TUMOR BIOPSY A tumor biopsy is the removal of a small amount of tissue to be looked at under a microscope. This test is needed to confirm the diagnosis and decide what the best treatment is. The biopsy most often is performed in the operating room by a surgeon who removes an enlarged lymph node or a small part of a tumor. In some medical centers the biopsy is done in the radiology department, where a needle is guided into the lymph node or tumor to obtain the biopsy sample (fine needle aspiration biopsy). In other cases, a surgical incision is made. Patients often are sedated for biopsies; your child’s comfort and anxiety level will always be considered in planning for this procedure. BLOOD TESTS Blood tests help diagnose medical problems and monitor for side effects of treatment. A specially trained nurse or technician uses a needle to collect blood from a vein. The blood samples are collected in tubes that are sent to a laboratory to be closely examined. In some cases, a finger prick may give enough blood for a test. These tests are usually done at the time of diagnosis to rule out other diseases and serve as a baseline for your child. Complete Blood Count Blood is made up of plasma (the liquid part of the blood) and cells floating in the plasma. There are three types of blood cells: white blood cells, red blood cells, and platelets. The white blood cells fight infection as part of the body’s immune system. The red blood cells carry oxygen throughout the body. The platelets stop bleeding by rushing to the site of an injury to form a clot. A complete blood count , or CBC, is a blood test that measures the amount and health of these three types of cells. The CBC is useful in diagnosing blood disorders. It also is used to diagnose cancers of the blood system, such as leukemia. Your child’s CBC results may change with each test because of other things going on in the body, such as infections or nutritional problems, or in response to medications like chemotherapy. Blood Chemistry A blood chemistry test measures the balance of fluid, electrolytes, and blood sugar. These measurements can provide information about the health and function of the kidneys and liver and about the body’s metabolism; they can also help diagnose certain diseases, such as diabetes. They can indicate how a disease is responding to treatment and monitor for possible side effects. Blood tests may be done to • measure creatinine and blood urea nitrogen (BUN) to monitor changes in kidney function • detect changes in liver function by measuring bilirubin • measure erythrocyte sedimentation rate (ESR) and levels of C-reactive protein (CRP), which are sometimes elevated by certain cancers. BONE MARROW ASPIRATION AND BIOPSY A bone marrow biopsy is a test done to determine whether tumor cells are in the bone marrow. A needle is inserted into the marrow inside the bone. Some of the bone marrow (the biopsy) and the fluid in the bone marrow (the aspirate) are collected. It is usually necessary to obtain bone marrow samples from both hip bones. Patients undergoing bone marrow aspirations and biopsies may experience pain, so children often are sedated for this procedure. If your child is uncomfortable after the test, a mild pain medication such as acetaminophen (Tylenol ® ) may be given, but not aspirin or ibuprofen (Motrin ® or Advil ® ). A specially trained doctor (a pathologist or hematologist) examines the biopsy and aspirate under a microscope to see if there is Ewing sarcoma detected. If the bone marrow is positive for Ewing sarcoma, it may be checked periodically during treatment to determine response to the treatment. Other tests—including immune-phenotyping, cytogenetics, and fluorescent in situ hybridization (FISH)—also may be done to detect Ewing sarcoma. A bone marrow aspirate and biopsy also is used to evaluate the white blood cells, red blood cells, and platelets to see that they are being produced normally.
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