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UC Davis Comprehensive Cancer Center

UC Davis Comprehensive Cancer Center

Tests and procedures

Many procedures and tests are used to diagnose your child's medical condition. They can be used to find out the extent of the disease, see how the disease is responding to treatment, monitor remission or the progression of the disease, and evaluate the side effects of treatment.

Depending on your child's type of cancer, symptoms and treatments, your child may have a few, many, or all of these tests. For any test, it's important to understand why the test is being done, how the results will influence treatment, what your child will experience during the test, what risks are associated with the test, and what you may be able to do to help make it easier for your child.

It's important to keep all of your scheduled appointments for the various tests and procedures. Often, the doctors are waiting for the results before they can proceed with the necessary medical care.

Below you will find information about these topics:

Medications that help decrease pain during procedures
Preparing children for medical testing
Types of tests and procedures

Medications that help decrease pain during procedures

For some tests and procedures, the most common risk is pain. Different types of medicine can help to decrease pain during the tests. Some medicines are given before the test and others are given during the tests. If you think your child has pain during a test, tell your doctor or nurse. Members of the health-care team can help prepare your child for the test and help your child find positive ways to cope with the test.

Local anesthesia (numbing the skin and tissues)

Before a test is done, a numbing medicine (such as EMLA or ELAMAX) can be placed on the skin where the needle will go. This cream numbs the skin and tissue about one-quarter of an inch under the skin. After the cream has numbed the surface of the skin, another numbing medicine can also be given using a small needle that is placed a little bit deeper into the tissue. This numbing shot may burn a little bit, but after one to two minutes, the tissue will feel numb all the way down to the bone. Using this type of pain medicine alone may be useful for older children who can lie very still.

Sedation

Sedation is the use of medicines that may make your child feel calm and sleepy, and possibly not remember having the test done. Two types of medicines are used. One type, the opioids, are pain medicines. These include fentanyl and morphine. The other type of medicines work by making your child relax and not remember the test. These include midazolam (Versed) and diazepam (Valium). Using these two types of medicines together helps some children relax and not experience pain during the test.

These medicines may cause your child's breathing to slow down. Your child will be closely watched for changes in breathing and blood pressure. Your child may be on a heart monitor during and after the test, until he or she is fully awake. Your child may not eat any solid foods or drink liquids for a certain amount of time before these medicines are given.

Deep sedation or general anesthesia

Deep sedation or general anesthesia is the use of anesthetic medicine, given into a vein or by a mask to make your child go completely to sleep. Your child will not feel pain, move, or remember the test during or after general anesthesia. Examples are ketamine and propofol.

There is a small risk that your child could have a slowing or stopping of the heartbeat or breathing during general anesthesia. Your child will be watched closely on a heart monitor during the test and until he or she is fully awake. A doctor or nurse, trained to give sedation or general anesthesia, will give the medicine and watch your child during and after the test. Your child will not be able to eat solid foods or drink liquids for a few hours before the test.

PROCEDURES AT UC DAVIS MEDICAL CENTER

Bone marrow aspirates, bone marrow biopsies and lumbar punctures are done at the University Surgery Center, in the main hospital. An instruction sheet with specific time, eating and drinking limitations will be provided by your nurse.

Other procedures that require your child to hold still for special radiology tests may have specific eating and drinking guidelines. Please call your nurse if you have questions.

Compliance with these instructions is vital or the procedure may be cancelled and your child's medical care delayed.

Also see GREAT information factsheet: What you can do to help your child in pain.

Preparing children for medical testing

The hospital experience can be very overwhelming for children. To make the experience more positive, it is important that your child feel a sense of control. Medical testing is a necessary part of the cancer journey. Children who understand what is going to happen, how it will happen and why it is necessary are able to participate in their care more easily.

You know your child better than anyone. The health team relies strongly on your assessment of how well your child understands what is happening. If you feel that you or your child needs additional information or support, discuss this with a member of the health-care team.

If you think your child is having pain during a procedure, tell your doctor or nurse. There are many ways to help decrease pain. Members of the health team are available to help prepare your child for the test and to help your child develop positive ways to cope with testing.

