Tests for bone cancer

You usually have a number of tests to check for cancer that starts in the bones. Bone cancer is also called bone sarcoma.

Bone cancer is different from cancer that has spread to the bones from another part of the body. This is called secondary 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.

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)

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

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

• a bone marrow biopsy

• bone scan

• PET-CT scan

• PET-MRI scan

• 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.

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.

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 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.  

Bone marrow biopsy

A bone marrow biopsy is a test to check whether there are cancer cells in your bone marrow. The bone marrow is the spongy tissue inside your bones that makes blood cells.

Not everyone needs to have a bone marrow biopsy. You might have this test if you have a type of bone cancer called Ewing’s sarcoma. This is because Ewing’s sarcoma can sometimes spread to the bone marrow.

You are usually awake for this test, but you have a local anaesthetic to numb the area. Your doctor or specialist nurse removes a sample of bone marrow cells. They usually take the sample from your hip.

You may have the bone marrow biopsy at the same time as your bone biopsy.

Bone scan

A bone scan uses a large camera called a gamma camera to look at your bones. It can show up changes and abnormalities in the bones. You may also hear a bone scan being called:

• a radionucleotide scan

• bone scintigraphy

• nuclear medicine bone scan

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

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

Other blood tests

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

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.

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

Coping

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