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Getting a diagnosis is important as it tells your doctor if you have acute lymphoblastic leukemia as opposed to another condition. If an acute lymphoblastic leukemia diagnosis is made, it can be used to predict how quickly the disease might progress and how it may respond to certain treatments.
Diagnostic techniques can also show what subtype of acute lymphoblastic leukemia is present. Identifying the subtype increases the accuracy of the predictions that your doctor can make about the course and severity of disease.
If you or your child have certain symptoms, a visit to your doctors is advised. Identifying diseases early often makes them easier to manage and increases the chances of successful treatment.
During your appointment, you may be asked about your medical history and for a description of any changes that you may have noticed. Your doctor might perform a physical examination of any areas that are swollen, bleeding, or bruised, and check for possible signs of infection.
Depending on the outcome of this assessment, your doctor may also want to take a blood sample to perform some initial blood tests.
If your doctor feels that further tests are needed, a referral to a specialist may be made. This will most likely be a hematologist, a doctor who has undertaken specialist training in diseases of the blood. The hematologist will go over the results and may suggest that further tests are performed.
These tests may include:
A sample is taken from the spongy marrow in the middle of the bone, normally from the hip.
In the case of a bone marrow aspiration, the sample will be a liquid, whereas in a biopsy, a small section of bone filled with marrow will be collected.
Bone marrow is where many blood cells are produced. Taking a sample from here can allow a hematopathologist (a specialist who studies blood cell diseases by looking at samples of cells and other tissues) to see what type of cells are being made and in what proportions. Cells that look unusual can be spotted using this test and classified according to any changes seen.1
This test is used if there is a concern that the leukemia may have spread into the brain and spinal cord. It assesses the number of cells in the fluid that bathes these organs. It is performed by inserting a needle into the base of the spine and drawing out some fluid.2
Further laboratory tests may be performed on the blood and bone marrow samples to diagnose ALL and/or determine the specific type of acute lymphoblastic leukemia.
There are some serious conditions associated with cancer that can occur. More blood tests may be performed to monitor for the conditions listed below, so that the best treatment can be provided as soon as possible.
Conditions screened for:
There are many different imaging methods used for diagnosis and staging of acute lymphoblastic leukemia. Some techniques are better at visualizing bone changes, whereas others focus on blood flow. Together these techniques can build up a comprehensive picture of what is happening in the body. While imaging is not essential for a diagnosis of acute lymphoblastic leukemia, it can be used to give a clearer picture of the health of the organs and show if the cancer has spread. This, in turn, can help predict the response to treatment. You may have one or several forms of imaging performed.
This is good for looking at soft tissue and fluid within the body. It uses high frequency soundwaves to create a dynamic image. This may be used to check your liver, spleen, and lymph nodes. The function of the heart may also be checked using a specialized form of ultrasound called echocardiography.
A method used to visualize what is going on within the body and spot any changes from normal that might indicate how far the cancer has spread. This scan also provides information on the health of multiple organs, particularly the head and chest.
MRI allows monitoring of the blood movement and inflammation within the body, along with structural information, and it can identify areas of increased or decreased blood flow. Cancers are often able to increase their own blood supply. An MRI test can help locate a tumor within the body and see if it is all in one place or in multiple areas.
Like a CT scan, MRI can take pictures of the whole body from multiple angles. It uses magnetism and radio waves to capture an image.
Once you or your child has a diagnosis, some of these tests may be repeated to show how you are responding to treatment.
1. Leukemia & Lymphoma Society. Diagnosis. https://www.lls.org/leukemia/acute-lymphoblastic-leukemia/diagnosis. Accessed Mar 25, 2021.
2. American Cancer Society. Tests for acute lymphocytic leukemia (ALL). https://www.cancer.org/cancer/acute-lymphocytic-leukemia/detection-diagnosis-staging/how-diagnosed.html. Published Oct 17, 2018. Accessed Mar 25, 2021
3. NHS. Diagnosis. https://www.nhs.uk/conditions/acute-lymphoblastic-leukaemia/diagnosis/ Published Sept 30, 2019. Accessed Mar 25, 2021.