rare condition called Ollier’s disease (enchondromatosis) can 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

Pain is the most common symptom of bone cancer. This depends on where the cancer is in the body. There may be some swelling in the affected area and it may be tender to touch.

Sometimes, because the bone is weakened from the cancer, it breaks easily after a minor fall or accident. This may be how the bone cancer is first diagnosed.

Many things other than cancer can cause these symptoms. However, any persistent bone pain (particularly if it happens at night) or any swelling should be checked by your doctor.


How chondrosarcoma is diagnosed

Usually you begin by seeing your GP. They will examine you and may arrange any necessary tests or x-rays. If your GP suspects you have a bone tumour, you should be referred to a specialist hospital or bone tumour centre for tests. Tests such as bone biopsies need to be done by an expert bone 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 and check the area of bone for any swelling or tenderness. You will probably have a blood test to check your general health.

You usually need different tests to diagnose a chondrosarcoma.

Bone x-ray

This uses x-rays to build up a picture of the bone. An x-ray of the bone can usually show the tumour.

Biopsy

The biopsy should be done at a specialist bone cancer centre. The doctor will take a sample of cells (a biopsy) from the bone. This is examined by a pathologist who is an expert in classifying types of tumour.

There are different types of biopsy.

Core needle biopsy

You will be given a local anaesthetic to numb the area first. The doctor removes small samples of the bone using a needle. This test can be done using a CT scan or MRI scan to help the doctor guide the needle to the correct area. Sometimes a general anaesthetic is used.

Open or surgical biopsy

This type of biopsy is not often used as a needle biopsy is much quicker and simpler. In an open biopsy, the doctor removes a small piece of bone during a minor operation. You have it done under a general anaesthetic. It may be necessary to do this if a needle biopsy cannot be done or does not 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 is very noisy, but you will be given earplugs or headphones to wear. You will 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 is important to let your doctor know beforehand.

You will probably be able to go home as soon as the scan is over.

Bone scan

This is a more sensitive test than the bone x-ray and can show 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

Grading is how the cancer cells look under a microscope. It gives an idea of how slowly or quickly a cancer may grow. This helps your doctor make decisions about your treatment.

Chondrosarcomas are graded from 1 to 3, with grade 1 being low-grade cancer and grade 3 being high-grade. Low-grade means the cancer cells look more like normal cells. They are usually slow-growing and less likely to spread. Most chondrosarcomas are low-grade.

In high-grade tumours, the cells look very abnormal. They are likely to grow more quickly, and are more likely to spread. Higher-grade chondrosarcomas are more likely to come back (recurrence) and may spread to other parts of the body.

Chondrosarcoma can sometimes develop into a more aggressive (fast-growing) type of bone cancer called de-differentiated chondrosarcoma.


Staging of bone sarcomas

The stage of a cancer describes its size and whether it has spread from where it started. Knowing the stage helps the doctors plan the most appropriate treatment.

Most people are grouped depending on whether the cancer:

  • is only in one part of the body – called localised disease
  • has spread from where it started to other parts of the body – called secondary cancer or metastatic cancer.

If the cancer comes back after it is first treated, doctors may call it a recurrence.

Your doctor can explain more about the stage of your cancer. You can read more about staging in our general information about primary bone cancer.


Treatment for chondrosarcoma

As chondrosarcomas are very rare, they are treated by expert doctors and other healthcare professionals at a specialist hospital. This means that you may have to travel some distance to have your treatment.

The type of treatment you have will depend on the position and size of the cancer, whether it has spread, its grade and your general health.

Surgery is the main treatment for chondrosarcoma. Some people may need a combination of treatments. Other treatments that may be used are chemotherapy and radiotherapy.

Surgery

Major improvements have been made in surgery for bone cancer. It is often possible to remove only the affected part of the bone and some healthy tissue around it. The bone is replaced with a metal implant (prosthesis) or bone taken from another part of the body (bone graft). 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 called limb-sparing surgery.

Unfortunately, it is not always possible to use limb-sparing surgery. Sometimes an amputation may be the only way to treat the cancer. This may be when cancer cells have spread from the bone into the nerves and blood vessels around it.

The type of surgery you have will depend on different factors. Your surgeon and nurse will talk to you about your options before you make any treatment decisions. You will usually see a physiotherapist before and after your operation.

It is often helpful to talk to someone who has had the same operation you are going to have. The medical and nursing staff can arrange this for you. There may be a counsellor on the unit who you can talk things over with.

Chemotherapy

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. It isn’t commonly used for chondrosarcoma. However, it may be helpful with certain types of chondrosarcoma.

Chemotherapy can make you feel better by relieving the symptoms of the cancer. The side effects can often be well controlled with medicines.

Radiotherapy

Radiotherapy uses high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells. Radiotherapy is not often used to treat chondrosarcomas, but is sometimes helpful.

Radiotherapy can cause side effects, such as a skin reaction in the treated area and tiredness. These side effects will usually improve a few weeks after treatment is over. These side effects can be mild or more troublesome. This depends on the dose of radiotherapy and the length of your treatment. The radiographers (people who give the radiotherapy) or your nurse will tell you what to expect.


Clinical trials for chondrosarcoma

Research into new ways of treating chondrosarcoma is going on all the time. New treatments that are carried out on patients are called clinical trials. They 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 takes 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 have the best standard treatment available.


Follow-up for chondrosarcoma

After your treatment is completed, you will have regular check-ups and x-rays. Your specialist will tell you how often 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.


Your feelings

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.

Some hospitals have their own emotional support services they can refer you to for more expert help.

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.

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.