Bone Cancer Diagnosis
Accurate diagnosis is essential to successful treatment of bone cancer. The wrong kind of biopsy may make it more difficult later for the surgeon to remove all of the cancer without having to also remove all or part of the arm or leg. A biopsy that is not done correctly may cause the cancer to spread. It is very important for the biopsy procedure to be performed by a surgeon with experience in diagnosing and treating bone tumors as well as limb salvage techniques.
If your doctor thinks you may have bone cancer, it’s important to go to a cancer center with a specialized bone cancer program. You should look for a program that does as many diagnostic procedures as possible.
If you have symptoms that may signal bone cancer, your doctor will examine you and ask you questions about your health and your family history. One or more of the following tests may be used to find out if you have cancer and if it has spread. These tests also may be used to find out if treatment is working.
Biopsy
A biopsy, which removes a tiny piece of bone, is used to confirm the presence of cancer cells. This is the only way to find out for certain if the tumor is cancer or another bone disease. It is very important for the biopsy procedure to be done by a surgeon with experience in diagnosing and treating bone tumors.
There are two types of bone biopsy:
Needle biopsy: A long, hollow needle is inserted through the skin to the area of bone to be tested. The needle removes a cylindrical sample of bone to look at under a microscope.
Open or surgical biopsy: An incision (cut) is made, and the surgeon removes a tiny piece of bone for examination under a microscope.
Your doctor will decide which type of biopsy is best for you based on several factors, including the type and location of the tumor. If possible, the surgeon who performs the biopsy should also do the surgery to remove the cancer.
Gabriel Francis Paz Goodenough knows the impact of storytelling. He’s spent 30 years working as a camera operator in television and film. But it wasn’t until his chondrosarcoma diagnosis that Gabriel’s outlook on storytelling changed.
“Cancer was this thing that just epically changed my look at life and the world,” he says. “I spent my career working on other people's stuff, and the night before my surgery, I decided I wanted to make a documentary.”
A chondrosarcoma diagnosis and surgery at MD Anderson
In 2019, Gabriel underwent a routine colonoscopy at a local hospital in Baltimore. He had some complications afterward and was admitted to the emergency room. That’s where a technician noticed a spot on Gabriel’s pelvis. An MRI and a biopsy showed he had chondrosarcoma. Gabriel knew right away that he wanted to see an oncologist who specialized in sarcomas.
A fellow filmmaker recommended MD Anderson. Gabriel got an appointment with sarcoma specialist Dejka Araujo, M.D., who instantly made him feel at ease about his diagnosis.
“Dr. Araujo was absolutely amazing,” Gabriel says. “I never had radiation therapy or chemotherapy, so in many ways, she has been my guide through the process, especially in terms of mentally dealing with having cancer and how to get through it.”
Since surgery to remove the tumor was recommended, Gabriel also met with orthopaedic surgeon Valerae Lewis, M.D. She told Gabriel he would need an internal hemipelvectomy, and he felt confident in Lewis’ extensive experience in performing the surgery.
“Very quickly after meeting Dr. Lewis I knew I could trust her with my life,” Gabriel says. “Dr. Lewis was – and is – my second guide. She saved my life as much as Dr. Araujo did."
Gabriel underwent a 12-hour surgery performed by Lewis and plastic surgeon Matthew Hanasono, M.D. Lewis removed the tumor and a portion of Gabriel’s pelvis. With the help of physical therapist Alex Penny, he took steps within 24 hours after surgery.
Physical therapy gets him back on his feet
Gabriel worked with Penny daily during the week he stayed in the hospital. Over the next few months of physical therapy at home, he gradually went from walking with a walker to using a cane to walking on his own.
“Working with Alex taught me how physical therapy is a lifelong thing,” Gabriel says. “I'm still healing. All the muscles that I lost on the inner side of my right leg are still getting stronger, and I’m still figuring out how to compensate for that. Physical therapy really gave me an understanding of the body.”
During his follow-up appointments every six months, Penny tests Gabriel’s progress by having him walk up and down stairs.
“They’re always amazed at my healing,” Gabriel says. “Every time I do it, I’m quicker and faster. It reminds me that when I finished this surgery, I couldn't walk without help at first.”
