Leukemia

Scripps cancer specialists are experts in detecting and diagnosing leukemia to plan the best course of treatment. If your doctor thinks you have leukemia, they will check samples of cells from your blood and bone marrow. Other tissue and cell samples may be taken to help guide treatment.

The following tests and procedures may be used to diagnose leukemia:

Blood tests

Complete blood count (CBC) and blood cell exam (peripheral blood smear) are often the first tests completed on patients with a suspected blood problem. The CBC blood test measures the number of red blood cells, white blood cells and platelets in your blood.

Blood chemistry and coagulation tests

Blood chemistry tests measure the amount of certain chemicals in the blood, but these tests are not used to diagnose leukemia. These tests can help detect liver or kidney problems caused by spreading leukemia cells or the side effects of certain chemotherapy drugs. 

Bone marrow aspiration and biopsy

Bone marrow samples are obtained by bone marrow aspiration and biopsy tests, usually done at the same time. The samples are often taken from the back of the hip (pelvic) bone, but in some cases they may be taken from the breastbone (sternum) or other bones.

Chromosome testing

Normal human cells contain 23 pairs of chromosomes (or bundles of DNA). In some cases of leukemia, the cells have chromosome changes. Sometimes a piece of a chromosome is missing — called a deletion. Information about chromosome changes can be useful in predicting a patient’s outlook and response to treatment. For this reason, chromosome testing is a standard part of the work-up of patients.

Lumbar puncture (spinal tap)

Cerebrospinal fluid (CSF) is the liquid that surrounds the brain and spinal cord. Because acute myeloid leukemia (AML) can sometimes spread to the area around the brain and spinal cord, doctors remove a sample of CSF for testing. The procedure used to remove this fluid is called a lumbar puncture (also known as a spinal tap). Often, a lumbar puncture is not used to test for AML unless the patient is having symptoms that could be caused by leukemia cells spreading into the brain and spinal cord.

X-rays

Chest X-rays can be done if the doctor suspects a lung infection. They may also be done to look for enlarged lymph nodes in the chest.

Positron emission tomography (PET) scan

A PET scan involves a type of radioactive sugar that existing cancer cells will quickly absorb so they can be identified under a special camera. It’s combined with a CT scan to give physicians the ability to view a picture of potentially cancerous areas through the PET while also seeing more detailed images from a CT scan. 

Computed tomography (CT) scan

A CT scan uses X-rays to provide detail about the size, shape and location of any growth.

Magnetic resonance imaging (MRI)

MRI uses radio waves to provide detailed images of the brain and spinal cord.

Ultrasound

Ultrasound can be used to look at lymph nodes near the surface of the body or to look for enlarged organs inside the abdomen, such as the kidneys, liver and spleen.

While the incidence of leukemia has not changed much since the 1950s, more people are surviving longer due mainly to advances in medicine and chemotherapy. 

Radiation therapy and chemotherapy are usually combined as the primary treatment for leukemia. Treatment of leukemia may also include:

Chemotherapy and targeted therapies

Chemotherapy and targeted therapies often play an important part of treatment for most patients with acute leukemia. Since acute leukemia patients have extremely low counts of healthy blood cells, they’re given blood and platelet tranfusions to help stop or prevent bleeding, as well as antibiotics to prevent or treat infection.

For patients with chronic lymphocytic leukemia (CML), oral chemotherapy may be used to control symptoms for several years. In addition, the drug imatinib has been used to treat CML for long-term remission. Known as a molecular targeting drug, it attacks the genetic alterations than can cause white blood cells to grow out of control.

Stem cell transplant

A stem cell transplant is a procedure to replace your diseased bone marrow with healthy bone marrow. Before a stem cell transplant, a patient receives high doses of chemotherapy or radiation therapy to destroy diseased bone marrow. Then the patient receives an infusion of blood-forming stem cells that help to rebuild bone marrow.

You may receive stem cells from a donor, or in some cases you may be able to use your own stem cells. A stem cell transplant is very similar to a bone marrow transplant.

Radiation therapy

Intensity-modulated radiation therapy (IMRT) may be part of a treatment plan for leukemia, depending on the extent of the cancer and other factors. Radiation therapy may be used to prepare for a stem cell transplant.

We are here for you — not only as your oncologists, but as a robust multidisciplinary team of experts who understands that your cancer journey is about much more than your medical treatment. Specifically, Scripps Cancer Center offers a variety of patient support services to ensure your physical, psychological and emotional well-being as well as resources for dealing with the logistical and financial aspects of cancer care. Our services and resources include:

• Oncology nurses and nurse navigators with extensive clinical expertise in cancer care to help guide you and your caregivers to make informed decisions and ensure your optimal care.
• Palliative care to provide an extra layer of supportive care to manage pain and relieve symptoms, offer emotional and spiritual support, and improve your quality of life. 
• Oncology social workers specially trained to provide counseling, connect you with community and medical resources, assist with transportation and housing and coordinate care after discharge.
• Our registered dietitian nutritionists offer individualized nutrition support for patients whose efforts to optimize their nutrition may be affected by cancer symptoms or treatment side effects.
• Referrals and professional care from experts in psychology, psychiatry and emotional health, including individual and family counseling to help with the emotional challenges of cancer.
• Physical rehabilitation and occupational therapy services, including wound care, voice therapy and swallowing therapy, lymphedema therapy, balance and vestibular rehabilitation, yoga and more.
• Scripps Center for Integrative Medicine for patients interested in mind-body healing through acupuncture, biofeedback, herbal nutrition, massage therapy, integrative cancer care and more.
• Nondenominational spiritual care offered by our chaplains to help coordinate spiritual care with your own clergy, rabbi or spiritual advisor.
• Visiting patient services if you reside beyond San Diego and want help arranging appointments or learning more about short-term lodging.

For the full spectrum of offerings, please visit our cancer patient support services section.