Tests for bone cancer

Tests your GP might do

Most people with symptoms that could be due to cancer start by contacting their GP surgery. Your first appointment may be a telephone appointment. Your GP surgery then might arrange for you to go in and see a doctor or other healthcare professional.

Read about the symptoms of bone cancer

Your GP can do some tests to help them decide if you need to see a specialist. This usually includes:

• a physical examination

• an x-ray

• blood tests

Your GP may also arrange for you to have other tests such as an MRI or CT scan. This depends on your symptoms and test results. You usually have an MRI or CT scan at your local hospital.

Physical examination

Your doctor usually asks you to lie or sit down. They will look and feel your skin to check for any abnormalities or areas that are swollen.

They may also listen to your chest and tummy (abdomen) to find out if they sound normal.

X-ray

An x-ray is a test that uses small amounts of radiation to take pictures of the inside of your body. You usually have an x-ray at your local hospital imaging department.

The x-ray can show changes in your bones such as:

• breakdown of an area of the bone

• new bone growth

• swelling of the bone

• swelling in the tissues that surround the bone

• a break in the bone (fracture)

Find out more about having an x-ray

Blood tests

Blood tests can check your general health including:

• how well your liver and kidneys are working

• the number of blood cells in your blood such as ​white blood cells,​ ​platelets​ and ​red blood cells​. You may hear this being called a full blood count

• if you have any signs of infection

Find out more about having a blood test

Tests your specialist might do

Depending on your symptoms and the results of your tests, your GP might refer you to a specialist doctor. This is usually an orthopaedic or cancer doctor specialising in bone cancer.  

Not all hospitals have specialist bone cancer centres. So you might have to travel to another hospital to be seen by a specialist.

Your specialist usually does more tests. These might include:

• MRI scan

• CT scan

• taking a sample of bone tissue called a bone biopsy

• PET-CT scan

• PET-MRI scan

• genetic tests on your cancer cells

• other blood tests

MRI scan

MRI stands for magnetic resonance imaging. It uses magnetism and radio waves to take pictures of the inside of your body.

MRI scans can help doctors take a closer look at any bone changes found on an x-ray. They can show how far a bone tumour has grown inside a bone.

Find out more about having an MRI scan

CT scan

A CT (or CAT) scan stands for computer (axial) tomography. It is a test that uses x-rays and a computer to create detailed pictures of the inside of your body. The computer puts them together to make a 3 dimensional (3D) image.

You might have a CT scan of your chest, abdomen and ​pelvis​. This can help to show where the cancer is.

Read more about having a CT scan

Biopsy of your bone

A biopsy is where a surgeon takes a small sample of bone from the abnormal area. They send it to the laboratory. A specialist doctor called a pathologist looks at the sample under a microscope. It is the only way to find out for sure if you have bone cancer.

You usually have a needle biopsy. This means that your doctor puts a long, thin needle into the abnormal area in your bone. They then gently draw a small amount of bone tissue through the needle. They might use an x-ray, ​ultrasound​ or CT scan to help them guide the needle into place.

You may have this test under ​local​ or general anaesthetic. General anaesthetic means that you are asleep and won’t feel anything.  

Find out more about having a bone biopsy

PET-CT scan

A PET-CT scan combines a CT scan with a ​PET scan​ to give detailed information about the cancer. You might have a PET-CT scan to:

• to work out where your cancer is and how big it is (the stage)

• show how well the treatment is working

• check whether the cancer has come back

Find out more about having a PET-CT scan

PET-MRI scan

A PET-MRI scan combines a PET scan and an MRI scan. It gives detailed information about your cancer. 

You might have a PET-MRI scan to:

• work out where your cancer is and how big it is (the stage)

• to check how well your treatment is working

These scanners tend to be only in the major cancer hospitals. 

Find out about having a PET-MRI scan

Genetic tests on your cancer cells

You might have tests on your cancer cells to look at:

• ​gene​ abnormalities

• changes to ​chromosomes​ and genes

You might hear these tests called cytogenetic tests or molecular analysis. 

This is different to testing you to see if you have an inherited faulty gene that increases your risk of getting cancer in the first place.

Your doctors use as a sample of blood and tissue from your cancer. You usually don’t need an extra test as they can use the tissue they took at biopsy or surgery.

It helps give detailed information about your cancer. It can also guide treatment decisions. There are different types of test:

FISH (fluorescence in situ hybridisation)

The FISH test looks at gene and chromosome changes. It uses a special fluorescent dye to make it easier to see particular gene and chromosome changes.

It can help your doctor to work out which treatment you need by understanding more about your cancer.

Find out more about FISH testing

Whole genome sequencing (WGS)

WGS looks at your complete set of ​DNA. The test compares the genetic information in your cancer with your blood sample. It picks up gene abnormalities to give more information about your diagnosis and guide treatment.

Panel testing

This type of genetic test looks at a specific set of genes. These are genes that doctors know are linked with bone cancer.

Other blood tests you might have

Your specialist usually repeats the blood tests your GP has done to check your general health. They might also check:

• if your red blood cells are sticking together. This is called the erythrocyte sedimentation rate or ESR

• the level of alkaline phosphatase (ALP). ALP is a chemical found in your blood and is a measure of bone activity

• the level of lactate dehydrogenase (LDH). LDH is a protein found in almost all body tissues

These blood tests are sometimes raised in people with certain types of bone cancer. For example:

• the ALP level is sometimes raised in people with osteosarcoma

• LDH is sometimes raised in people with Ewings sarcoma

Treatment for primary bone cancer

The tests you have help your doctor find out if you have bone cancer and how far it has grown. This is the stage of the cancer.

Read about the stages of bone cancer

This is important because doctors recommend your treatment according to the stage of the cancer.

Find out about the treatment options for bone cancer

Coping with primary bone cancer

Coping with a diagnosis of bone cancer can be difficult. There is help and support for you and your family.

Read about what you can do to cope with a diagnosis of bone cancer