You begin by seeing your family doctor (GP), who will check you and may arrange tests or x-rays. If your GP thinks you may have a bone tumour, they should refer you directly to a specialist hospital or bone tumour centre for more tests. Many of the tests for diagnosing bone tumours, such as bone biopsies, need to be done by an experienced team using specialist techniques.
The doctor at the hospital will ask you about your general health and any previous medical problems. They will check you and look at the painful area to check for any swelling or tenderness. You will probably have a blood test to check your general health.
You may need a variety of tests and investigations to diagnose an osteosarcoma. An x-ray of the painful part of the bone will usually identify a tumour, although sometimes they can be hard to see.
A small piece of the tumour will be removed and looked at under a microscope (a biopsy). You may have other tests to check whether the cancer has spread to other parts of the body.
Bone x-ray
This involves the use of x-rays to build up a picture of the bone.
Biopsy
The doctor will take a sample of cells (a biopsy) to be checked by a pathologist (a doctor that specialises in cell types). If your doctor thinks you have bone cancer, the biopsy should be done at a specialist bone cancer centre.
Needle biopsy
A small sample of the tumour is taken from the affected bone using a needle. You will be given a local
anaesthetic to numb the area. Sometimes a general anaesthetic is used.
Open or surgical biopsy
This type of biopsy is not often used, as the needle biopsy is much quicker and simpler. In an open biopsy, a small piece of bone is removed during a small operation while you are under a general anaesthetic. You may need this if a needle biopsy cannot be done or does not give a clear result.
Bone scan
This is a more sensitive test than an x-ray and shows up any abnormal areas of bone more clearly. A small amount of a mildly radioactive substance is injected into a vein, usually in your arm.
Abnormal bone absorbs more radioactivity than normal bone so these areas are highlighted and picked up by the scanner as ‘hot spots’.
After you have the injection, you will need to wait 2 to 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.
MRI (magnetic resonance imaging) scan
This test uses magnetism to build up detailed pictures of your body. During the test, you will be asked to lie still on a couch inside a large metal cylinder that is open at both ends.
The test may take up to an hour. It can be slightly uncomfortable and some people feel a bit
claustrophobic during the scan. It is noisy, but you will be given earplugs or headphones. You can hear and speak to the person operating the scanner.
If you have any metal implants (such as surgical clips or pacemakers), it will not be possible for you to have this test. In this situation, another type of scan may be used.
CT (computerised tomography) scan
In some people with osteosarcoma, the cancer may spread to the lungs. You may have a CT scan to check for this. The scan takes a series of x-rays that build up a 3D (three-dimensional) picture of the inside of the body. The scan is painless and takes just a few minutes. CT scans use small amounts of radiation, which is very unlikely to harm you and cannot harm anyone you come into contact with.
You may be given a drink or an injection of dye that allows certain areas to be seen more clearly. This may make you feel hot all over for a few minutes. If you are allergic to iodine or have asthma, you could have a more serious reaction to the injection so it is important to let your doctor know before the scan.
You can normally go home as soon as the scan is over.
PET (positron emission tomography) scan or PET-CT scan
This uses low-dose radioactive sugar to measure the activity of cells in different parts of the body. A very small amount of a mildly radioactive substance is injected into a vein, usually in your arm. A scan is then taken a couple of hours later. Areas of cancer are usually more active than surrounding tissue and show up on the scan. After the injection, you will have to wait at least an hour before the scan. The scan takes 30 to 90 minutes. You can normally go straight home afterwards.
Usually, a scan that combines a PET scan and a CT scan (called PET-CT) is used, as it can give more information about the position and size of a tumour.
Waiting for test results can be an anxious time for you. It may help to talk about your worries with a relative or friend. You could also speak to one of our cancer support specialists.