Leukemia - Chronic T-Cell Lymphocytic: Diagnosis

Approved by the Cancer.Net Editorial Board, 08/2017

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many blood and bone marrow tests to diagnose leukemia. They also do tests to learn how much it may have spread. Doctors may also do tests to learn which treatments could work best.

A patient’s signs and symptoms may cause a doctor to suspect leukemia. But, blood and/or bone marrow tests are the only way to know whether a person has leukemia.

This list describes options for diagnosing T-cell leukemia. Not all tests listed below will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of leukemia suspected

  • Your signs and symptoms

  • Your age and medical condition

  • The results of earlier medical tests

In addition to a physical examination, the following tests may be used to diagnose T-cell leukemia:

  • Blood tests. The diagnosis of T-cell leukemia begins with a blood test called a complete blood count (CBC). A CBC measures the numbers of different types of cells in the blood. If the blood contains many white blood cells, T-cell leukemia may be suspected.

  • Bone marrow aspiration and biopsy. These 2 procedures are similar and often done at the same time to examine the bone marrow. Bone marrow has both a solid and a liquid part. A bone marrow aspiration removes a sample of fluid with a needle. A bone marrow biopsy is the removal of a small amount of solid tissue using a needle.

    A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. A common site for a bone marrow aspiration and biopsy is the pelvic bone, which is located in the lower back by the hip. The skin in that area is usually numbed with medication beforehand. Other types of anesthesia (medication to block awareness of pain) may also be used.

  • Molecular testing. Your doctor may recommend running laboratory tests on a bone marrow sample to identify specific genes, proteins, and other factors unique to the disease.

    • Immunophenotyping is the examination of antigens, a specific type of protein, on the surface of the leukemia cells. Immunophenotyping allows the doctor to confirm the exact type of leukemia.

    • Cytogenetics is the examination of the leukemia cells for abnormal changes to the long strands of genes called chromosomes. It helps doctors confirm the diagnosis and may help determine the person’s chance of recovery.

    Results of these tests will also help decide whether your treatment options include a type of treatment called targeted therapy (see Treatment Options).

  • Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. A pathologist then analyzes the sample(s). In addition to a bone marrow aspiration and biopsy (see above), the following types of biopsy may be needed depending on the type of T-cell leukemia suspected:

    • Skin biopsy. During a skin biopsy, a sample of skin tissue is removed to look for T cells in the skin.

    • Lymph node biopsy. In a lymph node biopsy, the doctor removes all or part of a lymph node to look for leukemia cells.

  • Computed tomography (CT or CAT) scan. A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer combines these images into a detailed, cross-sectional view that shows any abnormalities, including swollen lymph nodes or a swollen spleen. A CT scan can be used to measure the size of a swollen lymph node. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill to swallow.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is leukemia, these results also help the doctor describe the disease.

The next section in this guide is Stages. It explains how doctors describe the growth or spread of most types of cancer, called stage, and how this differs for T-cell leukemia. You may use the menu to choose a different section to read in this guide.