Exams and Tests

If your doctor suspects leukemia, he or she will ask about your medical history. Your doctor also will check for enlarged lymph nodes in your neck, underarm, or groin. He or she will also examine you to see if your liver or spleen is enlarged.

Your doctor will order blood tests, such as a complete blood count (CBC) and a blood profile. These provide important information about the cells in your blood. They are used to look into symptoms such as fatigue, weakness, fever, bruising, or weight loss.

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).
• A bone marrow aspiration and biopsy is the key to diagnosing most leukemias.

Tests that look closely at unusual cells, chromosomes, or proteins on cells can show what type or subtype of leukemia you have. 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.

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 subtypes of leukemia, such as acute promyelocytic leukemia. This test is called a reverse transcription-polymerase chain reaction test, or RT-PCR.

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 difficulty breathing.
• CT scan of the head, chest, and belly, to find out whether leukemia has spread there.
• Lumbar puncture, to find out whether 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 the leukemia has spread to the brain.

Also, a biopsy of a lymph node or other tissues may be done to look for cancer cells.