The preliminary signs of chondrosarcoma involve dull and deep pain in the affected area which is usually experienced in the night hours. The mean time from the diagnosis of chondrosarcoma from the onset of pain is usually 19.4 month in low grade tumors and much faster in high grade once [6].

In addition, there may be swelling accompanied by tenderness in the affected area. One of the major factors that distinguish bone cancer from other type of bone disorders is that there is persistent pain in the affected area which is generally felt during night. Another factor that needs mention is that individuals with chondrosarcoma often present with fractures after a minor fall or accident. This one feature is important for distinguishing bone cancer from other disorders of the bone.

• Pain

  The chief complaints were painful swelling and limitation of motion of the right knee for about half a year. The pain was a kind of dull ache. The skin around the right knee was red and hot. Moreover, she had a claudication gait due to the symptoms. [ncbi.nlm.nih.gov]

  […] greater load on the remaining bone, producing pain. [orthopaedicsone.com]

  The preliminary signs of chondrosarcoma involve dull and deep pain in the affected area which is usually experienced in the night hours. [symptoma.com]

  Suspect malignant change in a benign cartilaginous lesion that suddenly becomes painful. Borderline cartilaginous tumours In this group are cartilaginous tumours such as the enchondroma. [www0.sun.ac.za]

  Back and neck pain are among the most common conditions people suffer from. For some, back and neck pain is an annoyance or inconvenience; for others, it can be debilitating. [northwell.edu]

• Swelling

  Clinical findings Often asyptomatic initially; later, pain for months to years, swelling. Imaging MRI is the modality of choice; CT, plain films, show destructive, aggressive permeation of diaphysis by tumour. [medical-dictionary.thefreedictionary.com]

  Most patients present with painful progressive swelling in the anterior chest wall arising from the costochondrosternal junction. CT scan with intravenous contrast is the investigation of choice. [ncbi.nlm.nih.gov]

  Depending on the type of hip arthritis, symptoms can range from pain and swelling in the joints to difficulty using or moving the joint in a normal way. [northwell.edu]

• Surgical Procedure

  Although limited surgical procedures such as curettage are mentioned as a management option in low-grade chondrosarcomas, they tend to have a high rate of recurrences. [ncbi.nlm.nih.gov]

  […] from the symptoms and reduce blood loss, during a surgical procedure In case the tumor has metastasized into the lymph nodes, a surgery may be then followed by chemotherapy When EMC is at an inaccessible location, or is unsafe for surgical intervention [dovemed.com]

  The neurosurgeons at The Spine Hospital at The Neurological Institute tailor a surgical plan to each individual patient. Complete removal, when possible, may involve combined or multiple surgical procedures or approaches. [columbiaspine.org]

• Leg Edema

  We report a case of a 45-year-old female who presented with a 5-month history of left leg edema in 2015. Contrast-enhanced computed tomography showed a large mass in the left iliac vein with scattered calcifications. [ncbi.nlm.nih.gov]

• Aspiration

  To our knowledge, this is the first reported example of a primary clear cell chondrosarcoma initially evaluated by fine needle aspiration biopsy. [ncbi.nlm.nih.gov]

  The specimen obtained from fine needle aspiration was suggestive of a malignant fibrous histiocytoma. After further resection, the final diagnosis was dedifferentiated chondrosarcoma. [ajnr.org]

  These may include: X-rays Bone scan Blood test Bone marrow aspirate MRI CT scan If the results of the tests show chondrosarcoma, another referral will be made to a doctor who specialises in the treatment of bones (called an orthopaedic doctor). [canteen.org.au]

• Erythema

  Clinical examination of the left knee revealed swelling and warmth with some superficial erythema around the previous prosthesis. Image studies with CT, MRI and bone scan did not show any remarkable lesion or evidence of systemic metastasis. [ispub.com]

• Hip Pain

  We report a case of a 50-year-old female who presented with 6 months of left hip pain. Initial radiographs demonstrated an osteolytic lesion with adjacent area of sclerosis in the proximal left femur. [ncbi.nlm.nih.gov]

  […] in his right hip worse with activity. [orthobullets.com]

  For example, a patient with chondrosarcoma of the hip will complain of intermittenet anterior thigh/hip pain. The pain can present as either hip joint in origin or nonarticular hip origin. [physio-pedia.com]

