Blood cancer tests and diagnosis

Updated 09 Aug 2017

People find out that they have blood cancer in a variety of ways. Many people go to their GP with symptoms and are sent for blood tests to get more information, before being sent to hospital for further tests. Others have a routine blood test for something else entirely, and the results lead to them being sent to see a specialist. Some people with acute blood cancers become very unwell very quickly and will have tests in hospital that show that they have blood cancer.

However you find out, the time around your diagnosis can feel very uncertain. The information in this section is designed to help you understand and feel reassured about the tests and processes involved with getting a diagnosis for blood cancer and monitoring you during and beyond treatment.

We also have detailed information on how different types of blood cancer are diagnosed, so if you're worried about  – or have been diagnosed with – a certain type of blood cancer, select it from the menu to find more specific information about what to expect.

If you have any questions, or just need someone to talk to, you can call our Support Line freephone on 0808 2080 888 (Mon–Fri 10am–4pm) or email us at support@bloodwise.org.uk 

> If you're going through the process of getting a diagnosis you might find our fact sheet What to expect from your appointments helpful.

What tests will I need?

You might need a number of tests to work out if you have blood cancer and what type of cancer you have (confirm your diagnosis). Once you've started treatment you'll have regular tests to see how you’re doing. 

The most common types of tests for blood cancer are blood tests and biopsies, but you may also need scans to monitor your symptoms or see how well your treatment is working.

The tests you'll have will depend on your symptoms and what type of blood cancer you have (or is suspected). To see which tests you can expect for specific conditions, use the menu to choose a particular type of blood cancer. Everyone is different and symptoms vary between people, so even people with the same condition may not have all the same tests.

It’s important to remember that many tests – and particularly blood tests – can also be used to diagnose a wide range of health conditions. If you’ve been sent for any of these tests, this doesn’t necessarily mean that your doctor thinks you have blood cancer.

Blood tests

Blood tests can be used to help diagnose and monitor blood cancer. There are lots of different tests that can be done using a blood sample.

What does a blood test involve?

You might have a blood test at your doctor’s surgery, or you may need to visit the blood clinic at the hospital.

  • Blood will be taken from your vein using a thin needle and syringe. It might be a bit uncomfortable as the needle goes in but it's usually over quite quickly.
  • If you’re in hospital and have a PICC line, blood samples might be taken from there instead.
  • Once it’s been taken, your blood sample will be sent off to the lab.
  • Your doctor should tell you when you can expect the results.

Common blood tests for diagnosis and monitoring

Full blood count (FBC)

This test measures the number of each type of cell in your blood: red cells, white cells and platelets. In the lab, a machine will very accurately count the blood cells in your sample. If the count is too high or too low, a small drop of your blood is smeared onto a slide and a doctor or senior scientist will look at it under a microscope.

Infection screening / virology testing

It’s important for your healthcare team to have a good understanding of your general health before you start treatment, so you’re likely to have some tests for conditions such as HIV, hepatitis B and C. This is because if you are infected (or have been infected) with these viruses your doctor may need to treat them while your cancer is being treated

Liver function tests

If you need chemotherapy you’ll have a series of liver function tests. Many drugs are broken down in the liver. If your liver isn’t working normally, it might be necessary to adjust the dosage of your medication.

Peripheral blood film

This test is used to look at your red blood cells, white blood cells and platelets and check they are the right size and shape and see whether they are healthy.

Urea and electrolytes

This test checks how well your kidneys are working. This helps your healthcare team work out your drug doses and checks for any damage the cancer or treatment has caused.

Other tests

Some flow cytometry (immunophenotyping) and cytogenetic testing can also be done using a sample from a blood test.

Bone marrow biopsies

A bone marrow biopsy allows doctors to take a small sample of your bone marrow. They can then look at this under a microscope and see whether there are any abnormal cells.

There are two types of bone marrow biopsy:

  • aspirate, which takes the liquid bone marrow,
  • trephine, which takes the spongy bone marrow along with some of the bone.

Bone marrow biopsies can be used to diagnose blood cancer, see how it has affected your body, and check how well a treatment is working.

People with some types of blood cancer (or suspected blood cancer) may need to have one or more biopsies, although not everyone will need one. To see which tests are used for different types of cancer select a type of cancer from the menu.

What happens during a bone marrow biopsy?

  • You’ll lie on your side and a small needle will be used to give some local anaesthetic (only numbing a specific area of the body) into the skin around the back of your hip bone.
  • Using an aspirate (a larger needle that's inserted into the bone), a small amount of bone marrow is sucked out from your hip bone; this procedure is called a bone marrow aspirate.
  • A piece of bone may also be taken using a different needle, and this is called a trephine.Diagram showing a syringe positioned around the hip for a bone marrow biopsy

Taking the sample is usually quite quick, but it may feel painful while it’s being done. For this reason, you may be offered medication to help with the pain (such as gas and air or some tablets to make you feel more relaxed – sedatives), althought most people manage without this.

You won’t get your results immediately. Your doctors will need prepare the bone marrow samples and then look at them under a microscope or pass them through a machine called a flow cytometer.

Lymph node biopsies

A lymph node biopsy is a small operation that takes a sample of a lymph node (gland) affected by cancer. It's most often used to confirm that you have lymphoma but it can also be used to diagnose some other types of blood cancer.

What happens during the test?

The procedure is done at the hospital, often under a local anaesthetic. Occasionally a general anaesthetic is needed, meaning you’ll sleep through it.

