Bone cancer - Diagnosis

Diagnosis-Bone cancer

If you're experiencing bone pain, your GP will ask about your symptoms and examine the affected area, before deciding whether you need to have any further tests.
They will look for any swelling or lumps, and ask if you have problems moving the affected area. They may ask about the type of pain you experience – whether it's constant or comes and goes, and whether anything makes it worse.
After being examined, you may be referred for an X-ray of the affected area to look for any problems in the bones. If the X-ray shows abnormal areas, you'll be referred to an orthopaedic surgeon (a specialist in bone conditions) or bone cancer specialist for a further assessment.
Some of the tests you may have to help diagnose and assess bone cancer are described below.

X-rays

An X-ray is a procedure where radiation is used to produce images of the inside of the body. It's a particularly effective way of looking at bones.
X-rays can often detect damage to the bones caused by cancer, or new bone that's growing because of cancer. They can also determine whether your symptoms are caused by something else, such as a broken bone (fracture).
If an X-ray suggests you may have bone cancer, you should be referred to a specialist centre with expertise in diagnosing and treating the condition. As bone cancer is rare, there are a small number of specialist centres, so you may have to travel outside your local area for advice and treatment.

Biopsy

The most definitive way of diagnosing bone cancer is to take a sample of affected bone and send it to a laboratory for testing. This is known as a biopsy.
A biopsy can determine exactly what type of bone cancer you have and what grade it is (see below).
A biopsy can be carried out in two ways:
  • A core needle biopsy is performed under anaesthetic (depending on where the bone is located, this could be a local anaesthetic or general anaesthetic). A thin needle is inserted into the bone and used to remove a sample of tissue.
  • An open biopsy is performed under a general anaesthetic. The surgeon makes an incision in the affected bone to remove a sample of tissue.
You may need to have an open biopsy if the results of a core needle biopsy are inconclusive.

Further tests

If the results of the biopsy confirm or suggest bone cancer, it's likely you'll have further tests to assess how far the cancer has spread. These tests are described below.

MRI scan

A magnetic resonance imaging (MRI) scan uses a strong magnetic field and radio waves to produce detailed pictures of the bones and soft tissues.
An MRI scan is an effective way of assessing the size and spread of any cancerous tumour in or around the bones.

CT scan

A computerised tomography (CT) scan involves taking a series of X-rays and using a computer to reassemble them into a detailed three-dimensional (3-D) image of your body.
CT scans are often used to check if the cancer has spread to your lungs. Chest X-rays may also be taken for this purpose.

Bone scans

A bone scan can give more detailed information about the inside of your bones than an X-ray. During a bone scan, a small amount of radioactive material is injected into your veins.
Abnormal areas of bone will absorb the material at a faster rate than normal bone and will show up as "hot spots" on the scan.

Bone marrow biopsy

If you have a type of bone cancer called Ewing sarcoma, you may have a test called a bone marrow biopsy to check if the cancer has spread to the bone marrow (the tissue inside your bones).
During the test, a needle is inserted into your bone to remove a sample of your bone marrow. This may be done under either local or general anaesthetic.

Staging and grading

Once these tests have been completed, it should be possible to tell you what stage and grade the bone cancer is. Staging is a description of how far a cancer has spread and grading is a description of how quickly the cancer is likely to spread in the future.
A widely used staging system for bone cancer in the UK uses 3 main stages:
  • Stage 1 – the cancer is low-grade and has not spread beyond the bone
  • Stage 2 – the cancer has still not spread beyond the bone, but is a high-grade
  • Stage 3 – the cancer has spread into other parts of the body, such as the lungs
Most cases of stage 1 bone cancer and some stage 2 bone cancers have a good chance of being cured. Unfortunately, stage 3 bone cancer is more difficult to cure, although treatment can relieve symptoms and slow the spread of the cancer.

Coping with a diagnosis

Being told you have bone cancer can be a distressing and frightening experience. Receiving that type of news can be upsetting at any age, but can be particularly difficult if you are still in your teenage years, or if you're a parent of a child who has just been told they have bone cancer.
These types of feelings can cause considerable stress and anxiety, which in some cases can trigger depression. If you think you may be depressed, your GP may be a good person to talk to about support and possibly treatment.
You may also find it useful to contact the Bone Cancer Research Trust, which is the UK's leading charity for people affected by bone cancer, if you need more information. If you're a teenager you may want to contact the Teenage Cancer Trust, which is a charity for teenagers and young adults affected by cancer.