Beginning the Chondrosarcoma Journey

Beginning the Chondrosarcoma Journey

Sunday

WHAT ARE THE METHODS USED TO DIAGNOSE CHONDROSARCOMA?

If a patient has symptoms of a chondrosarcoma, the doctor may need to perform a physical examination based on the symptoms described by the patient. If the patient has a firm, mass attached to the underlying bone with pain or tenderness, this may be an indication to suspect Chondrosarcoma. Recent noticeable growth of a lump, pain and swelling are often the most common complaint. Sometimes, however, there is no obvious evidence of pain and the diagnosis can be confused. There is usually no swelling in any adjacent joint, and range of motion is normal unless tumor has grown large enough to interfere. Fracture of the involved bone is rare. However, in some patients this is the first indication that chondrosarcoma may be present. Systemic symptoms can be associated with the size and location of the tumor. For example, pelvic tumor can present with sciatica, numbness or tingling, extra bladder pressure, or bowel problems. Tumor located in the rib cage can cause pressure upon the lungs, heart, liver or stomach.

In order to determine the diagnosis properly, the doctor may order x-rays and other tests such as a CAT scan, MRI or bone scan. One of these tests, alone, is not enough to determine the diagnosis. So, a combination of these tests helps to reveal the size and characteristics of the tumor and adjacent tissue.

The Radiologist may detect changes consistent with Chondrosarcoma which is most often present on x-ray film as ill-defined lesions with a moderate-sized to large soft tissue component and often demonstrating calcified cartilage. Cat Scan, MRI, Bone Scan, and Ultrasound will give further clarification, and definition of the tumor, and/or in order to determine if other organs are involved.

What do Radiologists look for in a bone scan?
(paraphrased from http://gamma.wustl.edu/bs087te143.html)
"Benign Osteochondroma (exostosis) may show normal to dramatically increased bone uptake. Osteochondroma (benign bone tumor) is relatively uncommon in the spine (1-4% occur in the spine and account for 4% of solitary primary spine bone tumors). 

Normal to mild uptake in an exostosis generally excludes malignancy. However, marked uptake is not specific for malignant degeneration. More intense uptake is seen in growing children. Fracture, of course, results in intense uptake. Thus, the role of bone scan in exostosis or multiple hereditary exostosis is questionable.
Thin-slice CT may provide the diagnosis if marrow and cortical continuity can be demonstrated. MRI will show the characteristic cartilaginous cap (intermediate on T1- and high on T2-weighted images). If this cap is greater than 1 to 2 cm in thickness, concern must be raised of chondrosarcoma.

Chondrosarcoma, the second most common malignant spinal primary bone tumor, is a destructive, lytic tumor with a chondroid matrix consisting of "rings and arcs" radiographically. Cortical destruction is always present (excluded by CT in this case). A soft tissue component is common. In bone scan, these produce patchy or homogeneous increased uptake."

According to an article entitled:
Enchondroma and Chondrosarcoma 
By Flemming DJ, Murphey MD
 
"The judicious use of computed tomography, magnetic resonance imaging, and nuclear medicine in conjunction with appropriate clinical data allows the radiologist to establish the correct diagnosis of benign or malignant medullary chondroid lesion in the majority of cases."

There are no blood tests available at this time useful for diagnosing Chondrosarcoma. Blood tests will eliminate the possibility of other kinds of bone cancer.


Once sufficient studies have been done the doctor may also cut out a small piece of tissue and have a pathologist look at it under the microscope to see, if there are any cancer cells. This is called a biopsy.

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7 comments:

Carol Sands said...

