At Mount Sinai Kravis Children’s Hospital’s Children’s Cancer Program, we offer young cancer patients access to the most advanced treatments and exceptional care.
There are a variety of diagnostic procedures and tests available to determine if and where there are cancer cells in the body. We use whatever approach is most appropriate for your child’s symptoms, the type of cancer we suspect, and other factors. We may numb the skin (local anesthesia) or use awake (conscious) or asleep (deep) sedation to decrease any pain or discomfort. These are the most common diagnostic tests and procedure:
- Biopsies involve removing a small piece of tumor or tissue so we can examine it for cancer cells. Biopsies help us learn what type of cancer, if any, is present. There are many ways to perform a biopsy and it may involve numbing medicine (anesthesia). The exact procedure depends upon the area that needs to be biopsied, and the age of the child.
- Bone marrow aspirates require placing a needle in the bone (usually the hipbone) and pulling a small amount of bone marrow into a syringe. Analyzing the bone marrow shows us whether the cells in the bone marrow are healthy. Bone marrow is the liquid/spongy part inside bone, where the body makes blood cells. Since your child may feel some pain when we insert the needle and some pressure while we remove the bone marrow cells, we usually do this procedure under anesthesia or sedation.
- Bone marrow biopsies allow us to study an actual piece of bone, and we can perform bone marrow biopsies at the same time we perform bone marrow aspirates. During this procedure, we place a needle in a bone (usually the hip bone), remove a small piece of bone, and send it to the pathology laboratory for testing. To alleviate any possible pain or discomfort, we usually perform this procedure under anesthesia.
- Computerized axial tomography scans combine a series of X-ray images taken from different angles and use a computer to make a three-dimensional picture of the inside of your child’s body. We may use contrast (dye) given through the bloodstream or by mouth. During the scan, your child lies still on a table, while the scanner takes pictures. Some children need anesthesia to be able to relax and lie still for the duration of the test.
- Diagnostic ultrasound, also called sonography, uses high-frequency sound waves to produce images of structures within your child’s body. Ultrasound works by bouncing sound waves off solid parts of the body, which create the images. We use a special clear gel on the skin surface of the part of the body we are studying, which allows the sound waves to go from our wand into the body. We can see the image immediately, on the ultrasound machine’s screen.
- Echocardiogram (echo) tests help us evaluate the strength and function of a child's heart. The test does not involve needles, injections, or radiation. It uses sound waves, as with an ultrasound, to create a picture of the heart. We start by placing a clear jelly on the body part we want to look at, while the child is comfortably in bed, usually watching TV. We apply a small probe (ultrasound camera) to the chest to send sound waves to the heart, which creates a picture of the heart and blood flow in real time. A pediatric cardiologist interprets the results and report to the referring physician.
- Lumbar punctures, also known as a spinal taps, help us see if there are cancer cells or an infection in the fluid around your child’s brain and spinal cord. During the test, your child may lay on his or her side if sedated, or sit up if awake, chin tucked to the chest and knees pulled up to the chest. While your child’s back is in this curved position, we place a needle between the bones of the spine (vertebrae) below the spinal cord, remove some fluid from the spinal canal through the needle, and send it to the laboratory for testing. We can also use this procedure to treat some types of cancer, administering chemotherapy into the spinal canal through the same needle, usually while your child is under anesthesia.
- Magnetic resonance imaging (MRI) uses a special machine to take pictures of the inside the body. The scanner uses a magnetic field and radio waves to create an image of the organs and tissues within your child’s body. The MRI may last anywhere from 30 minutes to two hours. Some children may need anesthesia to stay still for the entire test.
- Nuclear scans use a radioactive marker or tracer, which we administer intravenously. This marker contains a small amount of radiation, about the same amount as an X-ray. We use several types of markers, depending on the kind of scan. The most common markers are FDG (used in a positron emissions tomography scan, which lets us detect fast-growing tumors, which are often cancerous), technetium (used in a bone scan to identify tumors or infections), and metaiodobenzylguanidine (helps us see a kind of tumor called a neuroblastoma). Another, less common, nuclear test is the Gallium scan, which uses gallium to help us find swelling, infection, and cancer. Usually, we administer the tracer, and then do the scan; different tracers require different waiting times. It can take up to an hour to take the scans because of the marker and because some children need sedation to stay still during the test.
- Pulmonary Function Tests (PFT) evaluate how well your child’s lungs are working: how much air the lungs can hold, and how well your child can let air out of the lungs. We perform a PFT inside a machine that has clear walls and a seat. We ask your child to wear a nose plug and blow into a plastic mouthpiece connected to the machine. The machine measures the amount of air your child was able to breathe in and the force of the air breathed out. We may need to repeat this test a few times to get an accurate reading.
- Hearing Test because some chemotherapy drugs can affect hearing, so we may check your child periodically throughout treatment. For this test, we have children wear a set of earphones and raise their right hand when they hear a sound in the right ear and their left hand when they hear a sound in the left ear. We may ask your child to repeat a list of words to test speech as well. We do not use headphones with very young children; we use other techniques. This test takes 10 to 15 minutes and parents can stay in the room during the test.