What imaging tests you undergo depends on your situation. Your doctor may recommend one or more imaging tests to evaluate the area of concern, including:
- Bone scan
- Computerized tomography (CT)
- Magnetic resonance imaging (MRI)
- Positron emission tomography (PET)
Removing a sample of tissue for laboratory testing
Your doctor may recommend a procedure to remove a sample of tissue (biopsy) from the tumor for laboratory testing. Testing can tell your doctor whether the tissue is cancerous and, if so, what type of cancer you have. Testing will also reveal the cancer's grade, which helps doctors understand how aggressive the cancer may be.
Types of biopsy procedures used to diagnose bone cancer include:
- Inserting a needle through your skin and into a tumor. During a needle biopsy, your doctor inserts a thin needle through your skin and guides it into the tumor. The needle is used to remove small pieces of tissue from the tumor.
- Surgery to remove a tissue sample for testing. During a surgical biopsy, your doctor makes an incision through your skin and removes either the entire tumor (excisional biopsy) or a portion of the tumor (incisional biopsy).
Determining the type of biopsy you need and the particulars of how it should be performed requires careful planning by your medical team. Doctors need to perform the biopsy in a way that won't interfere with future surgery to remove bone cancer. For this reason, ask your doctor for a referral to a team of doctors with extensive experience in treating bone tumors before your biopsy.
Tests to determine the extent (stage) of the bone cancer
Once your doctor diagnoses your bone cancer, he or she works to determine the extent (stage) of your cancer. The cancer's stage guides your treatment options.
Stages of bone cancer include:
- Stage I. At this stage, bone cancer is limited to the bone and hasn't spread to other areas of the body. Stage I cancer is low grade, which means the cancer cells are less aggressive.
- Stage II. This stage of bone cancer is also limited to the bone and hasn't spread to other areas of the body. But Stage II cancer is high grade, which means the cancer cells are more aggressive.
- Stage III. At this stage, bone cancer occurs in two or more places on the same bone. Stage III tumors can be either low or high grade.
- Stage IV. This stage of bone cancer indicates that cancer has spread beyond the bone to other areas of the body, such as other bones or internal organs.
The treatment options for your bone cancer are based on the type of cancer you have, the stage of the cancer, your overall health and your preferences. Different bone cancers respond to different treatments, and your doctors can help guide you in what is best for your cancer. For example, some bone cancers are treated with just surgery; some with surgery and chemotherapy; and some with surgery, chemotherapy and radiation therapy.
The goal of surgery is to remove the entire bone cancer. In most cases, this involves special techniques to remove the tumor in one single piece, along with a small portion of healthy tissue that surrounds it. Types of surgery used to treat bone cancer include:
- Surgery to remove the cancer but spare the limb. If a bone cancer can be separated from nerves and other tissue, the surgeon may be able to remove the bone cancer and spare the limb. Since some of the bone is removed with the cancer, the surgeon replaces the lost bone with some bone from another area of your body, with material from a bone bank or with a special metal prosthesis.
- Surgery for cancer that doesn't affect the limbs. If bone cancer occurs in bones other than those of the arms and legs, surgeons may remove the bone and some surrounding tissue, such as in cancer that affects a rib, or may remove the cancer while preserving as much of the bone as possible, such as in cancer that affects the spine. Bone removed during surgery can be replaced with a piece of bone from another area of the body, with material from a bone bank or with a special metal prosthesis.
- Surgery to remove a limb. Bone cancers that are very large or located in a complicated point on the bone may require surgery to remove all or part of a limb (amputation). As other treatments have been developed, this procedure is becoming less common. You'll likely be fitted with an artificial limb after surgery and go through training to learn to do everyday tasks using your new limb.
Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy is most often given through a vein (intravenously). The chemotherapy medications travel throughout your body.
Chemotherapy may also be used in people with bone cancer that has spread beyond the bone to other areas of the body.
Radiation therapy uses high-powered beams of energy, such as X-rays, to kill cancer cells. During radiation therapy, you lie on a table while a special machine moves around you and aims the energy beams at precise points on your body.
Radiation therapy, typically given along with chemotherapy, is often used before an operation. This may increase the possibility that amputation won't be necessary.
Radiation therapy may also be used in people with bone cancer that can't be removed with surgery. After surgery, radiation therapy may be used to kill any cancer cells that may be left behind. For people with advanced bone cancer, radiation therapy may help control signs and symptoms, such as pain.
Coping and support
A cancer diagnosis can be overwhelming. With time you'll find ways to cope with the distress and uncertainty of cancer. Until then, you may find it helps to:
- Learn enough about bone cancer to make decisions about your care. Ask your doctor about your bone cancer, including your treatment options and, if you like, your prognosis. As you learn more about bone cancer, you may become more confident in making treatment decisions.
- Keep friends and family close. Keeping your close relationships strong will help you deal with your bone cancer. Friends and family can provide the practical support you'll need, such as helping take care of your house if you're in the hospital. And they can serve as emotional support when you feel overwhelmed by cancer.
- Find someone to talk with. Find a good listener who is willing to listen to you talk about your hopes and fears. This may be a friend or family member. The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful. Ask your doctor about support groups in your area. Or check your phone book, library or a cancer organization, such as the National Cancer Institute or the American Cancer Society.
Preparing for your appointment
If you have any signs and symptoms that worry you, start by making an appointment with your family doctor or a general practitioner. If your doctor suspects you may have bone cancer, you may be referred to a specialist. Bone cancer is often treated by a team of specialists that may include:
- Orthopedic surgeons who specialize in operating on cancers that affect the bones (orthopedic oncologists)
- Doctors who specialize in treating cancer with chemotherapy or other systemic medications (oncologists)
- Doctors who use radiation to treat cancer (radiation oncologists)
- Doctors who analyze tissue to diagnose the specific type of cancer (pathologists)
- Rehabilitation specialists who can help you recover after surgery
How to prepare
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well-prepared. Try to:
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins or supplements that you're taking.
- Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Bring your previous scans or X-rays (both the images and the reports) and any other medical records important to this situation.
Questions to ask
Preparing a list of questions for your doctor can help you make the most of your time together. List your questions from most important to least important in case time runs out. For bone cancer, some basic questions to ask your doctor include:
- What type of bone cancer do I have?
- What is the stage of my bone cancer?
- What is the grade of my bone cancer?
- Will I need any additional tests?
- What are the treatment options for my bone cancer?
- What are the chances that treatment will cure my bone cancer?
- What are the side effects and risks of each treatment option?
- Will treatment make it impossible for me to have children?
- I have other health conditions. How will cancer treatments affect my other conditions?
- Is there one treatment that you think is best for me?
- What would you recommend to a friend or family member in my situation?
- Should I see a specialist? What will that cost, and will my insurance cover it?
- If I would like a second opinion, can you recommend a specialist?
- Are there any brochures or other printed material that I can take with me? What websites do you recommend?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time to cover other points you want to address. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?