DIAGNOSTIC PROCEDURES

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.

Bone Marrow Aspirate: 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 the blood cells are made. For this test, a needle is placed in a bone (usually the hipbone) 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.

You 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 you could bleed under the skin or get an infection where the needle is placed.

Bone Marrow Biopsy: While a bone marrow aspirate is done to look at the blood cells in the bone marrow, a bone marrow biopsy is done to study an actual piece of the bone. For this test a needle is placed in a bone (usually the hipbone) and a small piece of bone is removed. The bone is sent to the pathology laboratory for testing.

You 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 you may bleed under the skin or get an infection where the needle is placed.

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 before the pictures are taken. This dye contains about the same amount of radiation as an X-ray. The dye goes to the spots in the bones that are not normal. The scan may take up to an hour.

You will need to lie still during this test. Some patients may need sedation (medicine that makes you sleepy) to be able to lie still for the whole scan. Some patients may feel closed in when the scanner passes over their body, but a bone scan itself does not hurt. MUGA (multigated acquisition) takes a picture of your heart to see the amount of blood that is pumped with each beat. A special dye (a radioactive marker) is given in the vein before the pictures are taken. This dye contains about the same amount of radiation as an X-ray. The dye travels in the blood stream to the heart, and the pictures are taken and analyzed.

Complete Blood Count (CBC): Measures the different kinds of cells in the blood. The cells that are counted are the white blood cells, red blood cells, and platelets. A CBC is done to judge your response to treatment.

Computerized axial tomography scan (CT scan): Uses a special X-ray to make a three-dimensional picture of the inside of the body. The scan is done in the Radiology Department. Contrast dye may be given in a vein and/or by mouth. You will need to lie still for up to 1 hour while the CT scan takes pictures around your body. Some patients need sedation to be able to lie still for the whole scan. Having a CT does not hurt, but you may become uncomfortable from lying still for a long time.

Creatinine Clearance: Measures how well your kidneys are working. Creatinine is a protein that is in the blood and urine. You will collect your urine in a container for 24 hours. You will need to collect the urine every time you go to the bathroom. The amount of urine needs to be accurate. Your blood will be tested for the level of creatinine in the blood. The amount of ursine and the amount of creatinine in the blood are used in a formula to measure kidney function.*

* If you do not have a central line, a small needle will be placed in a vein (an IV.) 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.

Echocardiogram (ECHO): A test of the strength and function of the heart. A clear jelly is placed on the chest. The person doing the test will use a small round handle 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.

Electrocardiogram (EKG): Measures the rhythm of the heart. Small leads (plastic or paper circles with a metal center) are placed on different places on the chest and sometimes the legs. A small amount of jelly 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 a day, the test equipment is called a Holter monitor. The monitor is attached around the waist and hooked to the leads. Having an EKG or Holter monitor does not hurt.

Lumbar Puncture: A lumbar puncture (also called a spinal tap) 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. You will be asked to lie on your side with chin tucked to chest and knees pulled up to the chest. In some cases you can sit up and curl the back by tucking the chin in the chest. When the back is in a curved position, a needle can be placed in between the bones of the spine (vertebrae). Fluid from the spinal canal can be removed through the needle and dripped into a tube that is sent to the laboratory to be tested. For some types of cancer, chemotherapy may be given into the spinal canal through the same needle after the cells are removed for testing. You may have a headache or backache after the test. There is a small chance that you could get an infection in the spinal canal after the test or an infection or bleed under the skin where the needle is placed.

Magnetic resonance imaging (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. You will need to lie still on the table inside the MRI machine while the pictures are made. You may not wear anything metal (jewelry, belt, etc.) because the machine attracts metal. You will hear a rhythmic knocking sound, like a drumbeat, when the machine is on.

Having an MRI can last from 30 minutes up to 2 hours. Some patients need sedation to lie still for the whole test. An MRI does not hurt, but some patients do not like the knocking sound and may become uncomfortable from lying still for a long time.

PET Scan or Positron Emission Tomography:  An imaging technology that has the unique ability to detect the metabolic (chemical) processes of the body. While other imaging modalities show anatomical or structural changes in the body, a PET scan can reveal chemical changes in the tissues often before anatomical or structural changes have occurred or are evident on other imaging modalities, such as a CT scan. This is especially significant in the diagnosis of cancer, since cancerous tissue is more metabolically active than normal tissue.

Pulmonary Function Tests (PFTs): Measure how well the lungs are working. The test measures how much air the lungs can hold and how well you can push air out of the lungs. You may 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. You will probably be asked to repeat the test a few times to get an accurate reading.

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

Urinalysis: Tests the urine. A small amount of urine is collected in a cup and sent 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.

X-ray: A picture taken of the inside part of the body. For example, X-rays can show if a bone is broken or if there is fluid in the lungs. X-rays do not hurt.