Symptoms, Risk and Diagnosis

The main goal at the Siteman Cancer Center is to get a correct diagnosis of your leukemia. Some forms are slow-growing and may initially be handled with active surveillance. Specialists here excel in using the technology and experience to make an accurate diagnosis, often down to the genetic level so the best treatment options may be identified.

Symptoms of Leukemia (and other conditions)

Some patients with chronic leukemia are discovered by accident during testing for something else. The early signs and symptoms of ALL may be similar to the flu or other common diseases.

Check with your doctor if you have any of the following:

  • Weakness or feeling tired (all types ).
  • Fever or night sweats (ALL, CLL, CML, hairy cell).
  • Easy bruising or bleeding (ALL, AML, hairy cell).
  • Petechiae (flat, pinpoint spots under the skin, caused by bleeding) (ALL, AML).
  • Shortness of breath (ALL, AML, hairy cell).
  • Weight loss or loss of appetite (all types).
  • Pain in the bones or stomach (ALL).
  • Pain or feeling of fullness below the ribs (ALL, CLL, hairy cell) on the left side (CML).
  • Painless lumps in the lymph nodes of the neck, underarm, stomach, or groin (ALL, CLL, hairy cell).
  • Enlarged lymph nodes and spleen (all types).
  • Having many infections (ALL, hairy cell).
  • Typically, CLL and CML cause no symptoms and are found on a routine blood test.

Risk Factors

  • Being male (ALL, AML, CLL, Hairy cell).
  • Smoking, especially after age 60 (AML).
  • Having had treatment with chemotherapy or radiation therapy in the past (ALL, AML).
  • Having had treatment for childhood acute lymphoblastic leukemia (ALL) in the past.
  • Being exposed to radiation from an atomic bomb or to the chemical benzene (ALL, AML).
  • Having a history of a blood disorder such as myelodysplastic syndrome (AML).
  • Being Caucasian (ALL).
  • Being older than 70 (ALL, CLL, hairy cell).
  • Having certain genetic disorders, such as Down syndrome (ALL).
  • A family history of CLL or cancer of the lymph system (CLL).
  • Having relatives who are Russian Jews or Eastern European Jews (CLL).
  • A gene mutation called the Philadelphia chromosome (CML).


Determining the exact condition, and what specific type, often takes more than one approach:

The following tests and procedures may be used:

  1. Physical exam and history examines the patient’s past illnesses and treatments, and any signs of disease, such as a swollen spleen, lumps, or anything else that seems unusual.
  2. Complete blood count (CBC): A sample of blood is drawn to check for the number of red blood cells, white blood cells and platelets, as well as the amount of hemoglobin (the protein that carries oxygen) and the portion of the sample made up of red blood cells.
  3. Peripheral blood smear: This procedure checks a sample of blood for cells that look “hairy,” the number and kinds of white blood cells and changes in the shape of blood cells.
  4. Blood chemistry studies: These test a blood sample for the amounts of certain substances released into the blood by organs and tissues in the body to look for signs of disease.
  5. Bone marrow biopsy: This test involves aspiration of bone marrow, blood and a small piece of bone from the hipbone or breastbone to look for microscopic signs of cancer.
  6. Immunophenotyping: A laboratory test examines the antigens or markers on the surface of a blood or bone marrow cell to see what type of cell it is. This test helps diagnose the specific type of leukemia by comparing the cancer cells to normal cells of the immune system.
  7. Flow cytometry: This laboratory test measures the number of cells in a sample, the percentage of live cells and certain characteristics of cells, such as size, shape and the presence of tumor markers on the cell surface. Measurements are based on how the light-sensitive dye reacts to the light.
  8. Cytogenetic analysis: This laboratory test looks at cells in a sample of tissue under a microscope to look for certain changes in the chromosomes.
  9. Comprehensive gene profile: A laboratory test to identify gene aberrations to personalize treatment.
  10. CT scan: This procedure makes a series of detailed pictures of areas inside the body, which are taken from different angles and use contrast dye to look for things such as swollen lymph nodes or spleen.

Staging of Leukemia

After leukemia has been diagnosed, tests are done to find out the status of the disease. Staging is typically not done for acute blood disorders such as ALL and AML. Instead the disease is divided into:

  • Untreated: The leukemia has been diagnosed but is untreated except for symptom management. The CBC is abnormal and more than a certain percentage of cells reflect the type of leukemia.
  • In remission: The CBC is normal, the number of abnormal cells is low and there are no symptoms of leukemia.
  • Recurrent: The leukemia has come back in the blood or bone marrow after it was treated.


The prognosis (chance of recovery) and treatment options depend on the following:

  • The age of the patient.
  • Overall health of the patient.
  • Whether the cancer has spread to the brain or spinal cord.
  • Whether there are certain changes in the genes, including the Philadelphia chromosome.
  • Whether the cancer has been treated before or has come back.