Surgical Procedures: Surgery and Staging for Chondrosarcoma

Chondrosarcoma is a type of bone cancer that can start anywhere there is cartilage. Cartilage is a type of tissue that is smooth and moveable. It helps support parts of your body and helps protect your joints and bones. This type of bone cancer usually happens in people over 20 years old. It can happen in the:

• Pelvic (hip) bones.
• Legs.
• Arms.

But can also happen in the: 

• Trachea.
• Larynx.
• Chest Wall.
• Scapula.
• Ribs.
• Skull.

What is staging and how is it done? 

Staging is a way to find out if and how far the cancer has spread in your body. Your provider will have you get a few tests to figure out the stage of your cancer. For chondrosarcoma, these tests may be: 

Physical Exam: This is an exam to look at your body and to talk about your health history. 

Blood Tests: Your provider may want you to have blood tests to see how your liver and kidneys are working. Other blood tests check for markers that could be related to chondrosarcoma.

Imaging: Radiology tests can look inside your body to see if your cancer has spread. These tests can include:  

• X-Ray. 
• CAT scan (CT scan). 
• Positron emission tomography scan (PET scan).  
• Magnetic resonance imaging (MRI). 
• Bone Scan.

Procedures: These may include: 

• Incisional biopsy:  A small part of tumor or abnormal tissue is removed for testing. 
• Fine needle aspiration (FNA): A thin needle removes a piece of tissue for testing. This may be done using an ultrasound or CT scan to help guide your provider.
• Core biopsy: A larger piece of tissue is removed with a thick needle. This may be done with an ultrasound or CT scan to guide your provider. 
• Excisional biopsy: The whole tumor is removed.

The biopsy samples are sent to a lab where they are looked at under a microscope by a pathologist (a doctor who specializes in looking at tissues). The samples may have more testing to figure out the exact type of cancer. This information is used to write a pathology report that is sent to your healthcare provider. 

Staging of chondrosarcoma is based on many factors, such as: 

• Tumor grade (how abnormal it looks under a microscope). 
• Tumor size. 
• If the lymph nodes or other organs have cancer in them. 

Chondrosarcomas are described as stages I-III (1-3). There are also several uncommon subtypes of chondrosarcoma. Your care team will talk with you about your stage and type of cancer.

Surgical Procedures Used in the Treatment of Chondrosarcoma

Surgery is often the first treatment used for chondrosarcoma. The type of surgery depends on a few things, like the size of the cancer and where it is found.

Some surgeries that may be used are: 

• Wide Resection: Removal of the tumor and a wide margin of normal-looking bone and tissue that is around the cancer.
• Wide local excision:  Removal of the tumor and some normal-looking tissue that is around the cancer, trying to leave a “clean margin” of cancer-free tissue. By removing some healthy-looking tissue, there is less chance cancer cells will be left in the body.
• Curettage (intralesional excision): The surgeon uses a sharp tool called a curette to scrape out the tumor without removing the bone. This leaves a hole in the bone which may be filled with bone cement.
• Limb-sparing surgery:  This procedure is used to keep as much of the limb’s function as possible, and to help save the appearance of the affected limb. Only the bone and tissue affected by the chondrosarcoma is removed, to avoid amputation (total removal of the limb). During the surgery, the cancerous bone and tissue is removed and replaced with bone and tissue grafts and/or artificial (manmade) bone implants or other material. 
• Amputation: Part of or all of the affected limb is removed. 
• Lymphadenectomy: Lymph nodes are removed to test them for cancer. 

Other surgical procedures, like reconstructive surgery or cryosurgery, may be used depending on where the tumor is, your health, and other factors. You may also get chemotherapy and/or radiation therapy before or after surgery. Treatment before surgery is called neoadjuvant treatment and is done to shrink the tumor as much as possible before removing it. Chemotherapy or radiation given after surgery is called adjuvant treatment, used to kill cancer cells that may be left in the body.

What are the risks of surgery for chondrosarcoma? 

As with any surgery, there are risks and possible side effects. These can be: 

• Reaction to anesthesia (Anesthesia is the medication you are given to help you sleep through the surgery, to not remember it, and to manage pain. Reactions can include wheezing, rash, swelling and low blood pressure). 
• Bleeding. 
• Blood clots. 
• Infection. 
• Urinary retention (not being able to urinate normally). 

Before surgery, your surgeon will talk to you about any other risks based on your health and the surgery you are having.  

What is recovery like? 

Recovery from surgery to treat chondrosarcoma depends on the type of procedure you had. A hospital stay and rehabilitation therapy may be needed. 

You will be told how to care for your incisions (surgical cuts) and given any other instructions before leaving the hospital. 

Your medical team will talk with you about the medications you will be taking, such as those for pain, blood clot, infection, and constipation prevention and/or other conditions. 

Your healthcare provider will talk with you about any changes you should make to your activity level, which depends on the surgery you have had.

How can I care for myself? 

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity. 

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms. 

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.  

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense. 

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders. 

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.