Tests for bone cancer
This page tells you about tests you may have if your doctor suspects you have a bone cancer. If you have cancer that has spread to your bones from somewhere else, this is not the right page for you. We have information on secondary bone cancer that will be more suitable.
Tests for bone cancer
Your GP or specialist will examine you and ask about your symptoms, medical history and general health. You may then need to have more tests.
X-rays and scans
You will probably have an X-ray. You may also have a bone scan or an MRI scan. For an MRI scan you lie very still inside a large machine. The scan is painless but rather noisy. Some people can't have an MRI, for example, if they have a pacemaker.
The only way to tell whether a lump is a cancer is to get a small sample (a biopsy) and look at it under a microscope. A bone biopsy is a highly specialised procedure. Ask for the biopsy to be done at the specialist centre where you will be treated if the cancer is confirmed. The specialist will usually take the biopsy with a needle, under local or general anaesthetic.
After the tests
Bone biopsies take longer to process than most other biopsies. It is likely that you will feel anxious during this time. It may help to talk to a relative or friend about how you are feeling. Or you may want to contact a cancer support group to talk to someone who has been through a similar experience.
You can view and print the quick guides for all the pages in the Diagnosing bone cancer section.
If you suspect there is something wrong, you usually begin by seeing your GP. They will examine you and ask about your general health. Your doctor will ask you about your symptoms. This will include what the symptoms are, when you get them, and whether anything you do makes them better or worse.
Your doctor will ask you to lie down so that they can examine you. They will feel the area where you have any pain or swelling. It may feel tender or it may be possible to feel a lump. Sometimes the doctor cannot feel anything abnormal. After the examination, your doctor may refer you for an X-ray of the area where you have symptoms. If the X-ray shows any abnormal areas your doctor will refer you directly to a bone specialist (an orthopaedic doctor).
The bone specialist will ask you about your medical history and symptoms. You will have an examination – your doctor will feel the bone that is painful or swollen, and they will examine your chest and tummy (abdomen). If you have already had an X-ray of the abnormal area of bone, the specialist will look at the X-ray. They may suggest that you have further X-rays, blood tests and also a chest X-ray to check your general health. You have all these tests in the outpatient department. Your doctor may also suggest that you have an MRI scan. If the X-rays or MRI scan show abnormal areas of bone your specialist may ask you to have a bone biopsy. These tests are described below.
X-rays use a low dose of radiation to take pictures of the body. The bones show up well on X-rays and this is the first test you are likely to have. Sometimes X-rays can give a very typical picture, which can help the specialist to diagnose particular types of bone cancer. A primary bone tumour will usually show up as one of the following
- Breakdown of an area of a bone
- New bone growth
- Swelling around the bone
- Swelling in the soft tissues surrounding the bone
MRI scans are now routinely used to investigate possible bone tumours. MRI stands for magnetic resonance imaging. This type of scan uses magnetism to build up a picture of the inside of the body. MRI scans are very useful for showing up how far a bone tumour has grown inside a bone. The scan is completely painless but rather noisy. You may feel shut in and you have to stay very still while the scan is being taken.
Remember – if you suffer from claustrophobia, do tell your doctor before the date of the scan. They can discuss ways to help you get through it, including having a sedative if necessary.
You cannot have an MRI if you have
- A pacemaker
- Metal fragments in your eye – for example, because you are a metal worker and have had past accidents at work
- Surgical clips in your skull or brain from previous medical treatment
You can have a MRI if you have
- A replacement joint
- Replacement bone
- Had spinal fixation
You can have an MRI if you have had a joint replacement. The MRI won't affect your false joint but the metal in the joint may mean that the MRI image isn't so good. Do check with your doctor if you are at all concerned.
Some bone tumours are benign. They are not cancer and cannot spread. The only sure way to tell if a lump is a cancer or a benign tumour is to get a sample of the lump and examine it under a microscope. This is called a biopsy.
Remember – a bone biopsy is a highly specialised procedure. It must be done by a specialist. If your doctor suspects you may have a bone cancer, ask for the biopsy to be done at the specialist centre where you will be treated if the diagnosis is confirmed.
The biopsy sample will be examined by a pathologist. A pathologist is a specialist in body tissues and cells. The cells of a cancer look different to benign bone tumour cells. You might have a needle biopsy or a surgical biopsy.
A needle biopsy is when a needle is put into the abnormal area in your bone. The specialist will try to feel the lump so that they know where to put the needle. If the lump is hard to feel, the doctor may use an X-ray or CT scan to see exactly where it is and guide the needle into place. Once the needle is in the lump, the doctor will draw out a small amount of bone tissue. You may have this biopsy done under local or general anaesthetic. If you are having a local anaesthetic, you can ask for something to make you drowsy as well, if you are at all nervous.
A surgical biopsy is not used so often these days. Your specialist will probably only suggest this if your needle biopsy came back negative, but they still suspect that something is wrong. You have a minor operation where the specialist removes a small piece of bone. You may have this done under local or general anaesthetic.
Your specialist may give you an appointment to come back to the hospital when your test results have come through. Or you may have arranged with your specialist that you will be contacted at home. The results may take a little time. Bone biopsies take longer than most biopsies to process, so if you have to wait a while, it doesn't mean that anything has gone wrong. It is likely that you will feel anxious during this time, but try not to worry too much. It may help if you ask your specialist how long the results are likely to take so that you have some idea of how long you will have to wait.
While you are waiting for results it may help to talk to a close friend or relative about how you are feeling. Or you may want to contact a cancer support group or Cancer Chat to talk to someone who has been through a similar experience. Look at the bone cancer organisations page for an organisation that can give you information about support groups or counselling services near you.
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