Leukemia

Diagnosis

To find the cause of symptoms, the physician reviews the patient's personal and family medical history and perform a physical examination. In addition to checking general signs of health, the doctor checks for enlargement in the liver, spleen, lymph nodes under the arms, groin, and neck.

The doctor also may order laboratory tests, especially blood test that helps in the diagnosis of leukemia. Blood, drawn from a vein is examined under a microscope to determine the level of blood cell counts (i.e the number of mature cells and blasts). The test also include the examining of blood for signs that leukemia has affected the liver and kidneys.

Blood test disclose leukemia but to confirm, biopsy (removal of tissue to look for cancer cells) is performed in which a sample of bone marrow is examined by a hematologist, oncologist or pathologist. Samples of both liquid (aspirate) and solid bone marrow (biopsy) are taken, usually from a hip bone. In bone marrow aspiration, the doctor withdraws the sample by inserting a needle into a large bone (usually the hip) and removing a small amount of liquid bone marrow. In bone marrow biopsy, the doctor uses a very thick needle to remove a small piece of bone and bone marrow.

If leukemia cells are found in the bone marrow sample, further tests are performed to find the extent of the disease. These include :

Cytogenetic Examination : 
Cytogenetic examination of tissue is the method of analyzing the number and shape of the chromosomes or gene abnormalities in the cells. This is very helpful in diagnosing specific types of leukemia and in determining the treatment.

Immunophenotyping : 
This laboratory test is used identify specific type of cell, in a sample of blood cells, marrow cells, or lymph node cells, based on the types of antigens or markers on the surface of the cell. This process is used to diagnose the subtype of AML by comparing the cancer cells to normal cells of the immune system.

If leukemia has been diagnosed the following tests may be done to determine if the cancer has spread to other parts of the body.

Spinal tap or Lumbar puncture (LP) :  
Spinal tap checks for leukemia cells in the fluid that fills the spaces in and around the brain and spinal cord (cerebrospinal fluid). The collection of leukemia cells in the central nervous system can affect mental processes. The physician uses a long, thin needle to remove fluid from the spinal column. The needle is inserted in between the bones in the spine following a small injection into the skin over the injection site in order to minimize discomfort.

Chest x-rays : 
A chest x-ray film of the organs and bones inside the chest is frequently taken to look for signs of infection or lymph node involvement by leukemia.

Ultrasound Scan :
A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs in the abdomen and make echoes. The echoes form a picture of body tissues called a sonogram.

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