Commmon Medical Procedures and Tests

Medical tests and procedures are not only used to diagnose cancer, but also to see how well the treatment is working and to make sure that the treatment is causing as little damage to normal cells as possible. Many of these tests will be repeated from time to time throughout treatment.

Parents and children say that knowing about the tests before they are done helps them to cope. You may want to ask your doctor these questions before any testing is done:

• Which tests will my child have? What will my child need to have this test? An IV? An oral contrast?
• Where and how is each test done?
• Will the tests be painful? If so, what can be done to make my child more relaxed and in less pain?
• Who will do the tests? Has the staff doing the testing worked with children?
• What information does the doctor expect to get from the tests?
• How soon will the results be known? What do the results mean?
• Will the tests be covered by insurance?

Some of these tests are painful; most are not. For some tests, your child may need to remain still for as long as an hour. Ask your doctor what you and the treatment team can do to help your child become more comfortable during the tests. For procedures that require your child to remain very still, medicines can be given to help your child relax or become sleepy. For tests that can be painful, such as the bone marrow aspiration test and spinal tap, pain medicines are often given. Sometimes a general anesthetic, a drug that causes your child to lose consciousness and all feeling, is given.

Relaxation therapy (methods used to make one feel more relaxed and to feel less pain), guided imagery (using the imagination to create mental pictures), hypnosis (a trance-like state that can be brought on by a person trained in a special technique), music, and other techniques can also help to ease your child's discomfort and fear. When your child is relaxed, the procedures are less painful. Ask your treatment team to help you guide your child through relaxation exercises both before and during the procedures. Often a combination of pain medicine and relaxation techniques is used.

Your child will want to be with you during the procedures, and in most situations, that is possible. See Common Health Issues. The following chart provides information about some common medical procedures your child may have.

Commmon Medical Procedures and Tests

Biopsy

Procedure/Test Purpose What is Done General A biopsy determines if a tumor is not cancerous (benign) or cancerous (malignant). If the biopsy is "positive," cancer is present. If it is "negative," cancer cells were not seen. A doctor removes part or all of the tumor or part of the bone marrow. A pathologist, a doctor who specializes in recognizing changes caused by disease in humans, looks at the tissue under a microscope. Bone marrow aspiration or bone marrow biopsy This type of biopsy examines the bone marrow under a microscope to see if leukemia is present or if the treatment is working. For other cancers, this test tells whether the disease has spread to the bone marrow. For young people, a bone marrow test is most often done in the hip bone. The child lies on his or her stomach with a pillow under the hips. A needle is put through the skin and into the middle of the hipbone, and a small sample of marrow is quickly drawn into the syringe. The most painful part of the test lasts for a few seconds.

Blood Studies

Procedure/Test Purpose What is Done Tumor markers This type of test searches for substances that may increase in the blood of a person with cancer. It can help to diagnose cancer and to find out how well the child is responding to treatment. A sample of blood is usually obtained through a needle inserted in a vein or by pricking the tip of the finger and sqeezing out a few drops of blood. Sometimes blood is obtained via tubes (catheters) that have been surgically placed through the chest and into one of the major blood vessels leading to the heart. Complete Blood Count (CBC) A CBC test checks the white blood cells, hemoglobin, hematocrit, and platelet count in a sample blood. See above. White blood cell (WBC) count A WBC count measures the number of WBCs in the blood and is also used to find certain types of immature cells - called blast cells - typical of leukemia. WBCs protect the body from infection. Chemotherapy and other treatments can lower the number of WBCs, increasing the risk of infection. If the test reveals a low WBC count, treatment may need to be delayed until the count goes up. See above. Hemoglobin Hemoglobin is the substance in red blood cells that carries oxygen to the body's tissues. Low hemoglobin indicates anemia. Anemia can cause your child to look pale and feel weak and tired. It may be a side effect of chemotherapy or a sign that the cancer has returned. See above. Hematocrit Hematocrit determines the size, function, and number of red blood cells. A low hematocrit also may mean that anemia is present. See above. Neutrophils (also called ANC-absolute neutrophil count) This blood study tests for the body's ability to fight bacterial infections. See above. Platelet count This test measures the number of platelets. Platelets help the blood clot. A low platelet count, which may be due to side effects of medicine or to infection, or may mean that leukemia is present, could cause one to bleed or bruise easily. See above.

Lumbar Puncture

Procedure/Test Purpose What is Done Lumbar puncture or spinal tap This test obtains a sample of spinal fluid - the liquid that surrounds the brain and spinal cord. The doctor looks at the fluid under the microscope to see if any infection or cancer cells are present. It is also used to give anticancer drugs directly to the brain and spinal cord. The child, in a curled position, lies on one side or sits. A needle is inserted between the small bones of the spine into the fluid space around the spinal cord. A sample of the spinal fluid is taken. This test can be somewhat painful.

Imaging Tests

Procedure/Test Purpose What is Done General Imaging tests take pictures of images of areas inside the body to see what is happening. Tests are generally not painful, but the equipment may be frightening to children. Some machines, such as MRIs, make very loud noises. Angiograms An angiogram obtains an x-ray of the blood vessels and shows changes in the blood vessels and in nearby organs. Clogged blood vessels or blood vessels that have moved may mean that a tumor is present. A special dye is injected into an artery and travels through the blood vessles. Then a series of x-rays is taken. The dye makes the blood vessels show up on an x-ray. Ultrasound Ultrasound obtains a picture of part of the body by using sound waves. The waves echo or bounce off tissues and organs, making pictures called sonograms. Tumors have different echoes than normal tissues, making it possible to "see" abnormal growths. A small hand-held device called a transducer is used to send the sound waves to a site in the body. The transducer is rubbed firmly back and forth over the site after the skin has been lubricated with a special gel. Radioisotope scanning This test studies the liver, brain, bones, kidneys, and other organs of the body. The child either swallows or has an injection of a mild, radioactive material that is not harmful. After a short wait, a scanning device is passed over the body to detect where the radioactive material collects in the body and allows the doctor to locate tumors. Your child will not be radioactive during or after these tests. CT scan (computerized tomography scan) or CAT scan This test obtains a three-dimensional picture of organs and tissues; ordinary x-rays give a two-dimensional view. Using pencil-like x-ray beams to scan parts of the body, a CT also gives better pictures of soft tissues than does an x-ray. It provides precise and very useful details about the location, size, and type of tumor. While the child lies still, a large machine moves back and forth, taking pictures. The scan takes 30-90 minutes. Sometimes a special dye is injected into a vein before the scan. If your child has a central venous line in the chest, it generally cannot be used during a CT scan of the chest. It is important to prepare your child for an IV in the hand. MRI (magnetic resonance imaging) An MRI creates pictures of areas inside the body that cannot be seen using other imaging methods. MRI uses a strong magnet linked to a computer. Because an MRI can see through the bone, it can provide clearer pictures of tumors located near the bone. The child lies on a flat surface, which is pushed into a long, round chamber. Your child will hear a loud thumping noise, followed by other rhythmic beats. The test takes 15-90 minutes, during which your child must lie still. Sometimes a special dye is injected into a vein before the test.

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