Oncologist-approved cancer information from the American Society of Clinical Oncology
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Ewing Family of Tumors - Childhood

This section has been reviewed and approved by the Cancer.Net Editorial Board, 5/2013
Diagnosis

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages in this guide, use the colored boxes on the right side of your screen, or click “Next” at the bottom.

Doctors use many tests to diagnose EFT and find out if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of tumors, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the tumor has spread. This list describes options for diagnosing this group of tumors, and not all tests listed will be used for every person. Your child’s doctor may consider these factors when choosing a diagnostic test:

  • Age and medical condition
  • Type of tumor suspected
  • Signs and symptoms
  • Previous test results

In addition to a physical examination, the following tests may be used to diagnose EFT:

Blood tests. A complete blood count (CBC) is a blood test done to count the number of each type of blood cells. Abnormal levels of white blood cells, red blood cells, and platelets can be a sign that the tumor has spread. The doctor may also check liver and kidney function and look for high levels of a particular blood enzyme (lactate dehydrogenase or LDH), which sometimes helps to determine the presence of a tumor in the body.

Imaging tests

X-ray. An x-ray is way to create a picture of the organs and tissues inside of the body, using a small amount of radiation. Doctors can usually find bone tumors with an x-ray.

Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears gray to the camera, and areas of injury, such as those caused by a tumor, appear dark.

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a contrast medium (a special dye) is injected into a vein or given orally (by mouth) to provide better detail.

Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body. This substance is absorbed mainly by organs and tissues that produce the most energy. Because a tumor tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body. For EFT, an integrated PET/CT scan is often more sensitive than a PET scan alone.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium may be injected into a patient’s vein or given orally to create a clearer picture.

Surgical tests

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. If the tumor is an arm or leg, an orthopedic oncologist (a doctor who specializes in cancers of the musculoskeletal system) or an interventional radiologist who has experience with EFT should perform the biopsy. The doctor may take a sample of the tumor itself, the bone marrow (the soft, spongy tissue that is found in the center of larger bones), or both. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed during the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease).

Bone marrow biopsy and aspiration. These two procedures are similar and often done at the same time. Bone marrow has both a solid and a liquid part. A bone marrow biopsy is the removal of a small amount of solid tissue using a needle. An aspiration removes a sample of fluid with a needle. The sample(s) are then analyzed by a pathologist. A common site for a bone marrow biopsy and aspiration is the hipbone in the lower back. The skin in that area is usually numbed with medication beforehand, and other types of anesthesia (medication to block the awareness of pain) may be used. 

Post-biopsy laboratory tests

Using the tissue sample removed during the biopsy, the doctor can conduct other laboratory tests to learn more about the tumor.

Immunohistochemistry. This test detects EFT cells in the tissue sample.

Cytogenetic tests and reverse transcription polymerase chain reaction (RT-PCR). These tests determine if the genetic changes that characterize EFT cells are present in the sample.

After these diagnostic tests are done, your child’s doctor will review all of the results with you and your child. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging.

Choose “Next” (below, right) to continue reading this guide to learn about the different stages for this group of tumors. Or, use the colored boxes located on the right side of your screen to visit any section.

© 2005-2014 American Society of Clinical Oncology (ASCO). All rights reserved worldwide.

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