Also see GREAT information factsheet: How patients and siblings react to hospital care.

Types of Tests & Procedures

Audiogram
Biopsy
Blood cultures
Bone marrow aspirate
Bone marrow biopsy
Bone scan
Central venous catheter placement
CHEM panels
Complete blood count
Creatinine clearance
CT scan
Echocardiogram
Electrocardiogram
Fertility planning
Gallium scan
Glomerular filtration rate
Lumbar puncture
Magnetic resonance imaging (MRI)
Nuclear medicine scans
Neuropsychological evaluation
PET/CT scan
Pulmonary function tests
Spinal tap
Ultrasound
Urinalysis
Venipuncture
Ventriculo-peritoneal shunt
X-ray

Audiogram

An audiogram measures hearing. Your child may be asked to wear headphones or to sit in a soundproof booth during testing. Very young children may need to have their hearing tested while asleep. This type of hearing test, called a BAER, is done by measuring the child's brain waves when he or she is exposed to different sounds. An audiogram does not hurt.

Biopsy

In a biopsy, a small piece of tissue is taken out of the body and tested for cancer cells.

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

Some biopsies are done in the operating room under general anesthesia. Other biopsies are done using local anesthesia. The type of anesthesia used will depend on where the tumor is in the body.

Blood cultures

A blood culture is a test to detect germs such as bacteria or yeasts (a type of fungus) in the blood. A test may be ordered when a child has symptoms of an infection, such as a high fever or increased white blood cell count. A sample of blood is taken and sent to the laboratory. The culture can tell what type of germ is causing the infection, which will determine the treatment. It can take up to 72 hours to get the results from a blood culture test. Until the blood culture results are known, the doctor will order antibiotics that are most likely to kill the most common types of bacteria in children with cancer. If the culture results show bacteria are present, the culture will help your doctor know whether to change to another antibiotic.

tests & procedures
Bone marrow aspirate

A bone marrow aspirate is a test that is done to see if cells in the bone marrow are healthy. Bone marrow is the liquid, spongy part of the bone where blood cells are made.

For this test, a needle is placed in a bone (usually the hip bone) and a small amount of bone marrow is pulled into a syringe. The marrow is sent to the laboratory to be tested for cancer cells.

Your child may feel some pain when the needle is placed in the bone and may feel pressure when a syringe removes the bone marrow cells. The most common risk related to this test is pain. There is a small chance that your child could bleed under the skin or get an infection where the needle is placed.

Most commonly, the patient lies on his or her abdomen for this test. A staff member will help get your child into the proper position and support that position throughout the procedure.

  • Numbing medicines and sometimes sedation can minimize pain and anxiety.
  • Lying still can be stressful. Practicing the position before the test can help your child to feel in control and understand what he or she needs to do.
  • Helping your child understand what may happen usually reduces anxiety.
Bone marrow biopsy

A bone marrow biopsy is done to study an actual piece of the bone. It may be completed at the same time as bone marrow aspirate.

For this test, a needle is placed in a bone (usually the hip bone) and a small piece of bone is removed. The bone is sent to the laboratory for testing.

If your child is awake, he or she may feel some pain when the needle is placed in the bone and may feel pressure or "tugging" when the needle removes a small piece of bone. The most common risk associated with this test is pain. There is a small chance that your child may bleed under the skin or get an infection where the needle is placed.

Most commonly, the patient lies on his or her abdomen for this test. A staff member will help get your child into the proper position and support that position throughout the procedure.

  • Numbing medicines and sometimes sedation can minimize pain and anxiety.
  • Lying still can be stressful for children. Practicing the position before the test can help your child to feel in control and understand what he or she needs to do.
  • Helping your child understand what will happen usually reduces anxiety.
  • A large pressure bandage will be placed on the site after the procedure. This needs to be observed for excessive bleeding and removed the next day.
  • Pain at the site of the test is not uncommon for one or two days afterward. Tylenol may be used as directed by your doctor.
Bone scan

A bone scan takes pictures of the bones to see if tumor or infection is present. A special dye (a radioactive marker) is given in the vein three hours before the pictures are taken. This dye contains about the same amount of radiation as an X-ray. The dye goes to spots in the bones that are not normal. After the injection your child will wait three hours before having the scan; the scan will take about an hour.

