Primary Bone Cancer: Diagnosis

March 21, 2017

Primary Bone Cancer: Diagnosis

If your healthcare provider thinks you might have primary bone cancer (cancer that starts in your bones), you will need certain exams and tests to be sure. Diagnosing bone cancer starts with your healthcare provider asking you questions. He or she will ask you about your health history, your symptoms, risk factors, and family history of disease. Your healthcare provider will also give you a physical exam.

What tests might I need?

You may have 1 or more of the following tests:

  • X-rays and other imaging tests

  • Blood tests

  • Biopsy

X-rays and other imaging tests

An X-ray of the bone is usually the first test you will have if your doctor thinks you might have a primary bone cancer. Most bone cancers will show up on X-rays. The tumor will often give the bone a ragged look. Or it may form a hole in the bone. X-rays can often show the size, location, and shape of a primary bone tumor. If the tumor looks like cancer, the doctor might suggest other imaging tests, such as an MRI, to get a better look at the tumor. A doctor can often tell if a bone tumor is likely to be cancer based on how it looks on the X-ray or other imaging tests. But a biopsy of the tumor is needed to know for sure. 

Blood tests

Your doctor might order blood tests to measure the levels of some substances in your body, such as alkaline phosphatase. Levels of this substance are often high in people who have recently broken a bone or who have bone cancer. This test may not be accurate in children and teens, who can have high levels because their bones are still growing. Other blood tests can also be done to help improve the accuracy of this test.


A biopsy is the only sure way to tell for sure if you have bone cancer. A biopsy can also help the doctor tell if the tumor is a primary or secondary bone cancer. A secondary bone cancer is one that has spread to the bone from another part of the body.

Your doctor can take a bone biopsy in 2 ways:

  • Surgical biopsy (also called an open bone biopsy)

  • Needle biopsy 

Your biopsy should be done by a surgeon who is experienced in diagnosing and treating bone tumors. 

Surgical biopsy

A surgical biopsy is also called an open bone biopsy. This is considered a minor surgery because the doctor makes a small cut or incision. The incision allows the doctor to take a sample of tissue from the bone tumor.

Before the biopsy, tell your doctor if you are taking any blood-thinning medicines. Usually, you will be told to stop taking these medicines a few days before a surgical biopsy.

Young children need general anesthesia, which makes them sleep during the surgery. Most adults also have general anesthesia before a surgical biopsy. Some people can be awake for the procedure. They only need medicine to numb the skin above the bone tumor.

During the biopsy, the doctor cuts through your skin to remove a small part of the tumor. In some cases, the doctor removes the whole tumor. But this must be carefully planned and is not normally done. Often, during the surgery, a doctor called a pathologist will examine a piece of the removed bone tissue. He or she will look for cancer cells. The pathologist will also see if more tissue needs to be removed. This is called a frozen section analysis.

Needle biopsy

Needle biopsies can be done in 2 ways:

  • Fine needle biopsy

  • Core needle biopsy

Before any needle biopsy, tell your doctor if you are taking any blood-thinning medicines. Usually, you will be told to stop taking these medicines a few days before the biopsy.

A needle biopsy is typically done with a local numbing medicine injected over the biopsy site. You might also get medicine into a vein to make you feel relaxed or sleepy.

If the tumor is near the surface of your body, the doctor can aim the needle by feeling the tumor. If the tumor is too deep to feel by hand, the doctor may use a CT scan to guide the needle to the tumor. The CT scan takes pictures of the inside of your body. The doctor can see on a computer screen where the needle is going. 

Fine needle biopsy. A fine needle biopsy uses a very tiny, hollow needle. The doctor inserts the needle into the tumor and removes small amounts of fluid and tissue. A fine needle biopsy is only accurate for some types of tumors. It isn’t used very often for bone tumors.

The procedure normally takes only 10 to 15 minutes. The doctor looks at the samples right away to make sure enough cells were taken.

Core needle biopsy. With a core needle biopsy, the doctor uses a large needle to remove a small plug, or core, of tissue. The tissue removed is often enough to diagnose any type of tumor.

During the biopsy, you may feel some pressure and mild pain. But it is important to stay still. You'll have a small amount of bleeding where the doctor inserts the needle. The doctor or nurse will put pressure on the small needle hole until the bleeding stops. Then the area will be cleaned and covered with a bandage.

Getting your test results

It usually takes a few days for biopsy results to come back. Waiting for the results can be stressful. But it is important to get the correct diagnosis. When your healthcare provider has the results, he or she will contact you. Your provider will talk with you about other tests you may need if primary bone cancer is found. Make sure you understand the results and what follow-up you need. 


March 21, 2017


Bone tumors: Diagnosis and biopsy techniques. UpToDate.

Reviewed By:  

Alteri, Rick, MD,Levin, Mark, MD