How is Bone Cancer Diagnosed?

First published April 16, 2020

If you think you may have bone cancer and want to understand how it’s diagnosed, there are a variety of methods your doctor might use to confirm it. Bone cancer symptoms typically start with bone pain and swelling; from there, patients turn to their doctors for physical exams, imaging tests, and biopsies.

If you’re wondering what bone cancer looks like or what its symptoms are before getting into the diagnostic process, those guides cover that ground in depth. This article walks through what happens once you’re in front of a doctor: the tests, the biopsy, and how staging and grading come together to shape a treatment plan.

How Is Bone Cancer Diagnosed?

Diagnosing bone cancer is a multi-step process. It typically starts with a medical history and physical exam, moves into imaging tests to get a closer look at the affected bone, and, if those results are concerning, ends with a biopsy, since that’s the only way to confirm whether a tumor is cancerous.¹ Once a diagnosis is confirmed, doctors stage and grade the cancer to guide holistic treatment for bone cancer.

Here are the diagnostic steps at a glance:

Recognizing the Symptoms That Lead to Diagnosis

The symptoms and signs of bone cancer are usually what lead to a diagnosis in the first place, most often pain in the affected bone that gets worse at night or with activity, along with swelling or a lump. For many people with bone cancer, these symptoms are the reason they see a doctor at all. There is currently no test that screens for bone cancer before symptoms appear, which is part of why recognizing these signs early matters.¹ Once those symptoms bring you to a doctor, the following process typically happens next.

The most common types of bone cancer are osteosarcoma, chondrosarcoma, and Ewing sarcoma, which differ based on the type of cell where the cancer began.

What Tests Are Used to Diagnose Bone Cancer?

Medical History and Physical Exam

The doctor starts by taking a complete medical history and physical exam, asking about symptoms, risk factors for developing bone cancer, and overall health, while looking for information about potentially malignant tumors. Since bone cancer can sometimes be secondary bone cancer, the doctor will also want to find out if the tumor started in the bone or spread there from another type of cancer elsewhere in the body.²

Imaging Tests

Imaging tests create pictures of the inside of the body and help doctors tell bone cancer apart from other bone diseases like osteoporosis or infection.¹ They’re useful for several reasons: determining if a suspicious area might be cancer, seeing if cancer started elsewhere and spread to the bone, figuring out how far cancer has spread (which factors into it bone cancer stages), checking if treatment is working, and watching for signs cancer has returned.³

• X-rays: usually the first test ordered. Most bone cancers show up on an X-ray, appearing “ragged” instead of solid, or as though a hole has formed in the bone. A chest X-ray may also be done to check whether cancer has spread to your lungs.
• CT scans: help stage cancer and show whether it has spread to other organs or lymph nodes. CT scans can also help guide a biopsy needle into a tumor.⁴
• MRI: uses magnetic fields and radio waves rather than radiation to produce a detailed image of bone and soft tissue, helping determine the size and spread of the tumor.⁴
• Radionuclide bone scan: shows whether cancer has spread to other bones and how much damage has occurred.⁴
• PET scan: uses a small amount of radioactive sugar and a specialized camera to spot cancer cells throughout the body, and can help distinguish a benign tumor from a malignant one.⁴

Blood Tests

Blood tests aren’t needed to diagnose bone cancer itself, but they help after a diagnosis is made. High levels of certain chemicals in the blood, like alkaline phosphatase, can suggest the cancer may be more advanced, though these levels can also rise for reasons unrelated to cancer.²

What Happens During a Bone Biopsy?

Imaging results might strongly suggest bone cancer, but a biopsy is the only way to know for certain.⁴ During a biopsy, a doctor removes one or more pieces of tissue from the tumor. The biopsy sample is then examined under a microscope by a pathologist, who confirms whether it’s cancerous and, if so, what type and grade it is.

The type of biopsy depends on whether the tumor looks likely to be benign or malignant, and on the tumor’s type and location^2,4:

• Needle biopsy: a thin, hollow needle is inserted through the skin to remove a small sample of tissue. If the tumor is near the surface, the doctor can often aim the needle by feeling the area; for tumors too deep to feel, imaging like CT is used to guide the needle. This is usually done with numbing medicine at the biopsy site, though some situations call for general anesthesia.
• Surgical biopsy: a doctor, usually an orthopedic surgeon, reaches the tumor through a cut in the skin. An incisional biopsy removes only a small part of the tumor; an excisional biopsy removes the entire tumor, which tends to be more feasible for smaller tumors.

