Rare bone cancer patient shares his story
Diagnosing Bone Cancer
To learn if you have bone cancer, you'll likely visit a number of specialists, including an orthopedic oncologist and surgeon. You'll also have to have a few tests, maybe even a biopsy.
By Dennis Thompson Jr.
Medically Reviewed by Pat F. Bass III, MD, MPH
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If you have symptoms that point to bone cancer, you will undergo a series of tests designed to determine if you have cancer and, if so, what form of bone cancer. The tests also will help establish whether the cancer originated in the bone, called primary bone cancer, or has spread to the bone from another cancerous organ, which is known as metastatic bone cancer. Doctors use the results of these tests to decide the best approach for treatment.
Diagnosis likely will begin with your own primary care doctor, who will take your personal medical history to see if there are any inherited conditions that could lead to bone cancer. However, as the tests become more sophisticated, you likely will have to see an orthopedic oncologist, a specialist who deals with musculoskeletal cancers. A surgeon also will need to be consulted and may perform biopsies and remove tumors.
Bone Cancer Diagnosis: Imaging Tests
Doctors who suspect a tumor in a limb that has intermittent or constant pain will recommend an imaging test to see if there is a bone cancer tumor present. Options for imaging tests include:
- X-rays:Most bone cancers are easy to see on X-rays. The cancer site appears ragged, while the bone around it seems solid. There may also be a tumor present that has grown out into nearby muscle, fat, or connective tissues like ligaments or cartilage.
- CT (computed tomography) scan:This test produces detailed cross-sectional images. A scanner revolves around you, using X-rays to take many pictures. The images are then combined in a computer to form a comprehensive look at particular areas on the inside of your body. These scans can help locate cancer, determine its size, and find out if it has spread into other organs.
- MRI (magnetic resonance imaging):These scans use strong magnets linked to a computer to create a detailed image of the inside of your body. They are great at determining the exact shape of a bone cancer tumor.
- Bone scan:Patients receive an injection of a low-level radioactive material that is attracted to abnormal or diseased bone cells in the skeleton. X-rays are then taken. Bone cancer will show up on the images as dense gray or black areas called hot spots. However, arthritis and other bone diseases also look this way, so doctors likely will follow up with other imaging tests or take a biopsy.
- PET (positron emission tomography) scan:These tests use a substance called irradiated glucose, which is injected into the body and migrates quickly to cancer cells because of cancer's high rate of metabolism. This is a useful test for looking for cancer throughout a patient's body, and sometimes can help determine if a tumor is cancerous or benign.
Bone Cancer Diagnosis: Blood Tests
Your doctor may also ask for a blood test to see if the results may indicate bone cancer. The test will look for:
- How many blood cells are present in your bloodstream.Cancer can affect the blood, altering normal blood cell content.
- The level of alkaline phosphatase in your blood.This enzyme is found at high levels in the blood when bone-forming cells become exceedingly active. This much activity normally occurs when a child is growing or when broken bones are mending. Otherwise, it is an indication that a bone cancer tumor is working at high speed, churning out abnormal bone tissue.
Bone Cancer Diagnosis: Biopsy
In the end, the only way to be completely sure if you've got bone cancer is to have a biopsy. Tissue is taken from the site of the suspected tumor and examined under a microscope. There are two ways to remove the tissue:
- Needle biopsy:A surgeon will guide a needle into the bone cancer site (anesthesia will be used to numb the area) and withdraw tissue and blood for testing. A CT scan often is used to help guide the needle to the correct location.
- Surgical bone biopsy:In this type of biopsy, a surgeon cuts through the skin to remove tissue from the suspected cancer site. It is important that a skilled surgeon perform this sort of biopsy, as any mistakes could limit treatment options later on. In fact, it is often good to have the same surgeon who will be performing your cancer surgery also take the biopsy.
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