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Chordoma Treatment

The Brain & Spinal Tumors Treatment Center at The Department of Neurosurgery at Rutgers Health and RWJBarnabas Health provides high-quality care for patients for chordoma patients using an interdisciplinary approach. We have a board-certified team of physicians in fields such as neurology, neurosurgery, neuro-oncology, neuropathology, radiation oncologist, and medical oncologists, as well as support staff, who have treated even the most challenging cases of brain and spinal tumors. We utilize state-of-the-art diagnostic tools, technology, and treatment methods to strive for the best possible treatment outcome of brain and spinal tumors, including chordomas.

Many of our patients are referred to us by other physicians, because of our reputation for providing top-quality treatment and care to our patients. We offer advanced surgical treatment with the intent of eradicating the chordoma. By using the latest surgical therapies, including radiosurgery, we can treat even those tumors that have been deemed inoperable.

Because chordomas are exceedingly rare, very few physicians ever see these cases in their entire careers. Our brain and spinal tumor treatment center is among one of the few institutions in the country offering chordoma treatment.

What Is Chordoma?

Chordoma is an extremely rare, malignant (cancerous) bone tumor found in any part of the bones of the spine or skull. They are slow-growing, yet aggressive and life-threatening tumors, with wildly different outcomes. These tumors are uncommon, affecting about 1 person in 1 million every year; only 1-4% of all primary bone tumors are chordomas. There are about 300 new diagnoses every year in the United States, according to the Chordoma Foundation, and about 100,000 people living with chordoma at any given time, worldwide.

Most patients diagnosed with chordoma are between 40-70 years of age, and the condition is slightly more frequent in males.

Chordoma Subtypes

In about 30% to 40% of patients, the tumor metastasizes (spreads) to other areas of the body.

  • Conventional chordomas: These are the most common types of chordoma. They are slow-growing, but cancerous.

  • Dedifferentiated chordomas: These tumors, also called sarcomatous tumors, grow more quickly. They often grow elsewhere in the body (metastasize) after being removed.

  • Chondroid chordomas: These grow even more slowly than conventional chordomas and are usually found at the base of the skull.

Chordoma Risk Factors

According to the Chordoma Foundation, the cause of chordomas is unknown, and no identifiable environmental, dietary, or lifestyle risk factors have been proven to cause the disease.

Chordoma Symptoms

The symptoms of a chordoma depend on the location of the tumor, but may involve headaches, visual problems, pain, nosebleeds, or a runny nose. Other symptoms of chordoma include:

  • Pain, weakness, or numbness in the back, growing worse over time

  • Long history of mild discomfort in the lower spine

  • Tenderness in the lower back from prolonged sitting

  • Constipation (caused by the tumor growing and pushing forward on the rectum)

  • Lower back pain that radiates down the legs

How Is Chordoma Diagnosed?

After discussing a patient’s medical history, performing a general physical, and conducting a neurological exam, your physician may suspect a spinal tumor and refer you to a neurologist, who is an expert in the ield of brain and spinal tumors.

A chordoma cannot be diagnosed until a biopsy has been performed by a neuropathologist. Before this can happen, your doctor must first detect and locate a spinal tumor. During an exam, sometimes, a lump can be found at the base of the spine. In other cases, imaging tests need to be performed to locate a tumor; these include computed tomography (CT) scans and magnetic resonance imaging (MRI) scans. These scans can also help a neurologist or neurosurgeon develop treatment strategies.

The following tests can confirm diagnosis of a chordoma and pinpoint the location of the tumor:

  • Physical exam: A physician may be able to feel a large soft tissue mass in the middle of the sacral area of the spine, or during a rectal examination.

  • Neurological exam: Patients will be examined for loss of sacral nerve sensation, such as lower leg weakness. Your doctor will ask if you have back pain, loss of bowel and/or bladder control, loss of sexual function (from the tumor’s involvement with the nerves of the sacral area of the spine), and more.

  • Spinal magnetic imaging scan (MRI): These tests are the preferred method for diagnosing tumors of the spinal cord. MRI technology works by using radio waves to produce images of the spinal column, spinal cord, and nerves.

  • Computerized tomography scan (CT): By using a narrow beam of radiation to produce detailed images of the spine, your neurologist can spot any abnormal change in the spinal canal. However, this test is rarely used to diagnose chordomas or other spinal tumors.

  • Biopsy: Once a tumor has been located, the only way to determine its exact type is by taking a small tissue sample and examining it under a microscope. By identifying the tumor’s type and histologic grade, a treatment plan can be developed.

Chordoma Treatment

Chordomas are complicated to treat because they involve critical structures of the body, including the spinal cord, brainstem, as well as important nerves and blood vessels. Ideally, a chordoma can be treated with surgery to completely eliminate the tumor. However, because the spinal cord is delicate, it can be permanently damaged if the nerves are mishandled. To determine whether surgery is the right treatment course for you, your neurologist will take your age and overall health into account.

Treatment options for a chordoma and most other spinal tumors include:

  • Surgery: Most chordomas require surgical treatment, regardless of the location of the patient’s tumor. If a patient is a good candidate and otherwise in good health, surgery is the first-line treatment. A neurosurgeon can access spinal tumors using state-of-the-art techniques and instruments to access tumors that were previously thought inaccessible. The neurosurgeon can successfully distinguish the tumor from surrounding healthy tissues by using a high-powered microscope used in microsurgery. Also, the neurosurgeon can monitor the function of the spinal cord during surgery, which minimizes the risk of injury.

  • Radiation therapy: Not all tumors can be completely removed. When this is the case, surgery may be followed with radiosurgery such as Gamma Knife. as it uses radiation therapy to eliminate tumor remnants which remain after surgery.

  • Chemotherapy: This treatment is a standard cancer therapy, which uses medications to destroy cancer cells and stop growth. It may be used either as a standalone therapy or in combination with radiation.

  • Drugs: While there are no FDA-approved drug treatments specifically for chordoma, doctors sometimes prescribe corticosteroids to reduce inflammation. These drugs are usually only used for short periods to avoid serious side effects.

  • Clinical trials: These are experimental treatments being tested as a means to prevent, detect, treat or manage chordomas.

  • Alternative medicine: While these therapies don’t cure cancer, they are complementary and can be effective in relieving symptoms. Acupuncture treatment may be useful to help relieve nausea and pain, for example. Before you decide to proceed with any alternative treatments, make sure to consult with your treatment team, as some herbal remedies can interfere with medicines you may be taking.

Chordoma Prognosis

Even with successful surgical removal of a chordoma, these spinal tumors tend to recur in the same location as the original tumor. Often, patients undergo multiple surgeries over the years to treat local recurrences. However, even though the location of the tumor makes it difficult to completely eradicate, most chordoma patients have good long-term survival rates, especially by making lifestyle alterations.

Request an appointment online now or call 833-656-3876.