Diagnosis of bone cancer

Diagnosis is the process of finding out the cause of a health problem. 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 process of diagnosis may seem long and frustrating. It’s normal to worry, but try to remember that other health conditions can cause similar symptoms as bone cancer. It’s important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of bone cancer.

The following tests are usually used to rule out or diagnose bone cancer. Many of the same tests used to diagnose cancer are used to find out the stage (how far the cancer has progressed). 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, risk factors 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 diseases that increase the risk for bone cancer
• being around ionizing radiation at work or at home or from having had radiation treatment in the past
• chemotherapy in childhood with an alkylating drug
• bone disorders

Your doctor may also ask about a family history of:

• bone cancer
• risk factors for bone cancer
• retinoblastoma (a type of eye cancer)
• 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 in an area
• look at how much a leg, arm or joint can move
• feel the lymph nodes in an area
• listen to your lungs

Find out more about physical exams.

An x-ray uses small doses 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 3-D pictures.

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

Find out more about MRIs.

A computed tomography (CT) scan uses special x-ray equipment to make 3-D 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 cannot confirm that an area in the bone is a tumour. It may also be used to see how far a tumour has spread inside the bone, into the soft tissues around the tumour or into the lymph nodes.

Find out more about CT 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 confirm whether or not cancer cells are found in the sample. A biopsy is used to confirm the diagnosis of bone cancer and find out what type of cancerous tumour it is.

A biopsy is often guided by imaging with an x-ray, an MRI or a CT scan. A CT scan is most often used to guide a biopsy to bones that are deeper in the body, like the pelvic or hip bones.

Core biopsy uses a hollow needle or probe to remove tissue from the body. It is the main type of biopsy used to diagnose bone tumours.

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. It may be used if a core biopsy does not show whether an area is cancerous.

Bone marrow aspiration uses a needle to remove a sample of bone marrow. Bone marrow is the soft and spongy tissue inside the bones. It may be done if there is a Ewing sarcoma tumour, as they can spread to the bone marrow.

Find out more about biopsies.

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

Sometimes changes to the chromosomes can also be seen. One of these changes is a chromosomal abnormality called a translocation. A translocation happens when a piece of one 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 if the doctors think that the cancer has spread to the bone from another organ (called bone metastasis). This is because bone metastasis is more common in older adults than cancer that starts in the bone (primary bone cancer).

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 abnormalities, but they are not used to diagnose bone cancer itself.

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 increased with bone cancer. Checking their levels may help a doctor estimate your outcome (give 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.

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

Heart function tests are done to make sure that your heart is healthy enough to have chemotherapy, if it is needed. Some types of chemotherapy drugs used for bone cancer can cause heart problems. The main types of heart function tests are a multigated acquisition (MUGA) scan, an echocardiogram (echo) and an electrocardiogram (ECG).

Find out more about a MUGA scan, echocardiograms and ECGs.

A hearing exam may be done to show your healthcare team how well you can hear and find any hearing problems, before any chemotherapy treatments are started. Some types of chemotherapy drugs used for bone cancer can cause hearing loss.

Find out more about hearing exams.

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