Hi,

A month ago I took a hard fall right on my face. Since then I have had continuous pain in my upper arm, shoulder and scapula that chiro visits, PT nor meds have made much difference in. I realized that alot of the pain was coming from a hard knot on my upper arm which when i use that arm to much can often ve almost be at times unbearable. It wakes me a lot and throbs a lot through the day especially if I use that arm much or have it in a position for any length of time. I did have X-rays and they didn't show anything I terms of fracture or shadow. My PT is very seasoned. He felt it and said I should see an Ortho. I did that and he said based on X-ray he isn't too worried it is cancer but is sending me for an MRI as a precaution. My question is in those experience and with the feedback you get has there ever been cases where it really was cancer but DIDNT show on a standard X-ray ? I've had the knot awhile (since before the fall) and it has hurt from time to time but not like it has lately. I have fibro and do I Assumed it was a tight trigger point but now it feels hard like bone. Should I worry? Oh lady I have had night sweats since this flared up and I'm through the menopause at 56 yrs of age.

Elizabeth Munroz said...

Bone tumor is usually noticeable on xray even if it is benign. MRI gives more detail. Perhaps more time needs to pass before healing takes place from the fall. Night sweats is not a part of a chondrosarcoma experience. Has your physical therapy involved gentle swim exercise or jacuzzi? I hope you will get some answers soon.

Carol Sands said...

Thank you Ms. Munroz. I guess my worry is that if I just assume it is nothing and it could have been caught early, but I let it go then it will be too late to do much. The thing that bothers me most is that I have this about 6 months or longer and though painful in the past, it has become increasingly more sore since the fall and feels like a hard quarter size nodule and it is what is causing my pain; especially at night. Because I didn't even know I had caught my leg on anything i never had time to brace myself so my hands were more or less at my side when I fell so it is not as though i put pressure on my muscle by trying to catch myself. Anyway, I appreciate your feedback. I am so sorry for what you have been through. I think it such an act of love to share your wisdom and I thank you for taking time to respond. May God bless you for your kindness to others. Sincerely, Carol Sands

PS Please forgive the typos in the previous post. I was typing from my Iphone and it has a habit of changes words like lady should have been lately.

Elizabeth Munroz said...

Carol, If it should turn out to be chondrosarcoma, catching it early or later, the treatment would be the same, surgical removal of the tumor. Since you are aware of it, I doubt it could progress without your noticing and increase in size. In others who are unaware, it would still have to grow quite large for a more in depth surgery to be performed. So a smaller (newer) tumor would be to scrape it out of the bone. A larger tumor might need to have a portion of bone removed with the tumor and have some metal put in and bone cement to help it grow back together. It would only be a very large aggressive tumor that would require anything more intensive.

Don't worry about misspelling. I kinda liked the lady instead of lately. :)

Carol Sands said...

You are so kind. Thank you.

What I meant by letting it go, was that if I didn't do anything that it might metastisize if it were cancer. It is comforting to know that it wouldn't be that involved of a surgery. Based on some case histories I've read, it sounded like a very extensive surgery.

I am one to self diagnose and most times I am spot on. I'm often asked if I am a nurse. I am hoping that my instincts are off this time. My doctor like you, does not believe it is cancer based on the xray but is sending me for an MRI just to be 100% sure.

Thank you again for taking time to answer my questions. You are a blessing...Carol Sands

Elizabeth Munroz said...

I am often asked if I'm a nurse also. I always answer, "Unfortunately, I'm a chronic patient. And I want to be well informed. Incidentally, I have a doctor, nurse and paramedic in the family." That usually ends with a knowing nod from whatever professional I am visiting. :) I've learned a long time ago, Carol, that it pays to be well-informed. Obviously, it's a little bit like Russian Roulette trying to guess what is wrong with ourselves. So many symptoms can mimic that of other diseases. (Yours might be a Lipoma.)I had terrible bone pain a couple years back that I thought was arthritis, and bad night sweats that I decided was menopause. Turned out it's Leukemia. Only after I'd seen the blood results did I realize that and the doctor confirmed it a day later. So now I have a new battle to face. It's been two years and I'm doing well, though. I am so glad your doctor at least is taking the extra step by ordering the MRI for you. Make sure, whatever he says the results are, to get copies of the radiology report as well as the xrays and scans. You never know when you might need them again for a comparison in the future and they might be lost or tossed.

Anonymous said...

Well my husband has it and one of his tumors got bigger should we worry