Diagnosis of Bone Cancer

Executive Summary

Bone cancer is diagnosed based on signs and symptoms. The diagnosis of bone cancer relies on the type of tumor, such as benign and malignant. There are different types of tests for the diagnosis of bone cancer. Imaging tests are conducted for diagnosing bone sarcoma. Other diagnostic tests include blood tests, bone scans, x-rays, computed tomography (CT) scan, magnetic resonance imaging (MRI), positron emission tomography (PET) or PET scan, biopsy, needle biopsy and surgical biopsy.

Diagnostic Approach of Bone Cancer

Many tests are performed to find or Diagnosis of Bone Cancer. Also, tests are done to learn if cancer has spread to parts other than it started. 

For instance, imaging tests may be used to diagnose bone sarcoma and determine whether it has spread ​1​. Benign and cancerous tumors usually look different on imaging tests ​2​.

The different tests can be used for a person depending upon the following factors – 

  • Your signs and symptoms
  • The age and general health status
  • The type of cancer suspected
  • The result of earlier medical tests

The given tests may be used for the Diagnosis of Bone Cancer:

Blood tests

Some laboratory tests can help find bone sarcoma ​3​. People with Ewing sarcoma or osteosarcoma may have high alkaline phosphatase and lactate dehydrogenase levels in their blood. However, high levels are not always an indicator of cancer. Alkaline phosphatase levels are high when cells forming bone tissue are active.

Bone scan

A bone scan can help discover the stage of bone sarcoma. A bone scan utilizes a radioactive tracer to look inside the bone. It can help find whether cancer has spread to other places in the bone and how much damage it has caused. 

Healthy bone seems lighter to the camera, and areas of injury, such as those caused by cancerous cells, stand out in the image. However, other conditions like arthritis or infection look similar on the scan, so a confirmatory biopsy is often needed.

Also Read: Emotional wellness for cancer


Cancer makes the bone look different from the surrounding healthy bone. The bone may appear to have a hole. 

Computed Tomography (CT scan)

A CT SCAN takes pictures of the inside of the body using x-rays taken from different angles. A computer combines photos into a detailed, 3-dimensional image that shows abnormalities or tumours. Sometimes, a special dye known as contrast medium is given before the scan to provide superior detail to the image. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow. CT scans may be used to guide the biopsy needle.

Magnetic resonance imaging (MRI)

An MRI may help find a tumour in the bone and determine whether cancer cells have spread to the brain or spinal cord. MRIs provide a road map for the orthopaedic oncology surgeon to perform the best cancer surgery possible.

Positron emission tomography (PET) or PET-CT scan

A PET scan creates images of organs and tissues present inside the body. A small amount of a radioactive substance is injected into the patient’s body which is taken up by cells using the most energy. The cancer cells which use energy actively take up the radioactive substance, and the scanner then spots this substance to produce images of the inside of the body. In bone cancer, this scan provides a more comprehensive view to determine the presence of abnormal activity, even before a tumour may have developed. 


A biopsy removes a small part of tissue to examine under a microscope. A biopsy is a sure way to know if you have cancer in a particular region or organ of the body for most types of cancer. 

Needle biopsy

The area is made with a local anaesthetic before inserting a needle into the doubtful site to get a sample of cells. In some cases, a CT scan can be used to help guide the needle.

Surgical biopsy

It is usually performed under general anaesthesia by a surgeon, who will remove a sample of the tissue (incisional biopsy) or the whole tumour (excisional biopsy).

The patients should be seen in a sarcoma speciality centre even before the biopsy is performed because the type of biopsy and its procedure are essential in diagnosing and treating sarcoma.

After the tests for diagnosis are done, the doctor will analyze all the results with you. These results can help the doctor describe cancer if the diagnosis is cancer.

  1. 1.
    Ferguson J, Turner S. Bone Cancer: Diagnosis and Treatment Principles. Am Fam Physician. 2018;98(4):205-213. https://www.ncbi.nlm.nih.gov/pubmed/30215968
  2. 2.
    Krämer JA, Gübitz R, Beck L, Heindel W, Vieth V. Bildgebende Diagnostik der Knochensarkome. Unfallchirurg. Published online June 2014:491-500. doi:10.1007/s00113-013-2470-6
  3. 3.
    Gumay S. Pathological diagnosis of bone sarcoma. Gan To Kagaku Ryoho. 2000;27 Suppl 2:420-426. https://www.ncbi.nlm.nih.gov/pubmed/10895189