Your child will need to lie still during this test. Some children may need sedation (medicine that makes them sleepy) to be able to lie still for the whole scan. Some children feel "closed in" when the scanner passes over their body, but a bone scan itself does not hurt.

tests & procedures
Central venous catheter placement

Depending on the type of cancer your child has and which drugs are used to treat it, chemotherapy may be given in a variety of ways – by mouth, intravenously (into a vein using an IV), intramuscularly (into a muscle), subcutaneously (just below the skin – like an allergy shot) or intrathecally (into the spinal fluid).

Another way to give IV chemotherapy is through a catheter, a thin plastic tube that is placed into a large vein in the body. The catheter remains in place during the course of treatment so that drugs can be given without having to place a needle into a vein over and over again. The most commonly used are central venous lines. While the child is under general or local anesthesia, the catheter is put into a large vein in the chest by making a small incision (cut) near the collarbone. Two types of central venous catheters are commonly used: external and internal.

  • Examples of external lines include a CVL, Broviac or Hickman. Another type of external central line is called a PICC (peripherally inserted central line). This is a central line that is put in through a vein in the arm and then threaded up to a large vein that leads to the heart. It may be recommended for short-term uses.
  • An internal line is one that stays under the skin and needs to have a needle placed into it each time it is used. Examples of internal lines include a Port-a-cath, port, Medcomp or Mediport. This type of catheter may be more appealing to adolescents or for families who cannot take care of a catheter that needs special daily care. This type may not be recommended for some therapy protocols.

In addition to chemotherapy, other medicines and therapies can also be given through the catheter. These include pain medicine, blood products, nutrition, fluids and antibiotics. In addition, blood can be drawn from the body through the catheter.

CHEM Panels

Chemistry panels are groups of tests that are routinely ordered to determine a patient's general health status. These tests help evaluate the body's electrolyte balance and/or the status of several major body organs, like the liver. The tests are performed on a blood sample, usually drawn from a vein in the arm. Your child's doctor may order a complete panel of tests or only the specific individual tests that he or she thinks is most needed. The following tests are some of the most commonly used at UC Davis Medical Center for our pediatric cancer patients:

