A biopsy is the only test that can confirm a cancer diagnosis. However, before doctors conduct a biopsy, they may take a person’s medical history, perform a physical exam, and order various imaging tests.
Aside from a biopsy and imaging, doctors may also use bone scans and blood tests when evaluating a person for bone cancer. They will try to rule out bone cancer with less invasive tests before a biopsy.
This article discusses what a bone cancer diagnosis involves, including the initial exam, imaging, blood tests, and a definitive bone cancer test, which is a biopsy. It also explains what the test results mean.
A medical history and physical exam are the first steps in the diagnostic process. When taking a person’s medical history, a healthcare professional will try to find out whether a person has any genetic conditions that may predispose them to bone cancer.
The physical exam involves identifying local and systemic symptoms. Local symptoms are those that relate to the location of the tumor. Systemic symptoms are those that relate to how the whole body responds to cancer in general.
Healthcare professionals will also look for health problems in other body parts. This is because bone cancer
If this step suggests a possible bone cancer diagnosis, an urgent referral to a specialist is necessary.
If a healthcare professional suspects bone cancer, they may order one or more of the following imaging tests:
- X-rays: X-rays use radiation to create images. They are often the first test a doctor orders if the physical exam suggests a bone tumor.
- MRI scans: Instead of radiation, MRIs use strong magnets and radio waves to produce images. They provide a more detailed view than X-rays and help determine the extent of the tumor.
- CT scans: These combine many X-rays to create detailed cross-sectional images of a part of the body. CT scans generally do not offer as much detail about a tumor as MRIs, but doctors frequently use them to locate metastases of bone cancer in other parts of the body.
- PET scans: These involve the injection of radioactive sugar into the body, which can show a tumor because cancer cells absorb increased amounts of sugar. PET scans do not offer as much detail as MRIs or CT scans, but they can reveal metastases of bone cancer to other areas.
Blood tests for bone cancer measure the levels of two enzymes: alkaline phosphatase and lactate dehydrogenase.
These enzymes may be present in
Elevated alkaline phosphatase levels indicate bone turnover. This can happen in people with bone cancer as healthy bone tissue is destroyed.
Although alkaline phosphatase levels are typically higher in people with bone cancer, they can also be higher when a broken bone is healing. They also tend to be elevated in growing children and adolescents.
Because of this, alkaline phosphatase is not a reliable indicator of bone cancer.
If imaging tests suggest bone cancer is present, a biopsy is typically the
There are two types of biopsy: needle and open surgery.
During a needle biopsy, a healthcare professional will use a large needle type to remove a small amount of tissue from a tumor. In an open surgery biopsy, a healthcare professional removes either a piece of a tumor or an entire tumor.
Bone scans can reveal whether cancer has spread to other bones. These scans are helpful because they can show all the bones in the body in one scan.
Bone scans involve a healthcare professional injecting a small quantity of radioactive material into a person’s blood, accumulating in the bones. Then, the healthcare professional uses a special camera that employs radioactivity to create an image of the skeleton.
Parts of the bones that have active changes attract the radioactivity. They appear as “hot spots” on an image.
The test results provide a framework for doctors to determine the stage of bone cancer. A stage indicates the location of the tumor and where it has spread. It shows how serious the cancer is and helps doctors decide on the best course of treatment.
Stage classifications depend on the following:
- Grade: Microscopic examination reveals the grade, which is how likely cancer is to grow and spread. Low grade cells appear more normal, but high grade cells appear more abnormal.
- Extent of primary tumor: This indicates whether a bone tumor has grown outside of a bone into the surrounding tissues.
- Metastasis: This refers to tumors that have spread to lymph nodes and other organs.
Based on the above factors, primary bone cancer is
- Stage 1: low grade, localized tumors
- Stage 2: high grade, localized tumors
- Stage 3: tumors that have spread, regardless of grade
While staging is one factor that helps determine treatment, other considerations can also play a role. These may include the type of bone cancer and the person’s general health.
There are many tests for bone cancer, but a biopsy is the only one that can confirm a cancer diagnosis.
A biopsy is one of the last tests a doctor uses to make a diagnosis after a physical exam, imaging, bone scans, and blood tests indicate someone may have bone cancer.
The results of all these tests provide a framework for staging the cancer. This shows how much the cancer has progressed and helps determine treatment options.