How Leukemia Is Diagnosed in Adults

Health Writer
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Often thought of as a childhood cancer, leukemia is actually more common in adults, according to Dana-Farber Cancer Institute.

This type of cancer occurs when stem cells in the bone marrow produce blood cells that are abnormal, usually white blood cells. Since your immune system depends on these cells to function properly, your ability to fight off infection is significantly compromised.

While some of the symptoms of leukemia are the same in both children and adults, there are several differences that physicians look for when making the diagnosis in adult patients, according to Sean Fischer, M.D., medical oncologist and hematologist at Providence Saint John’s Health Center in Santa Monica, California.

“With leukemia, the types and subtypes almost make each feel like its own disease compared to the others,” he says. “That’s why diagnosis, especially at the earliest stage possible, is so important.”

Leukemia types

There are two broad types of leukemia that an adult patient may have, says Jack Jacoub, M.D., medical oncologist and medical director of MemorialCare Cancer Institute at Orange Coast Medical Center in Fountain Valley, California.

The first is acute, as with acute myeloid leukemia (AML), which often involves a rapid onset of symptoms like fatigue, fever, easy bruising, or uncontrolled bleeding. This type occurs when the bone marrow makes abnormal myeloblasts, a type of white blood cell. Red blood cells or platelets may also be affected.

The second is chronic, such as chronic lymphocytic leukemia, in which the bone marrow makes too many lymphocytes, another type of white blood cell. Symptoms that are more common with chronic types include swollen lymph nodes.

Getting to diagnosis

How each type of leukemia is diagnosed begins with the reason that a patient might come in to see a physician, says Dr. Fischer. With acute types, it’s likely that symptoms are severe, and a patient would be struggling to overcome them. For example, someone might think she has a nasty flu due to extreme tiredness, high fever, and general weakness.

With a chronic type, though, initial diagnosis usually happens because the patient is at the doctor for some other problem, and the leukemia shows up as abnormal blood cell counts on a routine blood test, which would prompt follow-up to detect the underlying problem.

“With acute leukemia, it can be urgent and life threatening, and it often feels that way,” Dr. Fischer says. “With chronic leukemia, you may have no symptoms and feel fine, or you could be having what feels like more minor issues like unexplained bruising or a rash on your ankles.”

With either type, an initial blood test is done, followed by a needle biopsy aspiration of bone marrow, usually from the pelvic bone, says Dr. Jacoub. This will show leukemic cells, chromosome changes in the bone marrow, and relevant DNA markers related to leukemia.

Looking ahead

If you’re diagnosed with leukemia, the next step will be a personalized treatment plan, often with multi-stage chemotherapy designed to eradicate as many abnormal cells as possible from the bone marrow, says Dr. Fischer.

While that treatment progresses, your oncologist will be looking at additional information on chromosomal and molecular distinctions, he adds. Those results will drive how your treatment is managed both immediately and in the long term.

But, he notes, keep in mind that this is a fast-moving field. So the diagnosis and prognosis experience of someone from even five years ago with a similar leukemia type may be very different from your own.

“The field is evolving so rapidly, with such exciting new therapies, that how we diagnose and manage these conditions is likely to be changing even just a few years from now,” he says. “That could lead to earlier diagnosis, especially with new genetic markers being identified.”