How is chondrosarcoma diagnosed?



This information has been written for patients, their families and friends, and the general public to help them understand more about chondrosarcoma: what it is and the different types. This information is produced in accordance with BCRT's information policy.

Going to the doctor

People report a variety of experiences when they seek medical advice about their symptoms. Most people with worrying symptoms go to their General Practitioner (GP). Some people are referred quickly for further tests or a second opinion, but often patients have to return to their GP at least three or four times

Primary Bone Cancers are very rare and many GPs will never come across a case in their whole career. The symptoms of chondrosarcoma are common to other disorders and can be initially diagnosed as other less serious conditions at the first visit.

The Bone Cancer Research Trust is trying to find ways to reduce the time between the start of symptoms and getting the correct diagnosis. This is not a simple task and currently there is only a small amount of research on the subject. In order to find ways to improve this, BCRT held a conference in 2011 to identify new approaches and are planning to fund more research into what could be done to improve the time to diagnosis.

Some patients go to their local hospital emergency department (A&E) or other health care centres. There is no scientific evidence available to examine whether patients presenting to their A&E are diagnosed any faster than patients who go to their GP.

For GPs in England and Wales there are NICE (National Institute of Clinical Excellence) guidelines that exist to help doctors in diagnosing primary bone cancers, including chondrosarcoma, see Box 1.

Box 1. National Institute of Clinical Excellence (NICE) Guidelines

According to the National Institute for Clinical Excellence (NICE) guidelines for suspected bone cancer and sarcoma:

  • If a primary healthcare professional has concerns about the interpretation of a patient's symptoms and/or signs, a discussion with the local specialist should be considered.

  • A patient who presents with symptoms suggesting bone cancer or sarcoma should be referred to a team specializing in the management of bone cancer and sarcoma, or to a recognized bone cancer centre, depending on local arrangements.

  • Patients with increasing, unexplained or persistent bone pain or tenderness, particularly pain at rest (and especially if not in the joint), or an unexplained limp should be investigated by the primary healthcare professional urgently.

  • A patient with a suspected spontaneous fracture should be referred for an immediate X-ray.

If a GP suspects a primary bone cancer, they will normally ask for an x-ray of the bone and refer a patient for a specialist opinion, usually at a local hospital. They may also ask for some blood tests to look at the patient's general health.

Again, according to the National Institute for Clinical Excellence (NICE) guidelines for suspected bone cancer and sarcoma:

  • If an X-ray indicates that bone cancer is a possibility, an urgent referral should be made.

  • If the X-ray is normal but symptoms persist, the patient should be followed up and/or a repeat X-ray or bone function tests or a referral requested.

If a GP suspects a primary bone cancer, they will normally ask for an x-ray of the bone or refer the patient for a specialist opinion. This is normally done at a local hospital or clinic. They may also ask for some blood tests to look at the patient’s general health.

If the x-ray shows that that the patient may have a primary bone cancer, then more tests are necessary. Some of these may also be done in a local hospital but at an early stage, patients should be referred to a Bone Cancer Centre for the completion of these tests.

Going to a Bone Cancer Centre for more tests

Bone cancer centres are specialist centres. They have a group of healthcare specialists who are experts in the diagnosis and treatment of bone cancer.

In England, there are currently five Bone Cancer Centres, which specialise in the diagnosis and treatment of primary bone cancers. These centres are at Birmingham, Newcastle, Oswestry, Oxford and Stanmore.

In the Republic of Ireland, there are no specific Bone Cancer Centres. Patients are initially seen in their local hospital and subsequently referred to specialist hospitals in Dublin or Cork for further tests and, if necessary, for treatment.

Welsh patients usually travel to Oswestry or Birmingham for these diagnostic tests.

In Scotland there are five sarcoma centres. These are in Edinburgh, Glasgow, Aberdeen, Dundee and Inverness. Patients with suspected primary bone cancer are seen at Glasgow, Edinburgh or Aberdeen for diagnosis.

In Northern Ireland, patients are usually seen in Belfast.

Multi-Disciplinary Teams

Specialists in many different areas of medicine at hospitals in Ireland and at Bone Cancer Centres and the Regional Cancer Centres in the UK work together as a ‘Multi-Disciplinary Team’ (MDT). The Multidisciplinary Team works together to diagnose chondrosarcoma and then design treatment plans for patients.

The MDT at the investigation (tests) and diagnosis stage will consist of:

  • Specialist bone sarcoma surgeons.

