Synonyms of Chordoma
- Clival Chordoma
- Familial Chordoma
- Intracranial Chordoma
- Sacrococcygeal Chordoma
- Skull Base Chordoma
- Spinal Chordoma
- No subdivisions found.
Chordomas are very rare primary bone tumors that can arise at almost any point along the axis of the spine from the base of the skull to the sacrum and coccyx (tailbone). The incidence of chordoma in the general U.S. population is about 8 per 10,000,000 people. They occur somewhat more often in males than females and, for unknown reasons, are rare in African Americans. Under the microscope, chordoma cells appear to be benign, but because of their location, invasive nature, and recurrence rate, the tumors are considered to be malignant. They arise from cellular remnants of the primitive notochord, which is present in the early embryo. In normal mammalian development, the notochord and substances produced by it are involved in forming the tissues that give rise to vertebrae. Normally, the tissues derived from the notochord disappear after the vertebral bodies have begun forming. However, in a small percentage of people, some tissues from the notochord do not disappear. Rarely, these leftover tissues give rise to chordomas.
About one-third of chordomas are found in the region around the clivus. The clivus is a bone in the base of the skull. It is located in front of the brainstem and behind the back of the throat (nasopharynx). Chordomas occur with equal frequency in the skull base, the vertebrae and the sacrococcygeal area towards the bottom of the spine.
Symptoms of the presence of chordomas vary with their location and size. Most chordomas occur randomly among the population (sporadic). However, some people develop this tumor as a result of a mutation inherited as an autosomal dominant trait.
Symptoms vary with the location of the tumor and from person to person. If the chordoma is located near the top of the spine or the base of the brain, headaches and changes caused by compression of cranial nerves may occur. The symptoms that result from compression of the cranial nerves are called "palsies". Other signs, less frequently encountered, are difficulty in swallowing, facial pain, partial facial paralysis, double vision, loss of hearing and problems with balance (ataxia).
If the chordoma is located at a vertebra of the spine, the symptoms will vary according to the location of the involved vertebra. As more bone becomes involved and degenerates, the symptoms will increase in intensity. Symptoms from spinal chordomas can be subtle and the tumor may take considerable time to be diagnosed. The more frequent signs are lower back pain without distinguishing characteristics and constipation. Other symptoms may include radiating pains in the leg and urinary complaints, such as not being able to control the flow of urine.
Most chordomas arise from remnant cells of the embryonic notochord, the precursor of the vertebrae and discs between the vertebrae. How and why these cells become malignant is not clear. However, there is a rare familial form of the disorder that is genetically transmitted as an autosomal dominant trait. Studies have pinpointed the mutated gene to the long arm of chromosome 7 at Gene Map Locus 7q33.
Chromosomes, which are present in the nucleus of every human cell, carry the genetic information for each individual. Human body cells normally have 46 chromosomes. These consist of 22 pairs of human chromosomes of which each member of a pair looks the same under a microscope and carries the same genes. The pairs are numbered from 1 through 22. The 23rd pair consists of two sex chromosomes. The sex chromosomes are designated X and Y. Males have one X and one Y chromosome and females have two X chromosomes. Each chromosome has a short arm designated "p" and a long arm designated "q". Chromosomes are further sub-divided into many bands that are numbered. For example, "chromosome 7q33" refers to band 33 on the long arm of chromosome 7. The numbered bands specify the location of the thousands of genes that are present on each chromosome.
Genetic diseases are determined by the combination of genes for a particular trait that are on the chromosomes received from the father and the mother.
Dominant genetic disorders are generally quite rare, because the gene changes that cause them are rare in the population. If a disorder is caused by a dominantly inherited gene change or mutation, this means that only a single copy of an abnormal gene is necessary for the appearance of the disease. The abnormal gene can be inherited from either parent, or can be the result of a new gene change (mutation) in the affected individual. This change usually occurs during embryonic development. The risk of passing the abnormal gene from affected parent to offspring is 50% for each pregnancy regardless of the sex of the resulting child.
Chordomas are more frequently found in males than in females by a factor of about 2:1. Most chordomas are diagnosed in people who are between 50 and 60 years of age but the tumors can occur much earlier and much later. In general, children and females are more likely to have skull base tumors and males are more likely to have sacral tumors.
Chondrosarcomas are the second most frequent primary malignant tumor of bone, representing approximately one-quarter (25%) of all primary bone neoplasms. Chondrosarcomas present with widely varying features and behavior patterns, ranging from slow-growing non-metastasizing lesions to highly aggressive metastasizing cancers. They are classified as central (originating within the marrow hollow of bone) or peripheral. Even more rarely, they may arise as lesions adjacent to the cortex.
For chordomas located in or near the skull base, imaging techniques such as magnetic resonance imaging (MRI) studies or CT scans are useful to make a tentative diagnosis but microscopic examination of tumor tissue obtained through a biopsy (surgery to obtain a small piece of tumor) or surgery to remove the tumor is essential to make a definitive diagnosis. Chordomas located within or near vertebrae, or the sacrum or coccyx, will usually be seen best using either MRI or CT scans, but diagnosis must be based on examining a piece of tumor tissue removed during surgery under the microscope.
Surgery is the primary form of treatment for chordoma with the goal being to remove all visible tumor. This is very difficult to do because of the location of most chordomas. Local recurrence (regrowth of tumor at the site of surgery) after surgical treatment is not uncommon; to prevent this from happening, radiation therapy is often given. The spread of tumor beyond its first location is uncommon, occurring in only about 10% of cases.
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Organizations related to Chordoma
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FROM THE INTERNET
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