• Diagnosis of Leukemia

    The doctor will ask about your symptoms and medical history and perform a physical exam. He or she will check for swelling of the liver, spleen, or lymph nodes in the armpits, groin, and neck.
    Tests may include:
    Blood Tests —to check for leukemia cells in the blood. Another blood test may be done to assess for the presence of specific genes associated with leukemia.
    Bone Marrow Aspiration —removal of a sample of liquid bone marrow to test for cancer cells
    Bone Marrow Biopsy —removal of liquid bone marrow and a small piece of bone to test for cancer cells
    If the biopsy shows leukemia cells, additional tests may be ordered to determine whether the disease has spread and what systems are affected. Staging of leukemia depends on the type of leukemia. Tests may include:
    Lumbar Puncture (Spinal Tap) —removal of a small amount of fluid that surrounds the brain and spinal cord to test for cancer cells
    Chest X-rays —films of the chest that may detect signs of cancer in the chest
    Acute leukemias are aggressive from the very beginning, but chronic leukemias have a longer and more indolent course. Over time, they may develop more aggressive characteristics as the cells making up the leukemia become more immature. As a consequence, chronic leukemias are classified not only by type but also the phase in which the disease is at the time.
    Chronic Myelogenous Leukemia is grouped by three general phases:
    • Chronic, with few immature cells, mild symptoms, usually responds to treatment
    • Accelerated, with fewer than 30% blasts, some symptoms (eg, fever, poor appetite and weight loss), not as responsive to treatment
    • Blast, with more than 30% blasts
    In the US, Chronic Lymphocytic Leukemia (CLL) uses a Rai classification to describe the phases of the illness:
    • Rai Stage 0, as low risk, with a high blood lymphocyte count
    • Rai Stage 1, as intermediate risk, with a high blood lymphocyte count and enlarged lymph nodes
    • Rai Stage 2, as intermediate risk, with a high blood lymphocyte count and an enlarged spleen or liver
    • Rai Stage 3, as high risk, with a high blood lymphocyte count and anemia
    • Rai Stage 4, as high risk, with a high blood lymphocyte count and low platelet count
    Acute leukemia is not staged because it involves bone marrow throughout the body and often has spread to other organs. Doctors classify it by type and subtype in an attempt to determine the prognosis and a recommended level of treatment.

    References

    American Cancer Society website. Available at: http://www.cancer.org/docroot/home/index.asp .

    Cecil Textbook of Medicine . 21st ed. W. B. Saunders Company; 2000.

    Conn's Current Therapy 2001 . 53rd ed. W. B. Saunders Company; 2001.

    The Leukemia & Lymphoma Society website. Available at: http://www.leukemia-lymphoma.org/hm%5Flls .

    National Cancer Institute website. Available at: http://www.cancer.gov/ .

    Textbook of Primary Care Medicine . 3rd ed. Mosby, Inc.; 2001.

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