  • Potassium – Potassium is one of the electrolytes and minerals (along with calcium, sodium, and magnesium) that are found naturally in the body. Working together, these electrolytes are needed to keep the body's balance of fluids at the proper level and to maintain normal functions, such as heart rhythm, muscle contractions and brain function. A potassium level that is too high or too low can be dangerous. Abnormal potassium levels may cause symptoms such as muscle cramps or weakness, nausea, diarrhea, frequent urination, dehydration, low blood pressure, confusion, irritability, paralysis and changes in heart rhythm. The chemical symbol for potassium is K.
  • Sodium – Sodium is another of the electrolytes and minerals found in the body. It helps regulate the water balance (the amount of fluid inside and surrounding the cells). It also plays an important role in nerve and muscle function. Too much sodium in the diet may raise blood pressure in some people and can increase the amount of water retained by the body, leading to swelling of the legs and hands. Low blood sodium levels are uncommon and most often occur as a side effect of taking medications that increase urination. Severe diarrhea or vomiting or heavy sweating may also cause low blood sodium levels. The chemical symbol for sodium is Na.
  • Blood glucose – Blood glucose tests measure a type of sugar, called glucose, in your blood. Glucose comes from carbohydrate foods such as breads, cereals, rice, fruits and desserts. It is the main source of energy used by the body. Insulin is a hormone that helps your body use and control the amount of glucose in your blood. Normally, your blood glucose levels increase slightly after you eat. This increase causes your pancreas to release insulin so that your blood glucose levels do not get too high. Blood glucose levels that remain high over time can damage eyes, kidneys, nerves, and blood vessels. Several different types of blood glucose tests are used. Fasting blood sugar measures blood glucose after you have not eaten for at least eight hours. Two-hour blood sugar tests measure blood glucose exactly two hours after you eat a meal. Random blood sugar measures blood glucose regardless of when you last ate.
  • Bilirubin – Bilirubin is a substance produced by the breakdown of old red blood cells and hemoglobin. Hemoglobin is the protein in red blood cells that carries oxygen from the lungs to the rest of the body. Bilirubin is removed from the body through the digestive system as part of the bile from the liver. Normally, the body is constantly making new red blood cells and breaking down old ones. The amount of bilirubin in a person's blood is usually very low. Higher-than-normal amounts of bilirubin in the blood cause a person's skin and eyes to become yellow (jaundice). A blockage in the bile duct or certain medical conditions, such as liver disease, may cause bilirubin levels to rise to an unhealthy level.
  • Alanine aminotransferase (ALT) – ALT is an enzyme (a type of protein) that is found mainly in the liver, but also in smaller amounts in the kidneys, heart, muscles and pancreas. ALT is measured to see if the liver is damaged or diseased. Low levels of ALT are normally found in the blood. However, when the liver is damaged or diseased, ALT levels increase. Most increases in ALT levels are caused by liver damage. The ALT test is often done along with other tests that check for liver damage, including aspartate aminotransferase, alkaline phosphatase, lactate dehydrogenase and bilirubin testing.
  • Asparatate aminotransferase (AST) – AST is an enzyme (a type of protein) that is normally found in red blood cells, liver, heart, muscle tissue, pancreas and kidneys. Low levels of AST are normally found in the blood. When an organ such as the heart or liver is diseased or damaged, additional AST is released into the bloodstream. The amount of AST in the blood is directly related to the extent of the tissue damage. After severe damage, AST levels rise in six to 10 hours and remain high for about four days. The AST test may be done at the same time as a test for alanine aminotransferase (ALT). The ratio of AST to ALT sometimes can help determine whether the liver or another organ has been damaged. Both ALT and AST levels can test for liver damage.
  • Uric acid in blood – Uric acid is produced from the breakdown of your body's cells and from the food you eat. Most of the uric acid is filtered out by the kidneys and passes out of the body in urine; the rest passes out of the body in stool. However, if too much uric acid is being produced or if the kidneys are not functioning normally, the level of uric acid in the blood increases. High levels of uric acid in the blood can build up in the body. This can cause a painful condition called gout. If gout remains untreated, uric acid crystals can build up in the joints and nearby tissues, forming hard deposits called tophi. High levels of uric acid may also cause kidney stones or kidney failure.
  • Magnesium – Magnesium is an important electrolyte needed for proper muscle, nerve and enzyme function. It also helps regulate energy production in cells and is needed to move other electrolytes (potassium and sodium) into and out of cells. Magnesium is one of the most abundant minerals in the body and is found mainly inside the bones and cells. Only a tiny amount of magnesium is normally present in the blood. It is absorbed through the small intestine. Magnesium deficiency is rare, but when it occurs it is often caused by conditions that interfere with the ability of the intestines to absorb magnesium from food. Symptoms of a magnesium deficiency include weakness, dizziness, irregular heartbeat, tremors and seizures. An increased amount of magnesium in the blood can be caused by kidney failure or by excessive use of certain medications that contain magnesium (such as antacids or laxatives). Problems with the thyroid gland can also cause magnesium levels to rise. Too much magnesium in the blood can cause low blood pressure, nausea, vomiting, diarrhea, dizziness, muscle weakness and slurred speech. Very high levels can lead to heart problems or an inability to breathe, especially in people with kidney disease.
  • Lactate dehydrogenase (LDH) – LDH is an enzyme that helps produce energy. It is present in almost all of the tissues in the body and becomes elevated in response to cell damage. LDH levels help doctors diagnose heart attack, lung disease, lymphoma, anemia and liver disease. LDH levels also help us to determine how well chemotherapy is working during treatment for lymphoma.
Complete blood count

The complete blood count, or CBC, is a very common blood test. It evaluates the three major types of cells in blood: red blood cells, white blood cells and platelets. A sample of blood is taken from your child's finger, heel or vein and sent to the lab to be analyzed. This test is often done to check for anemia, infections or other health problems, or to see how your child is responding to certain treatments, such as chemotherapy. Each one of these blood counts has a “normal range” that varies with age, sex, elevation above sea level, pregnancy status, and type of blood sample. Ask your child's doctor or nurse for the normal ranges for your child.

