Tests to diagnose leukemia

If your doctor suspects leukemia, he or she may:

• Ask about your medical history.
• Check for enlarged lymph nodes in your neck, underarm, or groin.
• Check for an enlarged liver or spleen .
• Do a complete blood count (CBC) and a blood profile. These tests let your doctor look into symptoms such as fatigue, weakness, fever, bruising, or weight loss.
• Do a bone marrow aspiration and biopsy. This is the key to diagnosing most leukemias and helps determine the type.

Finding the type of leukemia

If your blood work points to possible leukemia, your doctor will want to find out what kind you might have. Your treatment plan will depend on the specific kind of leukemia that you have.

• A blood test is usually enough to find signs of chronic lymphocytic leukemia (CLL).
• Tests that look closely at unusual cells, chromosomes, or proteins on cells can show what type or subtype of leukemia you have. These tests include:
  • A test that looks for certain changes in the cell chromosomes from a sample of blood or bone marrow (cytogenetic analysis).
  • A test that compares cancer cells to normal blood cells to find the specific kind of leukemia (immunophenotyping).
  • A test to look for genes that are "turned on" in several types of leukemia, such as acute promyelocytic leukemia. This test is called a reverse transcription-polymerase chain reaction test, or RT-PCR.

These tests can help guide treatment. Sometimes they can help your doctor and you know whether your leukemia is likely to go into remission or come back. In some cases, the tests can predict survival rates.

Your doctor may also order other tests, including:

• Chest X-rays, to find out if leukemia or an infection is the cause of lung problems such as persistent coughing, coughing up blood, chest pain, or trouble breathing.
• CT scan of the head, chest, and belly, to find out if leukemia has spread there.
• Lumbar puncture, to find out if leukemia cells are in your cerebrospinal fluid (CSF).
• MRI of the brain, to look into symptoms such as confusion, paralysis, numbness, vision problems, vertigo, or headaches. Those symptoms could mean that leukemia has spread to the brain.
• A biopsy of a lymph node or other tissues, to look for leukemia cells.