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Testing and Diagnosis

Just hearing the words cancer or blood disorder can leave you reeling from the questions in your head and the fear in your heart. Testing and diagnosis are the first steps toward answering those questions and helping to turn fears into an action plan.

Whether your physician suspects that your child has a serious illness, or your child has already been diagnosed and you are seeking a second opinion, the hematology and oncology team here at Cook Children's is here to walk you through each process and support you, your child and your family every step of the way.

The sophisticated testing and diagnostic tools at Cook Children's enable specialists to identify specific illnesses and disorders and to determine the best course or courses of care, depending on the results of the diagnoses. The types of testing your child undergoes will be determined by his or her current symptoms as well as a history of past illnesses and symptoms. Using the prescribed tests, clinical specialists will examine different body tissue and fluids to find and diagnose the cause of your child's symptoms. Testing protocols may include:

Physical exam and medical history

An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of your child's health habits and past illnesses and treatments will also be taken, as well as a family history.

Twenty-four-hour urine test

A test in which urine is collected for 24 hours to measure the amounts of certain substances. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it. A higher than normal amount of the substances homovanillic acid (HMA) and vanillyl mandelic acid (VMA) may be a sign of neuroblastoma.

Blood chemistry studies

A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it. Your child's blood may be tested for red and white blood cell counts, blood sugar levels, toxins, antibodies and a variety of illnesses and disorders related to diabetes, infection, cancers, anemia, hemophilia, liver function and a wide variety of blood-related ailments.

Cytogenetic analysis

A laboratory test in which cells in a sample of tissue are viewed under a microscope to look for certain changes in the chromosomes.

Bone scan

A bone scan takes pictures of the bones to see if there is an infection or tumor present. The patient is given a special dye called a radioactive isotope through an IV. The dye, which contains a small amount of radiation (about the same amount as an X-ray), travels to the bones so the scanner can detect any abnormal activity.

Bone marrow aspiration and biopsy

The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.


The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer.


An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

CT scan (CAT scan)

A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

Neurological exam

A series of questions and tests to check the brain, spinal cord, and nerve function. The exam checks a person's mental status, coordination, and ability to walk normally, and how well the muscles, senses, and reflexes work. This may also be called a neuro exam or a neurologic exam.

Ultrasound exam

A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.

Immunohistochemistry study

A laboratory test in which a substance such as an antibody, dye, or radioisotope is added to a sample of cancer tissue to test for certain antigens. This type of study is used to tell the difference between different types of cancer.

MIBG (metaiodobenzylguanidine) scan

A procedure used to find neuroendocrine tumors, such as neuroblastomas and pheochromocytomas. A very small amount of a substance called radioactive MIBG is injected into a vein and travels through the bloodstream. Neuroendocrine tumor cells take up the radioactive MIBG and are detected by a scanner. Scans may be taken over 1-3 days. An iodine solution may be given before or during the test to keep the thyroid gland from absorbing too much of the MIBG.

Magnetoencephalography (MEG)

The MEG is non-invasive diagnostic tool that uses magnetic fields created by brain activity. Because the MEG produces a highly accurate representation of the tumor's location in the brain (within millimeters), it is used for pre-surgical evaluation.

Genetics testing

These tests can tell the medical team a lot about the very specific type of disorder your child has and help them create a more exacting plan of care. Genetic testing also helps them determine which clinical trials your child may qualify and, of those, which are the best fit for your child particular needs. Genetic testing can also help determine your child's prognosis, and in the case of cancer, risk of recurrence.

Gallium scan

This nuclear medicine test uses a special camera that captures images of specific tissues in the body. The patient is given a radioactive tracer which travels through the body and locates areas where there is a build-up of white blood cells, which may be due to infection, inflammatory disease or a tumor.

Lumbar puncture (spinal tap)

This is an image-guided test that removes cerebrospinal fluid (the fluid that surrounds the brain and spinal cord) from the spine so it can be examined for infection or cancer cells.

Follow-up diagnostics

Because there are so many types of blood disorders and cancers, follow-up testing may be required to give the specialty team additional information in order to customize a treatment plan for your child's specific needs.

As treatment continues, some tests that were done to diagnose the illness or to find out the stage of cancer may be repeated (staging tests are performed to find out if the cancer has spread and, if so, to what extent.) Some tests will be repeated throughout your child's care to see if your child's condition has changed, how well the treatment is working and if changes to treatment need to be made based on the results of these tests. For cancer patients, once treatment is completed, follow-up tests can also show if the cancer has come back (recurred). This is important because if it does recur, catching it sooner gives your child a better chance of fighting the disease.

To learn more about the testing and diagnostics services available at Cook Children's, visit our pathology page or radiology page.

We are here to help.

If your child has been diagnosed, you probably have lots of questions. We can help. If you would like to schedule an appointment, refer a patient or speak to our staff, please call our offices at 682-885-4007.