BONE CANCER TESTS

Usually you begin by seeing your doctor who will examine you and ask about your general health.  Your doctor will ask you about your symptoms.  This will include what they are, when you get them and whether anything you do makes them better or worse.

Your doctor will ask you to lie down for a physical examination and will feel the area where there is pain or swelling.  It may feel tender or it may be possible to feel a lump. After your examination, your doctor may need to refer you to hospital for tests and X-rays.  You may be referred directly to a specialist or your doctor may send you to hospital for some tests first - usually an X-ray of the bone at the local hospital.

At the hospital
If you see a specialist, you will be asked about your medical history and symptoms.  The specialist will then examine you by feeling the bone that is painful or swollen.  You may be asked to have blood tests and a chest X-ray to check your general health.  Then your tests will be arranged in the out patients department.  You may be asked to have:-

  • X-rays     
  • A bone scan  
  • An MRI scan     
  • A biopsy

X-rays
X-rays use a low dose of radiation to take pictures of the body.  The bones show up well on X-rays and this is the first test you are likely to have.  Sometimes X-rays can give a very characteristic picture, which can help the specialist to diagnose particular types of bone cancer.  A primary bone tumour will usually show up as one of the following:-

  • Destruction of bone 
  • New bone growth 
  • Swelling over the bone 
  • Swelling in the soft tissues surrounding the bone
Bone Scan
Bone scans are very sensitive and can show up a number of problems with the bones.  You are given a small injection of a mildly radioactive material.  This collects in areas of damaged bone called hot spots.  Hot spots can mean bone cancer.  But they can also show if you have arthritis or other bone diseases.  The amount of radioactivity used in a bone scan is very small.  It soon breaks down and goes away and is nothing to worry about. 

MRI Scan                                                                                                                                                                          

MRI scans are now routinely done as an investigation for bone tumours.  MRI stands for magnetic resonance imaging.  This is a scan using magnetism to build up a picture of the inside of the body.  They are very useful for showing up how far a bone tumour has grown inside a bone.  MRI scans are completely painless, but rather noisy and you have to stay very still while the scan is being taken. You cannot have an MRI if you have any metal parts in your body, for instance a pacemaker or a joint replacement.  Do check with your doctor if you are at all concerned. 

Biopsy
Some bone tumours are benign - they are not cancer and cannot spread.  The only sure way to tell if a lump is a cancer or a benign tumour is to get a sample of the lump and examine it under a microscope.  This is called a biopsy.  Remember - a bone biopsy is a highly specialised procedure.  It should only be done by a specialist.  If it is done badly, it can spread the cancer.  If you are suspected of having a bone cancer, ask for the biopsy to be done at the specialist centre where you will be treated if the diagnosis is confirmed.

The biopsy will be examined by a pathologist.  This is a specialist in body tissues and cells.  The cells of a cancer look different to benign bone tumour cells.  There are 3 main types of biopsy you can have:- Fine needle aspiration + Core needle biopsy + Surgical biopsy

Fine needle aspiration is sometimes written as fna.  A thin needle is put into the lump in your bone.  The specialist will try to feel the lump so that he or she knows where to put the needle.  If the lump is hard to feel, the doctor may use an ultrasound scan to see exactly where it is and guide the needle into place.  

Once the needle is in the lump, fluid will be drawn out.  The fluid will contain cells which will be examined to see if they are cancerous.  

A core needle biopsy (or Tru-Cut biopsy) is the same as an fna, but uses a wider needle.  A core of bone tissue is drawn out, rather than just fluid and cells.  The tissue will be examined for cancer cells.  You may have this done under local anaesthetic.  You can ask for something to make you drowsy as well if you are at all nervous about it.  

Surgical biopsy is not used so often these days.  During a minor operation, a small piece of bone is removed.  This may be done under local or general anaesthetic.  Doctors do not do this test unless they have to.  Any operation carries an infection risk and infection in the bone can be difficult to deal with.    

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