A CBC test usually includes:

  • White blood count (WBC) -- White blood cells protect the body against infection. If an infection develops, white blood cells attack and destroy the bacteria, virus, or other organism causing it. When a person has a bacterial infection, the number of white cells can increase dramatically. Treatment for cancer kills healthy white cells as well as diseased ones. Children often have long periods of low white counts during treatment.
  • White blood cell types (WBC differential) -- The major types of white blood cells are neutrophils, lymphocytes, monocytes, eosinophils and basophils. Each type of cell plays a different role in protecting the body. The numbers of each one of these types of white blood cells give important information about the immune system. An increase or decrease in the numbers of the different types of white blood cells can help identify infection, an allergic or toxic reaction to certain medications or chemicals, and many conditions, such as leukemia.
  • Red blood cell (RBC) count -- Red blood cells are produced by the bone marrow. These cells carry oxygen from the lungs to the rest of the body. They also carry carbon dioxide back to the lungs so it can be exhaled. In this test, the number of red blood cells in the body is counted.
  • Hemoglobin (Hgb) -- Hemoglobin is the major substance in red blood cells. It carries oxygen and gives the blood cell its red color. This test measures the amount of hemoglobin in blood and is a good indication of the blood's ability to carry oxygen throughout the body. During cancer treatment, a child's hemoglobin may become low because the bone marrow is not producing a lot of new red blood cells. Sometimes when the nurses in the clinic are waiting for a CBC, they will do a quick test of the hemoglobin by using a machine called the “HemoCue.”
  • Hematocrit (HCT) -- This test measures the amount of space (volume) red blood cells occupy in the blood. The value is given as a percentage of red blood cells in a volume of blood. For example, a hematocrit of 38 means that 38 percent of the blood's volume is composed of red cells. With chemotherapy, the hematocrit goes down, less oxygen is in the blood, and the child usually has less energy.
  • Platelets -- This test measures the platelets, the smallest blood cells. They play an important role in blood clotting and the prevention of bleeding. Because platelets are produced by the bone marrow, platelet counts decrease when a child is receiving chemotherapy. Signs of lowering platelet counts are bruises, gum bleeding or nosebleeds.
tests & procedures
Creatinine clearance

A creatinine clearance test is a way to measure how well the kidneys are working. Creatinine is a protein that is in blood and urine. You will collect your child's urine in a container for 24 hours. You will need to collect the urine every time your child goes to the bathroom. The amount of urine needs to be accurate. In addition, your child's blood will be tested for the level of creatinine in the blood. The amount of urine and the amount of creatinine in the blood are used in a formula to measure kidney function.

If your child does not have a central line, a small needle, or IV, will be placed in a vein to take several blood samples needed for the test. A numbing medicine may be put on the area to decrease pain or discomfort from the IV.

CT scan

A CT (computerized axial tomography) scan uses a special X-ray to make a three-dimensional picture of the inside of the body. It is very helpful in detecting tumors, infections and blood vessel blockages. The scan is done in the radiology department. Contrast dye may be given in a vein and/or by mouth.

Your child will need to lie still for as long as one hour while the CT scan takes pictures of the body. Some children need sedation to be able to lie still for the whole scan. Having a CT scan does not hurt, but your child may become uncomfortable from lying still for a long time.

Echocardiogram

An echocardiogram (ECHO) is a test of the strength and function of the heart. A clear gel is placed on the child's chest. The person doing the test will place a small instrument on the chest to send sound waves, like in an ultrasound, to the heart. The sound waves create a picture of the heart. An ECHO does not hurt.

tests & procedures
Electrocardiogram

An electrocardiogram (EKG) measures the rhythm of the heart. Small leads (plastic or paper circles with a metal center) are placed on different parts of the chest and sometimes on the legs as well. A small amount of gel is put on the skin under the leads. The leads are attached to a monitor that measures the heart rhythm. When the rhythm needs to be measured over several hours or more, the test equipment is called a Holter monitor. This monitor is attached around the child's waist and hooked to the leads. Having an EKG or a Holter monitor does not hurt.

