How secondary cancer in the bone is diagnosed

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1 How secondary cancer in the bone is diagnosed This information is an extract from the booklet, Understanding secondary cancer in the bone. You may find the full booklet helpful. We can send you a copy free see page 6. Contents Blood tests Chest x-ray Bone x-ray Bone scan CT (computerised tomography) scan MRI scan PET scan Biopsy If a secondary bone cancer is found before the primary cancer Waiting for results Your doctor is likely to arrange a number of tests if they think it s possible that a cancer has spread to the bones. Waiting to have tests, and waiting for the results, can be a worrying time for you and the people close to you. You may worry that the cancer has come back or spread, but without the results of the tests you can t know for sure. You may find yourself torn between believing there is some other cause for your symptoms and thinking the worst. Uncertainty is often the hardest part and it can sometimes be easier to cope once the results of the tests are known. If the tests show that you have secondary cancer in the bone, this can come as a huge shock, even if you were expecting it. You may find it helpful to talk to your healthcare staff at the hospital, or cancer support specialists (see page 6). Macmillan and Cancerbackup have merged. Together we provide free, high quality information for all. Questions about cancer? Ask Macmillan of 6

2 To diagnose secondary bone cancer your doctor may do some of the following tests and investigations: Blood tests A blood test may be done to check your general health and the level of calcium in your blood. Chest x-ray You will probably have a chest x-ray to see if there are any signs of cancer in the lungs. Bone x-ray This is a simple x-ray that can show up changes in the bone and may show that a secondary bone cancer is present. A cancer of the bone may not always show up on a bone x-ray. Bone scan This is a more sensitive test than an x-ray and shows up any abnormal areas of bone more clearly. A small amount of a mildly 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. You will probably have to wait 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 doesn t cause any harm. Even if an abnormality is detected on the bone scan, it isn t always clear whether it s 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. CT (computerised tomography) scan A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body. The scan takes minutes and is painless. It uses a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for a few hours before the scan. Page 2 of 5 Questions about cancer? Ask Macmillan

You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes.

3 You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It s important to let your doctor know if you are allergic to iodine or have asthma, as you could have a more serious reaction to the injection. You ll probably be able to go home as soon as the scan is over. Someone having a CT scan MRI (magnetic resonance imaging) scan This uses magnetism to build up a detailed picture of areas of your body. The scanner is a powerful magnet so you may be asked to complete and sign a checklist to make sure it s safe for you. The checklist asks about any metal implants you may have, for example a pacemaker, surgical clips, bone pins, etc. You should also tell your doctor if you ve ever worked with metal or in the metal industry as very tiny fragments of metal can sometimes lodge in the body. If you do have any metal in your body it s likely that you won t be able to have an MRI scan. In this situation another type of scan can be used. Questions about cancer? Ask Macmillan Page 3 of 6

4 Before the scan, you ll be asked to remove any metal belongings including jewellery. Some people are given an injection of dye into a vein in the arm, which doesn t usually cause any discomfort. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test you ll lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It s painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It s also noisy, but you ll be given earplugs or headphones. You can hear, and speak to, the person operating the scanner. PET (positron emission tomography) scan A PET scan uses low-dose radioactive glucose (a type of sugar) to measure the activity of cells in different parts of the body. Before the scan, a very small amount of a mildly radioactive substance is injected into a vein, usually in your arm. Areas of cancer are usually more active than surrounding tissue and show up on the scan. This is a newer type of scan and you may have to travel to a specialist centre to have one. PET scans are not often needed, but you can discuss with your doctor whether one would be useful. You should be able to go home as soon as the scan is over. Biopsy Occasionally, the doctors may still not be sure what s causing the abnormality in the bone. You may need to have a small sample of cells taken from the affected bone (biopsy). Bone is extremely hard, and the piece that is removed has to be softened so that it can be examined under a microscope. The softening process takes several days and because of this you may have to wait days for the results of the biopsy. A biopsy can be carried out in either of the following ways: Needle biopsy Before a needle biopsy is done, a local anaesthetic will be injected to numb the area. A needle is then passed through the skin into the bone and a small piece of the bone is taken. This part of the test can be painful. If you are feeling very anxious, you may be given a sedative to help you relax. The test doesn t take very long and you may have it as an Page 4 of 6 Questions about cancer? Ask Macmillan

5 outpatient. If the sample is taken from your back, you may need to stay in hospital overnight. You re likely to be sore for a few days after the test, so your doctor may prescribe painkillers for you. Open biopsy For this test, a small piece of bone is removed while you are under a general anaesthetic. A small cut (incision) will be made in the skin above the affected bone so that the biopsy can be taken. You will have a couple of stitches to close the wound and it will be covered with a dressing. The stitches will need to be removed after about days the nurses will arrange for this to be done. An open biopsy takes about minutes. You may have to stay in hospital overnight. After the biopsy you are likely to be sore for up to a week so your doctor may give you some painkillers to take. If a secondary bone cancer is found before the primary cancer is diagnosed If this happens, your doctor may arrange for you to have tests to find out where the primary cancer is in your body. For example, your doctor may ask you to have a: mammogram to look for primary cancer in the breast chest x-ray and CT scan to check for lung cancer CT or ultrasound scan of the abdomen and pelvis to look for a kidney cancer prostate ultrasound and a blood sample to check for prostate cancer. Waiting for results Your doctor, together with other medical staff, will look at the results of all your tests before a firm diagnosis can be made. This may take some days or possibly a few weeks. The waiting period may be a worrying time for you, but it s important that an accurate diagnosis is made. While you are waiting for your test results, you may find it helpful to have the support of a relative, close friend or one of our cancer support specialists. More information and support Questions about cancer? Ask Macmillan Page 5 of 6

6 If you have any questions about cancer, ask Macmillan. If you need support, ask Macmillan. Or if you just want someone to talk to, ask Macmillan. Our cancer support specialists are here for everyone living with cancer, whatever you need. Call free on , Monday Friday, 9am 8pm We make every effort to ensure that the information we provide is accurate but it should not be relied upon to reflect the current state of medical research, which is constantly changing. If you are concerned about your health, you should consult your doctor. Macmillan cannot accept liability for any loss or damage resulting from any inaccuracy in this information or third party information such as information on websites to which we link. Macmillan Cancer Support Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ REVISED NOVEMBER 2010 Page 6 of 6 Questions about cancer? Ask Macmillan

Surgery for breast cancer in men

Surgery for breast cancer in men This information is an extract from the booklet Understanding breast cancer in men. You may find the full booklet helpful. We can send you a free copy see page 9. Contents