How bone cancer is diagnosed
Usually you begin by seeing your family doctor (GP). They will examine you and arrange any tests or x-rays that may be necessary.
Your GP may refer you to a local surgeon who specialises in bone diseases (an orthopaedic surgeon), or to a bone cancer specialist or bone tumour treatment centre (sarcoma unit).
If tests show that you may have primary bone cancer, you should be referred to a specialist hospital or bone tumour treatment centre (sarcoma unit). Children are referred to a children’s (paediatric) hospital for some of their care. Teenagers may be referred to a teenage cancer unit. These units have specialist doctors with experience in diagnosing and treating young people with cancer. They also have a team of people to support teenagers.
The specialist at the hospital or bone treatment centre will ask you about your symptoms. They will want to know about your general health and any previous medical problems. They will examine the affected area to check for any swelling or tenderness. You’ll usually have a blood sample taken to check your general health and you will have some of the following tests:
Bone x-rays may help to show whether the cancer has started in the bone (primary bone cancer), or has spread into the bone from a cancer elsewhere in the body (secondary bone cancer).
Sometimes the way the bone looks on an x-ray can help the doctor tell which type of bone cancer it is. This is often true for osteosarcoma.
However, you will need other tests before the doctor can definitely say whether it’s a primary or secondary bone cancer and which type of cancer it is.
MRI (magnetic resonance imaging) scan
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An MRI scan is used to assess the extent of the primary tumour so that the doctors can plan the best treatment.
This test uses magnetism to build up a detailed picture of areas of your body. The scanner is a powerful magnet, so you may be asked to complete and sign a checklist to make sure it’s safe for you. The checklist asks about any metal implants you may have, for example a pacemaker, surgical clips or bone pins. You should also tell the doctor if you’ve ever worked with metal or in the metal industry, as very tiny fragments of metal can sometimes lodge in the body. If you do have any metal in your body, you probably won’t be able to have an MRI scan. In this situation, another type of scan can be used.
Before the scan you’ll be asked to remove any metal belongings, including jewellery. Some people are given an injection of dye into a vein in the arm, which doesn’t usually cause discomfort. This is called a contrast medium. It can help the images from the scan to show up more clearly. During the scan, you’ll lie very still on a couch inside a long tube for about 30 minutes. It’s painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It’s also noisy, but you’ll be given earplugs or headphones. You can hear, and speak to, the person operating the scanner during the scan.
Bone sample (bone biopsy)
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A sample of bone is always needed to diagnose bone cancer. This is because x-rays and scans can’t always show whether or not a tumour is cancer. If it is cancer, the bone biopsy should show which type of bone cancer it is.
A bone biopsy is a specialised test. It should only be done by a radiologist or surgeon who’s an expert in bone cancers. There are two ways of taking a bone biopsy:
Core needle biopsy
Before the biopsy, the doctor will give you an injection of local anaesthetic into your skin and around your bone to numb it. Then they will pass the biopsy needle through the skin into the bone to take the sample. They use a special needle to do this. They may take several samples.
If the doctor can’t feel the bone lump or it’s deep within the body, the doctor may use an ultrasound or CT scanner to help them guide the needle into the right place. You will usually be awake during a core needle biopsy, although you may be given a sedative to make you feel more relaxed and drowsy. Sometimes the biopsy is done under a general anaesthetic, particularly for children.
For most people, a core needle biopsy will show whether the lump is a cancer. However, sometimes it doesn’t provide enough cells to give a clear diagnosis. In this case, you will need a surgical biopsy.
This type of biopsy is done less often than a core needle biopsy. The surgeon uses a surgical knife (scalpel) to open the affected area and remove a sample from the lump. You will be given a local or a general anaesthetic before a surgical biopsy. This depends on your general health, the size of the tumour and how deep it is inside your body.
The bone sample or samples are then sent to a specialist doctor (pathologist). The pathologist can tell whether the tumour is a cancer or not by examining cells from the sample under a microscope. If it is a cancer, your doctors may do further tests on the sample to find out which type of bone cancer it is.
Waiting for test results
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Waiting for test results can be a difficult time. It may take from a few days to a couple of weeks for the results of your tests to be ready. You may find it helpful to talk to a partner, family member or close friend. Your specialist nurse can also provide support, or you can talk to one of our cancer support specialists or another organisation.