Surgery for chordoma
No matter what stage of the disease you are facing or where your tumor is located, the way surgery is performed is very important.1 2 Here are three things to know before having surgery:
- Any tumor cells left behind after surgery can re-grow. Because of this, the entire tumor should be removed whenever possible, ideally with wide margins of healthy tissue surrounding the tumor. Completely removing the tumor lowers the risk of the tumor coming back after treatment.
- For most patients, radiation therapy is recommended after surgery and can sometimes be recommended both before and after surgery. The The health condition of a person after being diagnosed and treated for a particular disease. Outcome is usually measured at different time points. For example: one-, five-, or ten-year outcome. of your surgery can affect how well the radiation can be delivered, so plans for surgery should be made with the input of a radiation oncologist.
- Because chordomas tend to be located near important structures, surgery can cause serious side effects. Additionally, multiple surgeries over time increases the risk of serious side effects. Before surgery, you should ask your surgeon about the risks of surgery and what to expect afterwards. If you are not comfortable with the likely side effects of surgery, ask your doctors what other options you have. You should be comfortable with the treatment plan agreed on by you and your medical team.
You will probably hear the term margins or The healthy tissue surrounding the tumor that is taken out along with the tumor to make sure that no cancer cells are left behind. Negative or wide margins mean no tumor cells can be detected in the healthy tissue, which lowers the chance of recurrence. when your surgeon plans your treatment. Margins refer to the healthy tissue surrounding the tumor that is removed along with the tumor. Surgeons take out this healthy tissue to help make sure microscopic cancer cells are not left behind.
The size of the margin can determine how likely the tumor is to come back after surgery. Levels of surgical margins described by the A multidisciplinary, international group of over 60 doctors who have extensive experience caring for chordoma patients. The group is responsible for developing and publishing consensus guidelines, based on all available medical and scientific evidence, for the treatment of primary and recurrent chordoma.1 2 are:
- Removal of the entire tumor with at least 1 millimeter of healthy tissue surrounding the tumor. – The entire tumor is removed along with at least 1 millimeter of healthy tissue around the tumor.
- Less than 1 millimeter of healthy tissue removed along with the tumor but no visible tumor tissue left behind. – Less than 1 millimeter of healthy tissue around the tumor is removed, but no visible tumor tissue left behind.
- Visible tumor tissue has been left behind or tumor cells have spilled into the surrounding area because the tumor was cut during surgery. – Visible tumor tissue is left behind, or tumor cells have spilled into the surrounding area because the tumor was cut during surgery.
A wide resection is the best outcome, whenever possible. However, the location of chordomas near important structures sometimes makes wide resection difficult or impossible.1 2
To help you get the best care possible, we developed lists of questions with the input of chordoma patients and caregivers that can help you think about what you want to ask your doctors.
Skull base tumors
Surgery should be performed in a medical center with substantial experience in The bones at the bottom part of the skull that separate the brain from other structures. The clivus is one of the bones of the skull base. surgery. Skull base operations are usually done by a team that includes a neurosurgeon and an ear, nose, and throat (ENT) surgeon. ENT surgeons are also called otolaryngologists.1 2
Surgery to remove skull base chordomas can either be done Use of an instrument to look inside the body. Most skull base chordoma surgeries are done endoscopically through the nose., using a small scope through the nose or mouth, or through the side of the head. Depending on the size and location of your tumor, it may be necessary to do surgery from multiple directions to safely remove different parts of the tumor. Ask your surgeon about different surgical approaches that are available to you, and discuss the risks and benefits of each.
For suspected cases of skull base chordoma, biopsies are often performed at the time of surgery to help reduce the risks involved. In some cases, a pathologist will examine a sample of tumor tissue at the beginning of surgery so that the surgeons can proceed with surgery knowing what type of tumor they are removing.
