Many of the early signs of acute lymphoblastic leukemia (ALL) are similar to the flu or other common, less serious diseases. If you have symptoms of leukemia, your doctor will perform a thorough physical examination and talk to you about your medical history.
Many signs and symptoms of ALL can be attributed to a reduction in the number of normal blood cells in your body. Check with your doctor if you have any of the signs or symptoms described here.
Symptoms from Low White Blood Cells
- Flu-like symptoms, such as fever, sweats, and body aches
- Infections from bacteria or viruses
- Mouth inflammation, pain, or sores
Symptoms from Low Red Blood Cells
- Shortness of breath
- Pale skin
- Fatigue, weakness, lack of energy, or sleepiness
Symptoms from Low Platelets
- Bleeding from the gums
- Red spots on the palate or ankles
- Easy bruising or prolonged bleeding from cuts
- Frequent or severe nosebleeds
Other General Symptoms
- Loss of appetite
- Unexplained weight loss
- Pain or aches in the bones, stomach, arms, legs, or back
- Swelling of the abdomen (may indicate an enlarged spleen)
- Swollen lymph nodes in the neck, underarm, stomach, or groin
An accurate diagnosis of ALL requires several diagnostic tests. Any or all of the following tests may be used to diagnose leukemia.
Complete Blood Count and Peripheral Blood Smear
A blood sample is examined for the number of red blood cells and platelets, the number and type of white blood cells, the amount of hemoglobin (protein that carries oxygen) in the red blood cells, and the presence of lymphoblasts—immature lymphocytes that do not function like normal mature white blood cells.
Bone Marrow Aspiration and Biopsy
A leukemia diagnosis often cannot be made without looking at a sample of the bone marrow cells. In bone marrow aspiration and biopsy, samples of bone marrow and a small piece of bone are taken from the back of the pelvic bone using hollow needles. The samples are then examined under a microscope to see if leukemic cells are present. This short procedure can cause some brief pain at the biopsy site. But determining the percentage of cells in the bone marrow that are blasts provides valuable information. Normally blasts make up less than 5 percent of bone marrow cells, but in people with ALL blasts account for greater than 20 percent (often much greater).
Under a microscope, blood or bone marrow cells are examined for changes in their chromosomes. In some forms of leukemia, the cells have an abnormal number of chromosomes. In other forms of leukemia, two chromosomes exchange some of their DNA in what is known as a translocation.
Immunophenotyping (Flow Cytometry)
A sample of blood cells is examined through a sophisticated machine called a flow cytometer to see if leukemic cells are present and whether the disease is ALL or acute myeloid leukemia and, if it is ALL, whether it is a B-cell or a T-cell subtype.
Fluorescent in Situ Hybridization (FISH)
The fluorescent dyes used in this test attach to specific parts of certain chromosomes. FISH is very accurate, and many chromosomal abnormalities can be seen under a microscope using this technique.
Polymerase Chain Reaction (PCR)
PCR is a very sensitive test that may be used to determine whether a person has a certain chromosomal translocation, such as the Philadelphia chromosome, sometimes found in people with ALL (and often found in those with chronic myeloid leukemia).
A small needle is advanced into the spinal cavity in the lower back, and a small amount of cerebrospinal fluid (CSF) is withdrawn. The CSF is then examined for abnormal blood cells to determine whether the cancer has spread to the spinal cord and brain (central nervous system).
Imaging tests such as chest X-ray, computed tomography (CT) scan, magnetic resonance imaging (MRI) scan, or ultrasound may be performed to determine whether the leukemia is impacting other parts of your body. For example, a CT scan may be used to determine whether your spleen or lymph nodes are enlarged.
Sometimes leukemia can involve other parts of your body, such as the skin, testicle, or ovary. If your doctor thinks it will help with your treatment, you may undergo a biopsy of such a location if this is suspected.