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A first step in cancer treatment is the diagnosis. Diagnosis of cancer often involves a biopsy. A biopsy is a surgical procedure to remove a small sample of tissue from a tumor. A pathologist looks at the tissue under a microscope. The histology of the tissue, or how the cells look, gives information to identify the specific type of cancer.

A pathologist works a microscope to look at tissue histology to identify a specific type of pediatric cancer.

Most patients do not meet their pathologists, but these doctors play an important role in diagnosis and treatment.

Histology slide shows the bone marrow of a pediatric acute lymphoblastic leukemia patient under a microscope.

This histology slide shows bone marrow from an acute lymphoblastic leukemia patient under a microscope.

The methods used for the biopsy depend on where the tumor is located, the amount of tissue needed, and other procedures that are planned. Types of biopsy include needle biopsy and surgical biopsy.

  • Needle biopsy – A needle biopsy may be performed through the skin or during a surgical procedure. Depending on the tumor location, imaging scans may help doctors see the tumor and needle position. Some needle biopsies only use local anesthesia to numb the area where the biopsy will be taken.
  • Surgical biopsy – Doctors may have to cut into the skin to take a biopsy. This is often due to the location of the tumor. The surgeon will use MRI, CT, or other scans to help locate the tumor. Sometimes, a tiny video camera is used to see inside the body. Some biopsies may need only small incisions. Other biopsies require large incisions. In certain cases, doctors may remove the tumor at the same time as the biopsy. Local lymph nodes and other tissue samples may be examined to see if cancer has spread.

The pathologist views the cells under the microscope. If cancer cells are present, the tumor is malignant. If there are no cancer cells, the tumor is benign. Tumors are evaluated based on what the cells look like, how fast they are likely to grow, and how much the cells have spread.

  • Stage refers to where the cancer is in the body including where it started and where it has spread.
  • Grade describes how different cells look from normal cells, how fast the cells grow, and how likely they are to spread.

Doctors will use the information from the biopsy to plan treatment. Several factors are considered including:

  • Type of cancer
  • Size of the tumor
  • Whether cancer cells have spread to lymph nodes or other areas of the body

Learn more about cancer diagnosis and treatment.

Exam Under Anesthesia (EUA)

In some cases, doctors may perform an examination of a patient under general anesthesia. This procedure is called an EUA: exam under anesthesia. Because patients must be monitored during anesthesia, EUAs are done in an operating room under the care of an anesthesiologist. In childhood cancer, this procedure is usually used to diagnose retinoblastoma, a cancer of the eye. Sometimes, EUAs are used in other exams such as pelvic exams. Doctors try to limit the use of anesthesia when possible. However, certain exams require the child to be completely still. The type of exam, child’s age, and/or potential physical or emotional discomfort may call for the use of sedation.

Reviewed: June 2018