• Back Pain

  WELLNESS CENTER Back and Neck Care Millions of Americans suffer from back pain every year. The reasons for the pain are many, including bad posture, accidents, improper lifting, obesity, and weak muscles. [nebraskamed.com]

• Suggestibility

  The cases reported in the literature suggest male gender predilection and variable clinical outcomes ranging from disease-free survival to disease-related death. [ncbi.nlm.nih.gov]

• Aggressive Behavior

  De-differentiated and mesenchymal chondrosarcoma – high grade tumors with aggressive behavior and spread. It is diagnosed in fewer than 10% of cases. This bone tumor is a very different kind of chondrosarcoma that is especially difficult to treat. [drallison.org]

  Altered p53 is associated with aggressive behavior of chondrosarcoma: a long term follow-up study. Cancer 1998 ; 83 : 2324 –2334 ↵ Fuchs N, Winkler K. Osteosarcoma. [ajnr.org]

  DESIGN: To investigate possible hallmarks of this aggressiveness, we are presenting the clinicopathologic features of 6 cases of CCC, 4 of which presented aggressive features and 2 low-grade behavior. [thedoctorsdoctor.com]

  The presence of any of these adverse prognostic factors can indicate the possibility of a more aggressive behavior in extraskeletal myxoid chondrosarcoma, and a closer follow-up is suggested. [nature.com]

  For example, 6q13~q21 changes in chondrosarcoma appear to be associated with locally aggressive behavior (Sawyer et al., 1998), loss of 13q may be a predictor of metastases (Mandahl et al., 2002), c-MYC amplification and polysomy 8 can be used for prognostic [sarcomahelp.org]

• Dystonia

  […] right-handed female with a past medical history of parasellar chondrosarcoma status post-surgical debulking and proton beam therapy (70 Gy) three years prior to presentation experienced several hours of brief, repetitive episodes of transient hemiballism and dystonia [ncbi.nlm.nih.gov]

• Dysarthria

  […] status post-surgical debulking and proton beam therapy (70 Gy) three years prior to presentation experienced several hours of brief, repetitive episodes of transient hemiballism and dystonia; this was followed by abrupt onset of fixed hemiparesis and dysarthria [ncbi.nlm.nih.gov]

The following are the diagnostic procedures employed for detecting chondrosarcoma:

• X-ray of the bone is done to analyze the presence of lesions. In the results, if tumors are present, the bone appears to be thinned and expanded. The extent of damage to the bone depends on the grade of the cancer [7].
• Biopsy is carried out to analyze the type of the tumor cells [8]. 
• Imaging tests such as CT scan and MRI scan are used to examine spread of the cancer to other parts of the body. The most common area to get affected is the lungs and a CT scan may reveal this.
• Bone scan is a more sensitive test as compared to bone X-ray. 

The type of treatment employed depends on the nature, size and location of the tumor. The grade at which the cancer is detected also greatly affects the type of treatment method to be employed. The following methods are applied for treating chondrosarcoma:

• Surgery: Surgical removal of the tumor forms the basis of treatment of chondrosarcoma. If the cancer has been detected in the early stages, then limb amputation can be spared. However, it is not always possible to avoid limb amputation which is necessary to avoid spread of cancer to other parts of the body.
• Proton therapy has been widely used for its positive results in treating chondrosarcoma. In this, powerful radiation is administered which attacks on the tumor cells and spares the other healthy tissues of the body.
• The use of conventional chemotherapy may have limited application in the treatment of mesenchymal and dedifferentiated types of chondrosarcoma [9]. The use of doxorubicin and cisplatin chemotherapeutic agents in treatment of sensitive cancer cells has been implored in some inoperable cases of chondrosarcoma [10].

Prognosis of chondrosarcoma greatly depends on how early the cancer was detected and treatment initiated. When individuals are diagnosed during the grade I of the disease, prognosis is favorable and the survival rate 5 years after proper treatment is 90%. However, in those when the tumors have become aggressive, the prognosis is poor with only 10% patients surviving the treatment period.

There are high chances that the tumors develop back and therefore it is advised that regular checkup be carried out to detect early signs of new tumor development.

