Should I see a bone cancer specialist?

There are several types of bone cancer, but none of them are very common. Overall, there are only about 600 primary bone cancers diagnosed each year in the UK. It can be very difficult for GPs to decide who may have a suspected cancer and who may have something more minor that will go away on its own. The National Institute for Health and Clinical Excellence (NICE) has produced guidelines for GPs to help them decide which patients need to be seen urgently by a specialist. These guidelines on referrals for primary bone cancer were updated in June 2005.

When reading these guidelines, it is important to remember that

• Most bone tumours are diagnosed in either children, teenagers or young adults
• Half of all diagnosed bone tumours are in or near the knee
• A common symptom is pain that is not related to movement – the bone may be painful when you are resting or in bed at night
• Most bone tumours can be diagnosed with an X-ray

If you go to the doctor with bone pain or other suspicious signs that something is wrong, the first thing your doctor will do is send you to the hospital outpatient department for an X-ray. X-rays are a way to diagnose a bone cancer early. Ask your GP what they will do when the result comes back. Will the surgery contact you or will you have to contact them? If you don't hear, you should contact them anyway. It may be that nothing is wrong. But it is just as well to check and make sure you get the result.

There are particular signs on an X-ray that tell your GP that you could have a bone cancer and need to see a bone specialist (orthopaedic doctor) as soon as possible. The NICE guidelines say that a specialist should ideally see you urgently – within 2 weeks – if your X-ray shows

• Bone destruction
• New bone formation
• Swelling over and around the bone

If an X-ray shows other changes you may not need an urgent referral. Your GP will still refer you to a specialist for further investigation of your problems, but this may take several weeks.

Your GP will send you for an urgent X-ray if you have signs of a fracture with no obvious cause. This is called a pathological fracture. Pathological means it is due disease. A pathological fracture happens in abnormal bone because it is weak but this occus very rarely with a primary bone cancer. It can happen after a minor knock or when doing routine activities.

If your X-ray is normal, but you still have symptoms, your GP may repeat the X-ray or send you to see a specialist anyway. Your GP may organise some tests if you have

• Increasing, unexplained bone pain that doesn't go away, especially when you are resting
• An unexplained limp

If you have symptoms of cancer in the bone, but have previously had another, different cancer elsewhere in your body, your GP will probably arrange for you to see your original cancer specialist. Bone cancers are very rare and it is more likely that your symptoms could be caused by your original cancer spreading to the bones, rather than a new primary bone cancer. But it is important to remember that even if you have had cancer before your symptoms may be caused by something completely different. They are not necessarily a sign of the cancer coming back.

If you are worried that your GP is not taking your symptoms as seriously as you think they should, you could print this page and take it along to an appointment. Ask your GP to talk it through with you and then you may be able to decide together whether you need to see a specialist and if so, how soon.