What is chordoma?
Chordomas are tumors that can occur anywhere within the spine or the base of the skull, but almost a third of them show up in the lower back—the sacral area. Chordomas form from remnants of the notochord, embryonic tissue that eventually forms the center of spinal disks.
The tumors can appear relatively harmless in pathology reports. But although chordomas often stay inactive for a time, they can become aggressive and grow quite large locally, causing pain and nerve problems.
What are the symptoms of chordoma?
Chordomas can press on the spine and nerves as they grow, causing pain and nerve problems, such as tingling, numbness, or weakness. You may experience lack of bladder or bowel control. If the chordoma has grown very large, you may be able to feel a lump.
Treating chordomas can involve extensive surgery, so your doctor will be sure to get a definite diagnosis before planning your individualized treatment.
You will get magnetic resonance imaging (MRI) and computed tomography (CT) scans which will help your doctor determine if any cancer has spread to other parts of the body. If the tumor hasn’t spread, you will get a needle biopsy: Your doctor will use a needle gather a small sample of the tumor for biopsy in order to confirm the diagnosis.
Because this procedure can cause cells of the tumor to spread along the path of the biopsy needle and lead to the cancer spreading, your surgery team will be prepared to remove the tumor promptly if the pathologist confirms the diagnosis of chordoma.
When chordomas metastasize (spread) to other parts of the body, they can become life threatening, which is why it’s essential to have them treated promptly while they are still manageable.
Treatment involves preoperative planning, surgical en bloc resection (removal of the tumor and surrounding tissue where cancerous cells may have invaded), and postoperative therapy.
Because of the risk of chordomas spreading, a successful first surgery is very important. Operative intervention provides the best chance for cure and control of the tumor.
Depending on your situation, your surgery team might involve collaborative specialists in neurosurgery, surgical oncology, orthopedic oncology, urology, vascular surgery, plastic surgery or anesthesiology.
Intensive post-operative care is imperative for the success of your surgery, so after your procedure you will be moved to the neurosurgical intensive care unit (NCCU). As soon as you are ready, your team will create a plan for physical therapy, occupational therapy, and physical medicine and rehabilitation.
Your doctor may decide that radiation therapy is necessary to further reduce the size of the tumor or limit its chance of spreading. Proton beam irradiation is a kind of radiation therapy that works with the unique biology of chordomas and yields the best results.
Chordoma Ongoing Management
Because of the likelihood of chordoma regrowth, you will need to take charge of your continuing recovery with consistent follow-up.
During the first year after surgery, you will need an MRI every three months to ensure the chordoma isn’t returning. In the years that follow, your doctor may be able to gradually increase the time period between follow-up MRIs.