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, since some bone tumors can be associated with increased levels of certain proteins in the blood.

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 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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