diagnosis

my child has leukaemia............

diagnosis

Usually you will see your GP, who will examine you and take a blood test. If the results of the test are found to be abnormal in any way, your GP or a haematologist from the local hospital will contact you. A haematologist is a doctor who specialises in the treatment of blood problems. They will arrange for you to be seen quickly at the hospital for further tests and treatment.

 

Further tests at the hospital

Most people with ALL are referred for treatment at a specialist haematology unit, where a group of specialist doctors work together. This is known as a multidisciplinary team and normally includes:

 

one or more haematologists, a clinical oncologist (a doctor who specialises in radiotherapy and chemotherapy), specialist nurses who give information and support pathologists who advise on the type and extent of the leukaemia. Other staff will be available to help if necessary, such as: social workers, dietitians, counsellors and psychologists and physiotherapists. The doctor at the hospital will take your full medical history before doing a physical examination and a specific type of blood test, which checks the numbers of all the different types of blood cell.

 

If the blood test shows that leukaemia cells are present, your doctor will want to take a sample of your bone marrow. This is the most important test in finding out the exact type of leukaemia you have, and gives information that the doctors need to plan the best treatment for you.

 

Bone marrow sample/biopsy

A small sample of bone marrow is taken from the back of the hip bone (pelvis) or occasionally the breast bone (sternum). It is looked at under the microscope by a haematologist to see if it contains any abnormal white blood cells. The pathologist will be able to tell which type of leukaemia it is by identifying the type of abnormal white cell. Some other tests will be carried out on the bone marrow sample to help confirm the diagnosis. The bone marrow sample is normally taken under a local anaesthetic. You are given a small injection to numb the area and a needle is passed through the skin into the bone. A small sample of the bone marrow is then drawn into a syringe for examination under a microscope. The procedure can be done on the ward or in the outpatients department. The whole procedure lasts about 15–20 minutes. It may be uncomfortable when the marrow is drawn into the syringe, but this should only last a short time. You may be offered a short-acting sedative to reduce any pain or discomfort during the test. Sometimes a small core of marrow is needed (a trephine biopsy) and this procedure takes a few minutes longer. A special type of needle is passed through the skin to the bone marrow. The needle has a tip that can cut out a sample of the bone marrow. You may feel bruised after the test and have an ache for a few days. This can be eased with mild painkillers. A sample of bone marrow is usually taken from the back of the hip bone

 

Cytogenetics

Within each cell of the body are chromosomes, which are made up of genes. The genes control all activities of the cell. In leukaemia there are often changes in the structure of the chromosomes within the leukaemic cells, but not the normal cells of the body. The tests on the blood and bone marrow sample will include a chromosome analysis to look for any particular changes in the chromosomes, as the different types are associated with particular genetic changes. These tests, known as cytogenetic tests, can help to decide on the best treatment and predict how well the leukaemia may respond to that treatment.

 

Immunophenotyping

Another test on the blood or bone marrow sample will show which type of lymphocyte has become cancerous. Immunophenotyping can tell the doctors whether your leukaemia developed from B-lymphocytes or T-lymphocytes. Knowing which type of lymphocyte is affected helps the doctors to plan the most appropriate treatment.

 

Chest x-ray

This is taken to check for any sign of swollen lymph glands in the chest.

 

Lumbar puncture

A small sample of the fluid that surrounds your brain and spinal cord is taken to check for leukaemia cells. Your doctor uses a local anaesthetic to numb the lower part of your back and a needle is gently passed into the spine to draw off a tiny sample of the fluid. Having the lumbar puncture may be uncomfortable, but it only takes a few minutes. Some people may have a headache afterwards. If this happens let your doctor know so that painkillers can be prescribed for you. You may need to lie flat for a few hours afterwards.

 

Other scans

Other scans, such as a CT, MRI and ultrasound scan, may be done to find out if the leukaemia has spread to other parts of your body. Your doctor or specialist nurse can tell you about any scans that may be necessary.

 

Waiting for your test results

It will probably take several days for the results of your tests to be ready, and this waiting period will obviously be an anxious time for you. It may help if you can find a close friend or relative to talk things over with. You can also contact Cancerbackup or another organisation.

 

Classification of acute lymphoblastic leukaemia

There are two classification systems that break acute lymphoblastic leukaemia down into various sub-types. These are the WHO (World Health Organisation) classification system and the FAB (French-American-British) classification system.

 

The WHO system is based on the type of lymphocyte (either B- or T-lymphocyte) that has become cancerous. This system is important as it is useful for planning treatment and predicting response. There are three different sub-types:

 

>early (precursor) B-lymphoblastic leukaemia (most adults with ALL have this type)

 

>mature B-lymphoblastic leukaemia (sometimes called Burkitt-type ALL because it is similar to Burkitt lymphoma)

 

>early (precursor) T-lymphoblastic leukaemia.

 

The FAB classification system is less helpful for planning treatment or predicting outcome. It looks at the appearance of the leukaemia cells under a microscope (morphology). It is divided into three different sub-types:

 

>L1 – the leukaemic cells (lymphoblasts) are quite mature and similar to normal lymphocytes

 

>L2 – the lymphoblasts are more immature

 

>L3 – the lymphoblasts are very immature and do not function well.

 

Philadelphia chromosome

Some people with ALL have a particular genetic abnormality known as a Philadelphia chromosome which can be detected by cytogenetic tests. The Philadelphia chromosome develops when part of chromosome 9 (the ABL gene) wrongly attaches to chromosome 22 (the BCR gene) during cell division. This creates a new gene, known as BCR-ABL, which produces a specific new protein. The protein causes the production of an enzyme called tyrosine kinase, which makes the bone marrow produce abnormal blood cells. The Philadelphia chromosome is not inherited and cannot be passed on to your children.

 

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