On many occasions, leukemia is diagnosed incidentally during a regular routine blood test or physical examination for some other condition. This is because many types of leukemias do not show specific symptoms in the earlier stages; aside from that, many of the symptoms are similar to those of other disease conditions, so it’s difficult to differentiate.
However, if the patient appears anemic and bruises or bleeds easily and has enlarged lymph nodes, spleen or liver, the physician shouldn’t rule out leukemia. A blood test showing excessive numbers of abnormal white blood cells is highly suggestive of a leukemia diagnosis too.
When the CBC picture shows large number of abnormal white blood cells, and lower numbers of red blood cells and platelets, the physician will normally recommend a bone marrow biopsy through a special syringe where fluids and cells taken could help in diagnosing the specific type of blood cancer and the presence of its DNA markers and chromosome changes. The biopsy process is however on the painful side and the patient may be given local anesthetic or some mild sedative.
In case there are enlarged lymph nodes, a biopsy to confirm its relation to the leukemia may be necessary. Depending on its location, the node may be removed partially or whole and its contents examined microscopically to check for cancerous cells, the type as well as the rate at which they are proliferating. Local or general anesthetic may be given prior to the lymph node removal.
The doctor may also recommend a lumbar puncture or spinal tap to determine the extent of involvement and spread of the cancer. A fine needle is inserted into the space between two vertebra and the contents aspirated for microscopic examination.
Blood chemistry tests will also be recommended to check how well the organs are coping and to check for any abnormalities suggestive of any organs involvement. Usually chemicals like creatinine, uric acid, phosphate, BUN as well as some enzymes like LDH, ALT and AST are measured as they are higher in leukemia cases. These tests can also help the doctor get an idea of the stage of the cancer.
Other blood tests like the bleeding and clotting factors as well as cytochemistry to determine the types of cells involved in the cancer are used to aid in further diagnosis. Immunophenotyping as well as cytogenic and molecular studies may also be carried out on the blood cells and harvested biopsy materials for further diagnostic purposes.
Chest x-rays, CT, MRI and ultrasound scans further aid in determining the extent of the involvement of organs and the stage of the cancer. A proper diagnosis of the exact type of leukemia sub-type as well as the extent of its spread in the body is important in proper therapy. Though the tests take time, patience is the key word here.