Fertility planning

One of the side effects of your child's cancer treatments may be infertility. This means that some treatments may affect his or her ability to have children. A man may not be able to produce healthy sperm. A woman may not be able to produce mature eggs, or may have other conditions that prevent her from getting pregnant or maintaining a pregnancy. Infertility may be temporary or permanent.

If your son has entered puberty before treatment, it is possible to freeze sperm for future use. If your daughter has entered puberty before treatment, her fertility may be preserved through embryo freezing, egg freezing or ovarian tissue freezing. For children who have not yet entered puberty, testicular tissue freezing for boys and ovarian tissue freezing for girls are currently the only fertility preservation options. Tissue freezing shows a lot of promise, but it is still considered experimental.

If your son or daughter is undergoing radiation, his or her doctor can place external shields over the pelvic area to help reduce the risk of infertility. For boys, this is called testicular shielding. For girls, this is called ovarian shielding.  Shielding will help decrease radiation to the pelvic area. If a girl needs radiation to the pelvic area, it is also possible to surgically move the ovaries out of the radiation field. The ovaries are later moved back to their original position.

Making decisions about your child's future fertility while also dealing with cancer treatment is difficult. The idea of your child as a parent may seem very far away. Support is available from reproductive endocrinologists, oncologists, nurses, social workers, spiritual advisers and psychologists. There are a lot of resources to help you and your family. With all of the options available today, as well as those that will be developed in the future, your child can become a parent one day.

Gallium scan

A gallium scan is one type of nuclear medicine test that uses a special camera to take pictures of specific tissues in the body after a radioactive tracer makes them visible. The radioactive tracer is injected into a vein in the arm. It travels through the bloodstream and into the body's tissues, primarily the bones, liver, intestine and any areas of tissue where inflammation or a buildup of white blood cells is present. It usually takes the tracer a few days to accumulate in these areas, so in most cases the scan is done 48 hours and repeated at 72 hours after the tracer is injected. The gallium scan requires three visits to the nuclear medicine department – one for the injection, and then two more for the scans.

Your child will lie on his or her back on a table, and a large scanning camera will slowly move above and around the body. Each scan takes about 60 to 90 minutes. The scans do not cause any pain. Areas where the tracer accumulates in higher-than-normal amounts show up as bright or “hot” spots in the pictures. A gallium scan is used for specific types of cancers, mainly of the lymph nodes, bones or bone marrow. The results are interpreted along with the results of other tests, such as a physical exam, blood tests and X-rays. The radioactivity of the tracer decreases over a period of weeks. It remains in the body temporarily before it is eliminated as waste, usually in the urine or stool.

tests & procedures
Glomerular filtration rate

The glomerular filtration rate (GFR) test looks at how well the kidneys are working. A special dye is given into a vein. After the dye is given, a sample of blood is taken at certain times to measure how much dye is still in the blood. The GFR helps doctors understand how well the kidneys are working by measuring how quickly the dye is removed from the blood.

If your child does not have a central line, a small needle, or IV, will be placed in a vein to take several blood samples needed for the test. A numbing medicine may be put on the area to decrease pain or discomfort from the IV.

Lumbar puncture

A lumbar puncture (also called a spinal tap or LP) is a procedure that is done to see if there are cancer cells or an infection in the fluid around the brain and spinal cord. During the procedure, a small sample of cerebrospinal (pronounced sir-REE-bro-spine-al) fluid is collected and sent to the laboratory to be examined under a microscope. Sometimes a lumbar puncture is done to place chemotherapy medications into the spinal fluid; this is referred to as “intrathecal chemotherapy.”

What happens
Your child will receive general anesthesia with a drug called propofol for the LP and will not feel pain, be able to move, or remember the test after waking up. The doctor wants to obtain the best possible results from the procedure while minimizing pain and anxiety in your child. Typically, caregivers are invited to be present in the room with their child while the procedure is taking place.

