Investigations in suspected childhood cancer

Haematology

• FBC and film. Leukaemia usually reflected in the blood count: 4 or 5 WBC, ± thrombocytopenia and anaemia. Blasts often present. In a small percentage, blood count entirely normal. With other malignancies there may be signs of marrow infiltration (see above), anaemia or no abnormalities at all.

• BM aspirate and trephine if blood count abnormal. In children generally done under GA. Bilateral samples needed in the staging of neuroblas-toma.

Biochemistry

• Full biochemical profile.

• Urinary catecholamines for neuroblastoma (easy test to do in unexplained bone pain).

• Tumour markers: a-FP, |3HCG in hepatoblastoma or germ cell tumours.

Radiology

• CXR for mediastinal mass (mandatory pre-anaesthetic).

• CT/MRI scan of primary lesion. CT chest/abdomen may be required for staging. In young children sedation/general anaesthetic usually needed for CT/MRI scans.

Histology

• Solid tumours need adequate biopsy material for diagnosis taken under general anaesthetic.

Genetics

• Fresh tumour material from all childhood cancers should be sent for cytogenetic and molecular genetic studies. Information from these is increasingly being used in risk-stratifying therapy and in predicting outcome.

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