The first step in diagnosis is usually a physical examination and medical history. Your child's doctor will check for signs of disease, such as lumps in the neck. He or she will ask about your family's medical history and your child's past illnesses and treatments.
To determine whether your child has ALL, the doctor will also need to test your child's blood and bone marrow, and possibly other cells and tissues. The following tests and procedures may be used:
Blood cell count and other blood tests – Doctors examine a blood sample, checking the number of red blood cells and platelets. The number and type of white blood cells will be checked, too. The appearance of the cells will also be noted.
Bone marrow aspiration and biopsy – A small sample of bone and liquid bone marrow is taken from the hipbone or breastbone with a long needle. A specially trained doctor checks the sample for abnormal cells.
Cytogenetic analysis – This test looks for specific changes in the genetic material of lymphocytes.
Flow cytometry(immunophenotyping) – This test examines the characteristics of a patient's cells. In ALL, it can help determine whether cancerous cells began from B lymphocytes or T lymphocytes.
These and other lab tests can also help determine the subtype of ALL.
If your child is diagnosed with ALL, the doctor may suggest other tests and procedures. These will help determine whether the cancer has spread beyond the blood and bone marrow. The results will also help to plan a course of treatment. Additional tests are likely to include
imaging tests, such as a chest x-ray, computed tomography (CT) scan and ultrasound
lumbar puncture (spinal tap), which involves collecting fluid from the spinal column with a needle.
There are two main risk groups for childhood ALL. They are based on age and white blood cell counts at diagnosis. The risk groups are standard (low) risk and high risk. The risk level helps determine the best treatment.
Children with ALL should be cared for by a team with expertise in childhood leukemia. Long-term, regular follow-up exams are very important as well. This is because treatment for childhood ALL can have long-term effects on learning, memory, mood, and other aspects of health. It can also increase the chance of developing new cancers, especially brain tumors.