Usually you begin by seeing your GP (family doctor), who will examine you and arrange any tests or x-rays that may be necessary. Your GP will probably refer you to a local surgeon who specialises in bone diseases, known as an orthopaedic surgeon.

The orthopaedic surgeon at the hospital will take your full medical history before doing a physical examination. This will include an examination of the affected bone to check for any swelling or tenderness. You will probably have a blood test done to check your general health.

If tests suggest that there might be a primary bone tumour your doctors are likely to arrange for you to be seen at a specialist hospital, or bone tumour centre. There you will be seen by a team of doctors and nurses who are experienced in the treatment and care of people with these cancers. The team is known as a multi-disciplinary team. Many of the specific tests for diagnosing bone tumours, such as a bone biopsy need to be done by someone with experience in these specialist techniques.

The following tests may be used to diagnose a bone cancer.

Bone x-rays are the simplest way of diagnosing bone cancer and telling whether the cancer has started in the bone (primary bone cancer) or has spread into the bone from a cancer elsewhere in the body (a secondary bone cancer). Sometimes the x-rays give a characteristic picture that helps the doctor to diagnose a particular type of bone cancer. This is often the case for osteosarcoma. More commonly, however, if cancer is present, the x-rays will show either an area of bone that has been destroyed by cancer or an overgrowth of new bone cells around the cancer.

This test uses magnetism to build up a detailed picture of areas of your body.

During the test you will be asked to lie very still on a couch inside a long tube for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic during the scan. It is also noisy, but you will be given ear plugs or headphones.

Some people are given an injection of dye into a vein in the arm, but this does not usually cause any discomfort.

This is a more sensitive test than a simple x-ray and shows up any abnormal areas of bone more clearly.

A small amount of radioactive substance is injected into a vein, usually in your arm. Abnormal bone absorbs more radioactivity than normal bone, so these areas are highlighted and picked up by the scanner as 'hot spots'.

There is generally a wait of approximately 2–3 hours between having the injection and the scan itself, so you may like to take a magazine or book with you to pass the time.

The level of radioactivity used in the scan is very small and does not cause any harm to your body.

Even if an abnormality is detected on the bone scan, it is not always clear whether it is caused by cancer or by another condition such as arthritis. Sometimes a CT or MRI scan may help the doctors to decide whether the changes seen on a bone scan are caused by secondary bone cancer or another condition.

A biopsy is often needed, as x-rays and bone scans cannot always show if a tumour is benign (non-cancerous) or malignant (cancerous). When the cells are looked at under a microscope, the pathologist will be able to tell if the tumour is cancer or not. If the tumour is a cancer, further tests may be done on the sample to try and find out exactly what type of bone cancer it is.

Before the biopsy, a local anaesthetic is injected to numb the area. A special needle is then put into the affected bone to take a sample of cells. Several samples may be taken. If the lump is near the surface of your body and can easily be felt, the doctor will probably just feel it to guide the needle in. If the lump is in a bone deep within the body (such as in the abdomen) or is harder to feel, the doctor will use an ultrasound scan or sometimes a CT scan to see where the needle is going and guide it into the right place. Sometimes, particularly in children, the biopsy is done under a general anaesthetic.

For most people, a needle biopsy will show if the lump is a cancer. Sometimes, not enough cells are collected to get a clear answer, and then an open, or surgical, biopsy will be needed.

Open biopsy means using a surgical knife (scalpel) to open the area and remove a tissue sample from the lump. If the lump is small enough, the whole of it may be removed. An open biopsy may be done under a local or general anaesthetic. This depends on the position of the lump and how deep it is within the body. If the lump turns out to be benign, you may not need to have any more treatment. If it is cancer, your doctor will talk over the treatment options with you.

In the same way as for a needle biopsy, the sample of cells will be sent to the laboratory so that it can be tested by a pathologist. Often a large number of studies will be done even on a very small sample. It can take from a few days to ten days to get all the results. This can be a very worrying time for you, but it is very important that an accurate diagnosis is made. It may help you to talk about your worries with a partner or close friend, or you may wish to ring our information service or another support organisation for emotional support.