Procedures and Treatments

We provide the most compassionate care and expertise in providing a range or procedures and treatments from biopsies and bone marrow aspiration to surgery.

Tumor Biopsy

A tumor biopsy is a test where a small piece of tumor or tissue is taken out of the body to be examined for cancer cells. This procedure is done to determine the exact type of cancer present. A biopsy can also be done to determine whether treatment has gotten rid of cancer cells or to monitor continued remission.
There are two types of biopsies. The exact procedure depends upon the area to be biopsied and the patient’s age.

• A closed biopsy is when a needle is put into the tissue to obtain a sample without cutting open the skin
• An open biopsy is when the skin is opened during surgery to get a sample of tissue

Some biopsies are done in the operating room under general anesthesia (completely asleep). Other biopsies are done using local anesthesia to numb the skin. The type of anesthesia used will depend on the location of the biopsy.

Resources: Children's Oncology Group

Blood Studies

Blood studies are tests that examine a patient’s blood. They are the most common tests done for cancer patients and help doctors follow the course of a patient's disease and select the right treatment dosage.

Blood can be drawn in a variety of ways, depending on your child’s situation. The most common way to draw blood is to insert a needle into a vein. Children undergoing chemotherapy may have a central venous line in place from which blood can be drawn.

Resources:  Children's Oncology Group

Bone Marrow Aspirate/Biopsy

• A bone marrow aspirate is a test to see if cells in the bone marrow are healthy. Bone marrow is the “factory” where blood cells are made. Bone marrow is found in the center of bones and is made up of both spongy bone and liquid marrow. For this test, a needle is placed in a bone (usually the hipbone) and a small amount of liquid bone marrow is pulled into a syringe (usually 1-3 teaspoons). It is sent to the laboratory to be tested for cancer cells.

  Resources:  Children's Oncology Group

• A bone marrow biopsy is used to study an actual piece of spongy bone marrow. It may be completed at the same time as a bone marrow aspirate. For this test, a needle is placed in a bone (usually the hipbone); a small piece of spongy bone marrow is removed and sent to the laboratory to be tested.

• Resources: Children's Oncology Group

Central Lines

Maintaining intravenous (IV) access for children requiring chemotherapy is a challenge. There are devices available to make this process easier. The type of device chosen is dependent upon the type and duration of therapy.

Resources: Children's Oncology Group

The two most common types are:

• External catheters (also known as: BROVIAC®, HICKMAN®) – External catheters are tunnelled under the skin and are surgically placed in a major vessel of the body, most often in the chest are called external because a portion of the catheter is exposed which allows usage without a needle stick.

• Subcutaneous ports (also known as: mediport, port-a-cath, port, infusaport) – These devices are surgically placed and are totally implanted into the subcutaneous tissue (tissue that is directly under the skin), most often on the chest. They have an attached catheter that is inserted into a major vessel. A special "huber" (90 degree) needle is inserted through the skin and into the port by a medical professional before the port is used.

Images and Scans

Imaging tests take pictures of places inside the body to see if there is a tumor or infection present. There are various ways to capture images of the inside of a patient’s body, from using sound waves to X-rays to radioactive dyes. These tests to not generally cause pain.

Resources: Children's Oncology Group

• Bone Scan - A bone scan takes pictures of the bones to see if there is a tumor or infection present. A special dye called a radioactive isotope, or tracer, is given through an IV. This tracer contains a small amount of radiation, about the same amount as an X-ray. The tracer travels to the spots in the bones that are not normal. The scanner can then detect and take pictures of the areas where there may be tumor activity. Bone scans do not hurt.

  Resources: Children's Oncology Group

• CT Scan (CAT) - A CT scan (computerized axial tomography scan) is a special type of imaging test that uses a computer to make a three-dimensional picture of the inside of the body. CT scans are not invasive and are performed in the radiology department of a hospital. CT scans allow doctors to look not only at a person’s bones, but also at soft tissue and blood vessels. CT scans are often used for diagnosing cancer because doctors can see the exact size and location of a tumor inside the patient’s body.

  Resources: Children's Oncology Group

• Echocardiogram - An echocardiogram (echo) is a test that helps doctors evaluate the strength and function of a child's heart. The test uses sound waves to create a picture of the heart.

