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Diagnosis and tests

The doctor’s examination

When leukemia is suspected, the first and simplest step is a conversation with a doctor and a physical examination. This topic calmly explains what the doctor asks, which parts of the body they check and why, and which small signs matter.

Last updated: ~5 min read
A translucent glowing stethoscope on a dark navy background, soft waves of light spreading from its chest piece, with small blood cells floating nearby; no people.
Figure 1.Concept: a diagnosis begins with careful listening.

01Short answer

A doctor’s examination has two parts. The first is the history: your symptoms and when they began, tiredness, fever, night sweats, weight loss, frequent infections, bleeding and bruising, bone or joint pain, the medicines you take, past illnesses, exposure to radiation or chemicals, and blood disorders in the family. The second is the physical examination: paleness of the skin and the inside of the mouth and eyelids, petechiae and bruises, swollen or bleeding gums, lymph nodes in the neck, armpits and groin, an enlarged liver or spleen, signs of infection, breathing and heart sounds, temperature, pulse, blood pressure and weight. In ALL, the doctor sometimes also checks the testicles and the nervous system. The examination does not make the diagnosis, but it decides which tests are needed and how urgently.

02Simple explanation

First, the doctor listens to you: what is bothering you, since when, what has changed. Your story is the first piece of the diagnosis.

Then they look at your skin and mouth: paleness can point to anaemia, and tiny red spots and bruises to a shortage of platelets. Swollen gums occur in some types of leukemia.

The doctor checks the lymph nodes in your neck, armpits and groin. Enlarged, painless nodes are common in lymphocytic leukemias.

By pressing gently on your tummy, they assess the size of your liver and spleen. An enlarged spleen is especially typical of CML and CLL.

All these findings help the doctor choose the next step: which test, which examination and how urgently.

03Scientific explanation

Why the history matters. According to the ACS, when leukemia is suspected the doctor asks how long symptoms have lasted, about risk factors (previous chemotherapy or radiotherapy, exposure to chemicals such as benzene, smoking, certain inherited syndromes) and about family history. Sudden symptoms that build over a few weeks point more towards acute leukemia; mild signs lasting months point more towards chronic leukemia.

Signs of bone marrow failure. When the marrow cannot make enough normal cells, three groups of signs appear: anaemia (paleness, breathlessness, a racing heart), thrombocytopenia (petechiae, bruising, nose and gum bleeds) and neutropenia (frequent or lingering infections, fever). These can be seen on examination.

Build-up of leukemia cells. Leukemia cells can collect in the lymph nodes (lymphadenopathy), spleen and liver (splenomegaly, hepatomegaly), sometimes in the gums and skin (especially in monocytic AML) and, in T-ALL, in the middle of the chest (a mediastinal mass). According to the NCI, painless enlarged lymph nodes and spleen are common in CLL.

Measured values. Temperature, pulse, blood pressure, breathing rate, oxygen saturation and weight are recorded. They show whether the situation is urgent and serve as a baseline for comparison during treatment.

04What happens in the body?

The conversation: your story

The doctor asks when your symptoms began, how they have changed, how often you get infections, and about weight loss, night sweats and bleeding. Having a list of your medicines (including herbal products) and past illnesses ready saves time.

Lymph nodes, liver and spleen

With their fingers, the doctor checks the nodes in your neck, above the collarbone, in your armpits and groin, then feels your abdomen while you lie down. An enlarged spleen can also be felt as heaviness under the left ribs or feeling full quickly.

A diagram of a translucent human silhouette on a dark navy background; small glowing lymph nodes in the neck, armpits and groin, and the liver and spleen in the abdomen softly highlighted; no facial features.
Figure 2.What the doctor checks: lymph nodes, liver and spleen.

Skin, mouth and eyes

The doctor looks for petechiae (red pinpoint spots), bruises and paleness on the skin, and for swollen or bleeding gums and sores in the mouth. Sometimes the back of the eye is examined, because a very high white count or low platelets can cause changes there.

Under a magnifying glass on a dark navy background, a translucent skin surface with a few tiny reddish dots, and beside it a diagram of a softly lit gum line; no blood, wounds or faces.
Figure 3.Small signs: paleness, petechiae and the gums.

Heart, lungs and signs of infection

The heart and lungs are listened to with a stethoscope: with anaemia the pulse may be fast, and in T-ALL a mass in the chest can cause breathlessness and cough. The doctor also looks for sources of infection on the skin, in the mouth and in the throat.

