If tests show you have a bone cancer, the doctor may want to do some further tests to see if the cancer has spread outside the bone.
Tests may also be arranged to see how well your kidneys, heart and other organs are working, as these may be affected by any treatment that you have for the cancer.
The tests may include any of the following:
In primary bone cancer the most common place for the cancer to spread to is the lung. A chest x-ray may show whether the lungs have been affected.
CT (computerised tomography) scan
A CT scan takes a series of x-rays which build up a three-dimensional picture of the inside of the body. It may be used to check whether any cancer has spread to the lungs.
CT scans can also be used to help doctors guide a needle into the part of the bone where the tumour is when taking a sample (biopsy) from it.
A CT scan is painless and takes 10–30 minutes. The scan uses a small amount of radiation, which will be very unlikely to harm you and will not harm anyone you come into contact with.
A CT (Computerised Tomography) Scan machine
A CT scan is painless but takes 10–30 minutes
Before the CT scan you may be given a drink or injection of a dye (contrast) which helps the doctor to get clearer pictures from the scan. For a few minutes, this may make you feel warm all over. The contrast often contains iodine.
If you are allergic to iodine or have asthma you could have a more serious reaction to the injection, so it’s important to let your doctor know before. It is usually still possible to have the injection, but you will need to have steroid treatment on the day before, and the day of, the injection.
You'll probably be able to go home as soon as the scan is over.
PET (positron emission tomography) scan
A PET scan uses low-dose radioactive sugar to measure the activity of cells in the body. A very small amount of a mildly radioactive sugar is injected into a vein in your hand or arm before the scan.
Areas of cancer are normally more active than surrounding tissue. This means they absorb more of the sugar than other parts of the body and show up on the scan as brighter areas.
There are only a few PET scanners in the UK, so you may have to travel to a specialist centre if you need to have one.
Bone marrow sample
This test is only needed if you have, or are likely to have, Ewing’s sarcoma. It is done because rarely Ewing’s sarcoma can spread to the bone marrow.
Bone marrow is the spongy material inside bones. It is where blood cells are made. Small samples of bone marrow are taken from the hip bone (pelvis) and looked at under a microscope to see if they contain any abnormal cells.
Most people will have the bone marrow sample taken under a local anaesthetic, but for children a general anaesthetic is usually used. When a local anaesthetic is used, the test can be done on the ward or in the outpatients department and lasts about 15–20 minutes. You may be offered a short-acting sedative to reduce any pain or discomfort during the test.
Taking a bone marrow sample
You'll be given a local anaesthetic injection into the area around the bone to numb it. The doctor will then pass a special needle through the skin into the bone. When the needle is in position, the doctor will draw a small liquid sample from the bone marrow into a syringe. You may feel some discomfort when this is being done but it should only last for a few seconds.
Sometimes a small core of marrow is needed (a trephine biopsy). This procedure takes a few minutes longer. A special type of needle is passed through the skin to the bone marrow. The needle has a tip that can cut out a sample of the bone marrow. You may feel bruised after the test and have an ache for a few days. This can be eased with mild painkillers.
Your bone marrow samples will be sent to a laboratory to be looked at under a microscope. It may take a week to ten days to get the results.
You will have samples of blood taken to check your general health. If you’re going to have chemotherapy you may also have tests to check your kidneys, heart and hearing.
Some chemotherapy drugs can affect how well you can hear high sounds. So you may have hearing tests (audiograms) before and during your course of chemotherapy to check your hearing.
To check how well your kidneys are working, you may have a small amount of mildly radioactive liquid injected into a vein in your hand or arm. The radioactive liquid will be carried through your kidneys and you will then pass it out in your urine. A few hours after the injection, a nurse will take blood samples from you. These will show how well your kidneys are working.
You may also have an electrical trace taken of your heartbeat (an ECG) or an ultrasound scan of your heart (echocardiogram).