Tests for CLL
Some combination of the following tests will help your doctor work out whether you have CLL.
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Your doctor will examine your body and check different areas for swelling. In particular, the doctor will feel your abdomen (belly) to work out whether the spleen and liver are enlarged, and check your neck, armpits, groin and other areas for swollen lymph nodes (see this diagram of the lymphatic system).
A sample of your blood will be sent to a laboratory for a full blood count. This measures the number, size and maturity of each type of blood cell. A specialist doctor called a pathologist will study the blood sample under a microscope to look for leukaemia cells and work out what type of leukaemia is present.
Your blood sample will also be checked for certain markers that are on the surface of the leukaemia cells. This test is known as immunophenotyping. It is done with a machine called a flow cytometer. Finding certain markers (e.g. CD5, CD19, CD20, CD23, Kappa, Lambda) in your blood can help confirm the diagnosis of CLL.
Bone marrow biopsy
Some people have a bone marrow biopsy to check for leukaemia cells in the bone marrow and to work out the type of leukaemia.
During the biopsy, the doctor will apply a local anaesthetic to the skin to numb the area and you may be given a light sedative to help you feel relaxed. A thin needle is used to remove a small amount of bone marrow, usually from your hipbone (pelvic bone).
Although it can take up to 30 minutes to prepare for the biopsy, the actual procedure takes only a few minutes. It may be uncomfortable while the sample is taken, but you may be given some medicine to manage any pain.
Pain medicine may make you feel drowsy, so organise for a family member or a friend to drive you home afterwards. You may feel pain at the affected area for a week after the bone marrow biopsy.
The bone marrow sample will be sent to a laboratory for testing, and results are usually available within a week.
Each cell in the body contains chromosomes, which are threadlike structures that hold sets of instructions known as genes. Every kind of cancer, including blood cancer, changes the genes of the affected cells. These gene faults are not the same thing as genes passed through families. The fault is only in the leukaemia cells, not in the normal cells.
A genetic test known as fluorescence in situ hybridisation (FISH) is used to look for abnormal chromosomes in a blood or bone marrow sample.
Leukaemia cells may have damage to at least one chromosome, such as a part missing or deleted. Some of the common abnormalities found in CLL include deletions of parts of chromosomes 11, 13 or 17 or an extra copy of chromosome 12. There may also be mutations in other genes.
Genetic test results can help the medical team make a diagnosis and plan what treatments will work better than others. These tests also give some information about how CLL may progress (see Prognosis).
This imaging test uses x-rays to create a detailed, cross-sectional picture of the body. Only some people with CLL will need a CT (computerised tomography) scan. It can show if your lymph nodes are affected and if your spleen is enlarged.
Before the scan, you may have an injection of a dye (called a contrast) to make particular areas easier to see. Let your doctor know if you have had a reaction to iodine or dyes during a previous scan. You will lie on a table while the CT scanner, which is large and round like a doughnut, takes pictures. The scan can take up to 30 minutes, and most people are able to go home straight after.
Lymph node biopsy
Most people won’t need a lymph node biopsy because CLL is usually diagnosed from blood tests. But if you have an unusually enlarged lymph node, your doctor will check if this is due to a type of lymphoma called Richter’s transformation.
There are different types of lymph node biopsy. For a core needle biopsy, you will have a local anaesthetic and a CT scan or ultrasound will be used to guide a needle to the enlarged lymph node to collect a sample. For an excisional biopsy, you will be given a general anaesthetic and/or light sedation, and the doctor will make a cut in the skin and remove the whole lymph node. They close the area with a few stitches, and send it to the laboratory for testing. Most people can go home the same day.
Some people have further tests, such as an x-ray or ultrasound. These can show how advanced the CLL is and how it is affecting your organs. Talk to your medical team for more information.
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Dr Chun Kei Kris Ma, Clinical Haematologist, Western Sydney Local Health District; Delphine Eggen, Consumer; Dr Robin Gasiorowski, Staff Specialist, Haematology, Concord Hospital; Karl A Jobburn, Haematology Clinical Nurse Consultant, Liverpool Hospital; Yvonne King, 13 11 20 Consultant, Cancer Council NSW; Heather Mackay, Clinical Nurse Consultant, Westmead Hospital; Jennifer Paton, Consumer.
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