Being diagnosed with secondary bone cancer

If your symptoms suggest you may have secondary bone cancer, your GP 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 – check your health and how much calcium is in your blood.
  • Chest x-rays – show if the cancer has spread to the lungs.
  • Bone x-rays – may show changes in the bone and possibly a secondary bone cancer.
  • Bone scans – this looks at all bones in the body and may show any abnormal areas more clearly.
  • CT scan or a PET/CT scan.
  • MRI scans – use magnetism to produce a detailed picture of the affected area.
  • Bone sample (bone biopsy) – you may have this test if doctors aren’t sure what is causing the changes. A sample of cells is taken from the affected bone. There are two types of bone biopsies: core needle biopsy and 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 will 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 and may show a secondary bone cancer. Not all secondary bone cancers can be seen on an x-ray.

Bone scan

This scan looks at all the bones in the body. It’s more sensitive than an x-ray, and it shows up any abnormal areas of bone more clearly.

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.

After you have the injection, you will need to wait 2–3 hours before you have the scan. 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, PET/CT or MRI scan (see below) may help the doctors decide whether changes on a bone scan are caused by secondary bone cancer or by another condition.

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 10–30 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. You will be asked not to eat or drink for at least four hours before the scan.

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’s 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’ll probably be able to go home as soon as the scan is over.

MRI scan

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.

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 can't 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. The scan is done after at least an hour’s wait. It usually takes 30–90 minutes. You should be able to go home after the scan.

Bone sample (bone biopsy)

Occasionally, your doctors may still not be sure what’s causing the changes in the bone. In this case, you may need to have a small sample of cells taken from the affected bone (a biopsy). Bone is extremely hard, and the piece that is removed has to be softened so it can be examined under a microscope. The softening process takes several days, so you may have to wait 10–14 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. A biopsy needle is then passed through your skin into the bone and a small amount of bone issue is removed. 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 (see above) 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.

The procedure doesn’t take very long. You may have it as an outpatient and be able to go home afterwards. You’re 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.

A small cut (incision) will be made in your skin above the affected bone so that the biopsy can be taken.

Your doctor 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. You doctor will be able to tell you more about these.

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 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.