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Diagnosis of bone tumours

MRI scan showing tibial bone tumour
MRI scan showing tibial bone tumour

X-rays are often highly suggestive of a bone cancer but the critical test is the biopsy (where the doctor obtains a piece of the tumour to examine down the microscope).


The x-ray picture of an osteogenic sarcoma is often highly typical with excess bone tissue laid down within and around the tumour; similarly, there are features on plain x-ray that guide the radiologist to be highly suspicious that a bone tumour is a Ewing's sarcoma - but no feature on plain x-ray is diagnostic by itself.


Biopsy of the tumour is required to give the certain diagnosis. The biopsy specimen is then sent to the laboratory for microscopic examination/histopathology.


The doctor will then request staging scans: MR imaging is the best scan for delineating the extent of the tumour in the involved bone (see figure where the tumour in the  tibia - the shin bone- is seen in side view, just below the knee joint) and also for defining the extent of extraosseous spread (spread outside the bone).


CT scanning of the chest is then performed for determining whether there are lung metastases and isotope bone scanning is best for determining whether there are bone metastases – the two commonest sites for distant relapse.


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