Chondrosarcoma, also known as chondrogenic sarcoma, is one of the most common types of bone cancerA disease where abnormal cells split without control and spread to other nearby body tissue and/or organs. Cancer cells can also spread to other parts of the body through the bloodstream and lymph systems., and develops from the cartilage on the end of bones. Chondrosarcomas are most commonly found in the femur (thigh bone), shoulder, hip, or pelvis, but can also develop in the knees, ribs, skull, spine, and windpipe (trachea).
Cartilage is smooth, connective tissue that protects and lines joints and the ends of bones. There are three main types of cartilage in the body: hyaline, elastic, and fibrocartilage. Hyaline cartilage, also known as articular cartilage, is the most abundant type of cartilage in the body, and generally 2-4mm thick. It is most commonly found in the joints and on the ends of bones, and is slippery and smooth in order to help your bones move smoothly past each other. Hystine cartilage is most commonly found in the ribs, nose, ears, larynx (throat), trachea (windpipe), and on the ends of bones. Elastic cartilage, also known as yellow fibrocartilage, is less abundant, and supports the parts of the body that need to move to function. It is able to return to its original shape when moved, and is most commonly found in the ear and larynx. Fibrocartilage is a dense and generally stronger than the other types of cartilage. Its primary function is support weight-bearing areas of the body, and is most commonly found in the intervertebral discs of the spine and the meniscus of the knee. Most chondrosarcomas develop from hyaline cartilage.
Chondrosarcomas are often confused with another type of bone cancer known as osteosarcoma. Osteosarcoma, or osteogenic sarcoma, is the most common type of bone cancer that is usually found in the ends of long bones, such as the shin, femur (thigh bone) and humerus (upper arm bone). However, unlike chondrosarcoma, osteosarcomas develop from osseous (or bone) cells
• the smallest, living parts of the body. Cells work together to form or build the body
• a human is made up of millions of Cells
• Cells reproduce themselves to make sure a body stays working
• sometimes Cells can be abnormal or damaged and these can be cancer cells
as opposed to cartilage. For more information on osteosarcomas, please visit the rare cancers Australia osteosarcoma page.
Chondrosarcomas are generally diagnosed equally among the sexes, and tends to be diagnosed in people over 40 years old. However, anyone can develop this disease.
Types of Chondrosarcoma
There are several different types of chondrosarcoma, which are categorised based on the types of cells they originate from.
Conventional Chondrosarcoma
Conventional chondrosarcomas are the most common subtype of this disease. There are several different types of conventional chondrosarcomas, which are classified by their location.
Central Chondrosarcoma
Central chondrosarcomas are the most common type of conventional chondrosarcoma, and generally arise within the medullary cavity (the central, hollow portion of the bone that contains bone marrowIs soft, spongy tissue found in bones that makes blood cells.). This type of tumour is slightly more common in males, and often affects the femur, pelvis, or humerus. Central chondrosarcomas can be aggressive, but can have a good prognosisTo predict how a disease/condition may progress and what the outcome might be. when caught early.
Secondary Peripheral Chondrosarcoma
Secondary peripheral chondrosarcoma is a less common subtype of conventional chondrosarcoma that has metastasised (or spread) from an existing osteochondroma (a benignNot cancerous, can grow but will not spread to other body parts. or non-cancerous bone tumour). This type of tumour tends to be diagnosed in patients under 50 years old, and generally affects the pelvis or the shoulder. Secondary peripheral chondrosarcomas can be aggressive, but can have a good prognosis when caught early.
Periosteal/Juxtacortical Chondrosarcoma
Periosteal chondrosarcomas, also known as juxtacortical chondrosarcomas, are a very rare subtype of conventional chondrosarcomas that tend to affect the femur. Unlike other chondrosarcomas, these tumours are slightly more common in men and tend to affect people between the ages of 20-40. Although these tumours can be aggressive, they often have a good prognosis.
Clear Cell Chondrosarcoma
Clear cell chondrosarcoma is a less common type of chondrosarcoma that generally develops from the epiphysis (the rounded end of the long bone) of the humerus or femur. Unlike most types of chondrosarcoma, these tumours are significantly more common in men, and generally affect people between the ages of 30-50. These tumours are generally nonaggressive, and can have a good prognosis.
Myxoid Chondrosarcoma
Myxoid chondrosarcoma is a rare type of chondrosarcoma that can affect both bone and soft tissue. They most commonly develop in the deep soft tissue of the thigh and other extremities, and tend to affect people between the ages of 30-60 with a slight predilection for men. While this subtype can be aggressive, it can have a good prognosis when found early.
Mesenchymal Chondrosarcoma
Mesenchymal chordosarcomas are a rare and highly aggressive subtype of chondrosarcomas that commonly develop in facial bones, ribs, pelvic bone, and spine. Unlike other chondrosarcomas, this subtype tends to affect people between the ages of 25-30. Mesenchymal chondrosarcomas are very aggressive, and may not have as good of a prognosis as other types of chondrosarcomas.
