How are blood cancers diagnosed?

Blood cancer accounts for around 10% of all cancers diagnosed each year with around 35 Australians diagnosed each day with a blood cancer.

‘Blood cancer is the third biggest cause of cancer death across Australia, claiming more lives each year than breast cancer or skin cancer,’ says Geoff Magrin, who has worked in haematology for four decades.

‘The five main categories are leukemia, lymphoma, myelodysplastic syndromes (MDS), myeloproliferative disorder (MPD), and multiple myeloma.’

Blood tests

There are several blood tests that contribute to diagnosing blood cancer and rule out other conditions.

A Full Blood Examination (FBE) is a common lab test that measures the number of red cells, which contain haemoglobin to carry oxygen, white blood cells that fight infection, and platelets that protect from bleeding.

‘The results of a full blood count are compared to charts that list the normal range of numbers and ratios for each type of blood cell,’ explains Mr Magrin.

A result above or below the normal range may indicate an abnormality.

In addition, a “blood smear” (a thin blood film) is stained and examined under a microscope to highlight the appearance of the cells in order to classify them as normal or abnormal in amount and development.

Blood cancers are distinguished by the lack of normal cells, an excess of normal cells and /or the presence of cells with abnormal features, such as lymphoma cells or blasts in leukaemia.

‘A chemistry panel is important to asses kidney and liver function, calcium levels, markers of cellular burden, and assess for the absence of normal protein or excess of abnormal proteins (such as abnormal antibodies) in the blood,’ Mr Magrin said. 

Bone marrow aspiration & trephine biopsy

Blood cancers commonly commence in or spread to the bone marrow. ‘A bone marrow biopsy is used to diagnose some blood cancer, and to work out the extent of other cancers,’ said Mr Magrin.

A fluid sample and a solid tissue piece (core) are taken in this procedure. These procedures and examination of the samples is undertaken by haematologists.

Lymph Node Biopsy

Lymphomas are often diagnosed after growth of tissue in lymph node sites: groin, neck, underarms, abdomen. Removal of a sample with a fine needle, a larger core biopsy, or by complete removal of a node can assist in determining the type and treatment of the disease. These samples are examined by Anatomical Pathologists.

Flow cytometry

Flow cytometry is a test that uses lasers and pattern analysis to identify cells based on their size, complexity and the presence or absence of molecules tagged on the surface or within the cell.

Genetic testing

Cytogenetic testing, also called karyotyping, determines any potential chromosomal abnormalities or mutations in a blood cancer.

‘Two additional types of genetic tests are polymerase chain reaction (PCR) and fluorescent in situ hybridization (FISH).

‘Both PCR and FISH do not look at overall chromosomal changes but can be helpful in detecting specific, known genetic mutations,’ said Mr Magrin.

Pathology in Australia has the highest standards in the world and is a vital piece of the nation’s health infrastructure, helping not only diagnose cancers and informing the treatment.