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NCCN Guidelines for Patients



Acute Lymphoblastic Leukemia, Version 1.2017


Testing for ALL

Medical history | physical exam

Treatment planning starts with testing.

This section describes the tests that are

used to confirm (diagnose) ALL and plan

treatment. This information can help you

use the Treatment guide in Part 5. Not

every person with acute lymphoblastic

leukemia will receive every test listed.

Medical history

Your medical history includes any health events in

your life and any medicines you’ve taken. You will

be asked about any illnesses, injuries, and health

problems you’ve had. Some health problems run in

families. Thus, your doctor may also ask about the

health of your blood relatives.

ALL may cause symptoms. It’s important that your

doctor knows if you have them. Symptoms may

result from a shortage of blood cells. Or, they may

result from leukemia cells collecting in certain parts

of the body. But, some patients may have few or no

symptoms of ALL.

A medical history is needed for treatment planning.

See Guide 2 and Guide 3

for a full list of the

tests that may be recommended before treatment for

ALL. It may also help to make a list of old and current

medicines while at home to bring to your doctor’s


Physical exam

Doctors usually perform a physical exam along with

taking a medical history. A physical exam is a review

of your body for signs of disease such as infection

and areas of unusual bleeding or bruising.

Your doctor may listen to your lungs, heart, and

intestines. Your doctor may also feel different parts of

your body to see if organs are of normal size, are soft

or hard, or cause pain when touched. For example,

your doctor may feel your belly area (abdomen) to

check for signs of an enlarged liver or spleen. In

males, the testicles will also be examined.

Checking for signs of infection is a key part of

the physical exam. This is often referred to as an

infection evaluation. Enlarged lymph nodes are an

example of a common sign of infection. Your doctor

may feel certain areas such as your armpits and

behind your jaw to check for enlarged lymph nodes.


Fertility is important to think about after a cancer

diagnosis. If you or your partner are able to have

children, now is the time to think about this possibility

before treatment gets started. Your doctor may order

a pregnancy test before treatment as a precaution.

This test measures the level of a hormone in the

body called HCG (







This hormone is made during pregnancy. Your doctor

can check if you are pregnant by taking a urine

sample or doing a blood test.

If you are not pregnant but interested in having

children at a later time, your doctor may recommend

fertility counseling. Here you can learn about fertility

preservation, ways to try to protect your reproductive

organs, and the ability to have children.

Once you know what you want to do, let your doctor

know what your plans are for having children. Your

doctor will take time to look into your case—including

the risks of delaying treatment—to make a decision

about the timing of fertility preservation.