How Is Chordoma Diagnosed?

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To diagnose chordoma, your healthcare provider will review your symptoms and conduct several exams. These may include physical and neurological exams, diagnostic imaging, and a biopsy. Chordomas are rare tumors that grow slowly, so noticeable symptoms may take months or years to appear. As the tumor grows, some people may feel a lump under the skin, while others may feel symptoms like pain, pressure, or weakness in the surrounding areas.

This article takes a closer look at how chordoma is diagnosed, including the types of tests and imaging involved.

Caucasian nurse holding spine model against the patients backs. Clinic interior. - stock photo

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Chordoma cannot be accurately diagnosed at home without a physician. But it is possible to check for some of the signs that could potentially indicate a chordoma is growing.

The exact symptoms of chordoma will be different for everyone, depending on the size and location of the tumor.

Some of the tell-tale signs of chordoma include:

  • A lump under the skin, located along the spine or back of the skull
  • Any new or unusual pain in the face and neck or lower part of the body
  • Neurological symptoms such as headache, double vision, numbness, tingling, weakness
  • Trouble controlling the bladder or bowels
  • Voice, speech, or swallowing difficulties

Take note of your symptoms during your self-check at home. You will want to raise these concerns with your physician or other healthcare provider as soon as possible. This will help increase your chances of an accurate diagnosis, whether it's chordoma or another condition.

Physical Examination

Your visit to your physician to check for chordoma will start with a review of your recent symptoms, details about your medical history, and measuring your vital signs.

Then, your physician will complete:

  • A general physical examination: While checking your overall health and examining your body, your physician will closely examine the area where the chordoma is suspected (either the spine or base of the skull). If the tumor has grown large enough, it may be seen and felt as a soft lump of tissue.
  • A neurological examination: During this part of the exam, your physician, who may be a neurologist (a specialist in conditions of the nervous system), will check your coordination, movement, and strength. They will look for any issues that could signal a neurological issue, such as nerve sensation changes, weakness in the arms or legs, and elevated pain levels.


Chordomas are often detected and diagnosed through imaging tests. These tests give physicians a better view of organs inside the body, including any tumors like chordomas.

When a chordoma is suspected, your physician may order one or more of the following tests to help confirm the diagnosis:

  • MRI (magnetic resonance imaging) uses radio waves to give a detailed view of your organs, tissues, and bones. It allows physicians to see the location of a potential chordoma, and how it could be impacting the surrounding muscles, nerves, and blood vessels.
  • CT (computed tomography) scans provide three-dimensional images of internal organs. A CT scan may be recommended if the results of an MRI aren't fully clear.
  • PET (positron emission tomography) scans use a special radioactive dye to detect where cancer cells are located in the body. PET scans are not always used for diagnosing chordomas, because they're usually more helpful in picking up tumors that spread rapidly.

Imaging Results

Completed imaging scans will be looked at by a radiologist, a physician who specializes in viewing and interpreting imaging test results.

Labs and Tests

While imaging scans can show the likelihood of a chordoma being present, a test known as a biopsy is often needed to make an accurate diagnosis.

A biopsy involves removing a sample of tissues or cells from the suspected area and sending them to a lab for analysis and detection of cancer cells.

During a biopsy for a suspected chordoma, a hollow needle will be inserted into the skin to remove a tiny piece of the tumor from inside the body. Sometimes, the biopsy needle will be visually guided by a CT scan to help accurately locate the tumor that needs to be sampled. Needing this will depend on where the tumor is located.

Differential Diagnosis

Chordoma symptoms can be similar to several other bone tumor-related conditions. Physicians will use a process of elimination referred to as differential diagnosis to find the true cause of your symptoms.

In the case of a suspected chordoma, they may also investigate the following conditions:

  • Chondrosarcoma is a common type of bone cancer that can show up on the base of the skull. It looks similar to chordoma on imaging scans. Physicians typically use an MRI and a biopsy to tell the difference.
  • Benign notochord cell tumors (BNCT) are noncancerous tumors that are located on the spine. They look like chordomas but don't spread the way chordomas do. Imaging scans may be used periodically to check for spreading.
  • Giant cell tumors of the bone are tumors that are usually found around the sacrum area (near the tailbone). They are not cancerous, though, and can appear a bit differently than chordomas on imaging scans.
  • Other rare bone tumors like Ewing's sarcoma and osteosarcoma may form on the spine and skull base. They can look very similar to chordomas at first glance, but they tend not to spread into other tissues the way chordomas can.
  • The spread (metastasis) of another cancer can sometimes be confused with chordomas when tumors are found on the spine or skull base. This commonly includes lymphoma (an immune system cancer) and multiple myeloma (a blood cancer).


Chordomas are rare, cancerous bone tumors that grow on the spine or at the base of the skull. They can be difficult to recognize at first because noticeable symptoms may not appear until many months or years later, and these symptoms are similar to those of other bone tumors. Physicians rely on a physical exam, imaging scans, and a biopsy to confirm a chordoma diagnosis.

A Word From Verywell

Diagnosing a chordoma can be a long, challenging, and sometimes frustrating journey. But know that chordomas are manageable and treatable. Having access to a team of physicians and other healthcare professionals who specialize in this type of tumor can help ensure a timely and accurate diagnosis, as well as get you on the road to treatment and recovery. Organizations that help provide support and resources for chordoma patients include the National Cancer Institute, the Chordoma Foundation, and the American Cancer Society.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. National Organization for Rare Disorders. Chordoma.

  2. MedlinePlus. Chordoma.

  3. Cedars Sinai Hospital. Skull base chordoma.

  4. Duke Health. Chordomas.

  5. Chordoma Foundation. Treatment guidelines for newly diagnosed chordoma.

  6. Chordoma Foundation. Diagnosing chordoma.

  7. National Institutes of Health: National Cancer Institute Center for Cancer Research. Chordoma.

By Cristina Mutchler
Cristina Mutchler is an award-winning journalist with more than a decade of experience in national media, specializing in health and wellness content.