Chondrosarcoma overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
A chondrosarcoma is a particular cancer of the bone. Chondrosarcoma is a cartilage based tumor and is in a category of cancers called sarcomas. Chondrosarcoma is a rare cancer that can affect people (and animals) of any age. The aggressiveness of chondrosarcoma is graded based on how fast it grows and its likelihood to metastasize or spread to other parts of the body. Grade 1 is a low grade (slow growing) cancer, and grades 2 and 3 are higher grades (fast growing) cancers. Depending on the grading system used by your medical facility, it's also possible to have grade 4 which would be even more aggressive than lower grade tumors. The most common bones for chondrosarcoma to grow are the pelvic and shoulder bones along with the superior regions of the arms and legs. [2] But they can also be found in any bones of the body, even in the base of the skull.
Nearly all chondrosarcoma patients appear to be in good health. Since it is not like other cancers, it doesn't affect the whole system. Many patients are not aware that there is a tumor growing inside them until there is a noticeable lump or pain. Sometimes a patient has no symptoms and no awareness of any lump and perhaps, by having a test for something else gets diagnosed accidentally. Sometimes an unexpected fracture will be the first indication of a bone tumor.[3]
Classification
Chondrosarcoma may be classified into six subtypes based on topographical location of tumor, histological characteristics, makeup of surrounding matrix material.
Pathophysiology
On gross pathology, Greyish-white lobulated mass, necrosis, calcification, mucoid degeneration are characteristic findings of chondrosarcoma. On microscopic histopathological analysis abnormal cartilage, increased cellularity, nuclear atypia are characteristic findings of chondrosarcoma. Chondrosarcoma may be divided into three grades based on cancer cells morphology under microscope and growth rate of tumor.
Differential Diagnosis
Chondrosarcoma must be differentiated from other diseases such as chondroma, enchondroma, synovial chondromatosis, osteosarcoma.
Epidemiology and Demographics
Chondrosarcoma is the second most common malignant primary tumor of bone. Men are slightly more affected with liposarcoma than women. It is most frequent in middle-aged and older adults.
Risk factors
Common risk factors in the development of chondrosarcoma are benign cartilage tumors such as Enchondromas, Osteochondromas, Multiple exostoses, Ollier's disease, Maffucci's syndrome.
Natural History, Complications and Prognosis
Complications that can develop as a result of chondrosarcoma are metastasis and recurrence. The prognosis of chondrosarcoma is good with treatment. Chondrosarcoma is associated with a 5 year survival rate of 75%. The presence of grade 3 lesions are associated with a particularly poor prognosis.
Diagnosis
History and Symptoms
The most common symptoms of chondrosarcoma include pain and swelling in the area of tumor.
Physical Examination
Physical examination findings will depend on the location of the chondrosarcoma. Common physical examination findings of chondrosarcoma are localized swelling and tenderness.
Laboratory Findings
There are no specific laboratory tests for the diagnosis of chondrosarcoma.
CT
On CT scan, chondrosarcoma is characterized by matrix calcification, endosteal calcification, cortical breach, heterogenous contrast enhancement.
MRI
On MRI, chondrosarcoma is characterized by low to intermediate signal on T1, very high intensity in calcified portions on T2, and moderate to intense contrast enhancement on T1 contrast.
Treatment
Medical Therapy
Chemotherapy and radiotherapy are indicated for chondrosarcoma as adjuvant therapy. Proton therapy is a new kind of radiotherapy showing promising results with local tumor control at over 80%.