Blood Cancer

A blood cancer diagnosis can be determined in several different ways. Depending on your type of blood cancer, your signs and symptoms, and personal and family history. Diagnosis may include:

Staging

Staging refers to determining the cancer's severity and level of metastasis, or spread. This helps predict how cancer will progress, allowing doctors to create a personalized blood cancer treatment plan. Diagnosing and staging may co-occur depending on the case, and the following tests and procedures may be used for both processes.

Physical exam

Your doctor will likely order a physical examination before anything else, feeling or looking for swollen lymph nodes and swelling in the liver or spleen. They may also examine the skin, checking for signs of easy bruising or bleeding and any rashes. To assess the nervous system, the doctor may check your balance, sensation, and reflexes.

Blood tests

Your doctor may perform a blood test for cancer detection and diagnosis. One or more of the following tests may be used:

Complete blood count (CBC)

A complete blood count may be ordered to determine levels of white blood cells, red blood cells, and platelets. Abnormal levels of these cells may indicate cancer.

White cell differential

A white cell differential, also referred to as a diff, determines the percentage of each type of white blood cell present in your blood. A differential can detect immature white blood cells and other abnormalities, indicating blood cancer.

Peripheral blood smear

A single drop of blood is smeared across a surface for analysis under a microscope during a peripheral blood smear. Cancer may be present if the appearance or levels of the blood cells in the sample are abnormal.

Imaging tests

Aside from blood tests, a range of imaging tests may also be used to diagnose blood cancer:

Computed tomography (CT) scan

CT scans combine several different X-ray images taken from various angles to provide cross-sectional views of the body's structures. This allows doctors to see parts various of the body in great detail. This test cannot be used to diagnose blood cancer, but if the organs or lymph nodes appear swollen in a CT scan, it may indicate that cancer is present.

Positron emission tomography (PET) scan

Typically more sensitive than other imaging tests, PET scans use a small amount of radioactive material inside the body to highlight areas where cancer cells are present. PET images may also be combined with CT scans to provide a more detailed view.

Magnetic resonance imaging (MRI) scan

MRIs use large magnets, radiofrequency, and a computer to create detailed images of the body's organs and structures, helping doctors determine whether cancer is present.

Ultrasound

Ultrasounds release high-frequency sound waves into the body, which bounce off organs and bodily structures, creating "echoes." These echoes can then be turned into images, allowing doctors to analyze whether cancer is present in some body regions, such as the spleen or liver.

Biopsy

Your doctor may do a bone marrow or lymph node biopsy, in which a small piece of bone marrow or lymph node — or, in some cases, a whole lymph node — is removed to determine if cancer is present.

Bone marrow aspiration and biopsy

During the bone marrow aspiration, a needle is used to collect a small sample of liquid bone marrow (usually near the hip bone). Following this, a bone marrow biopsy is done to collect a solid portion of the bone marrow. Doctors can then analyze these samples to see if cancer may be affecting the blood, bone marrow, or blood-forming tissue. Local anesthesia helps to keep pain and pressure to a minimum during these diagnostic procedures.

Lymph node biopsy

During a lymph node biopsy, doctors will collect a partial or full sample of a lymph node. These biopsies can be done to diagnose a blood cancer, determine if the cancer has returned after treatment, or see if the blood cancer has become more aggressive. Depending on the location of the lymph node(s) needing biopsy, general or local anesthesia may be used.

Flow cytometry

Flow cytometry tests project lasers into bodily fluid streams containing cells or particles. These tests typically detect cancer cells in the bone marrow or blood when diagnosing blood cancers. The presence of certain protein markers, called antigens, can indicate cancer.

Urinalysis

A urinalysis, a urine test, may also be used during a blood cancer diagnosis. This test measures the levels of proteins, chemicals, red blood cells, and white blood cells in the urine. If abnormal proteins are present, doctors may order further tests or procedures to determine if cancer or a disorder is present.

Lumbar puncture

A lumbar puncture, also referred to as a spinal tap, may be done to determine how advanced blood cancer has become. A needle is inserted into the lower back to collect cerebrospinal fluid (CSF), which surrounds the brain and spinal cord. Doctors can then analyze this sample to determine if cancer cells are present. Local anesthesia is used to numb the area before this procedure.