Diagnosing children's cancers

Finding childhood cancers

The diagnosis phase means finding out a child has cancer and identifying and naming the type of cancer they have. Doctors get this information by examining a child, assessing symptoms and doing tests.

Children's cancers can be difficult to diagnose, as many symptoms can also be caused by other less serious conditions or injuries like the common cold or bumps and bruises from falls. Some symptoms can include:

• easy bruising or bruising that won't go away
• an unusual lump, bump or swelling
• unexplained paleness, tiredness, loss of energy and interest in things
• pain in one area of the body that won't go away
• limping or difficulties moving around
• unexplained fever or illness that doesn't go away
• frequent headaches, often with nausea or vomiting
• vision changes, such as blurred vision
• sudden unexplained weight loss.

Many of these symptoms can happen without any serious disease being present.

However, if a child has symptoms that won't go away, a check up with a general practitioner (GP) is advised.

What next?

If a GP finds symptoms that could be caused by cancer, or receives results from tests indicating cancer, they will refer the child to a specialist doctor working in a specialist centre for childhood cancers.

Depending on the symptoms, and type of cancer referral may be made to:

• a paediatric oncologist, who specialises in treating children with cancer
• a paediatric neurosurgeon
• a paediatric surgeon
• a paediatric haematologist, who specialises in treating blood disorders.

Further tests are usually required to find out what treatment and care is necessary.

Tests or procedures

Some of the following tests or procedures may be needed to diagnose, assess or treat a child's cancer.

Audiology

Baseline hearing tests and regular testing during treatment are done for children receiving drugs that can affect hearing.

Biopsy

A surgeon may remove part of a tumour to determine if it is malignant (cancerous).

Blood test

These are done at the time of diagnosis, during treatment and occasionally after treatment, to monitor the effects of treatment.

Bone marrow aspirate

A small amount of the marrow is taken out of the bone, then examined in the laboratory for signs of cancer.

Bone scan

An x-ray scan is done to get an image of a bone or bones, to see if there is any cancer present.

CT scan

Takes many pictures of soft tissue or organs inside the body, from different directions. These pictures are put together to create a three-dimensional picture of the body.

Central venous access device (CVAD)

A tube is used through which drugs and fluids can be given and blood specimens taken painlessly, they are semi-permanent.

Echocardiogram

An ultrasound test used to assess heart function. Heart function is monitored at regular intervals when certain medications are used.

Gallium scan

Identify sites of infection and malignancy. The first scan is usually 48 hours after receiving an injection of radioactive material into the vein and a second scan a week later.

Glomerular filtration rate (GFR)

This is a specialised test to monitor kidney function, used to monitor children being treated with some types of medications.

Insuflon

Insuflon is used when a medication needs to be injected several times, to reduce the need for daily injections.

Lumbar puncture

A few drops of spinal fluid are removed to see if cancer cells have passed into the cerebrospinal fluid surrounding the brain.

Magnetic resonance imaging (MRI) scan

Magnetic waves are passed through the body and produce different images depending on the type of cell they pass through. They are harmless. The MRI can give an accurate picture of a tumour and the surrounding structures.

Nasogastric tube (NGT)

A tube used to give liquids including nutrition and medicine.

Positron emission tomography (PET) scan

This gives a picture of how a part of the body is working to help identify malignant or benign tumours.

Ultrasound scan

A machine directs the ultrasound waves at a certain part of the body. Differences in how the sound waves are reflected helps form an image. This is interpreted to distinguish a healthy part from a tumour.

X-rays

These can show whether there is tumour in the chest, abdomen or bones because tumour tissue looks different from ordinary bone or normal tissue.

Helping children cope with having tests/procedures

Going through procedures and tests to help diagnose cancer can be a challenging time for both a child and the family. Understandably, some parents are anxious about what the test may mean for their child and how their child will cope.

Health professionals doing the tests will work with the child and parents to reduce any discomfort, pain or fear. Parents play a significant role in helping make this happen. In addition to professional play, therapists and procedural clinicians, reassurance, cuddles and distractions can help children promote their own natural coping strategies.

The Royal Children's Hospital Melbourne website also has some very helpful information for parents and patients about coping during any tests or minor procedures they may need before and after their cancer diagnosis.

Information reviewed by: Cancer Council Victoria with assistance from The Paediatric Integrated Cancer Service (PICS), parents and staff from the Oncology units at both The Royal Children's Hospital, Melbourne & Monash Children's, Monash Health, Melbourne and ONTrac, Peter Mac Victorian Adolescent and Young Adult (AYA) Cancer Service.