Leukemia may be suspected if you have certain risk factors or symptoms. Then diagnosis begins with a complete history and physical examination. The physical exam looks for pale skin, tender bones, enlarged lymph nodes, and enlargement of the liver and spleen. Leukemia cannot be fully diagnosed by physical exam. Instead, doctors will use blood tests, biopsies, and imaging studies to see if you have this cancer.
There are a number of different tests that can be used to diagnose leukemia:
Complete Blood Counts determine the numbers of RBCs, WBCs, and platelets in the blood. Looking at your blood under a microscope can also determine if the cells have an abnormal appearance.
Tissue biopsies can be taken from the bone marrow or lymph nodes to look for evidence of leukemia. These small samples can identify the type of leukemia and its growth rate. Biopsies of other organs such as the liver and spleen can show if the cancer has spread.
Flow Cytometry examines the DNA of the cancer cells and determines their growth rate.
Liver Function Tests show whether leukemia cells are affecting or invading the liver. These tests look for elevated liver enzymes and bilirubin levels. Bilirubin is a substance made by the liver from the breakdown of RBCs.
Lumbar puncture is performed by inserting a thin needle between the vertebrae of your lower back. This allows your doctor to collect spinal fluid and determine if cancer has spread to the central nervous system.
Imaging studies help doctors look for damage leukemia has caused in other organs. These may include:
Once your leukemia is diagnosed, it will be staged. Staging helps your doctor determine your prognosis. AML and ALL are staged based on how cancer cells look under the microscope and the type of cell involved. ALL and CLL are staged based on the WBC count at the time of diagnosis. The presence of immature cells white blood cells (myeloblasts) in the blood and bone marrow is also used to stage AML and CML.