Primary Bone Cancer: Tests to Check the Extent of the Cancer

If your healthcare provider thinks you have primary bone cancer (cancer that started in your bones), he or she will need to do more tests to be sure. Your healthcare provider will often order imaging tests before a biopsy is done. (A biopsy is when a small piece of the tumor is taken out to be checked for cancer cells.)

These tests can help your healthcare provider learn more about the type of cancer and its specific location. You will likely have more than one of these tests. These tests can show the size of the tumor and help show if the cancer has grown into nearby areas or spread to other parts of your body. If you do have cancer, the test results help your healthcare providers decide the best options for treating it. If you have any questions about these or other tests, be sure to talk with your healthcare team.

The tests you may have can include:

• X-ray

• MRI

• CT scan

• Bone scan

• PET scan

X-ray

An X-ray is a simple test that uses a small amount of radiation to get a black-and-white picture of your bones. Cancer can look like a black hole in the white bone.

A chest X-ray may also be done to see if the cancer has spread to your lungs.

MRI

An MRI uses magnets, radio waves, and a computer to create detailed pictures of the inside of your body. This test can help show the shape of the bone tumor and if it has grown into nearby areas.

MRIs don't hurt. But they can take a long time to complete, often an hour or longer. During that time, you must lie still on a table that is moved into a long, narrow tube. The scanner is a small space. If you are uncomfortable in small spaces, you may be given a sedative to relax you. Some hospitals and clinics have open MRI scanners. These are less confining, but the images may not be as sharp in some cases. When the scanner is working, it can be very loud. You may be given earplugs or headphones to wear. A 2-way intercom will let you talk to the technician during the test.

CT scan

A CT scan uses special X-rays to make detailed pictures of the inside of your body. During a CT scan, a doughnut-shaped X-ray machine scans the area of your body where your healthcare provider suspects there is cancer. 

A CT scan of the bone tumor can help show the extent of the tumor. CT scans can also help show if the cancer has spread to other parts of your body, such as your lungs. 

A CT scan is painless. Before the scan you may get an injection into your vein of contrast dye. The dye helps outline parts of your body so that they show up better on the CT scan.

During the test, you lie still on an exam table. The table slides through the center of the CT scanner. The scanner takes pictures of your body from many angles. The technician may ask you to hold your breath one or more times during the scan. A computer combines these pictures to create detailed cross-sectional images of your body.

Bone scan

Bone scans show areas of cell activity in bones, which can sometimes be a sign of cancer. Bone scans can often show where the cancer has spread. They can find metastases, or the spread of cancer, earlier than an X-ray. Bone scans don’t make detailed images. So other tests, such as X-rays or CT scans of the bone, may be needed if any abnormal spots are seen. 

For this test, a small amount of a mildly radioactive substance is injected into a vein. It travels through your blood vessels and collects in areas of abnormal bone growth. You need to wait about two hours between the injection and the bone scan. It’s recommended that you drink fluids during that time to help spread the dye around. You then lie on a table for about 30 minutes while a machine scans your body for the places the substance has collected. These are sometimes called hot spots. The amount of radioactive material used for this test is small. It shouldn’t be harmful to you or your family.

PET scan

A PET scan looks for cancer all over your body. It can sometimes tell if a tumor is cancer or not cancer (benign). For this test, a small amount of sugar that has a mildly radioactive tracer will be injected into a vein in your arm.  Cancer cells absorb more of the radioactive sugar than normal cells, so they are more likely to show up on the test. 

One hour after you get the radioactive tracer, you’ll get the PET scan. You will lie still on a table that is pushed into the scanner. It will rotate around you and take pictures. Other than the injection, a PET scan is painless. Some people are sensitive to the substance, and may have nausea, a headache, or vomiting. Some newer machines can do PET and CT scans at the same time, so areas that show up on the PET scan can be compared to the more detailed image of the CT scan.

Working with your healthcare provider

Your healthcare provider will talk with you about which tests you'll have. Make sure to follow your healthcare providers directions for how to get ready for the tests.  Ask questions and talk about any concerns you have.