Chondrosarcoma Grade III; Dedifferentiated Chondrosarcoma; Mesenchymal Chondrosarcoma
Chondrosarcoma is the second most common form of bone cancer that primarily affects people over 40 years old, although it sometimes affects younger adults, adolescents, and children. It usually originates in the legs, arms, shoulder blades, ribs, pelvis, or pelvic bones, but may be found in any bone and sometimes outside of the bones (e.g., adjacent muscles). Chondorsarcoma with multimodal therapy indicates that the response to treatment has been poor and requires a combination of chemotherapy, surgery, and radiation therapy before or after surgery.
DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM CODING
Diagnostic testing: Diagnostic testing for chondrosarcoma includes x-rays, CT or MRI imaging to identify the tumor. A biopsy confirms the diagnosis.
Physical findings: Physical findings of chondrosarcoma vary, depending on the location and size of the tumor. Individuals may experience pain, swelling or a lump at the tumor site, unexplained weight loss, fatigue, difficulties breathing, fatigue, and fever or night sweats.
ONSET AND PROGRESSION
Chondrosarcoma usually begins as a single tumor. Spread (metastases) to other parts of the body is common if the disease progresses to grade III, dedifferentiated, or mesenchymal chondrosarcoma. Inoperable, unresectable, and metastatic chondrosarcomas have poor prognoses, with less than a third of patients surviving five years.
Surgery is the main treatment. Doctors may also use adjuvant chemotherapy if the cancer has spread. Recurrent chondrosarcoma may require surgery and radiation, and perhaps ablation treatments (e.g., liquid nitrogen or heating probes) to remove residual tumor.
SUGGESTED PROGRAMMATIC ASSESSMENT*
Suggested MER for evaluation: The adjudicator needs medical evidence that specifies the type, extent, and site of the primary, recurrent, or metastatic lesion. Biopsy or needle aspiration information found in operative notes, pathology reports, summaries of hospitalization or other medical reports that include details of the surgical and pathological findings.
Suggested Listings for Evaluation:
Chondrosarcoma in adults treated with multimodal therapy meets 13.11D without regard to effectiveness of treatment. Pediatric chondrosarcoma meets listing 113.03.
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