Childhood Cancer

Childhood Cancer

Diagnosis of soft tissue sarcomas

The doctor will obtain your child’s medical history, perform a physical examination, and order a battery of tests including a complete blood count (CBC), liver function tests, and other blood tests including electrolytes and kidney function levels. Ultrasounds, computerized tomography (CT) scan, and magnetic resonance imaging (MRI) are often done to evaluate the size of the mass and its relationship to surrounding structures. Once the mass has been examined through imaging, a biopsy is needed so the cells can be tested to determine whether the mass is cancer and, if so, what type. The three kinds of biopsy are:

•  A needle biopsy, usually done through the skin (sometimes under the guidance of ultrasound or CT scan).

•  An incisional biopsy, where the surgeon only removes a small piece of the tumor.

•  An excisional biopsy, where the surgeon tries to remove most or all of the tumor.

The biopsy should be done by a surgeon who has experience with pediatric solid tumors so:

•  Enough tissue is removed to allow for a definite diagnosis; but

•  The procedure does not make it more difficult for the entire mass to be removed in a future surgery (if additional surgery is needed).

For further information on these procedures, see Chapter 14, Surgery.

Tests are necessary to establish a specific diagnosis, especially because non-rhabdomyosarcoma soft tissue sarcomas can appear very similar, even at the microscopic level. The different types of tumor cells have distinctive molecular and genetic characteristics that can be used to help doctors establish the exact diagnosis, determine a prognosis, and find the most appropriate treatments.

TJ was 2¾ when he came to me to help get his pants back up after using the bathroom. I saw one testicle was twice as large as the other and a darker color, almost purplish red. He said it didn’t hurt. I called the pediatrician, who did an exam and thought he had some trauma to the area. We went to the local hospital for an ultrasound, and they thought it looked like there was bleeding in his scrotum, so from there they sent us to a major research hospital to see a pediatric urologist. The urologist said TJ had a hernia and to come back for surgery, but I questioned that because it felt like a mass, like a third testicle. The pediatric urologist wanted us to wait 6 weeks for the surgery, but I knew there was something else wrong with my baby so I called the next day and I said I don’t want to wait 6 weeks. We were able to schedule the surgery for 3 weeks later.

The doctor came out after 20 minutes in surgery and said that the lump was not a hernia, so he wanted to keep him under and do a biopsy, although he did not think it could be cancer. An hour after that he returned and said, “I’m really sorry, I was wrong. One of the best pathologists in the world looked at your son’s tumor and it is cancer. It is rhabdomyosarcoma. We need to remove his testicle and the tumor right now.”