If you are diagnosed with leukemia, you will likely undergo many different types of tests. Diagnostic tests can help your doctor learn more about your condition and develop an appropriate treatment plan.
You may need to undergo imaging tests that help your doctor see inside your body. Imaging tests can show where cancer cells are located, detect whether these cells have spread to organs or other types of tissues, and diagnose other problems related to your leukemia.
Doctors generally don’t use imaging tests when making an initial diagnosis of leukemia. Instead, these tests are used to detect complications — additional problems that develop while you are living with a disease or undergoing treatments.
Usually, the first signs of leukemia are found using blood tests such as a complete blood count, which measures levels of different types of blood cells. Leukemia symptoms may also appear during a physical exam. A leukemia diagnosis is confirmed using a bone marrow aspiration and biopsy. During this procedure, doctors use a needle to collect a sample of bone marrow (the spongy tissue found inside certain bones).
Many other types of cancer lead to solid tumors — growths or masses of cells that divide too quickly. These tumors can often be detected by imaging tests.
However, leukemia is a blood cancer — it doesn’t lead to tumors. Instead, leukemia cells travel around the body through the blood. Because there are no tumors to detect, imaging tests aren’t used to confirm whether you have leukemia.
Your doctor may recommend one or more of the following types of imaging tests, depending on which complications you may be at risk for. You may be more or less likely to have certain complications depending on which type of leukemia you have — acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myeloid leukemia, or chronic lymphocytic leukemia (CLL).
X-rays are imaging tests that use beams of energy to take pictures of your bones, organs, and other tissues. Denser, more solid tissues like bones and tumors appear whiter on an X-ray. Softer tissues like muscle, fat, and blood show up as darker. You will be exposed to a small amount of radiation during an X-ray.
Doctors may recommend a chest X-ray to look for signs of a chest infection such as pneumonia. Infections can be a problem because leukemia often leads to neutropenia (low levels of white blood cells). White blood cells are needed for attacking germs like bacteria and viruses. When you don’t have enough of these cells, you have a higher risk of infection. Some people with leukemia and ongoing neutropenia need regular chest X-rays.
X-rays can also show enlarged lymph nodes within the chest. Lymph nodes are small structures located around the body that help fight infection. In people with ALL and CLL, leukemia cells can spread to the lymph nodes, causing them to swell.
If you need to get an X-ray, you may be asked to take off any jewelry or clothing near the area that is going to be imaged. You will stand in front of an X-ray machine or lie down on an X-ray table. The technician may cover some parts of your body with a shield and tell you how to position yourself. While the X-ray is taken, you may be asked to be very still or to hold your breath.
CT scans can show very detailed images of the inside of your body. This type of test uses X-rays from many different angles to show different “slices” of your organs and tissues.
A chest CT scan may be used in place of a chest X-ray to diagnose a chest infection or determine whether the lymph nodes in the chest are enlarged. CT scans can also detect swollen lymph nodes in other parts of the body.
A CT scan may also be used to look at the spleen. Most types of leukemia can cause splenomegaly (an enlarged spleen), which develops when leukemia cells build up in this organ. Splenomegaly can lead to abdominal pain, bloating, loss of appetite, or feelings of fullness. CT scans can detect whether cancer cells have spread to the spleen or other organs such as the liver.
When you get a CT scan, your doctor may tell you to avoid eating or drinking for a couple of hours before the test. You may need to take off your clothes and jewelry and put on a hospital gown. During the test, you will lie down on a table, which carries you into a large scanner with a doughnut-shaped hole. You will need to lie still during the scan, which usually takes between 10 and 30 minutes.
Some CT scans require contrast material (a type of dye that helps doctors better visualize certain tissues). The contrast material is a liquid that may be swallowed by mouth, injected into your vein, or administered into your rectum through an enema.
Positron emission tomography (PET) scans are sometimes used with CT scans. They can detect the same types of abnormalities but create more detailed pictures.
During a PET scan, a tracer (liquid that contains a small amount of radiation) is injected. Cancer cells consume more of the tracer than do healthy cells, making them show up more strongly on the scan. PET scans help doctors determine where the cancer cells are located.
Getting a PET scan usually involves changing into a gown and taking off any metal accessories. You will then be injected with the tracer. You may have to wait 30 to 60 minutes to allow the tracer to travel throughout your body. You will then lie on a table inside of the scanner. The scan itself typically takes about 45 minutes.
MRI uses magnets and radio waves to take very detailed images of the inside of your body. MRIs don’t involve any radiation.
Doctors may use an MRI to image the brain. Different types of leukemia, including AML and ALL, can spread to the brain and spinal cord. An MRI can detect whether there are any cancer cells in these areas.
An MRI can also detect swollen lymph nodes in the chest or abdomen and determine whether there are abnormalities in any of your internal organs or tissues.
When you get an MRI, you will have to remove all metal or other items that could affect the imaging process, including jewelry, glasses, wigs, hearing aids, dentures, underwire bras, and makeup that contains metal particles.
You will lie down on a sliding table that carries you into the MRI machine, which is shaped like a large tube. You may hear loud noises, including tapping or thumping sounds, during the test. You may also be given contrast material during an MRI. Altogether, the test can be as short as 15 minutes or it may take more than an hour.
Ultrasounds use painless sound waves to make images of your tissues. You aren’t exposed to any radiation during an ultrasound.
Doctors may use ultrasounds to look at whether leukemia cells have spread to the spleen, liver, kidneys, or other organs. They can also show whether lymph nodes are swollen.
You may have to prepare for an ultrasound by not eating or drinking for several hours before the test. Alternatively, depending on the area that is to be imaged, your doctor may tell you to drink a lot of water before the ultrasound so that your bladder is full.
During the ultrasound, a technician will place a gel on your skin in the area that is going to be imaged. They will move a handheld device over the surface of your skin, which will create images of the tissue inside.
Two-dimensional echocardiography shows the heart in motion. This test also sends out sound waves, which bounce off your heart tissues to form an image.
Doctors may recommend this test for some people with leukemia. Both AML and childhood ALL may be treated with chemotherapy drugs called anthracyclines. These medications can sometimes damage the heart. Therefore, doctors may use echocardiograms before and during anthracycline treatment to look for signs of heart problems.
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