Treatment of Sacral Chordoma

About the disease

Chordoma of the skull base is a subtype of sarcoma and develops in the bones at the back of the head. In some cases, chordoma can develop in the top of the spine as well. Chordoma of the skull base develops in the embryonic notochord, which is a rod-shaped, cartilage-like structure responsible for the formation and support of the spinal column. These cells remain inside the spine and the skull after the baby is born. Later in life, these cells can become malignant, but this is very rare.

Chordoma of the skull base develops gradually and there is a high probability that it will reoccur after treatment, which is why a timely diagnosis is essential. It is difficult to treat because it develops next to vitally important organs such as the spinal cord and brainstem. In its advanced stages, it can be very difficult to access it during surgery. According to The Chordoma Foundation, 32% of all chordomas develop in the skull, namely in the middle bone of the skull. A further 29% develop at the bottom of the spine. In 20% of all cases of chordoma, the cancer spreads to other organs. Nonetheless, chordoma of the skull base is very rare, with just 300 cases recorded annually in the USA.

Chordomas constitute only 3% of all bone cancers. On average, people diagnosed with chordoma of the skull base are over 50. The disease is slightly more common in males than females and a genetic predisposition is believed to play a vital role.

Symptoms

• Pain in the skull
• Headaches
• Neck pain
• Blurred vision
• Facial sensation may be affected in progressed stages
• Speech may be changed
• Tingling
• Numbness in the extremities

Diagnosis

• During a general examination, the doctor will inquire about the patient’s medical history and will palpate the skull for any signs of unusual and abnormal masses.
• MRI and CT scans produce images that can be used to examine the chordoma of the skull base without having to perform surgery. The images can help doctors to determine what stage the chordoma is at and whether or not it has spread to other organs.

Treatment

• Surgical resection of the chordoma of the skull base is the most effective way to prevent cancer from spreading further. Surgeons resect the tumor, trying hard to avoid damaging the nerves and arteries in the vicinity of the skull base.
• Radiation therapy is sometimes required after surgery, if some of the tumour was inaccessible. This can also reduce the possibility of it coming back.

Authors: Dr. Vadim Zhiliuk, Dr. Sergey Pashchenko