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Overview
To diagnose primary bone cancer, your doctor will ask about your medical history and do a physical examination. You will also have tests such as x-rays, CT/MRI and specialised scans and a bone biopsy.
The tests will help show where the cancer is and if it has spread. The cancer can be low or high grade (growing slowly or more quickly) and localised (only in the bone where it started) or advanced (this means it has spread to another part of the body).
Diagnosis
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 – highlight any cancerous areas in the body with a small amount of radioactive solution that is injected before a scan, e.g. PET, thallium or technetium scans
- bone biopsy – collects some cells and tissues from the outer part of the affected bone. 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. For an open biopsy, you have a general anaesthetic, then the surgeon makes a cut in the skin to remove a piece of bone. The sample is tested for cancer cells and checked for gene 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.
Staging
The test results will help show where the cancer is and if it has spread. This is called staging. Knowing the stage helps your doctors plan your treatment.
Grades of primary bone cancer
Grading describes how quickly a cancer might grow. In general, the lower the grade, the better the outlook.
- low grade – The cancer cells look like normal cells. They usually grow slowly and are less likely to spread.
- high grade – The cancer cells look very abnormal. They grow quickly and are more likely to spread.
Stages of primary bone cancer
Many cancers are staged using a system that divides them into 4 stages, but bone cancer is different. It is usually divided into localised or advanced. Ask your doctor to explain the stage of cancer to you.
- localised – The cancer contains low-grade cells and is found in the bone in which it started. It can be removed by surgery (resectable) or not removed completely (non-resectable).
- advanced (metastatic) – The cancer is any grade and has spread to other parts of the body (e.g. the lungs).
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