Extra checks in children and in ALL

In children, limping, bone pain and not wanting to walk can be important signs. In ALL, the doctor may examine the testicles in male patients (painless swelling) and the nervous system (headache, changes in vision, facial nerve weakness), because leukemia cells can collect there too.

05From examination to test

In simple steps, the doctor looks for answers to important questions.

Listen — Symptoms, medicines, family history.1ListenSymptoms, medicines, family history.
Look — Skin, mouth, paleness and signs of bleeding.2LookSkin, mouth, paleness and signs of bleeding.
Feel — Lymph nodes, liver and spleen.3FeelLymph nodes, liver and spleen.
Order a test — A blood count and the next step.4Order a testA blood count and the next step.
A first directionWhich tests are needed.
How urgentWhether it can wait.
A baselineFor comparison later.

06What the examination may find and what it may point to

FindingPossible causeNext step
Paleness, fast pulseAnaemia (too few red cells)Blood count
Petechiae, bruisesToo few plateletsUrgent blood count
Swollen gumsBuild-up of leukemia cells (e.g. monocytic AML)Blood count, smear
Enlarged lymph nodesInfection, CLL, ALL, lymphoma and othersBlood count, flow cytometry if needed
Enlarged spleen or liverCML, CLL, acute leukemia or other causesBlood count, ultrasound
Fever, a source of infectionPossibly too few neutrophilsUrgent blood count and treatment

* Most of these findings are far more often due to other causes, such as ordinary infections, than to leukemia. Only tests give a definite answer.

07Key terms

History
The information about symptoms and past health that the doctor gathers.
Palpation
The doctor feeling organs with their fingers.
Petechia
A pinpoint red or purple spot on the skin.
Lymphadenopathy
Enlargement of the lymph nodes.
Splenomegaly
Enlargement of the spleen.
Hepatomegaly
Enlargement of the liver.
Mediastinal mass
Enlarged tissue in the middle of the chest; can occur in T-ALL.
Vital signs
Temperature, pulse, blood pressure, breathing and oxygen level.

08Key points

  • The examination starts with a conversation — your story.
  • Paleness, petechiae and infections can point to a struggling marrow.
  • Lymph nodes, liver and spleen are checked by hand.
  • The examination does not diagnose; it points to the right tests.
  • Most of these signs have ordinary causes more often than leukemia.
  • Bring a list of your medicines to the appointment.
  • Bleeding, petechiae and fever need urgent attention.

09Frequently asked questions

The doctor checked a lymph node and said it is enlarged. Is it leukemia?

Not necessarily. Lymph nodes most often swell because of infections. The doctor considers the size, firmness, tenderness and how long it has lasted, and orders a blood count if needed.

Why does the doctor press on my tummy?

To assess the size of your liver and spleen. An enlarged spleen can occur in some leukemias, but also with infections and other conditions.

Is the examination painful?

Usually not. Feeling the abdomen can be a little uncomfortable, especially if the spleen is enlarged. If it hurts, tell the doctor.

If the examination is normal, is leukemia ruled out?

No. In the early stages or in chronic leukemia, the examination can be completely normal. That is why a blood count is done when there is a suspicion.

How can I prepare my child for the examination?

Tell them in simple words that the doctor will “listen and have a look”. Bring a favourite toy. Write down your child’s symptoms (limping, tiredness, bruises) in advance.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. The doctor checked a lymph node and said it is enlarged. Is it leukemia?

  2. Why does the doctor press on my tummy?

  3. Is the examination painful?

  4. If the examination is normal, is leukemia ruled out?

  5. How can I prepare my child for the examination?

My questions

12Sources

  1. American Cancer Society. Tests for Acute Myeloid Leukemia (AML)
  2. American Cancer Society. Tests for Acute Lymphocytic Leukemia
  3. American Cancer Society. Signs and Symptoms of Acute Lymphocytic Leukemia
  4. American Cancer Society. Signs and Symptoms of Chronic Lymphocytic Leukemia
  5. American Cancer Society. Signs and Symptoms of Childhood Leukemia
  6. National Cancer Institute (NCI). Adult Acute Myeloid Leukemia Treatment (PDQ®) — Patient Version
  7. National Cancer Institute (NCI). Chronic Lymphocytic Leukemia Treatment (PDQ®) — Patient Version
  8. MedlinePlus (U.S. National Library of Medicine). Swollen lymph nodes
  9. MedlinePlus (U.S. National Library of Medicine). Spleen Diseases
  10. National Cancer Institute (NCI). NCI Dictionary of Cancer Terms: splenomegaly
  11. NHS. Symptoms of acute lymphoblastic leukaemia
  12. NHS (UK). Swollen glands
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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