Diagnosis of Adult Acute Lymphoblastic Leukemia

If the symptoms suggest the possibility of Adult Acute Lymphoblastic Leukemia (ALL), following tests and procedures may be used to diagnose:

  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
    • The number of red blood cells, white blood cells, and platelets.
    • The amount of hemoglobin in the red blood cells.
    • The portion of the blood sample made up of red blood cells.
  • Peripheral blood smear: A procedure in which a sample of blood is checked for the presence of blast cells, number and kinds of white blood cells, the number of platelets, and changes in the shape of blood cells.
  • Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for abnormal cells.
  • Cytogenetic analysis: A laboratory test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out if there are certain changes in the chromosomes in the lymphocytes. For example, sometimes in ALL, part of one chromosome is moved to another chromosome. This is called the Philadelphia chromosome.
  • Immunophenotyping: A test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out if malignant lymphocytes began from the B lymphocytes or the T lymphocytes.

Prognosis

The prognosis (chance of recovery) and treatment options depend on the following:
  • The age of the patient.
  • Whether the cancer has spread to the brain or spinal cord.
  • Whether the Philadelphia chromosome is present.
  • Whether the cancer has been treated before or has recurred (come back).

Stages of Adult ALL

Once Adult Acute Lymphoblastic Leukemia has been diagnosed, tests are done to find out if the cancer has spread to the central nervous system or to other parts of the body. The extent or spread of cancer is usually described as stages. The following tests and procedures may be used to determine if the leukemia has spread:
  • Chest x-ray: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • Lumbar puncture: A procedure used to collect cerebrospinal fluid from the spinal column. This is done by placing a needle into the spinal column. This procedure is also called an LP or spinal tap.
  • Ultrasound exam: A procedure in which high-energy sound waves are bounced off internal tissues or organs in the abdomen and make echoes. The echoes form a picture of body tissues called a sonogram.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of the abdomen, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. When cancer cells spread outside the blood, a solid tumor may form. This process is called metastasis. The three ways that cancer cells spread in the body are:
    • Through the blood. Cancer cells travel through the blood, invades solid tissues in the body, such as the brain or heart, and form a solid tumor.
    • Through the lymph system. Cancer cells invade the lymph system, travel through the lymph vessels, and form a solid tumor in other parts of the body.
    • Through solid tissue. Cancer cells that have formed a solid tumor spread to tissues in the surrounding area.
There is no standard staging system for adult ALL. The disease is classified as:
  • Untreated
  • In remission
  • Recurrent.

Untreated Adult ALL

The ALL is newly diagnosed and has not been treated except to relieve symptoms such as fever, bleeding, or pain.
  • The complete blood count is abnormal.
  • More than 5% of the cells in the bone marrow are blasts (leukemia cells).
  • There are signs and symptoms of leukemia.

Adult ALL in remission

The Adult Acute Lymphoblastic Leukemia has been treated.
  • The complete blood count is normal.
  • 5% or fewer of the cells in the bone marrow are blasts (leukemia cells).
  • There are no signs or symptoms of leukemia in the brain and spinal cord or elsewhere in the body.

Recurrent Adult Acute Lymphoblastic Leukemia

Recurrent adult acute lymphoblastic leukemia (ALL) is cancer that has recurred (come back) after going into remission. The ALL may come back in the blood, bone marrow, or other parts of the body. If you are experiencing the signs or symptoms of adult acute lymphoblastic leukemia (ALL), contact us to request an appointment with our oncology specialists to begin diagnostic testing.