Diagnosis and Staging of leukemia
-Doctors sometimes find leukemia after a routine blood test.
-If patient has the symptoms that suggests leukemia, doctor must find out whether they are due to leukemia or some other cause.
-Doctor may ask about the personal and family medical history of patient.
-Doctor checks for swollen lymph nodes, spleen, or liver.
Blood tests
-The lab does a complete blood count to check the number of white blood cells, red blood cells and platelets.
-Leukemia increases the level of white blood cells. It may also decrease the levels of platelets and hemoglobin, which is found inside red blood cells.
-A biopsy is the only sure way to know whether leukemia cells are in the bone marrow.
-Before the sample is taken, local anesthesia is used to numb the area. This helps reduce the pain. Doctor removes some bone marrow from the hipbone or another large bone.
-A pathologist uses a microscope to check the tissue for leukemia cells.
Biopsy
.There are two ways to obtain bone marrow. Some people will have both procedures during the same visit:
.Bone marrow aspiration
-The doctor uses a thick, hollow needle to remove samples of bone marrow.
.Bone marrow biopsy
-The doctor uses a very thick, hollow needle to remove a small piece of bone and bone marrow.
Other tests
.The tests that doctor orders depends on the symptoms and type of leukemia.
.Patient may have other tests:
-Cytogenetics
-Spinal tap
-Chest x-ray
-The lab looks at the chromosomes of cells from samples of blood, bone marrow, or lymph nodes.
-Presence of abnormal chromosomes suggests the type of leukemia
-For example, people with CML have an abnormal chromosome called the Philadelphia chromosome.
Cytogenetics
-Doctor may remove some of the cerebrospinal fluid (the fluid that fills the spaces in and around the brain and spinal cord).
-The doctor uses a long, thin needle to remove fluid from the lower spine.
-The lab checks the fluid for leukemia cells or other signs of problems
Spinal tap
-An x-ray can show swollen lymph nodes or other signs of disease in the chest.
Chest x-rays
-For most cancers, staging is the process of finding out how far the cancer has spread.
-Most types of cancer are given stages of I, II, III, or IV, based on the size of the tumor and how far from the original site in the body the cancer has spread.
-Stages are useful because they can help guide treatment.
-Leukemia is not staged like most cancers.
Staging
Chronic Myelogenous Leukemia (CML) has 3 phases
-The number of blast cells (immature blood cell) in the blood and bone marrow and the severity of symptoms determine the phase of the disease.
-Chronic phase: Fewer than 10% of the cells in the blood and bone marrow are blast cells.
-Accelerated phase: 10% to 19% of the cells in the blood and bone marrow are blast cells.
-Blastic phase: 20% or more of the cells in the blood or bone marrow are blast cells.
.Stage I
-There are too many lymphocytes in the blood and the lymph nodes are larger than normal.
.Stage II
-There are too many lymphocytes in the blood, the liver or spleen is larger than normal, and the lymph nodes may be larger than normal.
Stages of chronic lymphocytic leukemia (CLL)
.Stage III
-There are too many lymphocytes in the blood and there are too few red blood cells. The lymph nodes, liver, or spleen may be larger than normal.
.Stage IV
-There are too many lymphocytes in the blood and too few platelets. The lymph nodes, liver, or spleen may be larger than normal and there may be too few red blood cells.
Colonoscopy
-Doctor inserts a long, lighted tube into the rectum and colon.
This exam can help tell if cancer has spread to the colon or rectum.
Staging of acute lymphoblastic leukemia (ALL)
-There is no staging system for ALL
Risk groups are used to plan treatment for children
-Standard (low) risk: Includes children aged 1 to < 10 years who have a white blood cell count of less than 50,000/µL at diagnosis.
-High risk: Includes children younger than 1 year or 10 years and older and children who have a white blood cell count of 50,000/µL or more at diagnosis.
Stage II
Cancer cells have spread from one or both ovaries to other tissues in the pelvis.
-Cancer cells are found on the fallopian tubes, the uterus, or other tissues in the pelvis.
-Cancer cells may be found in fluid collected from the abdomen.
Stage III
-Cancer cells have spread to tissues outside the pelvis or to the regional lymph nodes.
-Cancer cells may be found the outside the liver.
Stage IV
-Cancer cells have spread to tissues outside the abdomen and pelvis.
-Cancer cells may be found inside the liver, in the lungs, or in other organs.
Diagnosis of Paranasal sinuses and nasal cavity
cancer
The following tests and procedures may be used to diagnose paranasal sinuses and nasal cavity cancer
Physical exam and history
-X-rays of the head and neck
-MRI
-Nasoscopy
-Laryngoscopy
-Biopsy
Diagnosis of salivary gland cancer
The following tests and procedures may be used to diagnose salivary gland cancer
Physical exam and history
-MRI
-CT scan
-PET scan
-Ultrasound exam
-Endoscopy
-Biopsy
Acute myeloid leukemia (AML)
-There is no standard staging system for AML.
-In AML, the subtype of AML and whether the leukemia has spread outside the blood and bone marrow are used instead of the stage to plan treatment.
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