Chordoma. General info

Chordoma is a rare type of bone cancer

(from the http://www.macmillan.org.uk/ nurses website)

What is a chordoma?

A chordoma is a rare type of cancer that develops from the notochord. The notochord forms the spine in a developing baby in the womb. After about six months, most of the notochord is replaced by the bones of the spine. However, small amounts of the notochord may remain and these can sometimes develop into a chordoma.

Chordomas can be found in any part of the spine, with around half occurring at the bottom of the spine. About 2 in 5 (35-40%) of chordomas occur at the base of the skull or in the bones running down the middle of the face. The rest affect the bones in the spine (the vertebrae).

Chordomas tend to be slow-growing and don’t often spread to other parts of the body. If they do spread, the most commonly affected places are the lungs, liver, nearby lymph nodes, bone and skin. As these tumours gradually grow, they can affect the surrounding areas of bone and soft tissue. 

Chordomas can happen at any age, but mainly affect people aged 40-60. Less than 1 in 20 of all chordomas occur in people under the age of 20 and childhood chordomas are very rare. Chordomas, especially those that occur at the bottom of the spine, are more common in men than in women.

Causes of a chordoma

The exact cause of chordomas is unknown. Research is being carried out into possible causes.

Signs and symptoms of a chordoma

It may take some time for a chordoma to be diagnosed, as symptoms often develop gradually. The symptoms a person has will depend on where the tumour is. If the chordoma starts in the spine, symptoms may include

Chordoma in the base of the skull, symptoms may include:

• a headache
• pain
• double vision
• facial pain
• changes in hearing
• difficulty swallowing
• a feeling of dizziness (vertigo).

All of these symptoms are common to many other conditions and you will need further tests and investigations before an accurate diagnosis can be made.

How a chordoma is diagnosed

Usually you begin by seeing your GP, who will examine you and may arrange any necessary tests or x-rays

They may also decide to refer you to a specialist hospital or bone tumour centre for further tests. This is because many of the tests for diagnosing bone tumours, such as biopsies, require experience and specialist techniques

If you have a chordoma affecting the base of your skull, you may be referred to a neurologist (a doctor who specialises in treating illnesses of the brain and nervous system) or a neurosurgeon (a doctor who specialises in operating on the brain).

Tests and investigations

Your doctors need to find out as much as possible about the type, position and size of the tumour so they can plan your treatment. You may have a number of tests and investigations.

The doctor will examine you thoroughly and test your reflexes and the power and feeling in your arms and legs.

You will have a CT or MRI scan to find the exact position and size of the tumour.

CT (computerised tomography) scan

A CT scan takes a series of x-rays that build up a three-dimensional picture of the inside of the body. The scan is painless and takes 10-30 minutes. CT scans use small amounts of radiation, which will be very unlikely to harm you or anyone you come into contact with.

You may be given an injection of a dye, which allows particular areas of the inside of the body to be seen more clearly. For a few minutes, this may make you feel hot all over. If you are allergic to iodine or have asthma, you could have a more serious reaction to the injection, so it is important to let your doctor know beforehand.

MRI (magnetic resonance imaging) scan

This test is similar to a CT scan, but uses magnetism instead of x-rays to build up a detailed picture of areas of your body. Before the scan, you may be asked to complete and sign a checklist. This is to make sure it's safe for you to have an MRI scan.

Before having the scan, you'll be asked to remove any metal belongings including jewellery. Some people are given an injection of dye into a vein in their arm. This is called a contrast medium and can help the images from the scan to show up more clearly.

During the test you will be asked to lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It is painless, but can be slightly uncomfortable, and some people feel a bit claustrophobic during the scan. It's also noisy, but you'll be given earplugs or headphones.

Biopsy

To give an exact diagnosis, a sample of cells is sometimes taken from the tumour and examined under a microscope. This is called a biopsy. The biopsy involves an operation and you may have to stay in hospital for a few days. How the biopsy is done will depend on the position of the tumour in the spine. Your doctor will discuss whether a biopsy is necessary in your case and exactly what the operation involves.

Treatment for a chordoma

The treatment for a chordoma depends on a number of things, including your general health and the size and position of the tumour. The results of your tests will enable your doctor to decide on the best type of treatment for you. There are some risks associated with treatment and your doctor will discuss these with you.

As chordomas are very rare, they are usually treated at specialist hospitals by a team of doctors and other healthcare professionals. This means you may need to travel some distance for treatment.

Surgery

Where possible, surgery is used to remove the tumour and nearby tissues that might contain cancer cells. The type of surgery you have, and your recovery, will depend on a number of factors. Your surgeon will discuss the different types of surgery with you in detail before any decision is made about your treatment. Before your operation, you can ask questions so that you know exactly what is involved. No operation or procedure will be done without your permission (consent).

Sometimes it may be too difficult to remove a chordoma completely, for example if the chordoma has spread into nearby areas of the body. In this situation, your doctor may recommend other treatments in addition to, or instead of, surgery.

Radiotherapy

Radiotherapy uses high-energy x-rays to destroy the cancer cells. It can be used after surgery to destroy any remaining tumour cells. It may be used alone to treat chordoma or with chemotherapy if surgery isn't possible. It may also be given if the tumour comes back after initial treatment and further surgery is not possible.

Radiotherapy is also sometimes used to relieve symptoms, such as pain.

Newer methods of radiotherapy used for chordoma include stereotactic radiotherapy. This type of radiotherapy enables doctors to direct higher doses of radiation more accurately at the tumour and minimise the side effects of treatment.

Proton beam therapy is another type of radiotherapy that can be effective in treating chordoma. This treatment is currently unavailable in the UK. However, if it's suitable for you, the NHS may arrange for you to have it overseas. Proton beam therapy will hopefully be available in the UK from 2017. Your doctor can give you more information about this treatment.

Chemotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. Chemotherapy has not been shown to be very effective in treating chordomas. However, in some people it may help to control a chordoma that has come back (recurred) or has spread elsewhere in the body.

Clinical trials

Cancer research trials are carried out to try to find new and better treatments for cancer. You may be asked to take part in a clinical trial. Your doctor will discuss the treatment with you, so that you have a full understanding of the trial and what it means to take part. You may decide not to take part or to withdraw from a trial at any stage. If you do this, you will receive the best standard treatment available.

Targeted therapies

Targeted therapies use substances that target the differences in the biology between cancer cells and normal cells. Imatinib (Glivec®) is a targeted therapy that is being tested to see if it is helpful in treating chordoma. 

Follow-up

After your treatment is completed, you will have regular check-ups and possibly scans. These may continue for several years.

If you have any problems or notice any new symptoms between these times, let your doctor know as soon as possible.

Your feelings

You may find the idea of a tumour affecting your spine extremely frightening. You may experience many emotions, including anxiety, anger and fear. These are all normal reactions and are part of the process many people go through in trying to come to terms with their condition. Many people find it helpful to talk things over with their doctor or nurse, or with one of our cancer support specialists. Family members and close friends can also offer support.

Useful organisations

Brain and Spine Foundation

The Brain and Spine Foundation offers an information service for patients, carers and healthcare professionals, an education programme for GPs and medical undergraduates, and workbooks for schools and colleges. 

Chordoma Support Group

The Chordoma Support Group is an online peer group for patients, family and friends. Offers support, friendship andunderstanding and shared experience of living with chordoma.
Chordoma Foundation
The Chordoma Foundation is a nonprofit organization working to improve the lives of chordoma patients by accelerating research to develop effective treatments for chordoma, and by helping patients to get the best care possible