How is primary bone cancer diagnosed?

If you have symptoms, your doctor will ask about your medical history and do a physical examination. It is likely that you will have some of the following tests:

• x-rays – can show bone damage or whether new bone is growing
• blood tests – help check your overall health
• CT and/or MRI scans – create pictures to highlight any bone abnormality
• specialised scans – a small amount of radioactive solution is injected before a scan to highlight any cancerous areas in the body, e.g. PET, thallium or technetium scans
• bone biopsy – collects some cells and tissues from the outer part of the affected bone. This is best done in a specialised sarcoma treatment centre. 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 sample is taken using a needle. A CT or ultrasound scan is used to guide the needle into place. In an open biopsy, under general anaesthesia the surgeon makes a cut in the skin to remove a piece of bone. The sample is also checked for genetic changes
• bone marrow biopsy – a thin needle is used to remove a sample of marrow from the hip bone.

Selecting the bone site to biopsy

A bone biopsy is a specialised test. It is best to have the biopsy at the specialist treatment centre where you would be treated if it is cancer. The specialists will usually work together to decide the best site to place the needle. The site to biopsy must be carefully chosen so it doesn’t cause problems if further surgery is needed. This also helps ensure the sample is useful and reduces the risk of the cancer spreading.