Most people with ALL are referred for treatment at a specialist haematology unit, where a group of specialist doctors work together. This is known as a multidisciplinary team and normally includes:

• one or more haematologists
• a clinical oncologist (a doctor who specialises in radiotherapy and chemotherapy)
• specialist nurses who give information and support
• pathologists who advise on the type and extent of the leukaemia.

Other staff will be available to help if necessary, such as:

• social workers
• dietitians
• counsellors and psychologists
• physiotherapists.

The doctor at the hospital will take your full medical history before doing a physical examination and a specific type of blood test, which checks the numbers of all the different types of blood cell.

If the blood test shows that leukaemia cells are present, your doctor will want to take a sample of your bone marrow. This is the most important test in finding out the exact type of leukaemia you have, and gives information that the doctors need to plan the best treatment for you.

A small sample of bone marrow is taken from the back of the hip bone (pelvis) or occasionally the breast bone (sternum). It is looked at under the microscope by a haematologist to see if it contains any abnormal white blood cells. The pathologist will be able to tell which type of leukaemia it is by identifying the type of abnormal white cell. Some other tests will be carried out on the bone marrow sample to help confirm the diagnosis.

The bone marrow sample is normally taken under a local anaesthetic. You are given a small injection to numb the area and a needle is passed through the skin into the bone. A small sample of the bone marrow is then drawn into a syringe for examination under a microscope.

The procedure can be done on the ward or in the outpatients department. The whole procedure lasts about 15–20 minutes. It may be uncomfortable when the marrow is drawn into the syringe, but this should only last a short time. You may be offered a short-acting sedative to reduce any pain or discomfort during the test.

Sometimes a small core of marrow is needed (a trephine biopsy) and this procedure takes a few minutes longer. A special type of needle is passed through the skin to the bone marrow. The needle has a tip that can cut out a sample of the bone marrow. You may feel bruised after the test and have an ache for a few days. This can be eased with mild painkillers.

Within each cell of the body are chromosomes, which are made up of genes. The genes control all activities of the cell. In leukaemia there are often changes in the structure of the chromosomes within the leukaemic cells, but not the normal cells of the body.

The tests on the blood and bone marrow sample will include a chromosome analysis to look for any particular changes in the chromosomes, as the different types are associated with particular genetic changes. These tests, known as cytogenetic tests, can help to decide on the best treatment and predict how well the leukaemia may respond to that treatment.

Another test on the blood or bone marrow sample will show which type of lymphocyte has become cancerous. Immunophenotyping can tell the doctors whether your leukaemia developed from B-lymphocytes or T-lymphocytes. Knowing which type of lymphocyte is affected helps the doctors to plan the most appropriate treatment.

This is taken to check for any sign of swollen lymph glands in the chest.

A small sample of the fluid that surrounds your brain and spinal cord is taken to check for leukaemia cells. Your doctor uses a local anaesthetic to numb the lower part of your back and a needle is gently passed into the spine to draw off a tiny sample of the fluid.

Having the lumbar puncture may be uncomfortable, but it only takes a few minutes. Some people may have a headache afterwards. If this happens let your doctor know so that painkillers can be prescribed for you. You may need to lie flat for a few hours afterwards.

Other scans, such as a CT, MRI and ultrasound scan, may be done to find out if the leukaemia has spread to other parts of your body. Your doctor or specialist nurse can tell you about any scans that may be necessary.

It will probably take several days for the results of your tests to be ready, and this waiting period will obviously be an anxious time for you. It may help if you can find a close friend or relative to talk things over with. You can also contact Cancerbackup or another organisation.