How primary bone cancer is diagnosed

If primary bone cancer is suspected, your GP will arrange for you to have some tests and see a specialist. You will then be referred to a bone tumour treatment centre. Children and teenagers may be referred to special paediatric or teenage cancer units.

You will have different types of tests before doctors can give you a diagnosis. These may include:

  • Blood tests
  • Bone x-rays – may show if the cancer started in the bone and, sometimes, what type of bone cancer it is.
  • MRI scans – use magnetism to produce a detailed picture of the affected area.
  • Bone biopsy – a sample of bone is always needed to diagnose bone cancer. There are two types of bone biopsies: core needle biopsy and surgical biopsy. The samples are then sent to a pathologist who will examine them under a microscope and will be able to confirm the diagnosis.

Diagnosing primary bone cancer

Usually you begin by seeing your family doctor (GP). They will examine you and arrange any tests or x-rays you need. Your GP may refer you to a local surgeon who specialises in bone diseases (an orthopaedic surgeon), or to a bone cancer specialist.

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 will have a blood sample taken to check your general health. You’ll also have some of the tests listed in our section about further tests.


Bone x-rays

Bone x-rays may help 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 scan - what happens?

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, such as a pacemaker, surgical clips, bone pins, etc. 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 it's likely that you 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 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. You can hear, and speak to, the person operating the scanner.


Bone sample (bone biopsy)

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 if it’s deep inside 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 cancer. However, sometimes it doesn’t provide enough cells to give a clear diagnosis. In this case, you will need a surgical biopsy.

Surgical biopsy

This type of biopsy is done less often than a core needle biopsy. A 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

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 with your partner, family or a close friend. Your specialist nurse or one of the organisations listed on our database, can also provide support. You can also talk things over with one of our cancer support specialists on 0808 808 00 00.


Back to Tests and scans

Further tests after diagnosis

If you have been diagnosed with primary bone cancer, you may have some further tests to see if the cancer has spread.