If a physician suspects that a patient has a hematologic tumor, the following clinical tests can be used to reach a final diagnosis. The patient may need to undergo multiple tests to clarify the specific condition.
The nurse will draw a small amount of blood from a vein near the elbow of the patient’s arm for the following blood tests:
Full blood count
This is the most common clinical test to assess the level of white blood cells, red blood cells, and other blood components in the patient’s blood. If some of these indicators are found to be too high or too low, it may be a sign of disease.
Blood smear
This test is ordered if a complete blood count does not yield a definitive result or if the doctor believes that the patient is producing abnormal blood cells, so that he or she can see if the blood cells are normal in form and number.
Blood biochemistry tests
Measure blood glucose, cholesterol, protein, hormones, and other substances in the blood. This helps doctors understand a patient’s overall health and detect certain signs of disease. For example, certain proteins can indicate the size of a tumor and how fast it is growing.
White blood cell sorting count
Tests for different types of white blood cells in the blood. The test results help indicate the ability of the patient’s body to fight infection. It can also indicate signs of certain types of blood tumors, such as leukemia, and provide an initial assessment of the progression of the disease.
Fluorescence in situ hybridization (FISH)
Targeting primarily hematologic tumor cells, the test detects whether the cells are genetically mutated. The test results help clinicians develop the right treatment plan.
Flow cytometry
This test can be used to determine if a patient has an excessive number of white blood cells in the blood due to a hematologic tumor. During the test, the number, size, shape, and other characteristics of the white blood cells can be evaluated. The test can be performed on a patient’s blood or bone marrow sample.
Immunophenotyping
can distinguish between tumor cell types, which can help clinicians develop optimal treatment plans.
Karyotyping
Observes changes in bone marrow cytogenetics, which can help in developing treatment plans.
Polymerase chain reaction
can detect blood tumor markers. It is more sensitive than other assays and allows assessment of the efficacy of treatment regimens.
Bone marrow sample testing
The outer layer of human bone is hard, but the middle part is spongy and soft. That soft tissue is the so-called “bone marrow,” which is where the body produces red and white blood cells.
Clinicians need to find out if a disease is attacking the bone marrow of a patient, and some signs of blood disorders are first seen in the bone marrow sample and then in the blood sample.
Doctors usually take a small amount of bone marrow from the patient’s iliac bone. During this procedure, local anesthesia is administered first or general anesthesia is administered.
Specific steps
Bone marrow aspiration: A small amount of fluid from the bone marrow is aspirated with a hollow needle.
Bone marrow biopsy: a small amount of solid material from the bone marrow is aspirated with a slightly thicker needle.
It takes about 15-30 minutes to complete the entire procedure.
The sample is then sent to a pathology lab technician for analysis to assess whether the patient’s bone marrow is capable of producing sufficient amounts of healthy blood cells. Also, the presence of abnormal cells is identified.
The results of the bone marrow sample testing
When the final test results are returned to the clinician, they can help to:
- confirm or rule out certain diseases;
- assess the severity of a disease;
- understand whether treatment options are working.
Lymph node biopsy
Blood tumors can affect a patient’s lymphatic system. The lymphatic system is found throughout the body, including the tonsils and spleen, as well as the lymph nodes. There are hundreds of lymph nodes throughout the body, about the size of a pea, which have white blood cells that can be used to fight infection and disease.
Doctors may ask to get part or the whole lymph node to test for the presence of tumor cells in it, which is called a lymph node biopsy.
Specific lymph node biopsies
Lymph node biopsies are performed in the operating room, and the surgeon will simply administer local anesthesia to the area where the sample is planned, without putting the patient under general anesthesia.
The surgeon makes a small incision at the sample site, removes the lymph nodes, and closes them with stitches, usually without leaving a scar.
The pathologist will then analyze the lymph node sample to identify the presence of a hematologic tumor, a noncancerous mass, or an infection to determine if the patient has lymphoma, a blood tumor that attacks the lymphatic system.
The diagnosis can also be confirmed by imaging tests, which are painless tests that allow the doctor to look directly at the patient’s internal organs while showing the tumor or other disease.
X-ray chest films
help clinicians detect the presence of a tumor, infection, or enlarged lymph nodes.
CT (computed tomography) scans
CT scans take X-rays from different angles and put them together into a more detailed and complete picture. It can show enlarged lymph nodes and other organ abnormalities, or help doctors see if the tumor appears to have recurred. During the test, the patient will lie on the test table and the CT scanner will rotate around to take the picture. The entire test typically takes 10-30 minutes.
MRI (magnetic resonance imaging) scans
use high-frequency magnetic fields and radio waves to get more detailed and clear photos of organs, blood vessels, or bones. It can help clinicians find where a tumor is located or look at changes in the bone to detect signs of myeloma. During the test, the patient lies on a test table and enters a small tunnel-like apparatus. If the patient is claustrophobic, the doctor will provide appropriate medication in advance to help the patient relax. The entire testing process typically takes 15-45 minutes.
PET (positron emission tomography)
Using glucose containing radioisotopes to mark areas of active metabolism in the patient’s body, the doctor can learn if lymphoma or other types of cancer are present in the patient’s body. When a patient is tested, a doctor or nurse will give the patient a dose of glucose containing a radioisotope marker. The patient then needs to lie down on a testing table and access an imaging scanner. If the patient is accompanied by claustrophobia, the doctor will provide the appropriate medication beforehand to help the patient relax. The entire testing process typically takes 45 minutes.
Spinal tap
A sample of cerebrospinal fluid is obtained and tested to help the doctor know if blood tumor cells are present in the cerebrospinal fluid. This test is sometimes called a lumbar puncture.
The patient will lie on his or her side, and the doctor will apply local anesthesia to the patient’s back. A small amount of fluid is then drawn from the patient’s spine with a needle and a gauze dressing is applied to the back incision, and the cerebrospinal fluid sample is sent to the laboratory for testing.
The urine sample is tested
to detect proteins, blood cells, and other substances in the patient’s urine, where chemicals from the blood are usually filtered through the kidneys and into the urine.