Doctors can often spot bone cancer as ragged or hollow areas on an X-ray. While X-rays are usually a reliable first test, a doctor will typically need a bone biopsy to confirm a diagnosis.

An X-ray uses radiation to produce images of the inside of your body. It’s typically the first test a doctor or healthcare professional will order if they suspect you could have bone cancer.

Your bones typically look solid on an X-ray, but a bone tumor may have a ragged appearance. It could also look like a hole in your bone.

Bone cancer is rare. If you have symptoms such as bone pain, a doctor might order an X-ray to look for cancer and other possible causes.

After an X-ray, the only way to be sure that you have bone cancer is to take a small sample (biopsy) of your bone and send it to a lab for testing.

Early indications of bone cancer

There are no screening tests for bone cancer, but most bone cancers are still at an early stage at diagnosis. This is because early indications often prompt a visit to a doctor.

Early symptoms include:

These symptoms don’t always mean you have bone cancer. They could be due to many other conditions such as injuries, infections, or arthritis.

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Using X-ray imaging, a doctor can detect if there’s a tumor in or around your bone. This tumor could be benign (not cancerous) or malignant (cancerous).

Doctors can detect both primary and secondary bone cancers on an X-ray. Primary bone cancers are those that start in your bone. Secondary bone cancers start in another part of your body and then spread to your bone.

A radiologist may sometimes be able to tell if a tumor is malignant by the way it appears on the X-ray. But only a biopsy can tell for sure.

In a small 2019 study, X-rays were able to help doctors correctly identify bone cancer in 86.7% of people. They also correctly ruled out bone cancer in 93.3% of people.

Healthy bone appears solid on an X-ray image. In general, bone cancers show up on an X-ray as rough or ragged areas of your bone.

The most common type of primary bone cancer is osteosarcoma. According to the American Academy of Orthopedic Surgeons, X-ray images of osteosarcomas may look like new bone forming in a “sunburst” pattern or a white, cloud-like lesion.

X-ray images may also show multiple myeloma, a bone marrow cancer. Multiple myeloma may appear as punched-out areas in your bone.

Where does bone cancer usually show up first?

Bone cancer can show up in any bone in your body. It usually starts in the long bones in your legs or arms, such as your shin or upper arm, or in your pelvis.

Cancer that begins in your bones isn’t common. It’s more common for cancer to start in another area of your body, such as your prostate or lung, and then spread to your bone.

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If X-ray images suggest you have bone cancer, a doctor will likely do further tests to confirm a diagnosis and to see how far the cancer has spread.

These tests may also help a doctor understand the stage of your cancer and the best way to treat it.


Magnetic resonance imaging (MRI) scans use magnetic fields and radio waves to make detailed pictures of your bones, marrow, and tissues around your bone.

With an MRI scan, a doctor will have a better idea about the size and spread of any tumors.

CT scan

A computed tomography (CT) scan puts together a series of X-ray images using a computer to show a three-dimensional (3D) image of your body. CT scans can help a doctor see if the cancer has spread to your other organs, such as your lungs.

Bone scan

A bone scan provides more detailed information about the inside of your bones compared with an X-ray.

A healthcare professional will inject a small amount of radioactive material into your veins. Any abnormal areas of bone will absorb the radioactive material more quickly than healthy bone. These areas will then appear brighter during the scan.

PET scan

A positron emission tomography (PET) scan is another test that can help a doctor see if the cancer has spread to other parts of your body. Like a bone scan, it uses a radioactive substance injected into your blood. Cancer cells absorb larger amounts of the substance, so they’re more visible during the scan.


A biopsy can help confirm a bone cancer diagnosis. A doctor uses a thin needle to take a small sample of your bone that they send to a laboratory for testing.

Blood tests

Doctors don’t typically use blood tests to diagnose bone cancer. But they may order blood cell counts and blood chemistry tests to understand your overall health.

What is the best test to detect bone cancer?

An X-ray may be the first test a doctor uses to detect bone cancer. But the most definitive test to confirm bone cancer is a biopsy.

If the results from a needle biopsy are inconclusive, a doctor may need to do an open biopsy. During an open biopsy, a surgeon makes a cut in your bone to remove a sample of tissue.

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After you receive a diagnosis of bone cancer, a doctor may refer you to a specialist with expertise in treating cancers of the bone. The specialist may assign your tumor a grade, which is a measure of how likely it is to grow and spread. This will help them decide on a treatment plan.

Your treatment plan will depend on the grade, location, and size of your tumor, as well as your overall health. Treatment options may include:

X-rays are one of many tests to help diagnose bone cancer. Consider making an appointment to see a doctor if you notice:

  • severe bone pain
  • pain in your bone that doesn’t go away
  • swelling, redness, or lumps near your bone

An X-ray can often spot bone cancer, but a doctor will likely order a biopsy to confirm a diagnosis.

If you receive a bone cancer diagnosis, resources are available to support you before, during, and after treatment. Ask a doctor for a referral to a local support group, or try reaching out to organizations such as the American Cancer Society.