Diagnosing bone cancer

How bone cancer is diagnosed

To diagnose bone cancer you usually start by seeing your GP and they can arrange any tests you need. They may refer you to a bone surgeon or bone cancer specialist.

Bone x-ray

Bone x-rays may show if the cancer:

started in the bone (primary bone cancer)
spread to the bone from a cancer that started somewhere else in the body (secondary bone cancer).

Sometimes the way the bone looks on an x-ray can help the doctor tell which type of bone cancer it is. This is often the case for osteosarcoma.

An MRI scan uses magnetism to build up a detailed picture of areas of the body. The scanner is a powerful magnet. You will be asked to complete and sign a checklist to make sure it is safe for you. This will check whether you have any metal implants, such as a pacemaker or surgical clips. Tell your doctor if you have ever worked with metal. This is because tiny bits of metal can sometimes lodge in the body.

You have the scan in the x-ray department of a hospital. The person who does the scan is called a radiographer. They may give you an injection of a dye called a contrast. This helps show certain areas of the body more clearly.

During the scan, you need to lie still on a bed inside a long cylinder (tube). If you worry about being in small spaces (are claustrophobic), you may be able to have a sedative to help you relax. Talk to your GP or cancer doctor about this before the scan.

The scan usually lasts between 15 minutes and 1 hour. It is painless, but you may find it uncomfortable to lie still for that long.

Biopsy

The doctor may take a sample of cells from the tumour. This is called a biopsy. The sample is sent to a specialist doctor called a pathologist with experience in bone tumours. They look at cells from the sample under a microscope to tell if the tumour is a cancer or not. If it is a cancer, your doctors may do further tests on the sample to find out the type of bone cancer.

If your doctor thinks you have bone cancer, the biopsy should be done at a specialist bone cancer centre. The type of biopsy you have depends on where the lump is and its size.

We have more information about having a bone biopsy.

Immunohistochemistry testing

The tissue sample is tested using a special staining process. This is to look at any proteins the cancer cells might be producing. It can take about 2 weeks to get these results back.

Testing for genetic changes

Tests are done on the tissue samples to find out if there are any genetic changes in the sarcoma cells. It is sometimes called cytogenetic testing.

This information can help tell your doctor the type of sarcoma you have and if certain treatments are suitable for you.

Further tests

If the tests show that you have bone cancer, the cancer doctor may do further tests. These are to find out if the cancer has spread outside the bone. This is called staging. The results of the tests will help you and your cancer doctor decide on the best treatment for you. The tests needed will depend on the type of cancer.

Chest x-ray

The most common place for primary bone cancer to spread to is the lung. A chest x-ray can show if the lungs have been affected.
CT scan

Most patients with bone cancer will have a chest CT scan of their lungs. They might also have a CT scan of the affected bone.
PET-CT scan

A PET scan uses low-dose radiation to check the activity of cells in different parts of the body. You may have a PET scan and a CT scan together. This is called a PET-CT scan. It can give more detailed information about cancer or abnormal areas seen on other scans.
Bone marrow sample

The bone marrow is the spongy material inside the bones where blood cells are made.

When Ewing sarcoma is suspected or diagnosed, the doctor will take a small sample of bone marrow. This is because Ewing sarcoma can sometimes spread to the bone marrow. They usually take the sample from 1 side of the hip bone (pelvis). Sometimes they also take a sample from the other side.
Bone scan

A bone scan is a more sensitive test than an x-ray. It shows up any abnormal areas of bone more clearly. You will receive a small injection of a radioactive substance. Areas of abnormal bone absorb more radiation than normal bone. This means the abnormal bone shows up more clearly on the scanner. The amount of radiation used is small. It does not cause you any harm.

About our information

References

Below is a sample of the sources used in our information about primary bone cancer. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

European Society for Medical Oncology, ESMO. 2021. Bone sarcomas: ESMOeEURACANeGENTURISeERN PaedCan Clinical Practice Guideline for diagnosis, treatment and follow-up. Annals of Oncology. S. J. Strauss1 et al. Available at: https://www.esmo.org/guidelines/guidelines-by-topic/sarcoma-and-gist/bone-sarcomas (accessed July 2023)

UK guidelines for the management of bone sarcomas, Clinical Sarcoma Research (2016) 6:7. Gerrand C et al on behalf of the British Sarcoma Group. Available at: UK guidelines for the management of bone sarcomas - PMC (nih.gov)(accessed July 2023)

British Medical Journal, BMJ Best Practice. Osteosarcoma. Last updated May 2022. Last reviewed 27 Jun 2023. Available at: Osteosarcoma - Symptoms, diagnosis and treatment | BMJ Best Practice (accessed July 2023)

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by senior medical editor Fiona Cowie, Consultant Clinical Oncologist.

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We want our information to be as clear as possible. To do this, we try to:

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