You go to X-ray or MRI for an injury, joint pain or some other problem. The report comes back and you see a strange word: bone lesion. Of course, the first thought might be, “Is this cancer? But it is seen that many bone lesions are benign and are discovered incidentally. Some need no treatment even. But others may need more tests or regular monitoring to see what’s happening inside the bone.
So what do you do if your scan shows a bone lesion? Let’s look at what it might mean and when you should see an orthopaedic oncologist.
A bone lesion is an area of bone that looks different than the rest of the bone on an imaging scan. It is a general term, not a diagnosis of cancer. Bone lesions can occur for a number of reasons. Some are harmless swellings, while others may be linked to infections, past injuries, bone conditions or in rare cases – cancer. The doctor will examine the appearance of the lesion, where it’s located and any symptoms and medical history to help determine whether it needs further investigation.
A bone lesion does not always mean cancer. Many bone lesions are non-cancerous and do not spread to other parts of the body.
Causes of non-cancerous bone lesions:
Fluid-filled or blood-filled spaces that develop inside a bone.
Common, non-cancerous growths found in the long bones of children and teenagers.
Growths that often develop near joints, such as the knee. They are usually non-cancerous but can sometimes grow aggressively or return after treatment.
Growths made of bone and cartilage that develop near the ends of bones.
Growths made of cartilage that usually occur in the small bones of the hands and feet.
Conditions such as osteomyelitis (a bone infection) can sometimes look like a bone lesion on an X-ray or MRI.
Note: A bone lesion does not mean you have cancer. If the scan finds a lesion that looks benign and you have no worrisome symptoms, your doctor may suggest watching the lesion with follow-up scans instead of starting treatment right away.
While most bone lesions are benign, some symptoms and scan appearances should not be ignored.
See a doctor if you have:
These signs are not necessarily cancer. However, they stress the importance of looking for a cause and not assuming the lesion to be benign.
Sometimes, doctors need to take a closer look to tell the difference between an enchondroma (a non-cancerous cartilage growth) and a low-grade chondrosarcoma (a slow-growing type of bone cancer). An enchondroma is a benign tumor of cartilage-forming cells in the bone. Low-grade chondrosarcoma is a cancer that forms in the cartilage. It is usually slower growing than higher-grade chondrosarcoma. It can be hard to tell them apart because their appearances can overlap on X-rays and MRI scans.
Doctors consider several findings, including:
Single finding (e.g., size of the lesion) is not always sufficient to make diagnosis. The doctor may look at the images with your symptoms and in some cases, order further tests. Most importantly, solitary enchondromas usually do not turn into cancer. However, an uncertain cartilage lesion needs to be carefully evaluated before deciding whether to follow or treat it.
If your X-ray or MRI says you have a “bone lesion,” don’t panic. Take these steps:
Not every bone lesion needs biopsy. In fact, when a bone tumor is suspected, the decision and planning of the biopsy should be taken by the specialist who will coordinate the definitive treatment.
It can be concerning to hear that a lesion will be monitored instead of treated immediately. But this can be an appropriate approach for some lesions that appear benign or have no worrisome features.
Watchful monitoring may include:
The frequency of your follow-up scans depends on the type of bone lesion and what it looks like. Some benign lesions do not need further scanning, some require follow-up at regular intervals. Even if the lesion doesn’t hurt, don’t skip a follow-up scan recommended by your doctor.
If your report mentions an unexplained bone lesion, the right assessment can help you understand what this means and what needs to happen next. If you suspect a bone tumor, Dr Love Kapoor is an orthopaedic oncologist who can help you evaluate and take you through the correct diagnostic process. The purpose is to distinguish between those lesions that can be safely observed and those requiring further investigation or treatment.
Note: Bring old scans and reports to your appointment. It may be helpful to compare the old images to the new images.
If you have an incidentally found bone lesion, you may or may not know if you need to wait, repeat the scan or have it further evaluated. An orthopaedic oncologist’s assessment can help clarify these questions and guide the next steps. Based on the clinical assessment, Dr. Love Kapoor can review the available findings and make a recommendation on whether the lesion requires additional imaging, observation, biopsy or treatment.
No, a lytic lesion does not always mean cancer. On imaging, lytic lesions are less dense than the surrounding bone. They can be caused by a benign cyst, a non-cancerous tumor, an infection, or cancer. The imaging appearance and your medical history help determine the next steps.
Some benign bone lesions in children may gradually resolve as the child grows, while others remain unchanged for years. Whether a lesion resolves depends on its type, location, and the patient’s age. Your doctor can recommend monitoring or treatment based on the diagnosis.
No. If a lesion has typical benign features on imaging, a biopsy may not be necessary. A biopsy may be recommended when imaging and clinical findings do not establish a clear diagnosis or when a more serious condition is suspected. Management should be guided by the treating specialist.
Most bone islands are benign areas of dense bone that do not cause symptoms or require treatment. If the imaging appearance is unusual, symptoms are present, or there is a relevant medical history, further assessment may be recommended.
Most solitary enchondromas are benign cartilage tumors. Rarely, a cartilage lesion may be diagnosed as a low-grade chondrosarcoma. Changes in symptoms and imaging findings can help determine whether further evaluation is needed.
Neither scan is always superior. MRI is useful for evaluating bone marrow and surrounding soft tissues, while CT provides detailed information about bone structure and calcified areas. The doctor selects the appropriate scan based on the suspected lesion and clinical findings.
You can initially consult an orthopaedic doctor. However, if the lesion is suspicious, unexplained, or potentially a bone tumor, an orthopaedic oncologist is an appropriate specialist to consult. They can assess your imaging, recommend further investigations, and discuss suitable treatment options.
Having a bone lesion doesn’t automatically mean cancer. The right assessment can help you understand the finding, avoid unnecessary worry and make a right decision about your bone health.
Category: Bone Lesion
Tags: Bone cysts Bone Lesion Bone Tumor chondrosarcoma Giant cell tumours Orthopaedic Oncologist Osteochondromas
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