Diagnosis of bone cancer

Diagnosis is the process of finding out the cause of a health problem. Diagnosing bone cancer often means first ruling out other health conditions that share similar symptoms with cancer. It can be a very worrying time for you and your loved ones. Sometimes this process is quick. Sometimes it can feel long and frustrating. But it’s important for doctors to get all the information they need before making a diagnosis of cancer.

Diagnosing bone cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for bone cancer or other health problems.

The following tests are usually used to rule out or diagnose bone cancer. Many of the tests used to diagnose cancer are also used to find out the stage (how far the cancer has spread). Your doctor may also order other tests to check your general health and to help plan your treatment.

Your health history is a record of your symptoms, risks and all the medical events and problems you have had in the past. Your doctor will ask questions about your history of:

• symptoms that suggest bone cancer
• inherited conditions that increase the risk for bone cancer, such as Li-Fraumeni syndrome and Rothmund-Thomson syndrome
• exposure to ionizing radiation at work, at home or past radiation therapy treatment
• childhood chemotherapy treatment with an alkylating drug (a drug that kills cancer cells by damaging the cells’ DNA) such as ifosfamide and cyclophosphamide
• bone disorders such as Paget’s disease of bone and fibrous dysplasia

Your doctor may also ask about a family history of:

• bone cancer
• risks for bone cancer
• retinoblastoma
• other cancers

A physical exam allows your doctor to look for any signs of bone cancer. During a physical exam, your doctor may:

• check for a lump, swelling or pain around a bone
• look at how much a leg, arm or joint can move
• feel for lymph nodes that are larger than normal
• listen to your lungs

Find out more about physical exams.

An x-ray uses small amounts of radiation to make an image of parts of the body on film. It is usually the first test done to look for bone cancer. Most bone tumours show up clearly on an x-ray.

A chest x-ray may also be done to see if bone cancer has spread to the lungs.

Find out more about x-rays.

Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3D pictures.

An MRI is used to confirm the diagnosis of a bone tumour found on an x-ray. Doctors can also use it to see if the cancer has spread into other parts of the bone or surrounding tissues.

Find out more about MRIs.

A computed tomography (CT) scan uses special x-ray equipment to make 3D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.

A CT scan is used if an MRI can’t be done. Doctors may use a CT scan to see where the tumour is in a bone, if the tumour has grown into soft tissues around the bone or if the cancer has spread to any lymph nodes. Doctors can also use a CT scan to predict the risk that a bone could break (fracture). A CT scan of the chest can show cancer that may have spread to the lungs, which is where bone cancer most often spreads.

Find out more about CT scans.

A positron emission tomography (PET) scan uses radioactive materials called radiopharmaceuticals to look for changes in the metabolic activity of body tissues. A computer analyzes the radioactive patterns and makes 3D colour images of the area being scanned.

A PET scan may be combined with a CT scan to check if bone cancer has spread to other parts of the body.

Find out more about PET scans.

During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a lab. A report from the pathologist will show whether or not cancer cells are found in the sample. Doctors will do a biopsy to confirm the diagnosis of bone cancer and find out what type of tumour it is.

Doctors often use an x-ray, an MRI or a CT scan to guide them during a biopsy. A CT scan is most often used to do a biopsy to bones that are deeper in the body, like in the pelvis (hip).

A core biopsy uses a hollow needle or probe to remove tissue from the body.

A surgical biopsy uses surgery to remove tissue from a lump or mass to look at under a microscope. This test may also be called an open biopsy.

A bone marrow aspiration uses a needle to remove a sample of bone marrow. Bone marrow is the soft and spongy tissue inside the bones.

Find out more about biopsies.

Cell and tissue studies look closely at the cells of a tumour to determine the type of bone cancer. Cells can be taken from tissue removed during a biopsy or surgery.

Sometimes cell and tissue studies can show changes to the chromosomes. One of the changes that doctors look for with bone cancer is a chromosomal abnormality called a translocation. A translocation happens when a piece of a chromosome changes places with a piece from another chromosome. Ewing sarcoma tumours have a translocation where a piece of chromosome 11, or sometimes chromosome 21, changes places with a piece of chromosome 22.

Find out more about cell and tissue studies.

A bone scan uses bone-seeking radioactive materials called radiopharmaceuticals and a computer to create a picture of the bones. It is used to find out if bone cancer has spread to other bones.

A bone scan may also be done for people older than 40 to check if cancer has spread to the bone from somewhere else in the body (called bone metastases). Bone metastases are more common than cancer that starts in the bone (called primary bone cancer), especially in older adults.

Find out more about bone scans.

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are working and can help find problems.

Blood urea nitrogen (BUN) and creatinine levels may be measured to check if the kidneys are working normally. This is done before chemotherapy can be given.

Alanine aminotransferase (ALT) and alkaline phosphatase (ALP) levels may be higher with bone cancer. Checking their levels may help a doctor estimate a prognosis.

Find out more about blood chemistry tests.

A CBC measures the number and quality of white blood cells, red blood cells and platelets. A CBC is done to give your healthcare team information about your general health. Sometimes bone infections cause the same symptoms as bone cancer. A CBC can be used to rule out infections.

Find out more about a complete blood count (CBC).

To make the decisions that are right for you, ask your healthcare team questions about a diagnosis.