Bone pain and swelling are more frequently due to other conditions that are less serious than cancer. However, it is important to have your symptoms promptly evaluated by a doctor. Primary bone cancer that is diagnosed and treated before it has spread has the best outcomes.
Your doctor will review your medical history, perform a physical evaluation, and conduct some tests. In most cases, a biopsy is necessary to confirm the diagnosis of primary bone cancer. A biopsy involves obtaining a tissue sample for evaluation of cancer or abnormal cells.
Blood tests are used to test for biological markers, substances that are produced by some people with primary bone cancer. Bone specific alkaline phosphatase (BSAP) is an enzyme produced by osteblasts during bone formation. Cancer causes an increase in bone cell formation. If cancer is present, the BSAP levels may be elevated. However, BSAP levels are not useful for separating if the overproduction is a result of primary bone cancer or metastasized bone cancer.
Common imaging tests for evaluating cancer in the bones include X-rays, bone scans, and skeletal survey. X-rays can identify if bone cancer is present. A bone scan requires that you receive a small harmless injection of a radioactive substance several hours before your test. The substance collects in your bones in areas where the bone is breaking down or repairing itself. A bone scan shows the extent of bone cancer. A skeletal survey is a form of X-ray. A skeletal survey is an assessment of the entire skeleton that shows rapidly growing cancer cells. Your doctor may order other types of imaging tests as necessary.
A biopsy is used to confirm the diagnosis of primary bone cancer and rule out other conditions. A biopsy can identify primary bone cancer and metastasized bone cancer. The biopsy method that your doctor chooses depends on several factors, including the suspected type and location of the bone cancer.
If you have primary bone cancer, your doctor will assign your cancer a classification stage based on the results of all of your tests. Staging describes the cancer and if it has metastasized. Primary bone cancer can spread to the lungs, lymph nodes, liver, distant organs, and other sites on the bone. Staging is helpful for treatment planning and recovery prediction.
There is more than one type of staging system for cancer, and you should make sure that you and your doctor are referring to the same one. Generally, lower numbers in a classification system indicate a less serious cancer, and higher numbers indicate a more serious cancer. The stages may be subdivided into grades or classifications that use letters and numbers.