  Resources: Children's Oncology Group 

• Gallium Scan - A gallium scan is a nuclear medicine test that uses a special camera to take images of specific tissues in the body. Several days before the test is performed, a radioactive tracer is injected into the body through a vein in the arm. Over the next two to three days, the tracer travels through the body and builds up in locations where there is a build-up of white blood cells.

  Resources: Children's Oncology Group

• MIBG Scan (Meta-iodobenzylguanidine Scan) - MIBG (meta-iodobenzylguanidine) scans help locate and diagnose certain types of tumors in the body. MIBG is a substance that gathers in some tumors, particularly neuroblastoma tumors. When MIBG is combined with radioactive iodine (tracer), it provides a way to identify primary and metastatic (spread) disease. MIBG scans are helpful for locating both bone and soft tissue tumors.

  The test is performed by injecting a small amount of radioactive dye (tracer) through an IV. Pictures are then taken under a scanner that is similar to a CT scan. The scans may occur 24, 48, or 72 hours after the tracer is given. Doctors are looking for bright spots on the scan, these indicate cancer cells.

  Resources: Children's Oncology Group

• MRI (Magnetic Resonance Imaging) - An MRI (magnetic resonance imaging) uses a special scanning machine to take pictures of the inside of the body. The patient will lie still on the table inside the MRI machine while it takes pictures. There will be a rhythmic knocking sound during the scan, like a drumbeat. Some children are frightened by the sound. Parents are unable to stay in the same room during the test, however, a microphone and a mirror allow the parents and staff to always hear, see and talk to the patient.

  Resources: Children's Oncology Group

• Nuclear Medicine Scans - Nuclear medicine scans use small amounts of radioactive dye (tracer) to highlight areas of concern, such as cancer cells or infection. Pictures can then be taken of these areas. There are many types of nuclear medicine scans, including:

  • Bone Scan
  • PET Scan
  • Gallium Scan
  • MIBG Scan

  Resources: Children's Oncology Group

• PET Scan (Positron Emission Tomography Scan) - PET scans look at tumor activity in the body. PET scans are done by injecting a small amount of radioactive isotope, or tracer, into a vein. The tracer travels to places in the body where there is tumor activity. After the tracer is injected your child will have to lie very still on the PET scanner table while pictures are taken.

  Resources: Children's Oncology Group

• SPECT Scan (Single Photon Emission Computed Tomography) - SPECT scans are similar to PET scans. They use a special camera to make three-dimensional images of inside the body. SPECT scans are effective for getting information about blood flow to tissues and chemical reactions in the body. SPECT scans are often used for diagnosing and monitoring treatment for brain tumors and cancers affecting bones.

  Resources: Children's Oncology Group

• Ultrasound - An ultrasound uses sound waves to create an image of the tissue or organ that is being studied. The image can be seen on the screen of the ultrasound machine.

  Resources: Children's Oncology Group

Kidney Tests

The kidneys are a pair of identical organs located inside the body near the middle of the back. In adults, each kidney is about the size of a fist. Shaped like the beans that carry their name, the kidneys filter waste out of the bloodstream, creating urine which passes into the bladder.

Kidney tests measure how well the kidneys are working, particularly what types of substances are being released into the urine, at what levels and how quickly. Different tests measure different functions of the kidneys. Kidney tests can be performed using blood or urine samples and no not hurt of have any side effect.

Resources: Children's Oncology Group

Lumbar Puncture (Spinal Tap)

A lumbar puncture, also called a spinal tap, is an image-guided procedure performed on the lower back which removes fluid that surrounds the brain and spinal cord to examine it for cancer cells or infection. This fluid is called cerebrospinal fluid or CSF and is a clear liquid that delivers nutrients to the brain and cushions the spinal cord and brain. A lumbar puncture may also be performed to inject medication into this the spinal column. Children and adolescents are usually given anesthesia or sedation before a lumbar puncture is performed.

Resources: Children's Oncology Group

Pulmonary Function Test

A pulmonary function test (PFT) evaluates how well the lungs are working. The test measures how much air the lungs can hold, and how well the child can push air out of his or her lungs.

Resources: Children's Oncology Group