Medical professionals utilize numerous tests to find, or identify, a neuroblastoma tumor. They also do tests to find out if cancer has actually spread to another part of the body from where it began. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests reveal pictures of the within the body. Doctors may also do tests to find out which treatments could work best.
Neuroblastomas are usually discovered when a child is brought to the medical professional since of signs or symptoms she or he is having. If a tumor is believed, tests will be had to verify the diagnosis.
Medical History and Physical Exam
If your child has signs or symptoms that might be brought on by a neuroblastoma (or another tumor), the doctor will ask about the symptoms and how long they have existed. The doctor may also ask if there is any history of possible risk elements, such as a family history of neuroblastoma.
The doctor will analyze your child for possible signs of a neuroblastoma and other illness. For example, the doctor might be able to see or feel an abnormal mass or swelling. The doctor may feel to see if the child has swellings or bumps under the skin and analyze your child’s eyes carefully. They may also take a look at your child’s blood pressure because sometimes neuroblastoma cells can make hormones that trigger hypertension. Neuroblastomas can sometimes grow near the spine, which can impact motion and strength in the child’s arms and legs, so the medical professional will pay close attention to these.
Some signs that could be triggered by neuroblastoma, such as fever and enlarged lymph nodes, are far more likely to be brought on by an infection, so the medical professional may look for other signs of infection in the beginning.
Lab and Imaging Tests
If the history and test recommend a child may have a neuroblastoma (or another type of tumor), more tests will be done. These might include blood and urine tests, imaging tests, and biopsies. These tests are important because many of the symptoms and signs of neuroblastoma can likewise be brought on by other diseases, such as infections, and even other kinds of cancer.
Blood and Urine Catecholamine Tests
The body makes several types of hormones. Considerate afferent neuron usually release hormones called catecholamines, such as epinephrine (adrenaline) and norepinephrine, which get in the blood and eventually break down into smaller sized pieces, called metabolites. The metabolites usually lose consciousness of the body in urine. When epinephrine and norepinephrine are broken down by the body, the two most typical metabolites made are:
- Homovanillic acid (HVA).
- Vanillylmandelic acid (VMA).
Neuroblastoma cells can likewise make these catecholamines. These 2 catecholamine metabolites can be measured in blood and urine. For the most parts, neuroblastoma cells make sufficient catecholamines to be detected by blood or urine tests. If neuroblastoma cells are making catecholamines, the amount of HVA and VMA in urine or blood will be greater than anticipated.
If neuroblastoma is suspected or has actually been found, your child’s physician will most likely buy blood tests to examine blood cell counts, liver and kidney function, and the balance of salts (electrolytes) in the body. A urinalysis (urine test) might likewise be done to further check kidney function.
Imaging tests utilize x-rays, magnetic fields, sound waves, or radioactive substances to develop photos of the inside of the body. Imaging tests can be provided for a number of reasons, consisting of:
- To help learn if a suspicious location may be malignant.
- To learn how far cancer has actually spread out.
- To assist figure out if treatment has actually worked.
If neuroblastoma is extremely thought, the most typical imaging test to have first is normally an MRI or CT scan. If your child is diagnosed with neuroblastoma, they will have an MIBG scan as well. Many children who have or might have neuroblastoma will have several of these tests, however might not need all of these tests.
Kids with neuroblastoma are often very young, so it can be hard to do some of these tests due to the fact that the child may need to hold very still. Depending on your child’s age and the imaging test that they will have, they may get medications that are a type of anesthesia or sedation to assist them keep still.
Ultrasound might be one of the first tests performed in very young children if a growth is thought, since it is fairly quick and simple, it does not use radiation, and it can frequently give the physician a good view inside the body, specifically in the abdominal area (stomach). Ultrasounds are generally refrained from doing if the child has currently had an MRI or CT scan.
