Bone cancer (sarcoma) - Diagnosing bone cancer

Your GP will carry out a physical examination of the affected bone. They may also refer you for blood tests to rule out other conditions, such as an infection or some types of arthritis.

Some bone cancers can cause abnormalities in the blood. For example, in some osteosarcomas an increase in an enzyme called alkaline phosphatase can be detected.

You may also be referred for an X-ray which can detect bone cancer (see below). X-rays may also be recommended if you go to an accident and emergency department with a suspected broken bone.

If no obvious cause can be found for your bone pain, you will probably be referred to an orthopaedic surgeon (a specialist in bone conditions) at your local hospital for further tests.

X-rays

X-rays can often detect damage to the bones caused by cancer, or new bone that's growing because of cancer.

They can also help determine whether your symptoms are due to another cause, such as a bone fracture.

If your X-rays suggest that you may have bone cancer, you should be referred to a specialist centre with expertise in diagnosing and treating the condition.

As bone cancer is rare, there are a small number of specialist centres so many patients have to travel for advice and treatment.

Biopsy

The most definitive way of diagnosing bone cancer is to take a sample of affected bone and send it to a laboratory for testing. This is known as a biopsy.

A biopsy can also determine exactly what type of bone cancer you have, and what grade your cancer is. A grading system is used to describe how aggressive the cancer is, and how likely it will spread, with high-grade cancers being the most aggressive. This information is important for planning treatment.

A biopsy can be carried out in two ways:

• A core needle biopsy is performed under anaesthetic (depending on where the bone is located this could be a local anaesthetic or general anaesthetic). A thin needle is inserted into the bone and used to remove a sample of tissue.
• An open biopsy is performed under a general anaesthetic. The surgeon makes an incision in the affected bone to remove a sample of tissue.

You may need to have an open biopsy if the results of a core needle biopsy are inconclusive.

Further testing

If the results of the biopsy confirm (or at least suggest) bone cancer, you will probably be referred for further tests to assess how far the cancer has spread. These tests are described below.

MRI scan

A magnetic resonance imaging (MRI) scan uses a strong magnetic field and radio waves to produce detailed pictures of the inside of the affected bone.

An MRI scan is an effective way of assessing the size and spread of any cancerous tumour inside the bones.

CT scan

A computerised tomography (CT) scan involves taking a series of X-rays and using a computer to reassemble them into a detailed three-dimensional (3-D) image of your body.

CT scans are often used to check if the cancer has spread to your lungs. Chest X-rays may also be taken for this purpose.

Bone scans

A bone scan can give more detailed information about the inside of your bones than an X-ray. During a bone scan, a small amount of radioactive material is injected into your veins.

Abnormal areas of bone will absorb the material at a faster rate than normal bone and will show up as "hot-spots" on the scan.

Staging

Once these tests have been completed and the results have come through, it should be possible to tell you what stage and grade the bone cancer is at. Staging is a description of how far a cancer has spread and grading is a description of how quickly the cancer is likely to spread in the future.

A widely used staging system in England uses three stages to assess cases of bone cancer:

Stage 1 – the cancer is low-grade and has not spread beyond the bone. Stage 1 can be further divided into two sub-stages:

• Stage 1A – the cancer is still limited to the inside of the affected bone.
• Stage 1B – the cancer has started to spread into the outer layer of the bone.

Stage 2 – the cancer has still not spread beyond the bone but it is a high-grade type of cancer; again this can be divided into two sub-stages:

• Stage 2A – the cancer is still limited to the inside of the affected bone.
• Stage 2B – the cancer has started to spread into the outer layer of the bone.

Stage 3  – the cancer has spread into other parts of the body, such as the lungs.

Most cases of stage 1 bone cancer and some of stage 2 bone cancers have a good chance of being cured.

The same is not usually true with stage 3 bone cancer but it may be possible to relieve symptoms and slow the spread of cancer with treatments such as chemotherapy and, in some cases, radiotherapy.

Coping with a diagnosis

Being told you have bone cancer can be a distressing, bewildering and frightening experience. Receiving that type of news can be upsetting at any age but particularly cruel if you are still in your teenage years, or if you are a parent of a child who has just been told they have bone cancer.

Read more about coping with a cancer diagnosis.

These types of feelings can cause considerable stress and anxiety which in some cases can trigger depression. You may be depressed if during the past month you have been bothered by feeling down and hopeless and you no longer take pleasure in activities you used to enjoy.

If you think you may be depressed, see your GP as there are a range of effective treatments, such as medication and counselling, that can help.

Read more about the treatment of depression.

You may find it useful to visit the Bone Cancer Research Trust website, which is the UK’s leading charity for people affected by bone cancer.

If you are a teenager you can also contact the Teenage Cancer Trust, a charity for teenagers and young adults affected by cancer.