At UC Davis Medical Center your child cannot eat food or drink fluids for a certain amount of time before the procedure. You might hear this called “NPO” which means “nothing by mouth.” The reason for your child to be NPO before sedation is to be sure that his or her stomach is empty. Otherwise, the sedation medicine can cause nausea and vomiting.

When it is time for the LP, you and your child will go to the procedure room and meet the anesthesiologist who will monitor your child during the procedure. Once your child has the appropriate monitoring equipment on – blood pressure cuff, pulse oximeter, leads and oxygen mask – the anesthesia will be given into the IV and your child will fall asleep. This part of the procedure takes about 15 minutes .

Your child will lie down on his or her side with knees pulled up to the chest. In some cases, older children can sit up and curl their backs by tucking their chins to their chests (if not under anesthesia). Another doctor, typically a pediatric oncologist, will do the LP. Your child's back will be cleaned with a special soap and a sterile paper cloth will be placed over the area. The cloth has an opening in the center where the procedure will be done.

The LP is done by inserting a needle into the spinal column below the spinal cord into an area called the subarachnoid (pronounced sub-a-RACK-noid) space. The area where the needle is to be inserted is typically numbed by injecting a medication called lidocaine. After the area is numb, a different needle is used for the actual lumbar puncture. Your child may move in response to the slight pressure from the insertion of the needle, but will not feel any pain .

When the needle enters the subarachnoid space, cerebrospinal fluid will slowly drip back out through the needle and into a plastic tube for testing. When about one teaspoon of fluid is collected, the needle is removed, thrown away, and a Band-Aid is put on your child's back. This part of the procedure takes about 15 minutes.

If intrathecal chemotherapy is to be given, the small amount of cerebrospinal fluid is collected first. Next, a syringe with chemotherapy is attached to the end of the needle and the medicine is slowly pushed into the spinal fluid. Once completed, the needle is removed, thrown away, and a Band-Aid is put on your child's back. After the procedure, your child will be taken to the recovery area where a nurse will monitor your child for about an hour.

Risks for this procedure
There is a small chance that your child could get an infection in the spinal fluid after the test, bleed under the skin where the needle was placed, have pain at the site where the needle was inserted, or have headaches from leakage of the spinal fluid. Your child will need to lie flat for at least 20 minutes after the LP for medicine to circulate throughout the spinal fluid, and to minimize the possibility of a headache afterward. Rarely, the doctor may have difficulty placing this needle and more than one poke will be necessary.

Consider talking with a child life specialist about how to help prepare your child for this procedure and about additional services that may help you and your child cope with this experience.

 

Magnetic resonance imaging

An MRI uses a special machine (scanner) to look inside the body. The scanner uses magnetic waves to create a picture of the inside of the body. Your child will need to lie still on the table inside the MRI machine while the pictures are made.

Your child may not wear anything metal (jewelry, belt, etc.) because the machine attracts metal. You child will hear a rhythmic knocking sound, like a drumbeat, when the machine is on.

You may not be able to stay in the same room with your child during this test; however, you and the staff can always hear and see your child. Having an MRI can last from 30 minutes to two hours. Some children need sedation to lie still for the whole test. An MRI does not hurt, but some children do not like the knocking sound and may become uncomfortable from lying still for a long time.

tests & procedures
Nuclear medicine scans

There are a variety of types of nuclear medicine scans that are like a bone scan: a PET scan, Gallium scan, and MIBG scan. The purpose of these scans is to look for cancer cells. A special dye is given in a vein before pictures are taken. Each of these scans uses a different type of dye. The dyes have a small amount of radiation. The dye goes to the areas of the body where cancer cells are. Your child will need to lie still during these scans.

Neuropsychological evaluation

A neuropsychological evaluation is used to examine brain function and impairment. It consists of a number of tests and procedures that measure a child's intelligence, visual and verbal memory, attention and concentration, language skills, academic achievement and behavior. These tests are usually performed by a psychologist who works with both the child and parents to determine how well a child is functioning before, during and after treatment. Most of these tests are done sitting at a table or at bedside in a hospital and there is no pain and no needles. The tests may be done throughout one day or over several days for shorter periods of time.