  • Specialist sarcoma oncologists (oncologists are doctors that look after people with cancer).

  • Specialist sarcoma pathologist (pathologist are doctors that use laboratory techniques to diagnose disease).

  • Radiologists (doctors that diagnose disease and conditions from looking at x-rays, or scans).

  • Cytogeneticists (SY-tow-geh-NET-eh-sist), scientists who specialise in detecting damage to genes that help control the cell.

  • Clinical Nurse Specialists (CNS) sarcoma specialists perform an essential role in treating and caring for bone cancer patients. These nurses are specially trained to look after sarcoma patients.

What tests are done?

When a person is referred to a Bone Cancer Centre, further tests will be done to find out more and to confirm whether the patient has bone cancer, and if so what kind of tumour it is. Patients are likely to have several different tests, including:

  • X-rays are taken of the bone, including the joints above and below, and the radiographs (x-ray pictures) are studied. These x-rays may show swelling around the bone or areas of abnormal bone growth.

  • A chest x-ray is sometimes taken to show whether the cancer has spread to the lungs.

There is more UK patient information on x-rays in the Cancer Research UK Information about X-rays.

Republic of Ireland patient information about radiology from the Irish Health Service Executive (X-rays, MRI Scans and CT Scans can be found here: Radiology (X-ray, MRI Scans, CT Scans) and here: HSE (x-rays)

Blood Tests

There is more information about blood tests in the Cancer Research UK information on blood tests .

MRI Scan
  • Scan of entire bone and the surrounding soft tissues to gain more information about the tumour.

  • MRI stands for magnetic resonance imaging. This type of scan is similar to a CT scan but magnetism and radio waves are used instead of x-rays to build up a very detailed 3-dimensional image.

  • An MRI scanner is doughnut shaped; there is a short tunnel, which a motorised bed moves through during the scan.

  • The MRI scanner can be quite noisy, and some machines have a CD player so that patients can listen to their choice of music during the scan.

  • Sometimes an injection of a special dye, known as a contrast agent may be needed. This makes certain tissues show up more clearly and with greater detail on the scan.

  • The results of the scan will be examined by a radiologist and a report will be produced.

There is more information on what to expect when undergoing MRI scans in the Cancer Research UK information on MRI scans

Republic of Ireland patient information about radiology from the Irish Health Service Executive (X-rays, MRI Scans and CT Scans can be found here: Radiology (X-ray, MRI Scans, CT Scans) and here: HSE (x-rays).

  • CT stands for computerised tomography. They may also be called CAT scans, which stands for computerised axial tomography.

  • The scanner takes x-rays from many different angles and a computer builds up a 3-dimensional picture of the body in great detail. The pictures show slices of the inside of the body.

  • CT scanning of the lungs shows up any secondary tumours where the cancer may have spread (metastases).

  • A CT scanner looks like a large 'do-nut' with a bed for the patient to lie on. The bed will move slowly through the hole of the 'do-nut,' while the machine takes the pictures.

  • Before the scan, patients may be given a contrast medium. This contrast medium helps to improve the image of some particular tissues and it can also help the radiologist tell the difference between blood vessels and other structures. The contrast medium is usually injected into a vein.

  • The results of the scan will be examined by a radiologist and a report will be produced.

There is more information on what to expect when undergoing a CT scan in the Cancer Research UK information about CT scans.

Republic of Ireland patient information about radiology from the Irish Health Service Executive (X-rays, MRI Scans and CT Scans can be found here: Radiology (X-ray, MRI Scans, CT Scans) and here: HSE (x-rays).

PET Scan
  • PET stands for ‘Positron Emission Tomography.’ Most hospitals have PET scanning machines and these are sometimes used to help doctors understand more about the tumour

  • PET scans can examine the whole body, rather than a specific area. They can also detect how well treatments are working.

  • Before the scan, a small injection of radioactive glucose (a radiotracer) called fluorodeoxyglucose (FDG) will be given. Glucose is the fuel that cells use for energy. Cells that are very active such as cancer cells will take up more of this radioactive glucose than less active cells.

  • The tracer will take around an hour to spread around the body. During the scan, which can last about an hour, the patient lies on a bed and the scanner passes over them. The scanner detects where the radiation is concentrated and produces images.

  • When the body breaks down the radioactive glucose, particles called 'positrons' are released or emitted, the PET scanner detects the energy from the positrons and shows up as a 3-D image on a computer screen.

