What skeletal changes can be seen on diagnostic imaging?
Age-related changes, osteoarthritis, old fractures, bunions and other benign lesions are common findings.
Metastases can be lytic, sclerotic, or mixed depending on the primary tumor.
Primary skeletal tumors are uncommon and include both benign and malignant types.
When does a skeletal find become more suspicious?
Destructive pattern, rapid change, soft tissue component, or unexplained persistent local pain may warrant specialist investigation.
Previous cancer increases the significance of a new unclear skeletal finding but does not prove that it is metastasis.
In people without known cancer, both benign lesions and primary bone tumor must be considered based on imaging patterns.
What symptoms need to be assessed?
Persistent local bone pain, especially if it worsens and lacks a reasonable explanation, should be evaluated if it does not resolve.
Sudden severe pain after minor strain may be a pathological fracture and requires prompt assessment.
Neurological weakness or loss of sensation in a person with known cancer and back pain may be signs of spinal cord compression and require emergency care.
Seek emergency care if you experience new weakness, loss of sensation, or bladder dysfunction along with suspected spinal tumor involvement.
How is a suspected bone tumor investigated?
Swedish sarcoma guidelines state conventional X-ray as the first radiological method for suspected primary skeletal tumors.
If the X-ray shows suspicion of malignancy or does not explain the symptoms, MRI of the area can provide more information about the bone marrow and local spread.
Suspected primary skeletal tumors should be assessed in a specialist center before biopsy is planned.
How do you look for bone metastases?
The method varies between cancers. CT, bone scintigraphy, PET/CT and MRI are used based on the primary tumor and clinical question.
MRI is very sensitive for bone marrow changes and is often used for unclear or neurologically relevant findings.
No single method is best for all cancers and stages.
What should you ask about a skeletal find?
Is the change typically benign, degenerative or suspicious? Are there previous images that can show stability?
Is a targeted X-ray or MRI needed and is there any previous cancer diagnosis that affects the interpretation?
If biopsy is discussed in case of suspected sarcoma, ask if the sampling is planned together with the sarcoma center.