Complications

Complications can develop when the cancer has not been diagnosed in the initial stages. As a result, it can metastasize to other parts of the body. In addition, nerve dysfunction can also develop in patients with chondrosarcoma.

The exact cause that triggers the development of chondrosarcoma is unknown. It is however believed that chondrosarcoma may be present as a secondary condition in individuals with other medical illness such as:

• Osteochondromatoses also known as multiple heredity exostoses
• Paget’s disease
• Wilms tumor
• Maffucci syndrome
• Ollier’s disease

Chondrosarcoma may also affect some children who have received either chemotherapy or radiation therapy for treatment of other types of cancer. Some genetic studies also suggests that chondrosarcoma is associated with genetic anomalies like the loss of heterozygosity in many gene loci [3].

Chondrosarcoma is a rare form of cancer affecting about 600 patients in United States each year. This form of cancer accounts for about 20 to 27% of malignant bone tumors [4]. It affects more males than females, with a male to female ratio of 1.5:1.

Chondrosarcomas are classified into 2 types depending on their source of origin: Primary and secondary. Primary chondrosarcoma occurs spontaneously unlike secondary type that develops as a result of other associated disease conditions. Chondrosarcoma has also been divided into various grades depending on the extent of spread of the disease.

Grade I chondrosarcoma develops at slow rate and is less aggressive in nature. The malignant cells appear similar to those of normal cells of cartilage tissues. Grade II and III are characterized by rapid growing tumor cells which are more aggressive in nature [5]. The cells can appear abnormal and can spread to the neighboring sites such as lymph nodes and other organs. Grade IV chondrosarcoma is defined as anaplastic tumors having abnormal growth pattern.

So far, no guidelines have been formulated to prevent chondrosarcoma. However, if individuals can recognize unusual signs and symptoms and seek medical help then the cancer can be treated at the initial stages. This can help prevent the spread of the cancer to other parts of the body and improve the life expectancy rate.

Chondrosarcoma is a type of cancer that develops in the bones and joints. It is a rare form of cancer and usually affects adults aged 40 years and above. Chondrosarcoma can affect any part of the body that contains cartilages; but primarily begins with development of tumor cells in the arms, legs and or pelvis [1]. Chondrosarcoma may be classified as primary and secondary depending on its source [2].

Chemotherapy and radiation therapy are not effective in treating such type of cancer. Surgical removal of the malignant tumors along with other methods is employed for treating chondrosarcoma.

Definition

Chondrosarcoma is a rare form of bone cancer that develops in the bone and joints. Males more commonly fall prey to such type of cancer. Adults aged 40 years and above are more prone to develop chondrosarcoma. The common areas of tumor development include areas of arm, legs and pelvis.

Cause

There are two type of chondrosarcoma: primary and secondary. The exact cause that triggers the development of the primary type is not yet known. However, secondary chondrosarcoma is thought to develop as a result of certain types of disease conditions.

Symptoms

The tumors cells are large in size and measures more than 5 cm. Individuals usually experience a dull and deep pain in the affected area during night. In addition, the patients also complain of inflammation and tenderness in the areas that do not go away with medication.

Diagnosis

The condition is diagnosed using bone X-ray that helps in identifying the tumor locations. Imaging studies such as CT scan and MRI help in detection of the spread of the cancer to other parts of the body. Biopsy of the tumor cells is done to analyze the nature of the cells. Bone scan may also be required as it provides additional information about the tumor cells.

Treatment

Surgery is often the first line of treatment followed by proton therapy to destroy the cancer cells without affecting the healthy tissues of the body.

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3. Bovee JV, Cleton-Jansen AM, Kuipers-Dijkshoorn NJ, et al. Loss of heterozygosity and DNA ploidy point to a diverging genetic mechanism in the origin of peripheral and central chondrosarcoma. Genes Chromosomes Cancer. Nov 1999; 26(3):237-46.
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9. Italiano A, Mir O, Cioffi A, Palmerini E, Piperno-Neumann S. Advanced chondrosarcomas: role of chemotherapy and survival. Ann Oncol. 2013; 24(11):2916-22 
10. Van Oosterwijk JG, Herpers B, Meijer D. Restoration of chemosensitivity for doxorubicin and cisplatin in chondrosarcoma in vitro: BCL-2 family members cause chemoresistance. Ann Oncol. 2012; 23(6):1617-26