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Bone Cancer Investigations: Tests for Diagnosis

If a person is suspected to have bone tumor due to the presence of signs and symptoms, some investigations are required to confirm the diagnosis of the disease. Further, these can help in determining the stage of the disease, which in turn help in choosing an appropriate treatment option.

Following are some commonly used diagnostic tools for bone tumor:

  1. Imaging Tests: Imaging tests can reveal vital information in case of bone tumor and are widely used for the diagnosis. They can be used to establish the diagnosis and to assess the spread of disease to the distant organs. The extent of disease can also be assessed with the help of these techniques. These tests are also employed after treatment to evaluate the treatment efficacy and to detect any signs of disease progression/recurrence.

    X-ray Examination: This is usually the first test which is employed when a bone tumor (or any other bone abnormality) is suspected. In this test, X-rays (high energy radiations emitted by certain elements and x-ray generators) are directed towards the body part to be examined. These X-rays are reflected back or absorbed by different body tissues depending upon their density.

    The reflected X-rays are collected on an X-ray sensitive film to produce an image of the bones that reflect most of the x-rays. This test can provide information about the cancerous changes within the bones tissue which appear irregular compared to the nearby bone on X-ray film. Any abnormality observed during this test warrant detailed investigations.

    Magnetic resonance imaging (MRI) scan: This technique is considered very sensitive to outline the bone tumor. It is more sensitive to assess the soft tissue and neurovascular involvement by bone tumor. This technique provides detailed images of tissues inside the body using radio waves, strong magnetic field, and gadolinium contrast. It can accurately diagnose the extent of invasion and spread of disease to nearby/distant body parts.

    Radionuclide Bone Scan: In this test, a radioactive material, for example, technetium diphosphonate is first injected into the vein of the patient. The radioactive substance gets accumulated in the areas of bones affected by cancer and such areas are then detected with the help of radioactivity detectors.

    Computed tomography (CT) scan: In this technique, detailed cross-sectional images of body organs are generated using x-rays, with or without a contrast medium. It can help diagnose the spread of disease to nearby/distant lymph nodes and other organs, and may also be used to guide a biopsy needle into the affected area.

    Positron emission tomography (PET) scan: This technique uses a radioactive substance (e.g.fluorodeoxyglucose [FDG]) that is given intravenously prior to the procedure. Cancer cells absorb larger amounts of the radioactive substance than normal cells. The areas of higher radioactivity indicate cancerous tissue on the PET scan. Thus, this technique can diagnose spread of disease to distant body parts. It is usually combined with CT scan (PET/CT).

  2. Biopsy: Biopsy samples contain a small number of cells or a tiny piece of tissue collected from the affected area with the help of a biopsy needle. Depending on the size and location of the suspicious area, a fine needle biopsy, a core needle biopsy, or a surgical biopsy technique can be utilized. The biopsy sample is then tested in a laboratory and can provide very useful information about the cancer cells such as the type of cancer (including confirmation of primary bone tumor or any other cancer that has spread to bone), the severity of cancerous changes involved, and the presence of specific defective genes or proteins.

  3. Blood Tests: Blood tests can provide certain important information about the diagnosis and prognosis of bone tumor. Serum and urine immunoelectrophoretic analyses can be employed to rule out multiple myeloma. Level of Alkaline phosphatase and lactic dehydrogenase are checked as the level of these enzymes are increased in some cases of bone sarcomas and indicate a worse prognosis.

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