Filming a documentary after surgery and physical therapy
Physical therapy has allowed Gabriel to continue leading a healthy and productive life and pursue his dreams. However, the possibility of making a career change weighed on Gabriel the night before his surgery, and that’s when he decided to make a documentary about gun violence in his hometown of Baltimore.
“For so long, I was nervous to make my own film because it’s a lot of work and a lot of money,” Gabriel says. “But with cancer, anything feels a little easier. The night before my surgery, with my stepmom there, I did this grant application, and two months later, when I was in physical therapy, I ended up getting the grant.”
Gabriel spent the next couple of years working on the documentary while still undergoing physical therapy and attending his follow-up appointments at MD Anderson. In 2023, the film was shown at festivals.
Grateful for his care team at MD Anderson
Gabriel’s cancer diagnosis gave him the courage to film the documentary. He says his care team gave him the reassurance of choosing MD Anderson.
“From the beginning, I felt a love and a partnership from Dr. Araujo, Dr. Lewis and from everyone at MD Anderson,” Gabriel says. “I’ll be going to MD Anderson for the rest of my life, so I wanted to make sure I was at the right place. I fly to Houston from Baltimore for all of my scans, and to me, it's well, well worth it.”
Request an appointment at MD Anderson online or call 1-877-632-6789.
Bone Cancer Staging
If you are diagnosed with bone cancer, your doctor will determine the stage (or extent) of the disease. Staging is a way of determining how much disease is in the body and where it has spread.
This information is important because it helps your doctor determine the best type of treatment for you and the outlook for your recovery (prognosis). Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads.
Bone Cancer Stages
AJCC Staging System
(source: National Cancer Institute)
One system that is used to stage all bone cancer is the American Joint Commission on Cancer (AJCC) system.
- T stands for features of tumor (its size)
- N stands for spread to lymph nodes
- M is for metastasis (spread) to distant organs
- G is for the grade of the tumor
This information about the tumor, lymph nodes, metastasis and grade is combined in a process called stage grouping.
The stage is then described in Roman numerals from I to IV (1-4).
T stages of bone cancer
- TX: Primary tumor can't be measured
- T0: No evidence of the tumor
- T1: Tumor is 8 centimeters (around 3 inches) or less
- T2: Tumor is larger than 8 centimeters
- T3: Tumor is in more than one place on the same bone
N stages of bone cancer
- N0: The cancer has not spread to the lymph nodes near the tumor
- N1: The cancer has spread to nearby lymph nodes
M stages of bone cancer
- M0: The cancer has not spread anywhere outside of the bone or nearby lymph nodes
- M1: Distant metastasis (the cancer has spread)
- M1a: The cancer has spread only to the lung
- M1b: The cancer has spread to other sites (like the brain, the liver, etc)
Grades of bone cancer
- G1-G2: Low grade
- G3-G4: High grade
TNM stage grouping
After the T, N and M stages and the grade of the bone cancer have been determined, the information is combined and expressed as an overall stage. The process of assigning a stage number is called stage grouping.
To determine the grouped stage of a cancer using the AJCC system, find the stage number below that contains the T, N and M stages, and the proper grade.
Stage I: All stage I tumors are low grade and have not yet spread outside of the bone.
- Stage IA: T1, N0, M0, G1-G2: The tumor is 8 centimeters or less.
- Stage IB: T2 or T3, N0, M0, G1-G2: The tumor is either larger than 8 centimeters or it is in more than one place on the same bone.
Stage II: Stage II tumors have not spread outside the bone (like stage I) but are high grade.
- Stage IIA: T1, N0, M0, G3-G4: The tumor is 8 centimeters or less.
- Stage IIB: T2, N0, M0, G3-G4: The tumor is larger than 8 centimeters.
Stage III: T3, N0, M0, G3-G4: Stage III tumors have not spread outside the bone but are in more than one place on the same bone. They are high grade.
Stage IV: Stage IV tumors have spread outside of the bone they started in. They can be any grade.
- Stage IVA: Any T, N0, M1a, G1-G4: The tumor has spread to the lung.
- Stage IVB: Any T, N1, any M, G1-G4 OR Any T, any N, M1b, G1-G4: The tumor has spread to nearby lymph nodes or to distant sites other than the lung (or both).
Even though the AJCC staging system is widely accepted and used for most cancers, bone cancer specialists tend to simplify the stages into localized and metastatic. Localized includes stages I, II and III, while metastatic is stage IV.