Diagnosis of Chronic Myeloid Leukemia

There are several tests which help to diagnose cancer. They also do tests to see if cancer has spread to another part of the body from where it began. This process is the metastasis of cancer. For instance, imaging tests can represent if cancer has spread. Imaging tests show pictures of the body from the inside. Doctors can also do tests to learn which treatments would work best.

A biopsy is the sure short way for the doctor to know if an area of the body has cancer for most types of cancer. In a biopsy, the doctor takes a small tissue sample for testing in a laboratory. The doctor may suggest other tests if a biopsy cannot help diagnose.

The doctor may consider given factors when choosing a diagnostic test:

  • Your signs and symptoms
  • The age and general health status
  • The type of cancer suspected
  • The result of earlier medical tests

In addition to a physical examination there are other tests which will help to diagnose CML:

Blood tests

The blood test, the complete blood count (CBC) helps to diagnose the CML before having any symptoms. A CBC counts the number of different types of cells in the blood. A CBC is usually a part of a regular medical checkup. People with CML have a high number of white blood cells. However, white blood cell levels can also be due to reasons other than leukemia conditions. When the CML is more advanced, there can also be low levels of red blood cells, anaemia, and either high or low numbers of platelets.

Bone marrow aspiration and biopsy

These two procedures are similar and often done simultaneously to evaluate the bone marrow, which is the fatty, spongy tissue found inside larger bones. Bone marrow has both a liquid and a solid part. A bone marrow aspiration takes a sample of the fluid using a needle. A bone marrow biopsy removes a small quantity of solid tissue using a needle.

A pathologist then reviews the samples in a lab. Pelvic bone located by the hip is a common site for bone marrow aspiration and biopsy. Doctors generally give ” anaesthesia ” medication beforehand to numb the area. Anaesthesia is a medication that blocks the awareness of pain.

Molecular testing

Your doctor may recommend testing the leukemia cells for specific genes, proteins, and other factors unique to the leukemia. Results of these tests can help determine the treatment options.

Cytogenetics is a way to look at a cell’s chromosomes through a microscope to analyze the number, shape, size, and arrangement of the chromosomes to find genetic changes in the leukemia cells. Sometimes, this test can be done on the peripheral or circulating blood when the CML is first diagnosed, but immature blood cells that are actively dividing need to be used. Because of this, a bone marrow sample is usually the best way to get a sample for testing.

For most people with CML, the Philadelphia chromosome and the BCR-ABL fusion gene can be found through testing, confirming the diagnosis. Increased blood cell counts may suggest CML for a few patients, but the Philadelphia chromosome can’t be found on the usual tests even though the BCR-ABL fusion gene is there. Treatment for these patients is the same and works well for patients with a detectable Philadelphia chromosome.

Cytogenetic testing

Cytogenetic testing for CML monitors how well the treatment works and lowers the count of cells with the Philadelphia chromosome. The following tests are occasionally a part of cytogenic testing.

  • Fluorescence in situ hybridization is a test used to detect the BCR-ABL gene and monitor the disease while treatment is going on. This test doesn’t require dividing cells and can be done using bone marrow cells or a blood sample. This test is more sensitive to finding CML than the standard cytogenetic tests identifying the Philadelphia chromosome.
  • Polymerase chain reaction (PCR) is a DNA test that can determine the BCR-ABL fusion gene and other molecular abnormalities. PCR tests also help to monitor or find out how well the treatment is working. This test is quite sensitive and, depending on the technique used, can find one abnormal cell mixed in with around 1 million healthy cells. Bone marrow or blood samples are commonly used for testing.

After treatment begins, cytogenetic or molecular testing is repeated on another bone marrow sample to find out if there are fewer cells with the Philadelphia chromosome.

Imaging tests

Doctors can use imaging tests to determine if leukemia affects other body parts. For instance, a computed tomography (CT or CAT) scan or ultrasound examination is sometimes helps to look at and measure the size of the spleen in people with CML.

A CT scan takes pictures of the body from inside using x-rays taken from different angles. A computer then combines these pictures into a detailed, 3-dimensional image showing abnormalities or tumours. A CT scan also helps to determine the tumour’s size. Occasionally, a specific dye called a contrast medium is given before the scan to provide detail on the image. This dye can be delivered into a patient’s vein or provided as a pill or liquid to swallow.

An ultrasound uses high-frequency sound waves to form an image of the inside of the body.