Diagnosing

Pediatric Acute Lymphoblastic Leukemia (ALL)


Diagnosing Pediatric Acute Lymphoblastic Leukemia

Sheba Medical Center is dedicated to providing the best treatment and care to patients with ALL from before diagnosis all the way through specialized treatment plans. Our oncologists, hematologists, radiation oncologists, pathologists, and other specialists work closely together to diagnose and determine the type of your disease.

At Sheba, we keep you informed every step of the way as our experienced doctors guide you through the critical diagnostic part of your cancer care. Once a diagnosis is made, we come up with an individualized treatment plan tailored to your specific needs.

During your diagnostic evaluation at Sheba, we may perform the following procedures:

 

Complete blood count (CBC) and peripheral blood smear.

A CBC is a blood test that provides a count of the red blood cells, white blood cells, and platelets in your blood. During a peripheral blood smear, doctors look at the blood under a microscope for changes in the number and appearance of cells.

 

Bone marrow aspiration and biopsy.

Since leukemia starts in the bone marrow, obtaining samples and testing the bone marrow is an essential part of diagnosis. A bone marrow aspiration involves taking a sample of liquid bone marrow with a long, thin needle. During a bone marrow biopsy, a small piece of bone and marrow are removed and sent to the lab for testing. These procedures are performed at the same time.

 

Cytochemistry.

During this laboratory test, cells are exposed to chemical stains that only react with leukemia cells. This helps the doctors determine if leukemia cells are present and if so, which type.

 

Flow cytometry and immunohistochemistry.

This laboratory test uses a sample of cells that are treated with antibodies that only stick to certain proteins on the cells. This helps to determine exactly which type of leukemia a person has.

 

Chromosome tests.

Leukemia cells sometimes exhibit chromosomal changes that can help specialists identify the type of ALL, and the best course of treatment moving forward.

 

Fluorescent in situ hybridization (FISH).

This laboratory test uses fluorescent dyes that attach to certain genes or chromosomes. It can pick up on small changes that are not seen in other kinds of testing.

 

Lumbar puncture.

Since ALL can spread to the central nervous system (brain and spinal cord), doctors may remove a sample of cerebral spinal fluid (CSF) for testing.
 

Imaging tests.

Since leukemia doesn’t form tumors, imaging tests are not as useful as they are in other types of cancer. Still, they may be performed to determine whether the cancer has spread. Imaging tests that may be used include x-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, ultrasound (US), positron emission tomography (PET) scans, and bone scans.

 

Prognostic Factors

Leukemia does not have “stages” the way other cancers do. Certain prognostic factors can predict how well a person will respond to treatment:

  • White blood cell count at the time of diagnosis
  • Age of the patient (younger patients tend to have a better prognosis than older patients)
  • Genetic mutations in the cells
  • Response to the first cycle of chemotherapy

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