The goal of surgery for skull base tumors is All visible tumor has been removed, but not necessarily in one piece., or complete removal of all visible tumor tissue, whenever possible. Published medical studies have shown that complete resection of skull base chordomas is associated with lower rates of Tumor that has grown back after initial treatment. Recurrences can be isolated or multifocal, local or regional. and higher rates of survival.3 4 5
Skull base chordomas often touch important nerves and blood vessels, so it is not always possible to remove the entire tumor. Even in cases where all visible tumor can be removed, it is still likely that microscopic chordoma cells will be left behind after surgery. Therefore, radiation therapy is generally recommended after surgery to prevent any remaining cells from re-growing or spreading to other parts of the body.1 2 If the entire tumor cannot be removed, your surgeon should remove as much of the tumor as possible, especially around the brainstem and optic nerve, so that radiation therapy can be most effective. Read more on the Radiation for Chordoma page of our website.
Mobile spine and sacral tumors
Surgery should be performed in a medical center with substantial experience removing tumors of the spine and The five vertebrae at the base of the spine near the pelvis, and between the two hip bones. These bones are commonly referred to as S1-S5.. These centers have teams of surgeons that can include specialties such as neurosurgery, orthopedic surgery, plastic and reconstructive surgery, and colorectal surgery.1 2
The goal of surgery for The parts of the spine not including the sacrum. The cervical spine (neck), thoracic spine (upper back), and lumbar spine (lower back) are the parts of the mobile spine. and sacral chordomas is to completely remove the tumor in one piece with wide margins of normal tissue surrounding it.1 2 This is called During surgery, removal of the entire tumor in one piece without cutting it into smaller pieces.. Removing the tumor in more than one piece or rupturing the tumor during surgery can spill tumor cells into the area which can cause the tumor to re-grow or spread.6 7 8 Medical studies of patients who had surgery for a primary (newly diagnosed) chordoma have shown that complete resection with wide, tumor-free margins is associated with lower rates of recurrence and higher rates of survival.6 7 8 If you had a A procedure that uses a needle to remove a small tissue sample from the tumor to be tested in order to make a diagnosis., tissue that was touched by the biopsy needle should be removed so that any tumor cells that may have been left behind do not grow.
Once the tumor is removed, reconstructive surgery may be needed to repair or replace tissue lost during surgery. Metal hardware or bone grafts are often used to replace bones that were destroyed by or had to be removed with the tumor.
In some cases, surgery can cause serious side effects. Sacral patients can experience loss of bowel and bladder control, sexual function impairment, Chronic pain caused by nerve damage., and movement problems. Mobile spine patients can experience swallowing issues (The seven vertebrae that make up the neck. These vertebrae are commonly referred to as C1-C7.), mobility issues, and neuropathy. Surgeons can usually predict how severe these side effects will be depending on the location of the tumor and which nerves are involved.
Radiation is generally recommended along with surgery for mobile spine and sacral tumors, either after surgery or both before and after surgery.1 2 Read more on the Radiation for Chordoma page of our website.
Talk with your doctors about your options to decide what treatment plan is best for you.
Each patient’s recovery will differ depending on the size and location of the tumor, extent and difficulty of the surgery, and what nerves have been affected. Skull base patients may need rehabilitation services such as physical therapy for speech, vision, or swallowing issues. Patients with mobile spine or sacral tumors will very likely need rehabilitation therapy following surgery to help with any functional loss or mobility issues caused by the tumor or the surgery. Pain is common for most patients and can be quite severe.
- Physical therapy
- Occupational therapy
- Pelvic floor therapy
- Ostomy management
- Pain management
If radiation treatments are planned after surgery, these will begin once you have recovered from surgery. This could be anywhere from a few weeks to a few months, but unless there are unusual complications radiation treatments will typically begin within six months.
Follow-up after treatment
Following any treatment for chordoma, it is very important to maintain a regular schedule of MRIs and checkups with your doctor. These follow-ups will monitor your recovery, assess ongoing quality of life needs, as well as check for new tumor growth.
References and further information
The information provided herein is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your or your loved one’s physician about any questions you have regarding your or your loved one’s medical care. Never disregard professional medical advice or delay in seeking it because of something you have read on this Website.