Tests for acute lymphoblastic leukaemia (ALL)

You usually have several tests to check for acute lymphoblastic leukaemia (ALL). Your doctor may suspect ALL from a blood test. You then have more tests to confirm your diagnosis and find out more about the leukaemia.

Tests you might have include:

• blood tests

• taking samples of cells to check them for cancer. This is a biopsy

• scans

ALL is a type of blood cancer. It starts from white blood cells called lymphocytes in the bone marrow. The bone marrow is the soft inner part of the bones where new blood cells are made.

ALL is most often diagnosed in young children aged 0 to 4 years, but it can also affect adults. This page is about the tests used to diagnose ALL in adults. We have separate information about the tests for childhood ALL. 

Tests your GP might do

Most people with symptoms that could be due to cancer start by contacting their GP surgery. Your first appointment may be a telephone appointment. Your GP surgery might arrange for you to go in and see a doctor or other healthcare professional.

Some people are also diagnosed after they become unwell and go to accident and emergency (A&E).

Your GP can do some tests to help them decide if you need to see a specialist.

Tests your GP might do include:

• a physical examination

• blood tests

Depending on your symptoms and the results of your blood tests, your GP may also arrange for you to have other tests such as an x-ray or ultrasound scan. You usually have these tests at your local hospital.

Physical examination

Your GP will usually do a physical examination to try to find the cause of your symptoms.

Your doctor usually asks you to lie or sit down. They look at and feel your skin to check for any abnormalities such as signs of bleeding, bruising and infection.

They may also listen to your chest and tummy (abdomen) to find out if they sound normal. They will also feel your neck, abdomen and other areas where you have lymph nodes. This is to check if anywhere is swollen or painful.

You can ask for someone else to be in the room with you if you want, to act as a chaperone. A chaperone is a trained healthcare professional such as a nurse. A friend or relative can also stay with you for support. They can be with you during the examination.

Blood tests

Blood tests can check your general health including:

• how well your liver and kidneys are working
• the number of blood cells in your blood such as white blood cells,  platelets and red blood cells. You may hear this being called a full blood count
• if you have any signs of infection

Tests your specialist might do

Depending on your symptoms and the results of your blood tests, your GP might arrange for you to go to the hospital. Sometimes this is quite quick, and you might have to go there straight away. This can happen if your GP suspects that you have leukaemia.

The specialist you usually see at the hospital is called a haematologist. This is a doctor who specialises in blood conditions such as leukaemia.

Your specialist usually repeats the blood tests done by your GP as well as doing other tests.

Tests your specialist might do include:

• a bone marrow biopsy

• tests on your leukaemia cells

• a lumbar puncture

• scans such as chest x-ray, CT scan or MRI scan

• tests to check for infections

• tests for tissue typing

• tests to check your heart

Bone marrow biopsy

A bone marrow biopsy is often the first test you have at the hospital. This test can confirm if you have ALL. It can also help to find out more information about the type of ALL you have. 

You usually have this test under local anaesthetic. This means that you have a medication to numb the area but you are awake.

During a bone marrow test, your doctor or specialist nurse uses a needle to take a sample of bone marrow. They may then use a second needle to take out a piece of more solid bone marrow tissue. This is usually from the back of your hip bone.

The diagram below shows what a bone marrow biopsy looks like.

After the bone marrow biopsy, your doctor sends the tissue sample to the laboratory. A specialist doctor called a pathologist looks at the tissue under a microscope.

Tests on the leukaemia cells

Your doctor usually does a number of checks on the leukaemia cells. They use the blood and bone marrow samples you have given.

The tests include:

• immunophenotyping tests
• genetic tests  

Immunophenotyping

A specialist laboratory does immunophenotyping tests to look for changes on the surface of leukaemia cells. Bone marrow samples and sometimes blood samples are tested. Doctors use a technique called flow cytometry to do immunophenotyping tests.

These tests can help to find out:

• the type of leukaemia you have, such as ALL or another type of leukaemia

• the subtype of ALL you have such as B cell or T cell ALL

Doctors may also do immunophenotyping tests during and after treatment for ALL. It helps doctors find out how well treatment is working and whether your leukaemia is going away after treatment.

Genetic tests

There are different tests that look for changes in the genes and chromosomes of your leukaemia cells. Genes are coded messages made of DNA that tell our cells how to behave. Chromosomes are made of a very long strand of DNA and contain many genes. These tests are sometimes called cytogenetic or molecular studies.

Fluorescence in situ hybridisation (FISH)

FISH is a test that looks for chromosome changes in cells. It can help your doctor work out which treatment you need.

This test can check if you have the chromosome change that causes Philadelphia positive ALL. But there are also many other chromosome changes that are important in helping your doctor understand more about your leukaemia.

We also have a 2 minute video that explains what Philadelphia positive leukaemia is.

