Biopsy is a surgical procedure used to determine whether tumor tissue is benign or cancerous. For this test, a small piece of tissue is removed from the tumor and then examined under a microscope to check for the presence of cancer cells. The tissue is examined by a pathologist, a physician who is an expert at identifying the changes in body tissue caused by disease. This microscopic study of the tissue confirms or rules out a diagnosis of cancer.

Bone Marrow Aspirate and Biopsy

You will likely have many bone marrow biopsies throughout your treatment. This test is extremely important for accurately diagnosing some types of cancer as well as tracking the progress of your therapy. This procedure is usually performed by one of your doctors or nurse practitioners.

The bone marrow is a soft tissue inside some of your larger bones. The bone marrow produces red and white blood cells and platelets. By examining a small amount of your bone marrow, usually taken from your hip bone in an area called the ileac crest, your doctors can make important decisions about your care.

Guidelines about sedation or anesthesia differ from one hospital to another. You may receive medication to sedate you (put you to sleep). Some common drugs used are fentanyl and propofol and may be administered by an anesthesiologist. Ask your medical team about this.

The procedure will probably be done in a treatment room where you lie face down on an examining table. A small blanket or towel may be placed under your hips to raise them. If you receive sedation medicine, you will begin to feel sleepy very soon and will not feel any of the procedure. Some kids really like the feeling from propofol. Very dreamy and relaxing. If you want, you can bring a walk-man or CD player to help you stay calm.

After you are asleep (if you are sedated), the biopsy area is cleansed and a local anesthetic is injected to numb the skin. If you are not sedated, you will feel the prick of the needle and the local anesthetic will sting at first.

A biopsy needle is then inserted through your hip bone into
your bone marrow. A small amount of bone marrow is pulled up into a syringe for testing. If you are not asleep, you may feel some pressure and pain as the needle is pushed into your bone.

Once the bone marrow is extracted, a new needle will be placed in the same hole to get a small specimen of bone for further testing. The needle is pressed forward and rotated in both directions. This forces a tiny sample of bone into the needle. If a good sample is not gotten, the doctor or nurse doing the procedure may need to try again. The needle is then removed and a pressure bandage (to stop bleeding) is applied.

A bone marrow technician will examine the bone marrow and prepare a report for your doctor. This usually takes a few days.

Your back may be sore for a few days. Tylenol may help relieve the soreness. If you have multiple bone marrow biopsies throughout your treatment, your doctor or nurse will try to alternate sides to reduce scar tissue build up. After a while, you will begin to feel like a pin cushion but unfortunately it's necessary.

Lumbar Puncture or Spinal Tap

A lumbar puncture or spinal tap may be used to diagnose as well as treat your cancer. The term lumbar refers to your lower back between the pelvis and the ribs. You might have several spinal taps throughout your treatment.

During a spinal tap, a very small needle is inserted between two bones (vertebrae) of your spine. Using this needle, a small amount of spinal fluid is withdrawn to check for cancer in your central nervous system. A chemotherapy drug may also be injected through this needle to treat your cancer (referred to as intrathecal chemotherapy).

Spinal taps take only about 20 minutes. Usually, you are asked to lie on your side and "curl up into a ball", knees bent and pulled up as far as possible with your chin touching your chest. In this position, the bones or vertebrae in your spine separate, letting the needle pass between the vertebrae and into the spinal canal.

A local anesthetic is used to numb the skin before the needle is inserted. Even with the local anesthetic, you might still feel some discomfort. Try to use relaxation techniques like deep breathing and visual imagery to stay calm.

When the test is done, a piece of sterile tape is applied to your skin where the needle was inserted. Your medical team will tell you exactly what to do after the procedure, but you will usually be told to lie flat on your back for at least an hour to prevent a headache (caused by the temporary imbalance of your spinal fluid). Even with this precaution, you may still have a headache for several days that is worse when you sit or stand up. Sometimes drinking caffeine - cola or coffee - will help the headache subside.