For this test, your child lies on a table (or rests on your lap) while a little wand called a transducer is put on the skin over the stubborn belly (which is first oiled with gel). The wand produces acoustic waves and picks up the echoes as they bounce off organs. The echoes are transformed by a computer system into a black and white image on a screen. The test is not normally unpleasant, however it might trigger some discomfort if the transducer is pushed down hard on the stomach.
Ultrasound is utilized usually to try to find growths in the abdominal area. (It’s not used to look in the chest due to the fact that the ribs obstruct the sound waves.)
MRI scans supply comprehensive images of soft tissues in the body. These scans are very practical in looking at the brain and spinal cord. They might be slightly much better than CT scans for seeing the extent of a neuroblastoma growth, particularly around the spinal column.
MRI scans use radio waves and strong magnets to develop the images rather of x-rays, so there is no radiation. A contrast product called gadolinium may be injected into a vein prior to the scan to much better see information.
MRI scans can use up to an hour. For the majority of MRI makers, your child has to lie inside a narrow tube, which is restricting and can be traumatic. Newer, more open MRI makers might be an alternative in some cases, but they still require the child to remain still for long periods of time. The MRI device likewise makes loud ringing and clicking sounds that might be disturbing. Younger children and kids who will not have the ability to be still for an extended period of time are typically given medicine to assist keep them calm or perhaps asleep throughout the test.
Computed Tomography (CT or CAT) Scan
CT scans are frequently utilized to try to find neuroblastoma in the abdomen, hips, and chest.
Prior to the test, your child might be asked to consume a contrast solution and/or get an IV (intravenous) injection of a contrast dye. This assists much better overview structures in the body.
Younger kids or children that might not be able to hold still may be sedated (provided medicine to make them sleepy) before the test to reduce movement and help make sure the images come out well.
CT-guided needle biopsy: CT scans can also be used to help direct a biopsy needle into a tumor. It is not as common for kids to have a needle biopsy if neuroblastoma is believed because the quantity of the sample collected might not be enough for all of the tumor tests that are required.
This test is frequently an important part of learning how far a child’s neuroblastoma has actually spread. It is often done after a CT scan or MRI has currently been done. This scan uses a form of the chemical meta-iodobenzylguanidine (MIBG) which contains a percentage of radioactive iodine. MIBG is similar to norepinephrine, a hormone made by understanding nerve cells. It is injected into a vein and travels through the blood, and in a lot of patients it will attach to neuroblastoma cells anywhere in the body. Between 1 and 3 days later, the body is scanned with a special electronic camera to search for locations that picked up the radioactivity. This assists medical professionals know where the neuroblastoma is and if it has spread to the bones and/or other parts of the body.
MIBG scans can be duplicated after treatment to see if the growths are reacting well. It is also good to understand if the tumor uses up the MIBG due to the fact that in some cases, this radioactive molecule can be used at higher dosages to deal with the neuroblastoma (see Radiation Therapy for Neuroblastoma). The thyroid gland can also absorb MIBG, so a medication consisting of iodine is in some cases provided prior to and throughout the test to safeguard the thyroid.
A bone scan can help show if a cancer has actually spread to the bones, and can supply a picture of the whole skeleton at once. Neuroblastoma often triggers bone damage, which a bone scan can discover. This test utilized to be done routinely, but in lots of centers it has actually been replaced using of MIBG or PET scans. This test may be done after an MIBG scan, depending on those outcomes.
For this test, a percentage of low-level radioactive product (technetium-99) is injected into a vein. (The amount of radioactivity utilized is very low and will lose consciousness of the body within a day or so.) The substance settles in areas of harmed bone throughout the skeleton during a number of hours. Your child then lies on a table for about 30 minutes while an unique camera spots the radioactivity and produces a picture of the skeleton. More youthful children may be given medicine to help keep them calm or perhaps asleep during the test.
Locations of active bone modifications attract the radioactivity and appear as “locations” on the skeleton. These locations may suggest cancer, however other bone diseases can likewise cause the very same pattern. To assist tell these apart, other imaging tests such as plain x-rays or MRI scans, and even a bone biopsy may be needed.
