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ACUTE LYMPHOBLASTIC LEUKEMIA (ALL)
( By JASCAP )

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Symptoms and Diagnosis

How ALL is diagnosed?

Usually you will see your GP, who will examine you and take a blood test. If the results of the test are 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 for ALL

Most people with ALL are referred for treatment at a specialist haematology unit in the hospital. The doctor at the hospital will take your full medical history before doing a physical examination and a blood test to check 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 to find 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 a microscope to see if it contains any abnormal white blood cells. A haematologist can tell which type of leukaemia it is by identifying the type of abnormal white cell. Other tests will be carried out on the bone marrow sample to help confirm the diagnosis. Before the bone marrow sample is taken you are given a local anaesthetic injection to numb the area. A needle is then passed through the skin into the bone. A small sample of the bone marrow is drawn into a syringe to be examined under a microscope.


Figure: A bone marrow sample being taken

The procedure can be done on the ward or in the outpatients department, and takes 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 into the bone marrow. This 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.

Cytogenetics

Each cell in the body contains 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. Different types of leukaemia are associated with particular genetic changes. These tests, known as cytogenetic tests, can help to decide 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 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 passes a needle gently 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 they can prescribe painkillers for you. You may need to lie flat for a few hours afterwards.

Scans

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.

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 our cancer support specialists.

Symptoms of ALL

The main symptoms of ALL are caused by the increased number of immature cells (blast cells) in the blood, which reduces the number of normal blood cells.

Symptoms of ALL include:

  • Looking pale - which may be due to anaemia caused by a lack of red blood cells.
  • Feeling very tired - even breathless, at the slightest effort.
  • Feeling generally unwell and run-down - perhaps with a sore throat or sore mouth.
  • Aching joints and bones - the bones can be affected by leukaemia cells.
  • Having various infections one after the other - caused by a lack of healthy white blood cells.
  • Unusual bleeding - caused by a reduction in the number of platelets. This may include bruising (bruises may appear without any apparent injury), heavy periods in women, bleeding gums and frequent nosebleeds.
Occasionally, a person will not have any of these symptoms and the leukaemia is discovered during a routine blood test. Symptoms may appear very quickly over a few weeks, and treatment needs to be given as soon as possible. If you have any of these symptoms you should have them checked by your doctor, but remember they are common to many illnesses other than leukaemia.
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