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 suggest that you may have a primary bone tumour, you should always be referred to a specialist hospital or bone tumour treatment centre. This is important because some tests for diagnosing bone tumours, particularly taking a bone sample (bone biopsy), need to be done by a person with specialist experience.
Children may be 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 help support teenagers.
The specialist at the hospital or bone treatment centre will ask you about your symptoms. They will also 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, how the bone looks on an x-ray can help the doctor diagnose which type of bone cancer it is. This is often the case for osteosarcoma. However, other tests will still be needed before the doctor can definitely say whether it’s a primary or secondary bone cancer and what type of cancer it is.
This test looks at all the bones in the body. It shows up any signs of cancer in any other bones away from the main tumour.
A small amount of a radioactive substance is injected into a vein in your hand or arm. Abnormal bone absorbs more radioactivity than normal bone, so these areas are highlighted and picked up by the scanner as ‘hot spots’. The level of radioactivity used in the scan is very small and doesn’t cause any harm to your body.
You will need to wait for 2-3 hours between having the injection and the scan, so you may want to take a magazine, book or MP3 player with you to help pass the time.
If ‘hot spots’ do show up on a bone scan, it isn’t always clear whether they’re caused by cancer or by other conditions, such as arthritis. Sometimes a CT scan or MRI scan (see below) may help the doctors decide whether the changes seen on a bone scan are caused by bone cancer or by another condition.
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. Some centres may do an MRI scan of the whole skeleton instead of a bone scan. This is to check for signs of cancer in any other bones away from the main tumour.
An MRI scan 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 your 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 their arm, which doesn’t usually cause discomfort. This is called a contrast medium and can help the images from the scan to show up more clearly.
During the test you’ll lie very still on a couch inside a long cylinder (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. During the scan you’ll be able to hear and speak to the person operating the scanner.
Bone sample (bone biopsy)
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A sample of bone is needed to diagnose bone cancer. This is because x-rays and bone scans can’t always show whether a tumour is non-cancerous or cancerous and, if it is cancerous, the exact type of bone cancer it is.
A bone biopsy is a specialised test and should only be done by a radiologist or surgeon with specialist expertise in bone cancers. There are two ways of taking a bone biopsy:
Core needle biopsy
In a core needle biopsy, the doctor uses a special needle to take a sample from the bone. Before the biopsy, the doctor will give you an injection of local anaesthetic into your skin and around your bone to numb it. They will then put the biopsy needle into the bone to take the sample. You may have several samples taken.
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, particularly in children, the biopsy is done under a general anaesthetic.
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 situation a surgical biopsy is needed.
This type of biopsy is done less often than a core needle biopsy.
The surgeon uses a surgical knife (scalpel) to open the area and remove a sample from the lump. If the lump is small enough, all of it may be removed. A surgical biopsy may be done under a local or a general anaesthetic. This depends on your age, the size of the tumour and how deep it is within your body.
Once taken, the bone sample or samples are sent to a specialist doctor (pathologist). The pathologist can tell whether the tumour is a cancer or not by examining the cells from the bone samples under a microscope. If it is a cancer, your doctors may arrange for further tests on the sample to find out which type of bone cancer it is.
Waiting for test results
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It may take 2-3 weeks for you to get the results of all your tests. This can be a worrying time for you, but it’s important that the doctors make an accurate diagnosis. It may help to talk about your worries with a partner, relative or close friend. You may also find it helpful to call our cancer support specialists, or there are other organisations that may also be able to help.