Patients' Guide to Spinal Cancer

Spinal Chondrosarcoma is a Primary Bone Cancer

A look at the second most common primary malignant bone cancer in the adult population

Chondrosarcoma is a type bone cancer that affects your cartilage cells. Your pelvis, legs, and spine are common sites for this cancer to manifest. While chondrosarcoma can develop anywhere in your body that has cartilage, this article will focus on how chondrosarcoma tumors impact your back and neck.

Chondrosarcoma is a type of primary bone cancer—that is, this cancer is still confined in the bone where it developed as opposed to traveling (or metastasizing) from a different location. You can read about other types of primary spinal bone cancers in our articles about osteosarcoma, chordoma, and Ewing sarcoma. You can read about cancers that spread to the spine from other parts of the body in our article about metastatic spinal tumors.
Photo illustration of spinal cancer.Chondrosarcoma is a type of primary bone cancer—that is, this cancer is still confined in the bone where it developed. Photo Source: bone cancers make up less than 0.2% of all cancers, according to the American Cancer Society. More than 40% of adult primary bone cancer cases are chondrosarcomas—and 5 to 10% of those occur in the spine. Chondrosarcoma is the second most common primary bone cancer (after osteosarcoma).

What Is Chondrosarcoma?

Chondrosarcoma can occur in any region of your spine—from the vertebrae in your cervical spine (neck), to your thoracic spine (mid-back), and down to your lumbar spine (low back).

Outside of what’s known as “conventional chondrosarcoma,” there are several unique variances of this bone cancer. Two types of chondrosarcoma often seen in the spine are:

  1. Dedifferentiated chondrosarcomas, which begin as conventional forms of chondrosarcoma, but then parts of the tumor evolve and become aggressive. This type is common in middle-aged patients.
  1. Mesenchymal chondrosarcomas, which are rare and aggressive forms of chondrosarcoma. This type typically occurs in young adults.

Prevalence of Chondrosarcoma
Chondrosarcoma is more common in adults than children, with the average age of diagnosis being 51. While 40% of adults with primary bone cancer have chondrosarcoma, only 6% of kids and teens with primary bone cancer have chondrosarcoma.

What Causes Chondrosarcoma?

Researchers have not yet discovered the exact cause of chondrosarcoma. However, there is evidence linking the following medical conditions to the disease:

  • Hereditary multiple exostoses (benign cartilage outgrowth on bone)
  • Maffucci syndrome (benign cartilage growth within bone)
  • Ollier's disease (rare, benign cartilage growth near cartilaginous growth plate)
  • Paget’s disease (causes bones to become enlarged, deformed)
  • Wilms’ tumor (common type of kidney cancer in children)

Diagnosing Spinal Chondrosarcoma

Imaging tests are central to diagnosing chondrosarcoma. Your doctor will likely use computerized tomography (CT) scans and/or magnetic resonance imaging (MRI), because these tools give your doctor the best view of the tumor in your spine. X-rays aren’t used as often to detect chondrosarcoma.

Your doctor may also use spinal angiography to get detailed images of your spine’s arteries and veins. The images will show blood flow around the chondrosarcoma, and will help your doctor understand what blood vessels are impacted by the tumor. This can help guide treatment decisions.

While imaging tests will be performed as part of a chondrosarcoma diagnosis, a biopsy is necessary to confirm whether it is cancerous. There are two categories of biopsy: needle and surgical.

During a needle biopsy, the doctor extracts a small sample of the spinal chondrosarcoma tumor with a hollow needle. The procedure is typically done using a local numbing agent, though your doctor may have you sedated or under general anesthesia. Needle biopsy is preferred as it is less invasive and leads to decreased risk of tumor spilleage from the biopsy. The biopsy tract should be marked at the time of the biopsy so that it can be identified and excised as part of the surgical excision.

If a larger tumor sample is required, your doctor may opt to perform a surgical biopsy. During this procedure, the surgeon removes a sample of the tumor by cutting through the skin. As a much larger part of your body is impacted by this type of biopsy compared to a needle biopsy, you will most likely be under general anesthetic.

After the biopsy sample is extracted, a pathologist will examine the sample under a microscope and grade the tumor. The grades span from grade I to grade III.

  • Grade I is a low-grade, slow-growing tumor
  • Grade II is an intermediate tumor
  • Grade III is the most aggressive form of cancer and likely to spread
  • Most chondrosarcomas are either grade I or grade II

Symptoms of Chondrosarcoma in the Spine

People who develop chondrosarcomas in their spine often report constant bone pain, even during rest. Pain is often worse at night and in the morning with lying down.

Outside of pain, spinal chondrosarcomas can cause neurological symptoms, based on the spinal tumor's location. For example, chondrosarcomas at the top of the cervical spine, near the base of the skull, can cause headaches, dizziness, double vision, and hearing loss. At the other end of the spectrum, chondrosarcomas in the low back and pelvic region may cause bowel and bladder problems.

Once you have a diagnosis and tumor grade, you will meet with your spine surgeon to discuss next steps. Spinal chondrosarcomas are challenging to treat, given their location on the spine. Your medical team will discuss the options available and develop an action plan specifically for you.

Updated on: 08/06/19
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