Solid Tumors: Tests and Diagnosis

What tests are needed to diagnose solid tumors?

In most cases, diagnosis of a solid tumor requires a biopsy, though there are some exceptions, such as retinoblastoma, where a diagnosis is made by an eye exam.

A biopsy is a small sample of tissue obtained by a surgeon. Obtaining a biopsy is critical so that an exact diagnosis can be made and the proper treatment plan selected.

Biopsies are surgical procedures that are usually done in the operating room while the patient is asleep so that they don't experience any pain. The tissue from the biopsy is looked at under a microscope by a pathologist, a specialist at identifying problems with cells like cancer, who makes the diagnosis. Usually, it takes a day or two to gather all the information needed to make a diagnosis, although in some cases it may take longer.

Often, further genetic and other testing of the tumor tissue is done. This helps your child's doctors at Children's Hospital Colorado learn more about the tumor and be better able to predict its behavior and the most effective treatments.

What happens after my child is diagnosed with a cancerous tumor?

Once a diagnosis is made, the next step is to figure out if the tumor has spread in the body, a process called tumor staging. Staging varies for each tumor type. Staging is important because it helps your child's doctors decide the best treatment. Tumors that are widespread usually require more intensive treatment.

One part of staging involves getting X-rays and scans. A CT scan (or CAT scan) or MRI scan is usually done to look at the area where the tumor is, as well as to look at areas where the tumor is most likely to spread. PET scans are sometimes used to look for any areas in the body that use sugar faster than usual, indicating they have increased metabolic activity. Cancer cells often have increased metabolic activity, so PET scans are a sensitive way to find any areas in the body where cancer may be hiding.

Special scans may be done for specific tumor types, such as MIBG scans for neuroblastoma. Some cancers like to spread to the bone marrow, the substance inside of bones that make blood cells, so a bone marrow aspirate and biopsy is done as part of the staging process. About a teaspoon of bone marrow is obtained through a needle inserted into the marrow space through the back hipbones. Because this procedure is painful, it is almost always done while the patient is asleep in the operating room. It may be done at the same time as the biopsy of the tumor. In addition, basic blood tests are done to check blood counts and organ functions like kidneys and liver.

Why choose Children's Hospital Colorado for tumor testing?

All of these scans and tests can be done as an outpatient and don't require that your child stay in the hospital. However, it usually it takes a few days in the clinic to finish all the tests. Treatment isn't started until testing is finished so that your child's care team can plan the best course of treatment for your child.

Whenever possible, we prefer that these tests be done at Children's Hospital Colorado. This helps our oncologists get all of the necessary information and ensures the testing is as kid-friendly as possible. Our pediatric surgeons, radiologists, anesthesiologists and phlebotomists are experienced in working with children and their families. If these tests are done elsewhere, however, we will of course use it to provide the best care possible.