For some types of cancer there are tests that can find the cancer early, before it causes any symptoms. But right now, there are no special tests to find bone cancer early. The best thing to do is report any symptoms to a doctor right away.

Signs and symptoms of bone cancer

Pain: Pain in a bone is the most common symptom of bone cancer. At first, the pain is not constant. It may be worse at night or when the bone is used. As the cancer grows, the pain will be there all the time.

Swelling: Swelling in the area of the pain may not happen until weeks later. Depending on the where the tumor is, you may be able to feel a lump.

Breaks (fractures): The cancer may weaken the bone it grows in, but most of the time the bone does not break.

Other symptoms: Problems like weight loss and tiredness (fatigue) may mean that the cancer has spread. If it has spread to organs inside the body, there may be other symptoms, too. For instance, if the cancer spreads to the lung, the person may have trouble breathing.

Bone pain and swelling are usually caused by other problems, like an injury or arthritis. Most people with these symptoms do not have cancer. Still, if these problems go on for a long time without a known reason, you should see a doctor.

Tests to find bone cancer

There are many things doctors can do to look for bone cancer. Symptoms, a physical exam, imaging tests, and blood tests may all suggest bone cancer. But in most cases, a biopsy is needed to make sure, since other diseases can cause the same symptoms.

Imaging tests

X-rays: Most of the time, bone cancer will show up on x-rays of the bone. The radiologist (a doctor who is trained to read x-rays) can often tell whether or not a tumor is cancer by the way it looks on the x-ray. But a biopsy (see below) is the only way to know for sure. A chest x-ray may be done to see whether the bone cancer has spread to the lungs.

CT scans (computed tomography): For a CT scan, many x-rays of the body are taken from different angles. These pictures are combined by a computer to make cross-section pictures of your insides. Before the x-rays are taken, a contrast dye may be given into a vein. The dye helps better outline details. Some people have a reaction to the dye (hives, flushing, trouble breathing). Be sure to tell the doctor if you have ever had problems with contrast dye or have shellfish allergies. CT scans can also be used to guide a biopsy needle into a tumor.

CT scans take longer than regular x-rays. You will need to lie still on a table as the part of your body being scanned is placed within the scanner, a doughnut-shaped machine that goes around the table. The test is painless, but you may find it hard to hold still for minutes at a time. This is less of a problem with modern scanners, which are much faster.

CT scans help tell if your bone cancer has spread into your lungs, liver, or other organs. These scans also show the lymph nodes and distant organs where there might be cancer.

MRI (magnetic resonance imaging): MRI scans use radio waves and strong magnets instead of x-rays to make detailed pictures of parts of the body. Sometimes a contrast dye might be used, just as with CT scans.

MRI scans are often the best test for outlining a bone tumor. They are also useful for looking at the brain and spinal cord.

MRI scans take longer than CT scans, often up to an hour. And you have to be placed inside a tube, which can upset some people. The machine makes thumping and clicking noises, but many places will give you headphones with music to block this out.

Radionuclide bone scan: A bone scan helps show whether cancer has spread to other bones. It can also show how much the cancer has damaged the bone. In this test, a radioactive material is put into a vein in your arm. (The radioactivity is very low and causes no long-term effects.) The material is attracted to diseased bone cells throughout the body. A special camera then takes a picture. The picture shows the diseased bone as dense, gray to black areas, called "hot spots." These areas may be cancer. But arthritis, infection, and other bone diseases can look much the same. The doctor may use other tests or biopsies to find out for sure what is causing the hot spots.

PET scan (positron emission tomography): PET scans use a radioactive glucose (a type of sugar), which can be seen by a special camera. The radioactive material is put into a vein in your arm. Because cancer cells are very active, they take in large amounts of the sugar. A PET scan can be more helpful than many x-rays because it scans the whole body. It can sometimes help tell whether or not a tumor is cancer. PET scans are being combined with CT scans to better pinpoint some kinds of cancer.

Biopsy

A biopsy is a sample of tissue taken from a tumor so that it can be looked at it under a microscope. This is the only way to know that the tumor is cancer and not some other bone disease. The biopsy can also help tell if the cancer started in the bone or started somewhere else and spread to the bone. The surgeon doing the biopsy needs to have experience diagnosing and treating bone tumors. Mistakes at this point can lead to removing too much tissue, which can limit options for saving an arm or leg. (This is called limb-sparing surgery. It is discussed later in the section "How is bone cancer treated?")

There are 2 different types of biopsies: needle biopsy and surgical bone biopsy.

Needle biopsy: This can be done with a thin (fine) or a thick (core) needle. For both types, a drug is first used to numb the area for the biopsy. The fine needle biopsy removes a small amount of fluid and pieces of tissue. The doctor aims the needle by feeling the area. If the tumor is deep inside the body, the needle can be guided by a CT scan. A core needle biopsy uses a bigger needle. With a core biopsy, the doctor takes out a small cylinder of tissue.

Surgical bone biopsy: For this biopsy, the doctor cuts through the skin to get to the tumor and take out a small piece of it. This is often done using drugs to numb the skin and tissue around the tumor. It can be done under general anesthesia (when drugs are used to put the patient into a deep sleep). It can also be done using a nerve block, which makes a large area numb. If this type of biopsy is needed, it is important that the surgeon who will later remove the cancer also does the biopsy.

Last Medical Review: 10/21/2009
Last Revised: 10/21/2009