Leukemia

A leukemia diagnosis often arrives without warning. For many patients, it starts with routine bloodwork, such as a CBC at an annual physical that comes back abnormal. For others, it’s a visit to the ER for symptoms that feel like the flu. Either way, the moment a leukemia diagnosis enters the picture, everything changes. 

What happens next matters enormously. Leukemia is a group of blood cancers, each with a different biological profile, a different urgency, and a different treatment path. Getting an accurate diagnosis quickly, and from a team that specializes in leukemia, is the most important first step you can take. 

At Siteman Cancer Center, your treatment plan starts on solid ground from day one. 

Recognizing the Symptoms of Leukemia 

Leukemia symptoms vary widely from person to person. This variability is part of what makes leukemia diagnostically complex, and part of why any persistent, unexplained symptom deserves attention. 

Patients with acute leukemias often experience symptoms that are hard to ignore and escalate quickly. Patients with chronic leukemias are frequently diagnosed before symptoms appear, caught on routine bloodwork. Both paths lead to the same next step: specialized evaluation. 

Common symptoms that warrant further evaluation 

• Unexplained fevers or frequent infections that keep coming back 
• Persistent night sweats 
• Swollen lymph nodes or an enlarged spleen 
• Abnormal bleeding or bruising without a clear cause 
• Petechiae, or tiny red or purple blood spots under the skin 
• Fatigue or shortness of breath that does not improve with rest 
• Unintentional weight loss 

Most of these symptoms can have other explanations, which is exactly why leukemia can be missed on first evaluation. If you have experienced any combination of these symptoms for two weeks or more, it could be time to talk to your doctor and ask specifically about your bloodwork. 

Risk Factors That Increase Your Likelihood of Leukemia 

Leukemia can develop in anyone, regardless of family history. But certain factors are associated with a higher risk. Understanding your risk profile helps you and your physician make more informed decisions about monitoring and early evaluation. 

Known risk factors for leukemia 

• Age: Different types of leukemia carry different age-related risks. Acute lymphoblastic leukemia (ALL) is most common in children, while chronic leukemias are more common in older adults. 
• Prior exposure to chemotherapy or radiation therapy for another cancer. 
• Family history of leukemia in a first-degree relative. 
• Genetic conditions such as Down syndrome. 

Having one or more of these risk factors does not mean you will develop leukemia. But it does mean that regular bloodwork and physician monitoring are especially important for you. 

How Leukemia is Diagnosed 

An accurate leukemia diagnosis requires a sequence of increasingly specific tests, all done so that your care team has the precise information they need to build the right treatment plan.  

At Siteman, every step of the process happens under one roof, with specialists who understand what every result means for your specific leukemia. 

Blood tests are where the diagnosis begins 

The complete blood count, or CBC, is almost always the first signal in a leukemia diagnosis. An abnormal white blood cell count, whether it’s too high or too low, alerts your physician that something needs further investigation.  

This is why routine checkups matter: a CBC is included as part of your annual physical, and it can catch leukemia before symptoms appear. Reach out to a WashU Medicine physician to schedule an appointment today.  

If you receive an abnormal CBC, your physician will order more specific lab work to understand what is happening at the cellular level. They will examine the shape, count, growth rate, and genetic markers of the cells involved. 

Bone marrow biopsy confirms the diagnosis 

When blood tests point to leukemia, a bone marrow biopsy is usually the next step. During a biopsy, a specialist removes a small sample of bone marrow, typically from the hipbone. A pathologist then examines the sample under a microscope to identify the specific type of leukemia cells present. 

The biopsy is the definitive test in diagnosing your specific leukemia type. The results drive every decision about your treatment once received. 

Imaging maps how far it has spread 

PET and CT scans give your care team a full view of what is happening in your body. These tests identify problem areas, trace the spread of disease, and help your physicians understand the full scope of what they are treating. Both scans use contrast dye to highlight areas of concern. 

How Leukemia Is Classified 

Most cancers are described in stages, but leukemia classifications are different. Physicians classify leukemia based on two things: how the leukemia cells look under a microscope, and what genetic characteristics those cells carry. 

The genetic profile of your leukemia tells your physician how aggressive the disease is, how it is likely to behave, and which therapies it will respond to best.   

At Siteman, our researchers developed the ChromoSeq whole-genome sequencing test, which gives physicians a faster and more complete genetic picture than older multi-test approaches. That means your treatment plan is quickly tailored to your specific leukemia from the start of your care with us. 

The Factors That Shape Your Prognosis 

The prognosis for leukemia has improved significantly in recent years, driven by advances in targeted therapy, cellular therapy, and transplant medicine. Many of these advancements were pioneered at Siteman, ensuring you have advanced treatment options available now.  

What your specific prognosis looks like will depend on factors unique to your situation and health history. 

Factors your care team will consider 

• Whether your leukemia is newly diagnosed or has returned after prior treatment 
• The specific type and subtype of leukemia 
• The genetic profile of your leukemia cells 
• Your age and overall health at the time of diagnosis 

Your Siteman care team will review all of these factors with you and explain what they mean for your specific situation. You will not have to interpret this alone.