Because the wrong type of biopsy can make later surgery more difficult or increase the risk of cancer spreading, it’s important that a bone biopsy is performed by someone experienced with bone tumors, ideally the same doctor who would carry out any surgical treatment.

Reasonable questions to ask before a biopsy include how much experience the doctor has with that type of biopsy, whether they’re part of a team that treats bone cancers regularly, and how long results typically take.

Bone Cancer Staging and Grading

Once a diagnosis is confirmed, doctors determine how advanced the cancer is using staging and grading. Staging assesses how far the cancer has spread; grading indicates how aggressive the cancer cells appear compared with normal bone cells under a microscope, using the same biopsy sample the pathologist has already examined. Together, these factors guide treatment planning, since a low-grade tumor is generally managed differently from a high-grade one.

Here are the bone cancer stages (I-IV):

• Stage I: localized within the bone, hasn’t spread, and is low-grade (slow-growing)
• Stage II: still within the bone but high-grade, meaning more aggressive
• Stage III: spread within the same bone, with high-grade tumor cells
• Stage IV: the most advanced stage, where cancer has spread beyond the bone to other parts of the body, such as the lungs, liver, or other bones

Grading: Low-grade cancer cells look more like normal bone cells and grow slowly; high-grade cells are significantly abnormal and grow more aggressively, increasing the risk of metastasis.

What Happens After Diagnosis?

Once staging and grading are complete, your care team uses that information to build a treatment plan, which may involve surgery, radiation, chemotherapy, or a combination of these, depending on the type and stage of cancer. For a closer look at what that planning process involves, see our guides to how long you can live with bone cancer, which covers survival statistics by stage.

At Immunity Therapy Center, we focus on how to treat bone cancer naturally as a complement to whatever treatment plan your care team recommends, not a replacement for it. Our alternative cancer treatments are built around each patient’s specific diagnosis, stage, and grade, since no two cases are identical. The five-year survival rate across all bone cancers in children and adults is around 70%, though your own outlook depends heavily on your specific diagnosis, which is exactly why an accurate, thorough diagnostic process matters so much before treatment begins.⁵

Frequently Asked Questions

Is a biopsy always needed to diagnose bone cancer?

Yes. Imaging tests can strongly suggest bone cancer, but a biopsy is the only way to confirm it and determine the exact type and grade.

How accurate is imaging alone?

Imaging is very useful for narrowing down what a suspicious area might be, and doctors can sometimes recognize a likely tumor from an X-ray alone, but imaging can’t definitively distinguish cancer from other conditions like infection or benign bone damage. That’s why a biopsy is still needed to confirm a diagnosis.

How long does the diagnostic process take?

It varies, but a typical timeline runs from an initial exam and imaging within days, to biopsy results about a week later, with staging and grading following shortly after. More complex cases or additional imaging can extend this timeline.

Ready to Build Your Treatment Plan

Receiving a bone cancer diagnosis brings a lot of information at once, imaging results, biopsy findings, a stage, a grade, but each piece plays a role in building a treatment plan that fits your specific case. If you’ve been diagnosed with bone cancer and want to explore complementary support alongside your care plan, reach out to the Immunity Therapy Center team today. We’re here to be part of your journey to wellness.

Sources:

1. cancer.org. Can Bone Cancer Be Found Early? cancer.org/cancer/bone-cancer/detection-diagnosis-staging/detection.html
2. medicinenet.com. Bone Cancer. medicinenet.com/bone_cancer_overview/article.htm
3. cancer.org. Tests for Bone Cancer. cancer.org/cancer/types/bone-cancer/detection-diagnosis-staging/how-diagnosed.html
4. cancer.org. Tests for Osteosarcoma. cancer.org/cancer/osteosarcoma/detection-diagnosis-staging/how-diagnosed.html
5. cancer.org. Key Statistics for Bone Cancer. cancer.org/cancer/bone-cancer/about/key-statistics.html

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