Polymerare chain reaction (PCR)

PCR are tests that can pick up abnormal genes. It can tell if you have Philadelphia positive ALL. This helps your doctor work out the treatment you need. In leukaemia, it can also monitor how well your treatment is working.

Other genetic tests

New types of tests are being used to pick up gene changes. Some of these tests are called next generation sequencing (NGS).

Doctors use these tests to understand more about the gene changes that happen in leukaemia. These tests are done at specialist laboratories around the UK. They are called genomic laboratory hubs.

These tests can help to identify people with specific gene changes which cause them to not respond to treatment as well. Understanding these changes can help doctors find out what treatment will work best for you.

Lumbar puncture

A lumbar puncture is a test to check the fluid that circulates around the brain and spinal cord. This is called the cerebrospinal fluid or CSF.

During a lumbar puncture your doctor uses a thin needle to take a sample of the CSF from your lower back. You usually have a lumbar puncture under local anaesthetic. They then check the fluid for cancer or infection. This helps your doctor know what treatment you need.

The diagram below shoes what a lumbar puncture looks like.

Scans

You usually have a number of scans to check for ALL or infection. 

Chest x-ray

An x-ray is a test that uses small amounts of radiation to take pictures of the inside of your body. They are a good way to show changes in organs such as the lungs.

You might have a chest x-ray to check for signs of infection or leukaemia in the middle of your chest if you have any symptoms.

If the scan finds an abnormal collection of fluid in the lining of your lungs (pleural effusion) you may need to have the fluid removed and tested in a lab. This is called a pleural aspiration.

CT scan

A CT scan uses x-rays and a computer to create detailed pictures of the inside of your body. You usually have a CT scan of your neck, chest, abdomen and pelvis . 

. You might also have a CT scan of your head if your doctor wants to check if the leukaemia has spread to the central nervous system (CNS).

You might have a CT scan to:

• check if the leukaemia has caused any of your lymph nodes , spleen or liver to enlarge
• check how well your treatment is working if you had any swollen areas before the treatment
• look for infections

MRI scan

MRI stands for magnetic resonance imaging. It uses magnetism and radio waves to take pictures of the inside of your body.

You don’t often have an MRI scan for ALL. But there might be situations where your doctor might want you to have one. For example, if you have symptoms that suggest that you might have:

• leukaemia that has spread to the CNS
• bleeding in your brain

Ultrasound scan

Ultrasound scans use sound waves to create a picture of a part of the body. You might have an ultrasound scan to look for changes in your lymph nodes, liver or spleen.

You may also have it to help find a vein to put a central line. A central line is a long tube that goes into a large vein near the heart. They are used for taking blood samples and giving drugs.

PET-CT scan

A PET-CT scan combines a CT scan with a PET scan. The CT scan takes a series of x-rays from all around your body and puts them together to create a 3 dimensional (3D) picture. The PET scan uses a mildly radioactive drug to show areas of your body where cells are more active than others.

There are different reasons why you might have a PET-CT scan for ALL. For example, you may have a PET-CT scan after you are first diagnosed with T cell ALL. You usually have a PET-CT scan of your neck, chest, abdomen and pelvis.

Tests to check for infections

ALL and its treatment can weaken your immune system . This is because it stops your bone marrow from making blood cells that help fight infection. This increases your risk of getting an infection.

You have blood tests to check for specific viruses before you start treatment. This helps your doctor know your risk of developing these viruses during treatment or the risk of them flaring up.

Your doctor usually tests for:

• human immunodeficiency virus (HIV)

• hepatitis B virus (HBV)

• hepatitis C virus (HCV)

• herpes simplex virus (HSV)

• Epstein-Barr virus (EBV)

• cytomegalovirus (CMV)

Tissue typing

Tissue typing is a set of tests that you have using a sample of your blood and saliva. You might have it if your doctors think that you need treatment with a stem cell transplant using a donor’s stem cell. This is called an allogeneic transplant.

Tissue typing tests can show how closely a possible stem cells donor’s tissue matches your own.

Tests to check your heart

Cancer drugs can affect the muscle of your heart. Your doctor might check your heart before you start treatment.

Electrocardiogram (ECG)

An ECG is a test to check the electrical activity of your heart. You have small sticky pads on your chest, arms and legs. These connect to a machine that shows your heartbeat. Your doctor can see the heartbeat on the scream or print it out on paper. It helps your doctor decide if you need further tests.

Echocardiogram (Echo)

An echo is an ultrasound of the heart. Doctors can look at the picture to see the structure of your heart and how well it is working. It is painless and only takes about half an hour.

Treatment for ALL

The tests you have help your doctor find out if you have leukaemia and the type of leukaemia you have.

This is important because doctors use this information to recommend the best treatment for you.

Coping with a diagnosis of ALL

Coping with a diagnosis of ALL can be difficult. There is help and support available for you and your family.