Pre-Pointe Assessment

Introduction

Chondrosarcoma – proximal femur

Chondrosarcomas are malignant tumors of cartilage that account for approximately 25% of all primary malignant bone tumors. They are most common in older patients and most often affect the pelvis, sternum, scapula, or long bone cartilage of the extremities.

Typically, chondrosarcoma forms within the bone or cartilage cells surrounding the joint surface and can be slow-growing and spontaneous, or it can be the result of a malignant change from a pre-existing (secondary) bone tumor. [1] [2]

Epidemiology

Typical presentation is a slight male predominance of 1.5-2:1 at 4 and 50 years. It is possible to develop chondrosarcoma at a younger age group, which generally results in higher rates of malignancy and metastasis. The most commonly affected site is the proximal femur, followed by proximal humerus. [1][3][2]

Clinical Presentation

Patients typically present with pain, pathologic fracture, palpable mass, or localized mass effect. Hyperglycemia can occur as a paraneoplastic syndrome. [2]

Diagnosis

Chondrosarcoma histopathic

Imaging tests include:

• Bone scan: Shows where the damage and cancer has spread. Hot spots on the image appear dark gray or black.
• CT: To help detect cancer and see if it has spread to other areas.
• MRIs: Show the outline of a tumor.
• PET scans use radioactive tracers to look inside the patient and help find out if a tumor is cancer. They can also see if it has spread and find its exact location.
• X-rays: Show the shape and size of where the tumor is.
• Biopsy: A sample of a tumor is taken to test for cancer. It is done with needles or surgery. [4]

Medical Management

After a biopsy is done to confirm the diagnosis, surgery is the most common way to remove the tumor. Even for higher-grade tumors, limb-salvage curettage (by cryotherapy) is more common, and amputation occurs in rare cases.

Unlike most cancers, typical chondrosarcomas do not respond to chemotherapy and are resistant to radiation therapy. Different forms of chondrosarcoma, including dedifferentiated and mesenchymal, can be treated with experimental chemotherapy before or after surgery and follow the same pattern as osteosarcoma and Ewing’s sarcoma, respectively. Depending on the grade of the sarcoma, proton beam radiation has had some success, but does require very high doses and is considered less frequent than the surgical approach. [5] [6]

Physical Therapy Management

Physical therapy management most often occurs after surgery to remove the tumor. Depending on the location of the lesion, the surgeon may have different protocols, but physical therapy can focus on treatments that relieve pain, reduce edema, and improve the patient’s quality of life.

After surgery, an acute care physical therapist will teach patients skills such as bed movement, weight bearing, precautions, walking, and climbing and descending stairs. In outpatient physical therapy, patients will receive manual therapy and soft tissue mobilization to improve tissue malleability, reduce Edema and improved range of motion. Patients will also undergo therapeutic exercises to increase range of motion and muscle strength to address deficits that typically develop after surgery. Gait training will continue to incorporate and adapt to changing weight bearing precautions proposed by the surgeon. As the patient progresses, treatment becomes more effective and incorporates activities that are important to the patient. [7]

Alternative/Holistic Management

There are currently no evidence-documented reports on alternative/holistic management of chondrosarcoma.

Differential Diagnosis

The presentation of chondrosarcoma is similar to that of other musculoskeletal injuries/disorders of the affected joints. For example, a patient with chondrosarcoma of the hip complains of intermittent front thigh/hip pain. Pain can be of hip or non-articular origin. other Diagnosis of pain of hip origin includes osteonecrosis, stress fracture, hip dysplasia, or intra-articular pathology (labral tear, ligamentum teres tear, or joint loose body). Diagnosis of non-articular hip pain including bursitis tendinopathy muscle strain genitourinary disorders Metabolic disease Vascular condition or infection. [3]

Case Reports

Ferrer-Santacreu E Ortiz-Cruz E Diaz-Almiron M Well Kreilinger J. Chondroma versus chondrosarcoma in the long bones of the appendicular skeleton: clinical and radiological criteria-follow-up. Journal of Oncology [Cont.]. (February 23, 2016) [cited April 10, 2016]; 1-10. Available from: Academic Search Complete.