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Genereally, tumor is an abnormal growth of body tissue and it may be benign or malignant. Malignant tumor is also known as cancerous cells. It grows quickly and uncontrollable in any types of organ and tissue. This type of tumor may be fatal. On the other side, benign tumor is not as danger as malignant tumor. This is because, according to WebMD (n,d), benign tumor is a growth of cells that serve no purpose. It does not invade or spread to the other part of tissues or organs.
Chondrosarcoma is an uncommon malignant tumor of cartilage cells, which often occurring in the bone such as femur, humerus, ribs or pelvis (Oxford, 2007). Cartilage is a type of connective tissue that is stiff yet flexible and normally, it is found at our joints such as knee, elbow and ankle. Unlike the other connective tissues, cartilage does not contain blood vessels. The chondrocytes are supplied by diffusion, helped by the pumping action generated by compression of the articular cartilage or flexion of the elastic cartilage (NewsMed, n.d.). Chondrosarcoma most commonly affects adults, especially in their fifties and sixties. According to Elizabeth Munroz (2012), there are many types of chondrosarcoma that are named based on the way that they come into view under the microscope such as Conventional chondrosarcoma, Clear cell chondrosarcoma, Myxoid chondrosarcoma, Mesenchymal chondrosarcoma, and Dedifferentiated chondrosarcoma. Clear cells chondrosarcoma is a low-grade tumor with significant amount of glycogen (Davide Donati and Luca Sangiorgi, 2009). This type of tumor is less harm as it has a good prognosis and a low recurrence rate. In contrast, de-differentiated chondrosarcoma are very rare. According to Davide Donati and Luci Sangiorgi (2009) this tumor is a distinct variety of chondrosarcomaÂ containing two clearly defined components: a well-differentiated cartilage tumor (enchondroma orÂ chondrosarcoma grade I and II) paralleling to a high grade non-cartilaginous sarcoma. Patient with this type of chondrosarcoma have a very poor prognosis
Chondrosarcoma can be treated by surgical removal because these tumors are not sensitive to radiotheraphy or chemotheraphy (Oxford, 2007).
2. OVERVIEW / HISTOPATHOLOGY
Generally, many types of tumor begin with abnormal growth of soft tissue. It grows whether quickly or slowly and may invade the adjacent tissues. Chondrosarcoma begins with the quick abnormal growth of cartilage cells. Any existing benign tumor also can cause chondrosarcoma to develop to the adjacent soft tissues. According to Dennis Thompson (2009), no one is certain what exactly prompt chondrosarcoma, although it is suspected that genetic abnormalities or damaged chromosomes might have something to do with it. This is because chondrosarcoma sometimes affect people with inherited diseases like Maffuci's syndrome or Ollier's disease, which are types of noncancerous cartilage tumors that often affect the hands.
Chondrosarcoma is a type of tumor that usually affect adults, as stated by Andreou, et al (2011) that chondrosarcoma occur with the peak age of 40-60 years old adults with male to female ratio of 1.5 to 1. Elizabeth Munroz also adds that in United States, 2100 patients are diagnosed with this rare cancer. There are only a few cases that involve children. From the incidence of chonrosarcoma that has been recorded, less than 10% are de-differentiated chondrosarcoma (Elizabeth Munroz, 2012).
2.3 MORBIDITY / MORTALITY
If chondrosarcoma is caught before it has spread, patients have a five-year survival rate of 90 percent. But, if the bone cancer has reach to other organs or is more aggressive, the survival rate drops to 43 percent or lesser (Dennis Thompson, 2009).
Generally, tumor occurs from an incidence of abnormal growth of soft tissues. Chondrosarcoma occurs when the cartilage cells grow rapidly and it may metastasize to the other part of the body. The tumor grows starting from the medullary canal of the long bone such as femur and humerus. Davide Donati and Luca Sangiorgi (2009) also add that in some cases, the lesion can occur as an abnormal bony type of bump, which can differ inÂ size and location. There are two types of chondrosarcoma which arise in different ways. Primary chondrosarcoma develops centrally from the normal bone, while secondary chondrosarcoma arise from the benign precursor such as Exostoses, Osteochondromas or Enchondromas.
2.6 SIGNS & SYMPTOMS
The word 'symptom' means patients perception of the disease, while 'sign' can be detected by the physician during examination. There are some signs and symptoms that can be identified to detect if the person has chondrosarcoma.
Normally, people that affected with this disease will experience sharp pain at the site where the tumor is located. It will become worse at night and also during physical activity such as exercise or lifting heavy object. Plus, according to Harvard Health Publication (n.d.), patient may experience difficulty in moving their affected limbs, limping, there may be swelling at the painful area, a lump, and enlargement of an existing growth. But for pelvic tumors, there may be changes in urination.
3. IMAGING MODALITIES
Imaging modalities are the equipment used to diagnose the existence of chondrosarcoma. There are many imaging modalities that can be used to diagnose this disease such as conventional x-ray, Computed Tomography (CT) scan, Magnetic Resonance Imaging (MRI), bone scan, Positron Emission Tomography (PET) scan, and also needle biopsy.
