Tests for Neuroblastoma
In order to provide the most appropriate treatment several tests (investigations) are needed, which look at the lymph nodes affected by the tumour. Also looked at are other parts of the body where the tumour might have spread (metastasised) to, and parts of the body which might be affected by the treatment. These tests are done before treatment starts and at stages throughout the treatment.
The investigations your child will need are:
Blood tests:
Your child will need frequent blood tests both whilst having chemotherapy and between courses. Most children will have a portacath or Hickman line or local anaesthetic cream can be used to numb the skin before doing a blood test.
X-rays:
Of the chest and area affected by the tumour.
Biopsy:
This is a limited operation, usually under general anaesthetic, to remove a small piece of tissue from which a diagnosis can be made.
Bone marrow aspirate and trephine:
As some cancer affects the bone marrow, this is examined before treatment starts and at stages during treatment. A needle is put into the bone (usually the hip) and some marrow sucked out (aspirate). Sometimes a tiny piece of bone is also taken (a trephine). These samples are studied in the laboratory. An anaesthetic is always used; most children will have a general anaesthetic, although some older children choose a local anaesthetic. In some cases bone marrow is taken from more than one place.
Ultrasound scan:
Ultrasound scans are used to look at soft parts of the body, particularly the abdomen (tummy) and testes. They are an easy way of showing us the site and size of normal organs, glands and tumours, and can also be used to monitor the response to treatment.
It is not painful but your child has to lie still and will have some cold jelly on the area to be scanned. Young children may require sedation if they are unable to keep still.
Computerised axial tomography
(CAT or CT scan):
Computerised images are taken using x-rays. Your child has to lie on a couch which moves into a large ring containing the sensors. The scan does not hurt, but it is important to keep still. Small children will require a general anaesthetic or sedation. Sometimes a harmless dye (contrast) is used; this may be injected or swallowed depending on the scan. The scan takes about half an hour and a parent can usually stay with their child.
Urine:
Samples of urine are collected for a number of reasons.
- to look for infection,
- to assess response to treatment,
- to detect complications of treatment.
In addition, your child's fluid balance (how much fluid goes in and how much comes out) is important to monitor during chemotherapy. You will be required to keep details on how much urine is passed and chart this on the fluid chart.
EDTA (Kidney test):
Some of the drugs that your child will receive may have an effect on the kidneys. We will test the kidney function at regular intervals. This will involve an injection of a tiny amount of radioactive substance and a number of blood tests (usually three) over a few hours. Should the chemotherapy we use prove to be damaging the kidneys, the doses will be adjusted for the next chemotherapy courses.
MIBG :
This looks at places to which the tumour might have spread. A mildly radioactive dye is injected (usually on a Wednesday) and the scan performed the following day. This is quite harmless as the amount of radioactivity is very small. Your child lies on a couch with the camera above him/her. This does not hurt and takes about half-an-hour. Your child does not have to stay in hospital.
Because the dye used contains iodine, in order to protect your child's thyroid gland (in the neck) he/she will have to take iodine tablets/medicine for two days before and three days after the scan (this is currently being reviewed).
Bone Scan :
This looks for problems in bones, such as tumour or metastases (spread of tumour). A mildly radioactive dye is injected on the day of the scan. This is quite harmless, as the amount of radioactivity is very small. A few hours later the scan is done. Your child lies on a couch with the camera about him/her. This does not hurt and takes about half-an-hour.
Hearing test (Audiogram) :
As the chemotherapy drugs that your child will receive may have an adverse effect on hearing, he/she will undergo a hearing test before, and occasionally after part of the treatment. This is a painless test which involves wearing a set of headphones and responding to sounds of various tones and volume.
Echocardiogram :
This is an examination of the heart performed by ultrasound (i.e. like a pregnancy scan) which is not painful but requires that your child lies still and has some jelly applied to the chest and upper abdomen.
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