Chronic Lymphocytic Leukemia (CLL): Tests After Diagnosis
What tests might I have after being diagnosed?
After a diagnosis of CLL, you'll likely need some tests. These help your healthcare
providers learn more about the cancer and how to treat it. Some of these tests can
also be used to help show how well treatment is working. Or they can be used later,
to look for signs that the leukemia might be coming back. If you have any questions
about these or other tests, talk with your healthcare team.
The tests you might need include:
Imaging tests might be done if the healthcare provider believes there may be a problem,
such as infection or a swollen spleen. These tests may include the following.
A chest X-ray uses radiation to make a picture of the organs and glands inside your
chest. This test can't show leukemia cells. But it can show if you have an infection
in your lungs from leukemia. It can also help your healthcare provider see if lymph
nodes in your chest are enlarged. The test takes only a few minutes. It doesn't hurt.
A CT scan takes X-ray pictures of the inside of your body from many different angles.
It takes longer than an X-ray, but it gives more detailed images than an X-ray. A
CT scan can show enlarged lymph nodes and organs, pockets of infection in your organs,
and large clusters of leukemia cells. It can be used to measure lymph nodes to compare
the size in the future.
To have the scan, you lie still on a table as it slides through the center of the
ring-shaped CT scanner. The scanner directs a beam of X-rays at your body. A computer
uses the data from the X-rays to make detailed pictures. You may be asked to hold
your breath 1 or more times during the scan. You might be asked to drink a contrast
solution called a dye after the first set of pictures is taken. The dye may be put
into your blood by IV (intravenously) through a vein in your arm, instead of drinking
it. IV contrast dye may cause a warm feeling all over your body. In rare cases, it
can also cause hives or other allergic reactions. Let your healthcare provider know
about any reactions you have or if you've had any reactions in the past.
Blood tests are part of diagnosing CLL. But they will often be done after a diagnosis
as well. These tests measure your blood cell levels and check things such as how well
your liver and kidneys are working. The special kinds of testing done to look at leukemia
cells in the blood are noted below.
A biopsy is a small amount of tissue that’s taken and checked in a lab. There are
several types of biopsies.
Bone marrow aspiration or biopsy
The healthcare provider takes a small amount of bone marrow fluid (aspiration), solid
bone marrow tissue (core biopsy), or both. The fluid and bone marrow are tested for
the number, size, and maturity of blood cells and abnormal cells. Other tests can
also be done on these cells.
Bone marrow aspiration and biopsy are sometimes done before starting treatment to
learn more about the CLL cells. They may be repeated during or after treatment to
see if it’s working. Bone marrow samples are often taken from the back of the hip
(pelvic) bone. For the bone marrow aspiration, the provider numbs the skin over the
hip and puts a long, hollow needle into the hip bone. A small amount of liquid bone
marrow is removed. Even with the numbing, you may have some brief pain when the marrow
is removed. A bone marrow biopsy is often done just after the aspiration. A small
piece of bone and marrow is removed with a slightly larger needle that's pushed down
into the bone. The biopsy may also cause some brief pain.
Lymph node biopsy
Part or all of a lymph node might be removed to be tested. This isn't always done
in people with CLL. But it might be needed if your healthcare provider wants to know
if an enlarged lymph node contains leukemia cells.
How blood or bone marrow is tested
Tests can be done on blood or bone marrow samples to diagnose leukemia. They're also
used to guide treatment decisions. These tests can also show how quickly the CLL cells
are likely to grow. Later, they can give some ideas about how well treatment is working.
The tests include:
Flow cytometry and immunohistochemistry. These tests can be done on blood, bone marrow, or other biopsy samples. They look
for certain proteins on the surface of the leukemia cells. This is called immunophenotyping.
Cytogenetics. These tests look for changes in the chromosomes of cells in samples of blood, bone
marrow, or lymph nodes. For instance, in some cases of CLL, part of a chromosome may
be missing (called a deletion). Or there may be too many copies of a chromosome. This
test often takes a few weeks. This is because time is needed to grow the cells in
Fluorescent in situ hybridization (FISH). This is a type of cytogenetic test. It uses special fluorescent dyes that only attach
to certain parts of chromosomes. It can be used to look for changes in chromosomes
of cells in blood or bone marrow samples. The FISH test is very accurate and gives
results more quickly than standard cytogenetic tests.
Working with your healthcare provider
Your healthcare provider will talk with you about which tests you'll have and what
they're for. Follow your healthcare provider's directions to get ready for the tests.
Ask questions and talk about any concerns you have.