Chondrosarcoma: symptoms, diagnosis and treatment
A chondrosarcoma is a type of bone cancer that appears in cartilage, usually in the pelvis, shoulders and ribs. It is the most common type of cancerous bone tumor, since it represents 10 to 20% of all oncological bone pathology. The peak of prevalence is between the ages of 30 and 70 and is very unusual in those under 21 years of age.
Life expectancy 5 years after diagnosis is almost 70% in localized cases and 26.5% if signs of metastasis are found. With these figures, it is clear that it is a complex clinical entity with a reserved prognosis.
What is chondrosarcoma?
The term Cancer refers to a series of very diverse clinical entities with a common issue: in all of them genetic mutations occur in a cell line and it stops responding to normal patterns of senescence and division. Therefore, cancer cells grow uncontrollably and form tumors.
As indicated by the National Cancer Institute (NIH), not all cancer entities present with tumors. For example, chondrosarcoma is associated with a palpable mass, while leukemia is the growth of defective lymphocytes that are released into the blood.
For its part, chondrosarcoma (CS) harbors a heterogeneous group of tumors of the skeletal system. In general, these are primary, slow-growing, and characterized by the formation of neoplastic hyaline cartilage. Normal hyaline cartilage is essential for bone formation, as it is secreted by chondrocytes and provides the body with support, elasticity and growth.
In summary, chondrosarcoma is about a type of cancer that begins in cartilage cells and spreads to the surrounding bone tissue. As the St. Jude Childrens Research Hospital website indicates, this type of tumor can affect any area of the body that contains hyaline cartilage.
Types of chondrosarcomas
On the other hand, it should be noted that this type of neoplasm can be classified into 4 different grades. We expose them to you in the following list:
- I: low grade. It is a locally aggressive cartilaginous tumor, but its chances of growth and spread are low. It is difficult to differentiate it from a benign tumor.
- II: cells in grade II cancerous tumors have more atypia in their nuclei and are more abundant. In this type of cancer, mitosis is observed, that is, active cell division.
- III: cancer cells exhibit even more mitosis. The degree of spread to other tissues is high.
- IV: it makes up 10% of all chondrosarcomas, so it is the least common variant. It is called dedifferentiated chondrosarcoma and is associated with a worse prognosis.
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As the Mayo Clinic indicates, the most obvious symptom of a chondrosarcoma is presence of a swollen palpable mass in a specific area of the body. Localized pain in this area occurs in 80% of patients and manifests itself in an insidious, prolonged, progressive way, worsening at night.
On the other hand, 27% of patients suffer bone fractures as a warning symptom. As the chondrosarcoma grows, the bone weakens and therefore can break more easily. If the tumor mass pinches or affects any major nerve endings, the patient also has tingling and numbness.
What can cause a chondrosarcoma?
As with many types of cancer, the cause is not entirely clear. Anyway, according to the portal StatPearls, exist some chromosomal mutations that have been linked to chondrosarcoma. The changes are associated with the following portions of the genome: 9p21, 10, 13q14 and 17p13, that is, on chromosomes 9, 10, 13 and 17.
On the other hand, IDH gene 1 and 2 mutations have been linked to several types of cancer, including chondrosarcoma. The IDH1 gene, for example, is essential for proper cell function, protecting against harmful molecules and helping to break down fats for energy.
As indicated by the portal F1000 Research, mutations in IDH genes are associated with 52-59% of all chondrosarcomas. For this reason, the inhibition of these mutated genes in cancer patients is currently being studied as a possible treatment.
According to the American Cancer Society, malignant bone tumors represent less than 0.2% of all neoplasms with metastatic potential, so it is a fairly rare type of pathology. Still, chondrosarcoma accounts for 25-40% of all total bone cancers.
Here are a series of risk factors that could promote the appearance of chondrosarcoma:
- Advanced age: As we have said, practically all cases occur between 30 and 70 years of age. However, most patients are over 50 at the time of diagnosis.
- Being a man: males are 1.5 to 2 times more likely to suffer from it.
- Present benign lesions in the cartilage: Sometimes diseases that cause benign cartilaginous lesions can develop into this type of cancer.
If this tumor is suspected, the doctor will perform a series of procedures that allow images of the bone structure to be obtained. We refer to X-rays, computed tomography (CT) techniques and magnetic resonance imaging (MRI). However, cancer can only be confirmed with a biopsy.
The presence of calcifications in the cartilage can be a good starting point. Unfortunately, this does not differentiate a cancer from a benign tumor. In some cases, they are diagnosed in routine tests, as they can remain silent entities for quite a long time.
As indicated by sources already cited, chondrosarcoma it is considered an entity resistant to chemotherapy and radiotherapy. Therefore, the approach of choice is always surgery. En bloc excision of the affected tissue is recommended in grades II and III.
On the other hand, in grade I chondrosarcomas, to scrape locally the tissue (technique known as intralesional curettage), after which the cavity is filled with biomaterials that promote bone resorption and synthesis.
Both treatments will have a higher success rate depending on the location of the tumor. For example, 90% of patients survive 5 years after diagnosis in grade I pathologies. In the worst variant of all (dedifferentiated chondrosarcoma), only 10% of patients reach one year of life.
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A sometimes silent tumor
As you have seen, chondrosarcoma is the most common type of cancer within the rarity of bone neoplasms. It is sometimes very difficult to detect and, therefore, it is seen as a foreign entity in a normal radiological analysis. Although it may present as an obvious mass, symptoms tend to be very diffuse.
As with any other type of cancer, the faster it is detected, the greater the chances of survival. Therefore, in the event of any persistent abnormal pain or lump, it is necessary to see a medical professional promptly.
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