  • Areas of high positron concentrations show up as a different colour and brightness on the image compared to areas of low positron concentration.

  • The results of the scan will be examined by a radiologist

There is more Information on what to expect when undergoing a PET scan in Cancer Research UK information about PET scans.

Bone Scan
  • Bone scans are used to look for abnormalities in bones. Some patients may have bone scans if chondrosarcoma is suspected, but newer technologies such as PET scans are taking over.

  • A tiny amount of radioactive substance (radionuclide) is injected into the patient's blood, which is then taken up by the bones fairly quickly (~2-4 hours).

  • During the scan the radioactivity is detected by a specialised camera called a gamma camera. The radioactivity will collect more at areas of high activity (breakdown and repair) in the bone. These areas can be caused by a tumour.

  • The areas of high activity picked up by the gamma camera are known as 'hot spots.'

  • The scans are usually carried out in hospital nuclear medicine departments.

  • Patients will need to drink lots of fluids before the scan to help the radioactive substance travel to the bones quickly. The scanner looks a bit like a CT scanner (doughnut shape). Patients lie on the bed, which travels through the doughnut.

  • The results of the scan will be examined by a radiologist who will write the results in a report, which may take a few days to produce. Following the scan, the radionuclide will be passed completely from the body in the urine within 24 hours.

There is more information about bone scans in the Cancer Research UK information about bone scans.

Biopsy performed by a specialist oncological orthopaedic surgeon
  • A bone biopsy is a very specialised procedure that should only be performed by a specialist in orthopaedic surgery or sarcoma radiology. These biopsies should only be performed at a Bone Cancer Centre (see map).

  • A biopsy involves taking a small sample of a lump or tumour. A pathologist (a doctor who uses laboratory techniques to diagnose disease) looks at this sample under a microscope. This enables them to work out what type of cells the tumour is made up of and whether or not it is cancerous. This is known as the “histology”.

  • The biopsy sample can be taken using a specialised syringe-type needle, which is called “needle biopsy”, or during surgery, which is called “surgical biopsy”. In both cases, a small amount of the lump is taken. Sometimes a scan (ultrasound or CT) is performed at the same time to make sure that the biopsy is taken from the right place.

  • The biopsy is studied by pathologists. This takes time and so the results of a biopsy can take a week or more.

There is more Information on what to expect when undergoing a biopsy in the Cancer Research UK information on bone biopsies

Republic of Ireland patient information about biopsies from the Irish Health Service Executive can be found here: HSE Patient Information about Biopsies

The biopsy enables doctors to diagnose chondrosarcoma. This is important because other conditions (including non-cancerous conditions) can look like chondrosarcoma on x-rays and scans. This is known as a differential diagnosis.

What other diagnoses might be made if it isn’t chondrosarcoma?

After doing some or all of these tests the medical team will be able to make a diagnosis.

If the tests show that the patient does not have chondrosarcoma then there are a number of other conditions that it might be:

  • Enchondroma (En-Kind-dro-mah); a benign cartilage tumour.

  • Fibrous dysplasia (FY-bros dis-PLAY-zhuh); a bone disease, in which normal bone is replaced by weak bone-like tissue.

  • Osteomyelitis (OS-tee-oh-MY-uh-LY-tis); infection of the bone.
What if the tests confirm that it is chondrosarcoma?

At this point, most patients will be referred to their Regional Cancer Centre where the medical team will design the best treatment plan for the patient and treatment will start.

The hospital should be a specialist Bone Cancer Centre or a Children’s and Young People’s Cancer Centre if the patient is a young adult or a child.


The authors and reviewers of this information are committed to producing reliable, accurate and up to date content reflecting the best available research evidence, and best clinical practice. We aim to provide unbiased information free from any commercial conflicts of interest. This article is for information only and should not be used for the diagnosis or treatment of medical conditions. BCRT can answer questions about primary bone cancers, including treatments and research but we are unable to offer specific advice about individual patients. If you are worried about any symptoms please consult your doctor.

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BCRT shall hold responsibility for the accuracy of the information they publish and neither the Scheme Operator nor the Scheme Owner shall have any responsibility whatsoever for costs, losses or direct or indirect damages or costs arising from inaccuracy of information or omissions in information published on the website on behalf of BCRT.

Version 2 produced January 2013
Information will be reviewed in January 2015

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