What is chondrosarcoma?
Chondrosarcoma is a kind of bone cancer which develops in cartilage (cushioning material around bones). It is the second most common primary bone cancer. It usually occurs in adults and elderly age group.
What are types of Chondrosarcoma?
Chondrosarcoma can arise de novo – primary chondrosarcoma. Chondrosarcoma can also develop from pre-existing bone tumours like enchondroma, Osteochondroma and these are called secondary Chondrosarcomas. Secondary chondrosarcoma is usually of low grade.
Sometimes, chondrosarcoma may change it’s character and take an aggressive form of De-diffrentiated Chondrosarcoma
Mesenchymal Chondrosarcoma is another very high grade form of chondrosarcoma
What are symptoms of chondrosarcoma?
Patient may feel pain or sense of discomfort around the involved bone which may gradually worsen with time.
Sometimes , patient may also feel a swelling or lump around the involved bone.
When it has arisen from a pre existing osteochondroma, patient may feel increase in the size of the bony growth along with pain.
Sometimes, the bone may be weakened to such an extent that it may cause fracture of the bone (Pathological Fracture)
What is the cause of chondrosarcoma?
As with most of other Bone cancers, the exact cause of chondrosarcoma is not known. However, certain patients who have a pre existing bone tumour like enchondroma, osteochondroma are more prone to develop chondrosarcoma as compared to general population.
How is chondrosarcoma diagnosed?
Diagnosis of chondrosarcoma requires X-rays and MRI of the involved bone, along with a biopsy (Preferably Needle biopsy).
Since chondrosarcoma can spread to other parts of the body, a whole body PET-CT or Bone scan with CT chest is required to establish the stage of the disease.
What is biopsy? Who should do the biopsy?
In biopsy, some part of tumour tissue is removed and sent for examination under microscope. It can be open biopsy (in which a surgical incision is made to expose the tumorous bone and take out the diseased tissue) or a needle biopsy (in which a thin needle is used to take out the tissue without any incision). Since needle biopsy doesn’t involve any incision, the surgical trauma, pain and morbidity are lesser with needle biopsy.
It is very important that a biopsy should always be done by surgeon experienced with sarcomas who will be doing the definitive surgery since poorly done biopsies not only may yield false negative or inconclusive results but also wrongly placed biopsy scars can be detrimental for future limb salvage (which might unnecessarily cause increase in extent of surgery and hence the complications). In a nutshell, since the location and technical aspects of biopsy can affect the treatment options and final outcome of the patient, biopsy should always be done by Orthopaedic Oncologist or one of his team members.
We at Bone Cancer Clinic, Chandigarh do biopsy with a needle for almost all the cases with a very high diagnostic yield
Is FNAC same as needle biopsy?
NO. FNAC is entirely a different procedure than a needle biopsy though both are done with a needle.
FNAC stands for Fine Needle Aspiration Cytology and in FNAC only cells are aspirated from the abnormal tissue whereas in needle biopsy the abnormal tissue is taken out for analysis.
FNAC should not be done in bone and soft tissue tumours because the diagnosis of any bone and soft tissue tumour is based on the tissue material itself and not just the cells. Moreover, many a times FNAC may not be able to extract the cells and may give a false negative reports.
How is chondrosarcoma treated?
Treatment of chondrosarcoma requires some sort of surgery to remove the cancerous bone. The other modalities of Chondrosarcoma Treatment in India like chemotherapy or radiotherapy are usually not effective in the management of chondrosarcoma
What kind of surgery is performed in Chondrosarcoma?
With the advent of newer surgical techniques, it is possible to do a limb salvage surgery in majority of the patients in which only the part of the bone involved with osteosarcoma is removed rather than cutting the whole limb. The defect so created is reconstructed with artificial metal implant thereby saving the limb.
In some cases, the cancerous bone so removed is given very high dose of radiation so as to kill all the cancer cells and the sterilised bone so formed is fixed back to the parent bone with the help of plates and screws, a technique commonly called as Extra Corporeal Radiation Therapy (ECRT).
The cancerous bone so removed can also be sterilised by exposing it to very cold temperatures with the help of liquid nitrogen- a technique known as Cryotherapy.
In today’s era, in some patients, bone can be sterilised with liquid nitrogen without removing it completely from the body, a technique known as Pedicled Cryotherapy
Can chondrosarcoma be cured?
Yes. A chondrosarcoma which has not spread anywhere else has very good chances of cure which can be as high as 80-90%. The chance of cure depends on extent of disease involvement and grade of tumour
Whom to consult?
First chance is the best chance when it comes to managing chondrosarcoma or any bone cancer. Patient should consult a trained Orthopaedic Oncologist when diagnosed or suspected to have Osteosarcoma. Bone Cancer Clinic at Sector 19, Chandigarh is a centre dedicated exclusively for the management of such bone tumours.
Dr Rajat Gupta
Orthopaedic Oncologist
Bone Cancer Clinic
# 5, Sector 19 A, Chandigarh
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SCO 141 (Backside), Sector 14, Panchkula
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