Diagnosing blood cancers such as leukemia, lymphoma, and myeloma involves a series of tests and procedures to confirm the presence of cancer, identify its type, and determine its extent. Here’s an overview of the key diagnostic steps:

1. Medical History and Physical Examination

The diagnostic process begins with a thorough medical history and physical examination. Your doctor will inquire about your symptoms, medical history, family history of cancer, and any risk factors. During the physical examination, the doctor will look for signs such as swollen lymph nodes, an enlarged spleen or liver, and unusual bruising or bleeding.

2. Blood Tests

Blood tests are essential for diagnosing blood cancers. Common tests include:

  • Complete Blood Count (CBC): Measures the levels of red blood cells, white blood cells, and platelets. Abnormal levels or the presence of immature or abnormal cells can indicate blood cancer.
  • Blood Chemistry Tests: Assess the function of organs such as the liver and kidneys and detect substances released by cancer cells.
  • Peripheral Blood Smear: Examines the appearance of blood cells under a microscope to identify abnormalities.

3. Bone Marrow Tests

Bone marrow tests are crucial for diagnosing leukemia and myeloma. These tests involve examining the bone marrow, where blood cells are produced.

  • Bone Marrow Aspiration: A sample of liquid bone marrow is taken using a needle.
  • Bone Marrow Biopsy: A small sample of solid bone marrow tissue is removed with a needle.

Both samples are examined under a microscope to look for cancer cells, assess their type, and determine the proportion of abnormal cells.

4. Lymph Node Biopsy

A lymph node biopsy involves removing a part or all of a lymph node to check for cancer cells. This test is particularly important for diagnosing lymphoma.

  • Excisional or Incisional Biopsy: The entire lymph node or a portion of it is surgically removed.
  • Fine Needle Aspiration (FNA) Biopsy: A thin needle is used to remove a small sample of tissue from a lymph node.

5. Imaging Tests

Imaging tests help visualize the extent of the cancer and its spread to other parts of the body. Common imaging tests include:

  • X-rays: Useful for detecting bone damage or enlarged lymph nodes.
  • Computed Tomography (CT) Scan: Provides detailed cross-sectional images of the body to identify tumors or enlarged organs.
  • Magnetic Resonance Imaging (MRI): Uses magnetic fields and radio waves to create detailed images, particularly of the brain and spinal cord.
  • Positron Emission Tomography (PET) Scan: Detects cancer cells by highlighting areas of high metabolic activity.

6. Molecular and Genetic Tests

These tests analyze the genetic material of cancer cells to identify specific mutations and abnormalities. They are crucial for diagnosing certain types of blood cancers and guiding treatment decisions.

  • Fluorescence In Situ Hybridization (FISH): Detects specific genetic abnormalities in cells.
  • Polymerase Chain Reaction (PCR): Amplifies and detects specific DNA sequences to identify genetic mutations.
  • Cytogenetic Analysis: Examines chromosomes in cells to detect changes such as translocations or deletions.

7. Flow Cytometry and Immunophenotyping

Flow cytometry and immunophenotyping are used to identify specific types of cancer cells based on their surface markers. This is particularly useful for diagnosing different types of leukemia and lymphoma.

  • Flow Cytometry: Analyzes the physical and chemical characteristics of cells in a fluid sample.
  • Immunophenotyping: Uses antibodies to detect specific proteins on the surface of cells.

8. Lumbar Puncture (Spinal Tap)

A lumbar puncture may be performed to check for cancer cells in the cerebrospinal fluid (CSF), particularly if there are symptoms suggesting involvement of the central nervous system.


Diagnosing blood cancers involves a combination of medical history, physical examination, and a variety of tests to accurately identify the type and extent of the cancer. Early and accurate diagnosis is crucial for developing an effective treatment plan and improving outcomes. If you experience persistent or unusual symptoms, consult with a healthcare professional to undergo appropriate testing and receive a timely diagnosis.

By Sue