Leukemia Diagnosis, Treatment

by National Cancer Institute

(Page 2 of 4)

Diagnosis

If a person has symptoms that suggest leukemia, the doctor may do a physical exam and ask about the patient's personal and family medical history. The doctor also may order laboratory tests, especially blood tests.

The exams and tests may include the following:

Physical exam — The doctor checks for swelling of the lymph nodes, spleen, and liver.

Blood tests — The lab checks the level of blood cells. Leukemia causes a very high level of white blood cells. It also causes low levels of platelets and hemoglobin, which is found inside red blood cells. The lab also may check the blood for signs that leukemia has affected the liver and kidneys.

Biopsy — The doctor removes some bone marrow from the hipbone or another large bone. A pathologist examines the sample under a microscope. The removal of tissue to look for cancer cells is called a biopsy. A biopsy is the only sure way to know whether leukemia cells are in the bone marrow. There are two ways the doctor can obtain bone marrow. Some patients will have both procedures:

Bone marrow aspiration: The doctor uses a needle to remove samples of bone marrow.

Bone marrow biopsy: The doctor uses a very thick needle to remove a small piece of bone and bone marrow. Local anesthesia helps to make the patient more comfortable.

Cytogenetics — The lab looks at the chromosomes of cells from samples of peripheral blood, bone marrow, or lymph nodes.

Spinal tap — The doctor removes some of the cerebrospinal fluid (the fluid that fills the spaces in and around the brain and spinal cord). The doctor uses a long, thin needle to remove fluid from the spinal column. The procedure takes about 30 minutes and is performed with local anesthesia. The patient must lie flat for several hours afterward to keep from getting a headache. The lab checks the fluid for leukemia cells or other signs of problems.

Chest x-ray — The x-ray can reveal signs of disease in the chest.

A person who needs a bone marrow aspiration or bone marrow biopsy may want to ask the doctor the following questions:

• Will you remove the sample of bone marrow from the hip or from another bone?
• How long will the procedure take? Will I be awake? Will it hurt?
• How soon will you have the results? Who will explain them to me?
• If I do have leukemia, who will talk to me about treatment? When?

Treatment

Many people with leukemia want to take an active part in making decisions about their medical care. They want to learn all they can about their disease and their treatment choices. However, the shock and stress after a diagnosis of cancer can make it hard to think of everything to ask the doctor. Often it helps to make a list of questions before an appointment. To help remember what the doctor says, patients may take notes or ask whether they may use a tape recorder. Some also want to have a family member or friend with them when they talk to the doctor - to take part in the discussion, to take notes, or just to listen.

The doctor may refer patients to doctors who specialize in treating leukemia, or patients may ask for a referral. Specialists who treat leukemia include hematologists, medical oncologists, and radiation oncologists. Pediatric oncologists and hematologists treat childhood leukemia.

Whenever possible, patients should be treated at a medical center that has doctors experienced in treating leukemia. If this is not possible, the patient's doctor may discuss the treatment plan with a specialist at such a center.

Getting a Second Opinion

Sometimes it is helpful to have a second opinion about the diagnosis and the treatment plan. Some insurance companies require a second opinion; others may cover a second opinion if the patient or doctor requests it. There are a number of ways to find a doctor for a second opinion:

The patient's doctor may be able to suggest a doctor who specializes in adult or childhood leukemia. At cancer centers, several specialists often work together as a team.

The Cancer Information Service, at 1-800-4-CANCER, can tell callers about nearby treatment centers. A local or state medical society, a nearby hospital, or a medical school can usually provide the names of specialists.

The American Board of Medical Specialties (ABMS) has a list of doctors who have met certain education and training requirements and have passed specialty examinations. The Official ABMS Directory of Board Certified Medical Specialists lists doctors' names along with their specialty and their educational background. The directory is available in most public libraries. Also, ABMS offers this information on the Internet at http://www.abms.org.

Preparing for Treatment

The doctor can describe treatment choices and discuss the results expected with each treatment option. The doctor and patient can work together to develop a treatment plan that fits the patient's needs.

Treatment depends on a number of factors, including the type of leukemia, the patient's age, whether leukemia cells are present in the cerebrospinal fluid, and whether the leukemia has been treated before. It also may depend on certain features of the leukemia cells. The doctor also takes into consideration the patient's symptoms and general health.

These are some questions a person may want to ask the doctor before treatment begins:

• What type of leukemia do I have?
• What are my treatment choices? Which do you recommend for me? Why?
• What are the benefits of each kind of treatment?
• What are the risks and possible side effects of each treatment?
• If I have pain, how will you help me?
• What is the treatment likely to cost?
• How will treatment affect my normal activities?
• Would a clinical trial (research study) be appropriate for me? Can you help me find one?

People do not need to ask all of their questions or understand all of the answers at one time. They will have other chances to ask the doctor to explain things that are not clear and to ask for more information.

Methods of Treatment

The doctor is the best person to describe the treatment choices and discuss the expected results. Depending on the type and extent of the disease, patients may have chemotherapy, biological therapy, radiation therapy, or bone marrow transplantation. If the patient's spleen is enlarged, the doctor may suggest surgery to remove it. Some patients receive a combination of treatments.

People with acute leukemia need to be treated right away. The goal of treatment is to bring about a remission. Then, when signs and symptoms disappear, more therapy may be given to prevent a relapse. This type of therapy is called maintenance therapy. Many people with acute leukemia can be cured.

Chronic leukemia patients who do not have symptoms may not require immediate treatment. The doctor may suggest watchful waiting for some patients with chronic lymphocytic leukemia. The health care team will monitor the patient's health so that treatment can begin if symptoms occur or worsen. When treatment for chronic leukemia is needed, it can often control the disease and its symptoms. However, chronic leukemia can seldom be cured. Patients may receive maintenance therapy to help keep the cancer in remission. A patient may want to talk to the doctor about taking part in a clinical trial, a research study of new treatment methods.

In addition to anticancer therapy, people with leukemia may have treatment to control pain and other symptoms of the cancer, to relieve the side effects of therapy, or to ease emotional problems. This kind of treatment is called symptom management, supportive care, or palliative care.

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