How is bone cancer diagnosed?

To diagnose bone cancer, the doctor asks about the patient’s personal and family medical history and does a complete medical exam. The doctor may suggest a blood test to determine the level of an enzyme called alkaline phosphatase. A large amount of alkaline phosphatase can be found in the blood when the cells that form bone tissue are very active—when children are growing, when a broken bone is mending, or when disease or a tumor causes production of abnormal bone tissue. Because high levels of this enzyme can normally be found in growing children and adolescents, this test is not a completely reliable indicator of bone cancer.

X-rays can show the location, size, and shape of a bone tumor. If x-rays suggest that a tumor may be cancer, the doctor may recommend special imaging tests such as a bone scan, a CT (or CAT) scan, an MRI, or an angiogram. However, a biopsy—the removal of a sample of tissue from the bone tumor—is needed to determine whether cancer is present.

The surgeon may perform a needle biopsy or an incisional biopsy. During a needle biopsy, the surgeon makes a small hole in the bone and removes a sample of tissue from the tumor with a needle-like instrument. In an incisional biopsy, the surgeon cuts into the tumor and removes a sample of tissue. Biopsies are best done by orthopedic oncologists—doctors experienced in the diagnosis of bone cancer. A pathologist—a doctor who identifies disease by studying cells and tissues under a microscope—examines the tissue to determine whether it is cancerous.