Pediatric Cancer Services

Diagnosing cancer

Initial evaluation by the pediatric oncologist
When cancer is suspected, children are referred for a complete physical examination with a pediatric oncologist, who specializes in diagnosing and treating cancer in children. During this visit, the pediatric oncologist will conduct a physical exam and carefully take down the child's medical history.

Medical tests are also necessary to determine if cancer is present and if so, what type it is. This helps the cancer team plan out the best treatment. Many of these tests are performed on an outpatient basis at the Pediatric Specialty Center, located on the 2nd floor of the Yale-New Haven Children's Hospital (West Pavilion).

Children are made as comfortable as possible during these tests and parents can often stay with their child during diagnostic procedures. In addition, a child life specialist is available to help a child through these procedures using a variety of soothing techniques of your child's choosing. These include games, guided imagery or watching television or a tape. The procedure room has its own television and VCR.

Outpatient care at the Pediatric Specialty Center

Blood tests
A blood test is one way doctors may be able to identify if a child has cancer. A CBC or complete blood count test is just that—a count of all the types of blood cells. There are three types of blood cells: white blood cells, red blood cells and platelets. A CBC is used to detect any change in:

	the number of white blood cells or lymphocytes, which fight infection.
	red blood cells, which carry oxygen.
	platelets, which help blood clot.

Blood tests are often repeated throughout treatment. They may be done in your doctor's office or at the Pediatric Specialty Center at Yale-New Haven Children's Hospital.

Bone marrow aspiration and examination
Bone marrow is found inside some of the bones of the body. Examining a sample of bone marrow under a microscope is the only test that can confirm the presence of certain cancers such as leukemia. The results of bone marrow tests often determine if cancer is present and, if so, how it will be treated. A sample of bone marrow is usually removed from the hip bone with a needle while the child lies on his or her stomach or side. The marrow is liquid and looks like blood. This process is called aspiration. Sometimes, a biopsy needs to be performed, too.

Spinal tap or lumbar puncture
This technique allows the collection of a sample of cerebrospinal fluid (CSF). This fluid surrounds the brain and spinal cord. Certain cancers are known to spread to this fluid. This test is performed while the child lies on his or her side with legs curled up to the chest. A needle is placed between the small bones of the back to collect the fluid, which is then checked for the presence of cancer. In certain diseases, chemotherapy drugs are given straight into the fluid after it is collected.

Biopsy
All biopsy involves taking a sample of tissue to be analyzed in the lab. Needle biopsy involves taking a tissue sample by using a thin needle inserted into the tumor. If the tumor is deep inside the body, the needle can be guided while the doctor watches its progress on a monitor. This technique does not require surgery, but sometimes it does not yield enough tissue to perform a complete analysis.

An excisional or incisional biopsy may be preferred in certain cases. The surgeon removes or excises all of or only a portion of a tumor for further examination under a microscope. These types of biopsies are usually performed in an operating room at the hospital either by surgeons or radiologists while the child is under general anesthesia.

Imaging tests
A variety of imaging tests can help doctors determine if tumors are present and where they are located. They generally cannot tell if a growth is cancerous or not.

	Computed tomography (CT or CAT scan) CT is a type of X-ray that can make very precise images of the internal parts of the body and tumors. It is painless but the child must lie absolutely still during the scan. For this reason, some children require medication to make them sleepy. It may be necessary to drink a flavorless dye to help make the images more clear. In other cases, a small amount of dye may need to be injected into a vein. Unless a child has a known allergy to the dye, there are no side effects from either type of dye. The Pediatric Imaging Center is located next to the Pediatric Specialty Center on the 2nd floor of Yale-New Haven Children's Hospital (West Pavilion).
	Magnetic resonance imaging (MRI) With MRI, powerful magnets are used to create precise pictures of body tissues using radio waves. Radio waves are not harmful to your child's body tissues. There is no radiation. The procedure is painless but may require sedation because patients must remain absolutely still. During the scan, the room containing the MRI machine is kept cool to keep the magnets from overheating. Patients my hear a clicking noise made by the magnets. The MRI Center is located on the lowest level of Yale-New Haven Hospital at the corner of Howard and Davenport avenues. Use the Dana or Hunter entrances.
	Ultrasound Ultrasound uses sound waves to look at internal body structures or tumors. This procedure is painless. The child lies down and lotion is spread over the area to be scanned. A probe (transducer) is gently rubbed over the area as it is scanned. Video pictures are produced on a monitor. There is no radiation. Ultrasounds are done in the Pediatric Imaging Center, located on the 2nd floor of Yale-New Haven Children's Hospital (West Pavilion) next to the Pediatric Specialty Center.
	Nuclear medicine scans A variety of different scans are performed in the nuclear medicine department of the Children's Hospital. A small amount of radioactive material is injected into a vein. The amount of radioactivity is harmless. After some time has passed to allow the material to flow throughout the child's body, pictures are taken of particular areas to determine if any of the radioactivity has been absorbed. The child lies down and a machine moves slowly over the body parts being scanned. Sedation may be required. Nuclear scans are performed in the Pediatric Imaging Center, located on the 2nd floor of Yale-New Haven Children's Hospital (West Pavilion) next to the Pediatric Specialty Center.

Genetic studies
Cytogenic and molecular genetic studies (tests of the chromosomes or genes) can help distinguish one type of cancer from another that looks similar under the microscope. These tests can sometimes help predict whether the type of cancer will respond to therapy.

Learn more
YNHH Health Library: Questions to Ask Your Child's Physician

Last revised: Jan. 8, 2008 (dh)

All information is intended for your general knowledge and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness regimen.