Diagnosis

Doctors use many tests to diagnose cancer and determine more about the disease. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may also be used. Your doctor may consider these factors when choosing a diagnostic test:

• Age and medical condition
  
  
• The type of cancer suspected
  
  
• Severity of symptoms
  
  
• Previous test results

The following tests may be used to diagnose CLL:

Blood tests. The diagnosis of CLL begins with a complete blood count (a routine blood test) to measure the counts of different types of cells in a person’s blood. If the blood contains high levels of white blood cells, CLL may be present. At this time, the doctor will find out which types of white blood cells are increased.

Bone marrow biopsy. In a bone marrow biopsy, a doctor takes a sample of marrow, usually from the back of the hipbone, with a needle. The patient is given medication to numb the area beforehand. The cells from the marrow, along with the cells from the blood, are analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease).

CLL can usually be diagnosed from studies of the blood; a bone marrow biopsy is not needed for all patients. In some patients, it may be used to help determine prognosis (chance of recovery) or provide further information about the reasons that other blood counts may be abnormal.

Flow cytometry and cytochemistry. In these tests, cancer cells are treated with chemicals or dyes that provide information about the leukemia and its subtype. CLL cells have distinctive markers (cell surface proteins) on their surface. The pattern of these markers is called the immunophenotype. These tests are used to distinguish CLL from other kinds of leukemia, which can also involve lymphocytes. Both tests can be done from a blood sample.

Imaging tests. It is known that CLL is generally present throughout many parts of the body, even if the disease has been diagnosed early. Thus, imaging tests to determine if the cancer has spread are not needed for all patients, although they may be recommended at times to find out whether particular symptoms may be related to the CLL and to measure how well treatment is working.

• An x-ray (picture of the inside of the body) may show if cancer is growing in lymph nodes in the chest.
  
  
• A computed tomography (CT or CAT) scan (a three-dimensional picture of the inside of the body) can detect affected lymph nodes around the heart, windpipe, lungs, and abdomen. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail. CT scans can also determine if other organs, such as the spleen, are affected.

Learn more about what to expect when having common tests, procedures, and scans.

Find out more about common terms used during a diagnosis of cancer.