Diagnosing bone cancer

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science

This page was updated on June 8, 2022.


A multidisciplinary team of bone cancer experts uses a variety of tests and tools for diagnosing bone cancer, evaluating the disease, determining the affected bone(s) and developing an individualized treatment plan. During bone cancer treatment, imaging and lab tests track the size of the tumor(s) and monitor the response to treatment, allowing the care team to modify the patient's plan when needed.

Tests to detect bone cancer

Tools frequently used for diagnosing bone cancer include:

Bone biopsy

During a bone biopsy, the care team removes samples from the outer layer of the patient's bone to evaluate whether abnormal cells are present. A bone biopsy is not the same as a bone marrow biopsy. During a bone marrow biopsy, the care team examines cells located inside the patient's bone, not on the outside.

Two biopsy techniques to detect bone cancer are listed below.

Needle biopsy: The doctor numbs the area with a local anesthetic before inserting a needle into the bone to get a sample of cells. In some cases, a CT (computed tomography) scan may be used to help guide the needle.

Surgical biopsy: This is typically performed under general anesthesia by a surgeon, who removes a bone sample (incisional biopsy) or a bone tumor (excisional biopsy), if one is present.

Bone scan

A radionuclide bone scan may be used to diagnose and stage bone cancer.

This bone cancer detection tool may reveal whether the primary tumor has spread to other places in the bone, and how much damage it has caused. In a bone scan, a small dose of radioactive material is injected into a blood vessel, where it travels through the bloodstream. The material then gathers in cancerous cells in the bones and elsewhere in the body, where it is detected by a scanner through nuclear imaging. This test is very sensitive and may find small metastases before they would appear on a regular X-ray. However, other conditions such as arthritis or infection look similar on the scan, so a confirmatory biopsy is often needed.


Cancer may make the bone appear different than surrounding healthy bone on an X-ray. The bone may look ragged, or it may appear to have a hole in it. A chest X-ray may also help determine whether cancer cells have spread to the lungs.

CT scan

CT scans are usually used to help make an initial bone cancer diagnosis and to see whether the cancer has spread to other areas of the body. CT scans may also be used to guide the biopsy needle.


An MRI (magnetic resonance imaging) may help outline a tumor in the bone and may also help determine whether cancer cells have spread to the brain or spinal cord.

PET scan

A PET (positron emission tomography)/CT scan is an advanced nuclear imaging technique that combines CT scan technology with positron emission tomography into one machine. A PET/CT scan shows both the structure and function of cells and tissues in the body during a single imaging session. In the case of bone cancer, this scan provides a more comprehensive view to determine the presence of abnormal cells and tissues, even before a tumor may have developed.

Learn more about orthopedic oncology

Does a bone density test show cancer?

Bone density tests don't detect cancer, but a bone scan may identify cancerous cells. A bone density test measures the strength of bones and may be used to monitor cancer treatment that may cause bones to get thinner.

Next topic: How is bone cancer treated?

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