Dedifferentiated Chondrosarcoma
Dedifferentiated chondrosarcomas are a rare and highly aggressive subtype of chondrosarcoma that generally develop in the pelvis, femur, or humerus. It generally affects people between the ages of 50-60, and may spread to nearby soft tissue. Dedifferentiated chondrosarcomas are very aggressive, any may not have as good of a prognosis as other types of chondrosarcoma.
Treatment
If a chondrosarcoma is detected, it will be staged and graded based on size, metastasisKnown as secondary cancer, it grows/spreads from the original/ primary cancer. (whether the cancer has spread to other parts of the body) and how the cancer cells look under the microscope. Staging and grading helps your doctors determine the best treatment for you.
Cancers can be staged using the TNM staging system:
- T (tumour) indicates the size and depth of the tumour.
- N (nodes) indicates whether the cancer has spread to nearby lymphA clear fluid that moves through the body through the lymphatic system, carrying cells that fight infection. nodes.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0-IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissue.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and had not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localisedOnly to one area/place of body. cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also known as localised cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advancedAt a late stage, far along or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Grade
• A score that tells how quickly a tumour might spread and grow by looking at how the abnormal cells and tissue look under a microscope.
• Grade is not the same as stage.
• Grading is different depending on the type of cancer.
I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour. - Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testing, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including location, stage of disease and overall health.
Treatment options for chondrosarcomas may include:
- Surgery, potentially including:
- Wide en bloc resection.
- Curettage (cancer is scraped out with a small, sharp instrument called a curette).
- Limb-sparing surgery (surgery to remove the cancer only and salvage the limb).
- Amputation (removal of all or part of the affected limb).
- Bone graft (a portion of bone from another part of the body or another person is used to replace the bone lost to cancer).
- Radiation therapy.
- Chemotherapy
• a chemical drug treatment to kill or slow-growing cancer Cells
• these drugs are called cytotoxic drugs
. - Cryotherapy.
- Clinical trials.
- Palliative careLessening pain without curing the disease..
For more information on the treatment options, please refer to the Rare Cancers Australia Treatment Options page.
Risk factors
While the cause of chondrosarcomas remains unknown, the following factors may increase the likelihood of developing the disease:
- Ollier’s disease (also known as enchondromatosis).
- Maffucci syndrome.
- Multiple hereditary exostoses (MHE).
- Wilms’ tumour.
- Paget’s disease.
- Li-Fraumeni syndrome.
- Previous treatment with chemotherapy.
- Previous treatment with radiation therapy.
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Symptoms
Symptoms of a chondrosarcoma may include:
- Large massA growth of cells that come together to make a lump, either big or small, and may or may not be cancer. on a bone.
- Pressure surrounding mass in affected area.
- Pain that gets worse overtime or at night.
- Weakness in affected area.
- Limited movement in affected area.
- Swelling of affected area.
- Joint stiffness in affected area.
- Changes in bowelThe intestines (like a tube) that run between the stomach and anus (bum) and is made up of the small bowel (small intestine) and the large bowel (colon and rectum). (see ‘small intestine’; and ‘colon’ for more information). and/or bladderA small, elastic/muscle type sac/bag in the body, where urine (wee) is stored for urinating/weeing. Is found in the lower abdomen/belly area. habits (chondrosarcomas of the pelvis).
Not everyone with the symptoms above will have cancer, but see your general practitioner (GP) if you are concerned.
Diagnosis/diagnosing
If your doctor suspects you have a chondrosarcoma, they may order the following tests to confirm the diagnosisUsing medical test results, identify and name a disease and/or condition. and refer you to a specialist for treatment.
Physical examination
Your doctor will collect your overall medical history, as well as your current symptoms. Following this, they may examine your body to check for any abnormalities.
Imaging & blood tests
The doctor will take images of your body using magnetic resonance imagingTaking images/photos of inside body parts using magnet rather than x-ray. (MRITaking images/photos of inside body parts using magnet rather than x-ray.), a computed tomography scan (CT scanA 3-D (three dimensional) x-ray pictures that gives more information than a normal x-ray.), and/or positron emission tomography (PET scanA test that uses a radioactive drug to show a picture of how your tissues and organs are working. Also known as a positron emission tomography scan.), depending on where it is suspected the cancer is. The doctor may also look at other parts of the body and looks for signs of metastasis. Additionally, a bloodhello test may be taken to assessTo measure, look at and learn from. your overall health and help guide treatment decisions.
Biopsy
Once the location(s) of the cancer has been identified, the doctor will perform a biopsyTo take a small piece of body tissue and test it in a laboratory. to remove a section of tissue using a needle. The tissue sample will then be analysed for cancer cells. This can be done by a fine needle aspiration (FNA) or a core needle biopsy (CNB).