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This information is about a rare type of sarcoma of the bone called chondrosarcoma (pronounced con-dro-sar-coma). It should ideally be read with our information about primary bone cancer.
Primary bone cancers are cancers that start in the bone. They are rare, with only about 400 new cases each year in the UK. However, there are several different types of bone cancer. Chondrosarcoma is the second most common of these, with about 90 new cases each year in the UK.
Chondrosarcoma is a cancer of the cartilage. Cartilage 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 and is slightly more common in males. Chondrosarcoma is usually a slow-growing tumour and the most common sites are the pelvic bones, shoulder bones and the upper part of the arms and legs.
There are several different sub-types of chondrosarcoma. These include central, peripheral, de-differentiated, clear cell, mesenchymal and juxtacortical chondrosarcomas.
The exact causes of primary bone cancer are unknown. People who have had a rare type of non-cancerous (benign) bone tumour called a chondroma or an osteochondroma have a very small risk of developing a chondrosarcoma. Another rare condition called Ollier’s disease (also called enchondromatosis) can also increase this risk.
Patients with rare genetic conditions called hereditary multiple exostoses (HME) and Maffucci’s syndrome can also develop a chondrosarcoma.
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 the person has had a minor fall or accident.
Many of the symptoms described above 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.
Usually you begin by seeing your family doctor (GP), who will examine you and may arrange any necessary tests or x-rays. Your GP will probably refer you to a specialist surgeon (called an orthopaedic surgeon) who can carry out further investigations and decide whether you need to be referred 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 surgeon 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 done to check your general health.
Bone x-ray This involves the use of x-rays to build up a picture of the bone.
MRI (magnetic resonance imaging) scan This test is similar to a CT scan, but 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. A two-way intercom allows you to talk with the people controlling the scanner. If you have any metal implants (such as surgical clips, pacemakers, metal in the eye from previous accidents or trauma) it will not be possible for you to have this test.
Needle biopsy 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 that you may have.
Open 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.
Bone scan This is a more sensitive test than the simple 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’.
CT (computerised tomography) scan A CT scan takes a series of x-rays that builds up a three-dimensional picture of the inside of the body. The scan is painless and takes from 10-30 minutes. CT scans use a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with. You will 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.
Most people are able to go home as soon as their scan is over.
Chest x-ray In some people with chondro-sarcomas, the cancer may spread to the lungs. A chest x-ray is usually done to check for this.
Grading refers to the appearance of the cancer cells under the microscope and gives an idea of how quickly the cancer may develop. Low-grade means that the cancer cells look very like normal cells, and 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 high. Most chondrosarcomas are low-grade. Higher grade chondrosarcomas are more likely to recur and may spread to other parts of the body. Chondrosarcoma can occasionally develop into a more aggressive type of bone cancer known as dedifferentiated chondrosarcoma.
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 to decide on 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).
If the cancer comes back after initial treatment, this is known as recurrent or relapsed cancer.
The type of treatment that 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.
As chondrosarcomas are very rare they are usually treated at specialist hospitals by a team of doctors and other health professionals. This means that you may have to travel some distance to have your treatment.
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 or radiotherapy are not very effective for most chondrosarcomas and therefore surgery is the main form of treatment.
Major improvements have been made in surgery for bone cancer. In the past, if chondrosarcoma was found in a limb (arm or leg) it was often necessary to remove (amputate) the affected limb. Now, however, it is 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 is 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 any decision is made about your treatment.
It is often helpful to talk to someone who has had the same operation as 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 worries you may have.
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 controlled well with medicines.
Radiotherapy treats cancer by using high-energy rays, which 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 general side effects such as feeling sick (nausea) and tiredness. 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 what to expect.
Research into new ways of treating chondrosarcoma is going on all the time. Cancer doctors use clinical trials to assess new treatments. These are especially important for finding improvements in treatments for rare cancers, such as chondrosarcoma.
Before any trial is allowed to take place, it must have been approved by an ethics committee, which protects the interests of patients taking part.
If you decide to take part in a trial, your doctor or a research nurse must discuss the treatment with you so that you have full understanding of the trial and what it means to be involved. You may decide not to take part or withdraw from a trial at any stage and will then receive the best standard treatment available.
After your treatment is completed, you will have regular check-ups and x-rays. These will continue for several years. If you have any problems, or notice any new symptoms in between these times, let your doctor know as soon as possible.
The need for practical and emotional support will vary from person to person. It may depend on the treatment you receive and any side effects the treatment may cause. Your specialist will inform you of any potential side effects and how to deal with them before you agree to treatment.
Many different emotions may affect you. Anger, guilt, anxiety and fear are some of the most common feelings that people have. You may find yourself tearful, restless and unable to sleep. You may have feelings of hopelessness and depression. These are all normal reactions, but it is often difficult and distressing to admit to them.
You do not have to cope with these feelings on your own and there are people available to help you. You may find it helpful to talk to your family and friends about how you feel. 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 religious leader. Cancerbackup can put you in touch with counselling services in your area.
This section has been compiled using information from a number of reliable sources, including:
For futher references, please see general bibliography.
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