Bone Cancer

Diagnosis

Primary bone cancer is a rare disease, with only around 2,500 new cases diagnosed each year in the United States. 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 bone 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.

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