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.
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
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.