Tests for CLL
Some combination of the following tests will help your doctor to confirm a diagnosis of chronic lymphocytic leukaemia (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 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, which measures the number, size and maturity of each type of blood cell. A specialist doctor called a pathologist will look at the blood sample under a microscope to check for leukaemia cells and help decide what type of leukaemia is present.
A machine called a flow cytometer may be used to look for certain markers on the surface of the leukaemia cells. This is known as immunophenotyping. Finding certain markers (e.g. CD19, CD5, CD20, CD23, Kappa, Lambda) in your blood can confirm the diagnosis of CLL and help guide the choice of treatment.
Bone marrow biopsy
Some people have a bone marrow biopsy to check for leukaemia cells and to work out the type of leukaemia.
During the biopsy, the doctor uses a thin needle 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. You will be given a local anaesthetic to numb the area or light sedation to help you feel relaxed. It will be uncomfortable while the sample is taken, but you may also be given some medicine for pain.
Pain medicine may make you feel drowsy, so arrange for a family member or a friend to drive you home afterwards. 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) can check 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. In CLL, the chromosomes most commonly affected are 13q and 17p.
By identifying any changed or damaged chromosomes, genetic tests can help the medical team make a diagnosis and plan the most effective treatment. These tests also give some information about how the CLL may behave in the long term (see Prognosis).
Some people with CLL may need a CT (computerised tomography) scan. This test uses x-rays to create a detailed, cross-sectional picture of the body. It can detect if your lymph nodes are affected and if your spleen is enlarged.
Before the scan, you may have an injection of a dye (called 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 diagnosed in the blood. Rarely, an enlarged lymph node is removed to confirm the diagnosis of CLL. This is called a lymph node (or gland) biopsy.
You will be given a general anaesthetic and/or light sedation, and part or all of a lymph node will be removed through a cut in the skin. The area is closed with a few stitches, then the lymph node is sent to the laboratory for testing. Most people can go home the same day. You’ll need someone to drive you as the pain medicine can cause drowsiness.
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 Kate Melville, Haematology Staff Specialist, Calvary Mater Newcastle, and Conjoint Lecturer, The University of Newcastle; Karl Jobburn, Clinical Nurse Consultant, Haematology, Liverpool Hospital; Patricia Masters, Consumer; Karen Robinson, 13 11 20 Consultant, Cancer Council NSW; Dr Emma Verner, Staff Specialist, Haematology, and Medical Director, Bone Marrow Transplant and Apheresis Unit, Concord Hospital, and Clinical Senior Lecturer, The University of Sydney.
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