Diagnosis
If a person has any symptoms of bone cancer, a doctor will usually conduct a physical examination and take a full medical history, and often order imaging tests as described below. If the doctor still suspects bone cancer, he or she may recommend a biopsy. An accurate biopsy is very important for bone cancer. A biopsy that is performed incorrectly may cause the cancer to spread and may make it difficult to surgically remove the cancer without complications.
Biopsy
A biopsy is the only way to be certain of a bone cancer diagnosis. A doctor will remove a small sample of bone and have it examined under a microscope for cancer cells. The doctor may request any of the following biopsy procedures:
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Needle Biopsy
The doctor uses a long needle to extract a cylindrical tissue sample from the bone. The doctor sends this sample to a laboratory to be examined under a microscope for cancer cells.
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Surgical Biopsy
The doctor uses a surgical knife to make an incision and remove a sample of bone tissue. The doctor sends this sample to a laboratory to be examined under a microscope for cancer cells.
Imaging Tests
Bone X-Ray
X-rays use electromagnetic radiation to produce images of the inside of your body. Doctors can often see the size, shape and location of bone tumors on regular X-rays.
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Bone Scan
A bone scan uses a radioactive substance to identify cancerous tissues in the bones. A bone scan provides a picture of all of the bones in the body, and allows doctors to detect small areas of cancer cells not visible on plain X-rays. The radioactive substance collects in these areas and illuminates them on the skeletal X-ray.
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Computed Tomography (CT) Scan
A computed tomography (CT) scan uses X-rays to produce an image of your body. A special dye may be injected into your veins and you may be asked to drink a special fluid in order to make the internal organs stand out. A CT scan produces clear images of the soft tissues of the body, and can help a doctor determine if a bone tumor has grown into nearby tissues such as fat, muscles or tendons. A CT scan can also help determine if the cancer has spread to other sites.
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Magnetic Resonance Imaging (MRI) Scan
Magnetic resonance imaging (MRI) uses radio waves and a strong magnet to create clear and detailed images of body parts. Radio waves are absorbed by the body and then released in a certain pattern, which is translated by a computer in order to show "slices" of the body. If the doctor notices an abnormality on a bone X-ray, he or she may order an MRI to inspect it more closely. MRIs show the bone and soft tissue in much more detail than plain X-rays and can help doctors determine the extent of the cancer.
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Positron Emission Tomography (PET) Scan
For a PET scan, the doctor injects a radioactive substance (usually radioactive glucose) into the patient's bloodstream. This substance collects in cells that are metabolically active, including cancer cells, which can be visualized within an hour of injection of this radioactive indicator. The doctor then uses a PET scanner to detect these areas of radioactivity and to find the exact location of cancer in the patient's body. It can help the doctor determine if the cancer has spread to other bones, organs or parts of the body.
Laboratory Tests
Blood Test
The doctor may perform certain blood tests after diagnosis to get an idea of how advanced the disease is and to see how the liver, kidney, and bone marrow are working. For example, two blood samples that a doctor would obtain from the patient and have examined in a laboratory are the alkaline phosphatase and lactate dehydrogenase (LDH) enzymes. The alkaline phosphatase enzyme commonly occurs in high levels in children and adolescents who are growing. However, high levels of this enzyme in adults may be a sign of bone cancer. Lactate dehydrogenase is usually present in low levels in the body. High levels of LDH may indicate internal tissue damage related to cancer in the body. These blood tests alone cannot diagnose bone cancer, but help the doctor in the management of the cancer. As research is advancing, there are certain blood tests that can detect the presence of cancer cells in the blood. These are designed from each individual tumor sample and in the future can be used to detect residual disease.
