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How is primary bone cancer diagnosed?

If you have symptoms that could be caused by bone cancer, your doctor will take your medical history and perform a physical examination. Bone cancer can be difficult to diagnose, and it is likely that you will have some of the following tests:

x-rays – can reveal bone damage or the creation of new bone

blood tests – help check your overall health

CT or MRI scans – a special computer is used to create pictures to highlight any bone abnormality

PET scan – you will be injected with a small amount of radioactive glucose solution to highlight any cancerous areas on the scan

bone biopsy – removes some cells and tissues from the outer part of the affected bone for examination under a microscope. The biopsy may be done in one of two ways. In a core biopsy, a local anaesthetic is used to numb the area, then a thin needle is inserted into the bone under CT guidance to take a sample. In an open or surgical biopsy, the surgeon will cut through the skin under general anaesthesia to remove a piece of bone.

If Ewing’s sarcoma is suspected, you will have a procedure to examine cells from the inner part of the affected bone. A thin needle is used to remove a sample of fluid (aspirate) from the bone marrow.

Selecting the bone site to biopsy

A bone biopsy is a highly specialised test. It is best that the biopsy is done at a specialist treatment centre, preferably where you would be treated if it is cancer. The site to biopsy must be carefully chosen so it doesn’t cause problems if further surgery is needed. It is important that a bone biopsy is performed by a doctor who is an expert in bone cancer. This also helps ensure the sample is useful and reduces the risk of the cancer spreading.

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This information is reviewed by

This information was last reviewed June 2019 by the following expert content reviewers: Dr Richard Boyle, Orthopaedic Oncology Surgeon, Royal Prince Alfred Hospital and Chris O’Brien Lifehouse, NSW; Dr Sarat Chander, Radiation Oncologist, Peter MacCallum Cancer Centre, VIC; James Hyett, Consumer; Rebecca James, 13 11 20 Consultant, Cancer Council SA; Dr Warren Joubert, Senior Staff Specialist Medical Oncology, Division of Cancer Services, Princess Alexandra Hospital, QLD; Kristyn Schilling, Clinical Nurse Consultant – Cancer Outreach Program, St George Hospital, NSW; Prof Paul N Smith, Orthopaedic Surgeon, Orthopaedics ACT.