How secondary bone cancer is diagnosed

If your symptoms suggest you may have secondary bone cancer, your GP or cancer doctor will arrange for you to have some tests.

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

  • Blood tests – to check your health and see how much calcium is in your blood.
  • Bone x-rays – which may show changes in the bone and possibly a secondary bone cancer.
  • Bone scans – to look at all bones in the body. A bone scan may show any abnormal areas more clearly.
  • CT scan or a PET-CT scan.
  • MRI scans – which use magnetism to produce a detailed picture of the affected area.
  • Bone sample (bone biopsy) – which you may have if doctors are not sure what is causing the changes. A sample of cells is taken from the affected bone. There are two types of bone biopsies. They are a core needle biopsy and a surgical biopsy.

Sometimes a secondary bone cancer is found before the primary cancer. If this happens, you may have more tests to find out where the primary cancer is.

Diagnosing secondary bone cancer

You may see your GP or your cancer specialist. They will ask you about any symptoms you have and may examine you. You may have some of the following tests and scans.


Blood tests

You may have a blood test to check your general health and the level of calcium in your blood.


Bone x-ray

Bone x-rays can show changes in the bone such as a fracture, and may show a secondary bone cancer. Not all secondary bone cancers can be seen on an x-ray.


Bone scan

Bone scans show all the bones in the body. This scan is more sensitive than an x-ray and shows any abnormal areas of bone more clearly.

A small amount of a mildly radioactive substance is injected into a vein, usually in your hand or arm. Abnormal bone absorbs more radioactivity than normal bone, so these areas show as abnormal on the scan. The abnormal areas are often referred to as hot spots.

The level of radioactivity used in the scan is very small and does not cause any harm to your body. But you will be advised to avoid close contact with pregnant women or young children for a few hours after the scan.

After you have the injection, you will need to wait 2 to 3 hours before you have the scan. The scan itself may take up to an hour.

If hot spots do show up on a bone scan, it is not always clear whether they are caused by cancer or by other conditions such as arthritis.

Sometimes doctors may use other scans such as a CT, PET/CT or MRI. These can help to show whether changes on the bone scan are caused by cancer or another condition. They can also check whether any other areas have been affected.


CT (computerised tomography) scan

A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body. The scan takes 10 to 30 minutes and is painless. It uses a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with.

CT scan
CT scan

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You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It is important to let your doctor know if you are allergic to iodine or have asthma, because you could have a more serious reaction to the injection.

You will probably be able to go home as soon as the scan is over.

Someone having a CT scan

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos


MRI scan

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 is safe for you. The checklist asks about any metal implants you may have, such as a pacemaker, surgical clips or bone pins, etc.

You should also tell your doctor if you have 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 is likely that you will not be able to have an MRI scan. In this situation, another type of scan can be used. Before the scan, you will be asked to remove any metal belongings including jewellery.

Some people are given an injection of dye into a vein in the arm, which does not 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 will lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It is also noisy, but you will be given earplugs or headphones. You can hear, and speak to, the person operating the scanner.


PET-CT scan

This is a combination of a CT scan, which takes a series of x-rays to build up a three-dimensional picture, and a positron emission tomography (PET) scan. A PET scan uses low-dose radiation to measure the activity of cells in different parts of the body.

PET-CT scans give more detailed information about the part of the body being scanned. You may have to travel to a specialist centre to have one. You cannot eat for six hours before the scan, although you may be able to drink. A mildly radioactive substance is injected into a vein, usually in your arm. The radiation dose used is very small. You will wait for at least an hour before you have the scan. It usually takes 30 to 90 minutes. You should be able to go home after the scan.


Bone sample (bone biopsy)

Occasionally, your doctors may still not be sure what is causing the changes in the bone. In this case, you may need to have a small sample of cells taken from the affected bone. This is called a biopsy. Bone is very hard, so the piece that is removed has to be softened before it can be examined under a microscope. The softening process takes several days, so you may have to wait 10 to 14 days for the results of the biopsy. There are two ways of taking a bone biopsy:

Core needle biopsy

Before the biopsy, your doctor will give you an injection of local anaesthetic into your skin and around your bone to numb it. They pass a special biopsy needle through your skin into the bone, and take a small amount of the bone tissue. They may take several samples.

If the doctor cannot feel the bone lump or if it is 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 you may have the biopsy done with a general anaesthetic instead.

The procedure does not take very long. You may have it as an outpatient and be able to go home afterwards. You are likely to be sore for a few days afterwards. Your doctor will prescribe painkillers for you if you need them.

Surgical biopsy

Very occasionally a small piece of bone is removed while you have a general anaesthetic.

The doctor makes a small cut in your skin above the affected bone so that the biopsy can be taken. They will give you more information if you need a surgical biopsy.


Diagnosing the primary cancer

Occasionally a secondary bone cancer is found before the primary cancer is diagnosed.

If this happens your doctor may arrange for you to have tests to find out where the primary cancer is. Your doctor will be able to tell you more about these tests.

Our cancer support specialists on 0808 808 00 00 can also give you information about tests you may need to have.


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 can also provide support. You can also talk things over with one of our cancer support specialists on 0808 808 00 00.

Back to Secondary bone cancer

Treating

treatment for secondary bone cancer and what to expect

Organising

the practical, work and financial side

Coping

with and after cancer treatment

Resources

and publications to order, download and print