Tests and scans are integral tools in patient diagnosis and treatment for Leukaemia, Lymphoma, Myeloma and related blood disorders. Many different tests are required to:

• diagnose the disease – identify the disease type
• identify the disease sub-type – some diseases have different versions which may be more or less aggressive, and respond differently to treatments
• predict prognosis – testing may indicate how well a person may respond to treatment based on the recorded medical history of other patients who have had similar disease type
  
• determine which treatments are necessary – different disease types require different treatments based on medical research
  
• monitor the progression of the disease – to evaluate the response to treatment – does your body and your disease type respond positively to the treatment? Is the disease getting better or worse?
  
• determine whether the patient achieves remission from disease – is there any residual disease after treatment?
  
• screen at-risk people – is the disease hereditary? Have people come into contact with known carcinogens? People who are deemed at-risk may be tested for the likelihood of contracting the disease. Being at-risk may not necessarily lead to disease development.

Various testing procedures are required to achieve these outcomes. These tests may include:

• Pathology Tests – involves searching for abnormal cells under a microscope
• Diagnostic Imaging – using a range of machines to look at internal body structures without using invasive surgical procedures
  
• Blood Tests – can give an indication of how the disease is affecting the organs of your body, and may give an indication of disease progression
  
• Cytogenetic Tests – looking for changes to DNA in abnormal cells. The DNA tells the cells what to do and how to behave. It is changes to DNA that causes cancer.

Pathology Tests

A pathologist specialises in the diagnosis of disease through the microscopic examination of tissues and fluids from the body and searching for abnormalities. Some common ways the samples may be taken from the body include:

• Tissue biopsy / fine needle aspirate – a sample of the body tissue is taken from a region of the suspected cancer site. The sample may be taken via surgical incision, or may be removed via a thin needle in the outpatient clinic. The tissue may then be preserved to prevent deterioration, and stained. The staining will enable the pathologist to see aspects of the cell under a microscope.
• Bone Marrow Biopsy – A large needle is inserted into the bone to remove samples of the marrow. This is usually performed in the hip bone. A sample of the soft bone in the centre of the hip bone is removed and is called the trephine. Some marrow fluid is removed via a syringe and is called the aspirate. These samples are tested to identify the extent of the disease in the bone marrow and are used as diagnostic and prognostic tools.
• Lumbar Puncture – A procedure to remove fluid that circulates around the brain and the spinal cord. It can also be used to administer drugs that may be needed to treat the brain and spinal cord or to prevent spread of disease into those areas. Fluid may be removed via a needle inserted in the lower spine. The fluid can be tested to identify spread of disease and identify possible infection.

Diagnostic imaging

A non-invasive way of observing internal body structures without the use of surgery. Body organs and tissues can be viewed and abnormalities identified. There are various techniques for generating the images. These scans may be used in combination for more detailed information.

• X-Ray – radiation passes through the body and special photographic material placed on the other side of the body part will capture a picture. Dense materials like bones will appear white, while less dense areas will appear darker. Air spaces will appear black. X-ray may be used to detect spread of disease or possible infection.
  
• Ultrasound – uses high frequency sound waves and their echos to create an image. No radiation is used in ultrasound scans. As the sound waves pass into the body, they bounce off structures and are reflected back into the machine. The machine can interpret the reflected waves and converts them into an image on a screen. Ultrasounds can be viewed in two or three dimensional images.
  
• CT or CAT Scan (Computed Tomography) – a highly detailed X-Ray. Many X-rays are taken along the body. A machine combines the X-rays to make a series of images of cross-sectional slices across the body. The operator can look through a series of the slices to look at the length of the body part being examined.
  
• PET Scan (Positron Emission Tomography – show chemical and physiological changes related to metabolism. Metabolic changes often occur before physical changes are evident, so PET scans may show abnormalities long before they may be revealed using the other scanning techniques. PET scans use an injection containing radioisotopes which are absorbed into body organs and tissues. Changes in the amount of uptake of the isotopes in various regions would indicate possible disease.
  
• Gallium Scan – A radioactive form of Gallium is injected or is taken in a drinkable form. The gallium is taken up well by tumors and white blood cells indicating infection or lymphoma. Gallium scans are often used with lymphoma patients to assess treatment outcomes.
  
• MRI (Magnetic Resonance Imaging) – uses a strong magnet and radiofrequency waves to produce an image of the body’s internal structures. It provides detailed images of the body in any plane. MRI provides much greater contrast between the different soft tissues of the body than does computed tomography (CT), making it especially useful in oncological (cancer) imaging. Unlike CT it uses no ionizing radiation and is considered a relatively safe procedure.

Blood Tests

Blood tests are used to diagnose disease, check disease progression, observe treatment outcomes, confirm remission status, and provide information on how the body’s organs are coping with the treatment journey.

A Full Blood Count (FBC / FBE) measures the number of the different blood cell types in the peripheral circulation. This test counts the number red blood cells, white blood cells and platelets. Disease may alter the numbers of these cells, and chemotherapy is known to reduce all cell types temporarily.

Blood Chemistry Tests (ELFT / U&E) are performed to measure the blood’s electrolytes, enzymes, and waste products. Unusual levels of any of these can indicate the body is under stress. The level of liver and kidney function is easily assessed using this test.

Cytogenetic Tests

Cytogenetic tests are performed on blood and bone marrow samples to identify genetic abnormalities. These tests can:

• Count the number of chromosomes in the cell
• Look for abnormalities in the chromosomes

As all cancers occur when the DNA in the cells is altered, identifying the specific defect can aid in the correct diagnosis of the disease, and can aid in the selection of the appropriate treatment for the condition.