Tests for ALL
Tests for acute lymphoblastic leukaemia
If you have worrying symptoms, you usually begin by seeing your family doctor. Your GP will ask about your general health and symptoms. They will examine you by feeling for swollen organs or glands, and looking for signs of abnormal bleeding. They may also order a blood test.
If your GP suspects that you have leukaemia, they will send you to a specialist doctor called a haematologist. Your haematologist will ask you to have some tests including blood tests. You may have a chest X-ray or a CT scan.
Bone marrow test
Your specialist may want to check a sample of your bone marrow. In a bone marrow aspiration, the doctor puts a thin needle into the centre of one of your bones and draws out some bone marrow. Usually, the doctor takes the sample from one of your hip bones. In a bone marrow biopsy, the doctor uses a slightly larger needle to remove a small amount of bone and marrow together.
Your specialist will check to see whether you have something called the Philadelphia chromosome. This will help them decide which treatment to give you.
A lumbar puncture shows if there are any leukaemia cells in the fluid around your brain and spinal cord. This fluid is called cerebrospinal fluid (CSF).
There is more information in the cancer tests section.
You can view and print the quick guides for all the pages in the diagnosing ALL section.
If you have worrying symptoms, you usually begin by seeing your family doctor. Your GP will examine you and ask about your general health and symptoms. This will include
- What your symptoms are
- When you get them
- Whether anything you do makes them better or worse
Your doctor will examine you by
- Feeling for swollen organs or glands
- Looking for signs of abnormal bleeding
Your GP may also order a blood test.
If your GP suspects that you have leukaemia, they will refer you to a specialist doctor called a haematologist (pronounced heem-at-oll-oh-jist). Haematologists treat diseases of the blood. Your haematologist will ask you to have some tests.
At the hospital, the tests you have may include
Your doctor or nurse takes a small amount of blood from a vein in your arm, using a needle and syringe. They send the blood to the laboratory where it is examined to see the different types of cells. This is called a full blood cell count (FBC). They will also check whether the cells look normal or not.
Your doctor might also do other blood tests to see how well your liver and kidneys are working.
Blood cells grow in your bone marrow. Your specialist may want to check a sample of your bone marrow for signs of leukaemia or other illnesses. There are 2 different types of bone marrow test. You may hear them called
- Bone marrow aspiration
- Bone marrow biopsy or trephine biopsy
In a bone marrow aspiration, the doctor puts a thin needle into the centre of one of your bones, to draw out some of the liquid bone marrow. Usually, the doctor takes the sample from one of your hip bones. You will have a local anaesthetic injection first.
In a bone marrow biopsy, the doctor uses a slightly larger needle to remove a small amount of bone and marrow together.
You usually have an aspiration and biopsy at the same time. We have more detailed information about having a bone marrow test.
As well as looking at the bone marrow cells, the haematologist may test for changes in your chromosomes. These tests are called cytogenetics (pronounced sigh-toe gen-et-ics). They may also do tests for particular proteins that certain types of leukaemia cells make. Your doctor may call this immunophenotyping (pronounced imm-you-know-fee-no-typing).
Some people with ALL have a change in the leukaemia cells called the Philadelphia chromosome. This is called Philadelphia positive ALL. The Philadelphia chromosome is when a gene called the ABL gene on chromosome 9 breaks off and sticks to a gene called the BCR gene on chromosome 22. This produces a new gene called BCR-ABL. This causes the cell to make too much of a protein called tyrosine kinase. This protein encourages leukaemic cells to grow and multiply.
FISH (fluorescence in situ hybridisation)
FISH is a test that looks for gene changes in cells. It can help the specialist to work out which treatment to give you.
A lumbar puncture shows if there are leukaemia cells in the fluid around your brain and spine. The fluid is called cerebrospinal fluid (pronounced sare-eh-bro-spy-nal fluid) or CSF. Your doctor will put a needle into your spine and collect a small amount of fluid that drains out. There is more detailed information about having a lumbar puncture.
You may have X-rays to check your general health. In acute lymphoblastic leukaemia, you sometimes have a 'lump' of leukaemic cells growing in the centre of the chest, in the area around the heart. This area is called the mediastinum (pronounced mee-dee-a-sty-num) and the lump is called a mediastinal mass.
A CT scan is a type of computerised X-ray. You may have a CT scan to check for particular signs of leukaemia (such as the mediastinal mass described above) or to check your general health. There is information about having a CT scan in our cancer tests section.
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