3.1 COMPARISON OF IMAGING MODALITIES
First of all, plain radiography is taken with a high-energy radiation to produce an image. It is usually taken on the affected part and it will produce an image that may show the size or location of the tumor. Secondly, CT scan is a machine that operates with rotating x-ray tube. Thus, it creates a cross sectional image of tissues and organs. In the other side, MRI does not use radiation energy, but it uses magnetic energy to produce more detailed cross-sectional image of the body. Just like its name, PET scan used positively charged particles to discover subtle changes in the body's metabolism and chemical activities so the produced images show how the body is working, rather than its structure (Harvard Health Publications, n.d.). Next, bone scan use a scanner and low-level radioactive material to detect cancer cells in bones. Lastly, the method that is used to diagnose chondrosarcoma is by undergoing needle biopsy. A little piece of tissue sample from the affected side is removed and it is examined under a microscope to look for the cancer cells.
As there are many imaging modalities that can be used to diagnose chondrosarcoma, some of them may have the advantages when compared to the others. Here are some of the advantages of the imaging modalities. First, the advantage of using conventional x-ray is that it produces high energy radiation to form an image of the bone. So, it gives less radiation dose to the patient. Next, CT scan is well known with its 'donut' shape gantry. Thus, it is able to produce a cross sectional image of tissue and organ in human body which is more precise to locate the exact size and location of the tumor. MacMillan (2013) adds that CT scan also can produce a three-dimensional image inside of our body. Just like CT scan, MRI also able to produce a cross sectional image of tissue and organ. In addition, MRI is better because it does not involve the usage of radiation and therefore, reduce the risk of radiation exposure to the patient. Bone scan has its own advantages where it is used to spot the physical and metabolic changes of the bone (Johns Hopkins Medicine, n.d.). Besides, bone scan also able to detect whether the cancer has spread to the other part of the body. Apart from that, biopsy is also one of the methods to diagnose the presence of chondrosarcoma. The best part of undergoing biopsy is that there was zero dose of radiation given to the patient. The doctor will take a sample of tissue at the affected area and examine it under the microscope. This test provides best proof of cancer and also allows doctors to make a distinction of chondrosarcoma from other bone cancers (Dennis Thompson, n.d.).
Therefore, needle biopsy is the best way to proof the presence of chondrosarcoma and many types of cancer.
All of the imaging modalities that are stated earlier have their own strength. As an example, CT scan usually used to successfully classify the lesion as being of cartilaginous origin and the medullary extension of the lesion may be assessed more accurate with CT (Geoff Hide, 2011). MRI can determine the area of â€‹â€‹tissue involved, whether it involves the 'Intra-Medullary' and areas which suffer from swelling (Dr Mohd Mahamud Musman, 2008). Therefore, it is better than plain radiography which only can determine the bone involved. Bone scan also has its own strength where it can determine the state of the cancer, whether it is in one area or on the other bones (Dr Mohd Mahamud Musman, 2008). Here, biopsy is still the best way to diagnose chondrosarcoma. This is because, during the biopsy, the doctor not only can discover the pathology, but also can remove the surrounding cell that is affected with cancer, so that the cancer cells will not invade to the other part of the body and become malignant.
All of the imaging modalities stated earlier have their own limitations. MRI scanner tube is bigger than CT scan. Some patient may feel claustrophobic as the head need to be inside the scanner tube during the examination. Claustrophobic means fear to a closed place. MRI is very sensitive to motion. Therefore, patient needs to stay still for a long time. According to WebMD (2009), usually MRI last for 15-30 minutes and may last for an hour which may be difficult for the patient to remain motionless.
3.5 DIAGNOSTIC ACCURACY
Diagnostic accuracy of all imaging modalities are very important to ensure that there is no misdiagnose occurs during the diagnosis. It is insufficient to assess any presence of chondrosarcoma by using radiographs alone. According to Geoff Hide (2011), radiographs usually demonstrate a lucent lesion, which commonly contains matrix calcification, mainly in well-differentiated tumors. Malignancy of a tumor may be detected with the presence of soft-tissue mass or cortical destruction.
4. IMAGE FEATURES OF PATHOLOGY
6. TREATMENT / PROGNOSIS / CONCLUSION
Chondrosarcoma can be treated in many ways, depending on the severity of the cancer. Chondrosarcoma is also known as a malignant tumor which can metastasize to the other part of the body. So, the possible treatments that can be done to avoid it from become worse are either by surgery, radiotheraphy, or chemotheraphy. The treatment is done based on the overall health condition of the patient, stage, size, and location of the cancer cells. If the cancer has not spread to the other organs yet, surgery is the best treatment that can be given (Mayo Clinic, n.d). During the surgery, the cancerous bone and the surrounding tissues will be removed so that there will be no more cancer cells remain in the patient's body. Thus, the rate to heal is definitely high. As chondrosarcoma originates from cartilage, it must be removed surgically to avoid from bone fractures, reduce pain, and also prevent it from become malignant (Dr. Mohd Mahamud Musman, 2008). Radiotheraphy and also chemothreaphy are less effective way to treat chondrosarcoma. Elizabeth Munroz (2012), state that most chondrosarcomas (with the exception of mesenchymal chondrosarcoma) do not respond to chemotherapy or radiation therapy.
Prognosis for patients with chondrosacoma varies with different types and stage of chondrosarcoma. The higher the grade of the tumor, the poorer the prognosis. Low grade tumor has a lower chance of recurrence and better prognosis while high grade tumor such as de-differentiated chondrosarcoma has very poor prognosis and higher risk of recurrence and metastasis.