Leukemia--Acute Lymphocytic Overview

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Early Detection, Diagnosis, and Staging TOPICS

How is acute lymphocytic leukemia found?

At this time there are no special tests that can find acute lymphocytic leukemia (ALL) early. The best way to find it early is to report any possible signs or symptoms of leukemia to the doctor right away.

The doctor will ask you questions about your health (take a medical history), and do a physical exam. He or she will look for any swollen lymph nodes, any bleeding or bruising, or signs of infection. If the doctor suspects leukemia, blood tests will likely be done. If the results suggest leukemia, you will be sent to a specialist, such as a hematologist (a doctor who treats blood diseases) or an oncologist (doctor who treats cancer).

Tests to find acute lymphocytic leukemia

Most of the symptoms seen in leukemia can also be caused by other problems like infections. For this reason, your doctor will focus on finding out if you really have leukemia.

Blood cell counts

Often, the first test is a blood count. This test looks at the numbers of the different types of blood cells and at how they look under the microscope. Changes in these things can suggest leukemia.

Most people with ALL have too many white blood cells, not enough red cells, and not enough platelets. Many of the white cells will be blasts, a type of immature cell not normally found in the bloodstream. These cells don't work the way they should. These findings may suggest a person has leukemia, but often a sample of bone marrow cells must be looked at to be sure.

Bone marrow tests

Samples of bone marrow are obtained with tests called bone marrow aspiration and biopsy.

The samples are usually taken from the back of the hip (pelvic) bone while you lie on your stomach. The area is numbed and a needle is used to draw up a small amount of liquid bone marrow (this is the bone marrow aspiration). After that needle is removed, a slightly larger needle is moved through the bone to remove a small sliver of bone and marrow (this is the bone marrow biopsy). After the biopsy is done, pressure will be put on the site to help prevent bleeding. You will likely feel a brief, sharp pain with the aspiration, but only pressure with the biopsy.

A doctor with special training looks at the bone marrow under a microscope to see if leukemia is present and if it is, what kind of leukemia it is. Sometimes special tests that look at the cells (and even their DNA) are needed to help the doctor decide which type of leukemia a person has. You might hear some of the following terms used: cytochemistry, flow cytometry, cytogenetics, PCR, and FISH. These are complex medical and chemical tests. Your doctor can tell you which of these you might need. You can learn more about these tests in our detailed document Leukemia: Acute Lymphocytic.

Lumbar puncture

A lumbar puncture (or spinal tap) is done to look for leukemia cells in the cerebrospinal fluid (CSF), which is the liquid around the brain and spinal cord. The doctor first numbs an area on your lower back over the spine (usually while you are curled up on your side). A small needle is then put through the skin and between the bones of the spine and into the area around the spinal cord. Then some of the liquid is taken out. The fluid is looked at to see if it has leukemia cells in it. A lumbar puncture can also be used to put drugs into the CSF to try to prevent or treat the spread of leukemia to the spinal cord and brain.

Imaging tests

Imaging tests make pictures of the inside of the body. Because leukemia does not usually form tumors, imaging tests are not always as helpful as they are for other types of cancer. For people with ALL, these tests are done more often to look for infections or other problems rather than for the leukemia itself.

X-rays: You may get a chest x-ray to check for a lung infection. The x-ray can also show swollen lymph nodes in the chest.

CT (computed tomography) scans: This is a special kind of x-ray test in which a beam moves around the body, taking pictures from different angles. A computer combines the pictures to show a slice of the body. This test can help tell if any lymph nodes or organs in your body are swollen.

A CT scanner has been described as a large donut, with a narrow table in the middle opening. You will need to lie still on the table while the scan is being done. CT scans take longer than regular x-rays, and you might feel a bit confined by the ring while the pictures are being taken.

Before the test, you may get an injection of a contrast dye, or you may be asked to drink some contrast material. This helps doctors tell normal areas from abnormal ones. A second set of pictures is then taken.

The injection can make you feel flushed or warm, in the face or elsewhere. Some people get hives (itchy bumps). A few may have more serious allergic reactions like trouble breathing, feeling dizzy, or passing out. Be sure to tell the doctor before the scan if you have ever had allergies or a reaction to any contrast material used for x-rays. .

MRI (magnetic resonance imaging): MRI scans are very helpful in looking at the brain and spinal cord. These scans use strong magnets and radio waves instead of x-rays to make detailed pictures of the body. MRI scans take longer than CT scans. You may be placed inside a tube, which can feel confining. Newer, more open MRI machines may sometimes be another option. The MRI machine makes loud buzzing and thumping noises that you may find disturbing. Some places give you headphones to block this noise out.

Ultrasound: Ultrasound uses sound waves to make images of the organs. It can help show whether the kidneys, liver, or spleen are enlarged. It can also be used to look at lymph nodes. This is an easy test to have. For most ultrasounds you simply lie on a table and a kind of wand (transducer) is moved over the part of your body being examined.

Gallium scan and bone scan: These tests look at a slightly radioactive chemical that is put into the blood. The chemical collects in areas of cancer or infection. These areas, called "hot spots," can be picked up by a special camera. These tests are not often done in people with ALL, but they can be useful if you have bone pain that might be caused by either infection or cancer in the bones.

Last Medical Review: 12/08/2014
Last Revised: 01/12/2015