Positron Emission Tomography (PET) Scan
For a PET scan, a radioactive compound (usually a type of sugar associated to glucose, called FDG) is injected into the blood. The quantity of radioactivity utilized is very low and will pass out of the body within a day approximately. Since cancer cells in the body are growing rapidly, they absorb big quantities of the radioactive sugar. After about an hour, your child will be moved onto a table in the PET scanner. He or she will lie on the table for about 30 minutes while an unique camera develops a photo of areas of radioactivity in the body. More youthful children might be offered medication to assist keep them calm or perhaps asleep during the test. The picture from a PET scan is not as detailed as a CT or MRI scan, but it can provide valuable details about the entire body.
Some newer devices can do a PET and CT scan at the exact same time (PET/CT scan). This lets the doctor compare areas of higher radioactivity on the PET scan with the more in-depth look of that location on the CT scan.
The physician might buy an x-ray of the chest or another part of the body as an early test if a child is having symptoms but it’s unclear what may be causing them. However the images might not suffice to spot growths.
An MIBG scan or a bone scan is usually much better for taking a look at the bones in the remainder of the body and to see if neuroblastoma has actually spread to the bones.
A standard chest x-ray might be done if a child is having difficulty breathing, however a CT or MRI scan of the chest can reveal more about the growth size and location.
Exams and imaging tests may highly suggest a child has neuroblastoma, however a biopsy (removing a few of the tumor for seeing under a microscopic lense and other laboratory testing) is generally had to make sure. Throughout a biopsy, the doctor removes a piece of the tumor. The biopsy samples are sent to a laboratory, where they are viewed under a microscope by a pathologist (a physician with special training in recognizing cancer cells). Some neuroblastomas are quickly recognized when looked at by skilled physicians. But some might be tough to differentiate from other types of children’s cancers. In these cases, unique laboratory tests need to be done to reveal the tumor is a neuroblastoma.
In adults, biopsies are in some cases done utilizing local anesthetic (numbing medication), but in children they are more often done while the child is under basic anesthesia (sleeping). There are 2 primary types of biopsies:.
- Incisional (open or surgical) biopsy: This kind of biopsy is done by eliminating a piece of the tumor through a cut (cut) in the skin. For tumors deep in the body this might be done laparoscopically using long, thin surgical tools inserted through little cuts in the skin.
- Needle (closed) biopsy: For this kind of biopsy, a thin, hollow needle is put through the skin and into the growth to remove a little sample. If the tumor is deep within the body, CT scans or ultrasound can be utilized to help guide the needle into the growth. Needle biopsies are not normally valuable when a child might have neuroblastoma due to the fact that the amount of tumor in the sample is frequently not large enough to have all the special tests that are needed.
Other lab tests on neuroblastoma samples can help determine how rapidly the tumor may grow or spread in the body. What doctors learn more about a child’s neuroblastoma from these tests can help identify what treatments might work the very best. A few of these tests are explained in Neuroblastoma Stages and Prognostic Markers.
Bone Marrow Aspiration and Biopsy
Neuroblastoma often infects the bone marrow (the soft inner parts of particular bones). If blood or urine levels of catecholamines are increased, then finding cancer cells in a bone marrow sample is enough to identify neuroblastoma (without getting a biopsy of the primary growth). If neuroblastoma has currently been detected by a biopsy done in other places in the body, bone marrow tests are done to help determine the extent of the disease.
A bone marrow aspiration and biopsy are usually done at the same time. In most cases the samples are drawn from the back of both of the pelvic (hip) bones.
Even when the area is numbed with local anesthetic, these tests can be painful, so for the most parts the child is likewise provided other medications to decrease pain or even be asleep throughout the procedure.
For a bone marrow goal, a thin, hollow needle is placed into the bone and a syringe is utilized to suck out a percentage of liquid bone marrow.
A bone marrow biopsy is also done. A little piece of bone and marrow is removed with a somewhat larger needle that is lowered into the bone. When the biopsy is done, pressure is applied to the site to help stop any bleeding.