PET/CT scan

A PET/CT scanner combines two diagnostic imaging tools into a single powerful machine. A positron emission tomography (PET) scan detects changes in how your body's cells are functioning. The computed tomography (CT) scan provides information about the body's anatomy, size, shape and location. By combining these two tools, a PET/CT scan can help a physician detect cancer earlier, pinpoint its exact location in the body and provide accurate staging information. It also helps to improve therapy planning, measures the response of treatments such as chemotherapy or radiation therapy, and provides for earlier detection of a recurrence of cancer.

PET/CT SCAN AT UC DAVIS MEDICAL CENTER

The PET/CT scan is done in the Radiology Department at the main hospital. An instruction sheet with specific time, eating and drinking limitations will be provided by your nurse. About an hour before the scan, your child will be injected with a radioactive sugar substance that will circulate throughout the body and seek out cancer cells. The scan takes about 25 – 40 minutes and your child will have to lay very still for the test.

tests & procedures
Pulmonary function tests

Pulmonary function tests (PFTs) measure how well the lungs are working. The tests measure how much air the lungs can hold and how well your child can push air out of the lungs. Your child will be asked to blow into a plastic mouthpiece connected to a machine. The machine measures the amount of air breathed in and the force of the air breathed out. Your child will probably be asked to repeat the test a few times to get an accurate reading. At UC Davis Health System, the full pulmonary testing will be done at a testing lab in the main hospital. Spirometry testing, which may be done in the clinic area, is a quick, simple breathing test that evaluates your child's lung function by measuring air flow into and out of the lungs.

Spinal tap

A spinal tap (also called a lumbar puncture) is a test that is done to see if there are cancer cells or an infection in the fluid around the brain and spinal cord.

Ultrasound

An ultrasound works by bouncing sound waves off parts of the body. Clear gel is placed over the part of the body that is being studied. A small round instrument is then placed on the gel and moved around to get a clear picture of the tissue or organ. An ultrasound does not hurt.

tests & procedures
Urinalysis

A urinalysis tests the urine. A small amount of urine is collected in a cup, or by placing clean cotton balls into the baby's diaper. The nurse may test the urine or it may be sent to a laboratory to be tested. The number of white blood cells and red blood cells will be counted. The urine will also be tested for protein, bacteria and sugar.

Venipuncture

A venipuncture is the puncture of a vein, usually from the inside of the elbow or the back of the hand, in order to obtain blood samples, to start an IV or to give a medication.

Ventriculo-Peritoneal (VP) Shunt

A ventriculo-peritoneal shunt or VP shunt is used to treat hydrocephalus, which occurs when cerebrospinal fluid builds up inside the brain. If too much fluid builds up, the pressure can hurt the brain or even threaten the patient's life. A VP shunt is a long, plastic tube that allows fluid to drain from the brain's ventricle to a space within the body, usually the abdomen (peritoneal cavity). In this area, the body reabsorbs the fluid. The fluid does not go into the stomach. Your child will need to go to the operating room and be put to sleep with general anesthesia to have the shunt placed. Your child may be admitted to the hospital a few hours before the surgery to receive IV (intravenous) antibiotics. After the surgery, you may be able to feel part of the tube behind your child's ear.

Once the VP shunt has been placed, it helps keep the child healthy by relieving pressure within the brain. Also see GREAT information factsheet: Ventriculo-Peritoneal Shunts.

tests & procedures
X-ray

An X-ray is a picture that shows the inside of the body. For example, X-rays can show if a bone is broken or if an infection or fluid is in the lungs. X-rays do not hurt.

 

Sources: Family Handbook for Children with Cancer, Childhood Cancer: A Parent's Guide to Solid Tumor Cancers, National Cancer Institute, CureSearch/Children's Oncology Group, Fertile Hope, HealthWise, St. Jude Children's Research Hospital, UC Davis Medical Center. Last updated: 5/2007