Where does it occur and what happens?
The tumor can develop in any bone, but favorite places are the pelvic bones, the proximal femur and humerus, ribs, scapula, and less commonly, the bones of the hands and feet. A distinction is made between primary chondrosarcoma, which occurs in unchanged bone, and secondary chondrosarcoma, which develops at the site of a pre-existing benign cartilaginous tumor - osteochondroma or enchondroma. The most important characteristic is the degree of malignancy, determined under a microscope: low-grade tumors grow slowly, almost do not metastasize and can be easily cured by surgery, while high-grade tumors behave aggressively and can spread to the lungs.
- The pelvis, hip, shoulder, and ribs are most often affected
- Primary and secondary forms
- Secondary arises from benign cartilaginous tumors
- The degree of malignancy determines the prognosis
- Metastases most often to the lungs
- Typically affects adults over 40 years of age
Symptoms
The earliest and most constant sign is pain. It is deep, aching, increases gradually over weeks and months, bothers you at rest and especially at night, which distinguishes it from ordinary pain due to overload or arthrosis. Later, a dense, immobile formation appears, fused to the bone; the skin over it is usually unchanged. When located in the pelvis, the pain can radiate to the leg and resemble a pinched nerve, and in the chest it can cause shortness of breath. Sometimes the first manifestation is a bone fracture due to minor trauma, as the tumor destroys it from the inside.
- Deep aching bone pain
- Increased pain at night and at rest
- Tight stationary seal
- Limitation of movement in the nearest joint
- Edema of the limb
- Pathological fracture
- If the pelvis is affected, pain radiates to the leg
Diagnostics
The examination begins with an x-ray of the affected bone: cartilaginous tumors are characterized by areas of destruction with speckled calcifications and swelling of the bone. MRI shows the true size of the tumor, bone marrow involvement and soft tissue involvement - this is necessary for planning surgery. Computed tomography better assesses the destruction of the cortical layer and is necessarily performed for the chest to exclude metastases to the lungs. The final diagnosis and degree of malignancy are established only by a biopsy, which must be performed by a specialist from the center where the treatment will be carried out.
- X-ray of the affected bone
- MRI to assess tumor boundaries
- Computed tomography of bone and chest
- Biopsy with histological examination
- Determination of the degree of malignancy
- Examination in a specialized center
Treatment
The basis of treatment is surgical removal of the tumor en bloc with surrounding healthy tissue. The more complete the removal, the lower the risk of the disease returning, so the extent of the operation is planned in advance based on tomography data. Modern orthopedic oncology in most cases makes it possible to save a limb: the bone defect is replaced with an endoprosthesis, a bone graft or an individual design. Standard chemotherapy and radiation therapy for ordinary chondrosarcoma are ineffective; they are used for certain rare types of tumor and in situations where radical surgery is impossible. Tactics are determined by a council of specialists.
- Removal of the tumor within healthy tissue
- Limb salvage if possible
- Endoprosthetics and bone grafting
- Radiation therapy if radical surgery is not possible
- Chemotherapy only for certain options
- The decision is made by the council
- Rehabilitation after surgery
Observation and forecast
After treatment, regular follow-up examinations with x-rays or MRI of the surgical area and computed tomography of the chest are necessary, since the disease may return and metastases may appear years later. The observation schedule is set by the oncologist and usually lasts at least ten years. The prognosis depends primarily on the degree of malignancy and completeness of removal: with a low degree, most patients are cured. Lifelong surveillance is recommended for people with multiple cartilage tumors and hereditary syndromes because they are at increased risk of developing chondrosarcoma.
- Regular follow-up examinations
- Computed tomography of the chest
- Observation over the years
- Special control for multiple exostoses
- Rehabilitation and restoration of limb function
