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.

Tests to find acute lymphocytic leukemia

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

Medical history and physical exam

The doctor will ask you questions about your health (take a medical history), such as how long you have had symptoms and whether or not you have any risk factors.

The doctor will do a physical exam to look for any swollen lymph nodes, any bleeding or bruising, or signs of infection. Blood tests will likely be done. If the results suggest leukemia, your doctor may refer you to a doctor who treats blood diseases (called a hematologist), and you may have one or more of the tests described below.

Laboratory tests

Blood cell counts and other blood tests: 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 usually a sample of bone marrow cells must be looked at to be sure.

People already known to have leukemia have these tests to see how well treatment is working.

Often, patients also have other tests to measure the amount of certain chemicals in the blood to help tell how well their kidneys and liver are working and to make sure the blood is clotting as it should.

Bone marrow tests: Bone marrow aspiration and biopsy is used to take samples of bone marrow. These tests are used to tell whether a person has leukemia. They may also be done during treatment to see how well the treatment is working.

The samples are usually taken from the back of the hip (pelvic) bone. The patient usually lies on his or her stomach and the skin over the area is cleaned. Before the samples are taken, the skin and the surface of the back of the hip bone are numbed with medicine. Then the doctor makes a small cut in order to put in the needle.

For aspiration, a thin needle is used to draw up a small amount of liquid bone marrow. This is often painful for a moment. After that needle is removed, a slightly larger needle is moved through the bone with a twisting motion. Most patients feel this as pressure, not pain. The larger needle is used to remove a small cylinder of bone and marrow (about ½ inch long). After the biopsy is done, pressure will be put on the site to help prevent bleeding.

A doctor with special training in blood diseases looks at the bone marrow under a microscope. The doctor looks at the size and shape of the cells as well as other features to classify the cells into specific types. An important goal of this process is to see if the cells look mature or not. The most immature cells are called blasts. The number of blasts in the bone marrow is important in telling whether a person has leukemia. Normally, blasts are never more than 5% of bone marrow cells. A person with ALL has at least 20% to 30% blasts in their bone marrow.

Sometimes doctors can’t tell what type of leukemia someone has just by counting and looking at the cells. Other special tests that look at the cells (and even their DNA) 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.

Spinal fluid: 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. For this test, the patient is usually lying on their side. The doctor first numbs an area in the lower back over the spine. 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: The chest may be x-rayed to see if a person has 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.

Sometimes a test that combines the CT scan with a PET scan (PET/CT scan) is done. For a PET scan, glucose (a form of sugar) that has a radioactive atom is injected into the bloodstream. The amount of radioactivity used is very low. Cancer cells in the body absorb large amounts of the sugar. A special camera can then create a picture of areas of radioactivity in the body. The doctor can then compare areas of higher radioactivity on the PET scan with the more detailed appearance of that area on the CT.

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 when a person has bone pain that might be caused by either infection or cancer in the bones.


Last Medical Review: 06/25/2013
Last Revised: 02/07/2014