You might have one whole lymph node removed – an excision biopsy. Or you might have just the core of lymph node removed under local anaesthetic with the help of an ultrasound or CT scan. This is called a core biopsy or incisional biopsy.

This sample is then examined under the microscope in a laboratory.

Scans explained

Scans can be used to help diagnose some types of blood cancer such as lymphoma. For most other types of blood cancer they aren’t routine, but they can be used to check out symptoms such as a swollen spleen.

Types of scan

CT scan

A CT (computed tomography) scan is a type of X-ray. A CT scan is not a routine test done for blood cancers, but there may be specific reasons it needs to be done, such as if you have a swollen liver or spleen.

You’ll lie on a table that moves into a cylindrical tunnel while pictures are taken. You may need to have a dye injected into one of your veins, to help get a better image. You need to stay very still for this test, so children under five may have medication to help them sleep through it.

MRI scan

MRI (magnetic resonance imaging) shows up soft tissues (non-bony parts) and uses radio waves rather than X-rays. An MRI is not a routine test done for blood cancers, but there may be specific reasons it needs to be done.

You’ll be asked to lie on a table, which will move you through the scanner. You may need to have an injection of some dye. You need to stay very still for this test so children under five may have medication to help them sleep through it.

PET scan

A PET (positron emission tomography) scan is similar to an MRI, but you’re injected with a radioactive sugar. The levels of radiation used are very small and won’t harm you or anyone nearby. This test may be done if you have swollen lymph nodes. It may also be done to compare your results after treatment.

You need to stay very still for this test so children under five may have medication to help them sleep through it.

X-rays

This scan provides very good images of the denser tissues in the body, such as bone. You'll lie on a table while scans are taken. Your doctors may use an X-ray when you’re first diagnosed, to check for infection or chest problems. People with myeloma may have a series of X-rays – this is sometimes called a skeletal survey.

Ultrasound scans

Ultrasound scans can be used to give more information about your condition. For example, it could be used to measure the size of your spleen, which is often enlarged if you have lymphoma. Ultrasound is also used to help see lymph nodes during a biopsy.

A small handheld device will be moved over the part of your body being scanned. It shouldn't be painful or uncomfortable. 

Staging, classification and risk scoring

Once it’s confirmed what type of blood cancer you have, your team will do a number of tests to check your general health, find out how far your condition is developed, and work out your likely outlook (prognosis).

All of this information helps them work out which treatment will be most appropriate for you.

These tests could include:

  • Blood tests – to check your health such as how your heart, liver, kidneys and thyroid are working and check for any specific health problems such as hepatitis that might affect which treatments you can receive.
  • Scans – (particularly if you have lymphoma) to see how developed the cancer is.
  • Chromosomal tests – these help doctors work out which type of treatment might work best for you.

You might hear this process called:

  • Staging – which means the process of testing to see how far the cancer has spread or grown.
  • Classification – which means sorting your condition into a particular group – this can be useful as cancers in different groups/classifications respond differently to treatment.
  • Stratification or risk scoring – which means finding out how ‘high risk’ you are that your cancer will develop – this can be useful when deciding which type of treatment you should have.

Cytogenetic testing

Every kind of cancer, including blood cancer, changes the chromosomes (genes) in the affected cells. (These gene faults are not the same thing as genes passed through families.)

The study of these gene changes is called cytogenetics or molecular genetics.

Cytogenetic testing is also known as cytogenetics, genetic testing, molecular testing, karyotyping, chromosomal abnormality or FISH testing.

Why are these tests done?

The purpose of these tests is to look for gene changes that indicate what type of blood cancer you have. Knowing if you have particular genetic changes can help doctors:

  • decide on what treatment you'll have – this is because some genetic changes mean you'll be more or less likely to respond to certain types of treatment, and 
  • have a better idea of your likely outlook (prognosis) – people with some genetic changes may be expected to have a different prognosis.

How is the test done?

Cytogenetic tests are usually done on cells from your blood or from your bone marrow before you start any treatment. These cells can come from a sample from a blood test or bone marrow biopsy.

Your cells will be sent to a laboratory where they will be grown over a number of days and then viewed under a microscope. The cells may be treated to make the chromosomes show up and help identify any unusual changes.

The results of the test will be sent back to your specialist doctor.

Immunophenotyping (flow cytometry)

Immunophenotyping (also called immunophenotype analysis or flow cytometry) is a way of looking at the pattern of proteins on your cells. It's used to see if there are any unusual cells in your blood and, if so, how many there are.  

This test can confirm a diagnosis of some types of blood cancer, help your specialist work out exactly which type of blood cancer you have, and give your healthcare team a clearer picture of your outlook.

How does it work?

You'll have a bone marrow biopsy or a blood test. Then in the laboratory, a sample of your cells will be combined with a particular type of antibody (a protein made by your white blood cells to fight infection), which will stick to the surface of abnormal cells, but not to a normal cell. As the cells pass through a machine, the results are plotted on a graph, showing how many abnormal cells are in the sample, and what type they are.

The test is very sensitive – even if there are only a small number of abnormal cells in the sample, it will see them.

Finding the right support and information

You should have been given the names and contact details of your consultant, clinical nurse specialist and other members of your healthcare team. It’s worth taking some time to think about what information you want to know, and when and how you want to receive this.

Your team should be on hand to answer any questions you might have and work with you to make decisions about your treatment. If you don’t have the contact details of a key worker of clinical nurse specialist, do not hesitate to ask for these from your consultant.

> For more information about treatment decisions, download our fact sheet

 

PIF memberStandard member