Leukemia Diagnosis and Staging

April 19, 2024 
This page was reviewed under our medical and editorial policy by Guido Marcucci, M.D., Chair, Department of Hematologic Malignancies Translational Science, City of Hope Duarte

Leukemia is diagnosed using various tests that look for cancer cells in the blood and bone marrow. After a diagnosis is made, the health care team may share more information about the cancer’s stage.

This guide to leukemia diagnosis and staging is designed to help patients and their families learn more about this part of their leukemia treatment journey.

How Is Leukemia Diagnosed?

Doctors use a number of diagnostic tools to look for leukemia. These may include those listed below.

Physical exam and medical history: During a physical exam, a doctor reviews the patient’s medical history and looks for physical symptoms — such as bruising or signs of infection — which may indicate low blood cell counts.

Blood tests: Blood tests may be used to look for the presence of cancer. A complete blood count (CBC) counts blood cell and platelet levels, while a peripheral blood smear examines blood cells under a microscope. Leukemia cells may be circulating in the blood, but are sometimes confined to the bone marrow.

Bone marrow aspiration and biopsy: During this procedure, a hollow needle is inserted into the hipbone or breastbone to extract a sample of liquid bone marrow. This sample is then examined under a microscope to look for cancer cells.

Leukemia Blood Test

Blood cancers like leukemia are the only cancer types that, in some cases, may be diagnosed via a blood test. Though there isn’t a specific blood test for leukemia, a CBC test is used.

The CBC is not only a diagnostic tool, but it may also be used to measure the stage of the cancer and to check how the body is responding to treatment.

Leukemia Screening

No current screening protocol for leukemia is available, but patients with a higher risk for the disease may be more closely monitored for leukemia symptoms. Ongoing research may lead to the development of a formal screening program.

Patients who have any of the following risk factors for leukemia may talk to their doctor about their risk and report any symptoms:

  • Exposure to radiation or certain chemicals, including benzene
  • Genetic syndromes, including Down syndrome, Klinefelter syndrome or Fanconi anemia

Leukemia is also more common in children or adults over 50.

Leukemia Stages

Leukemia staging is different from cancers that develop solid tumors. While each type of leukemia staging is based on the individual type of leukemia, the most common method in the United States is the Rai system. In Europe, the Binet classification method is most often used.

With the Rai system, which is used for certain leukemia types, the cancer is assigned a number from 0 to 4. That number is based on blood cell and platelet levels; whether or not the lymph nodes, liver or spleen are enlarged; and whether or not the patient has anemia. The Rai classification is broken into the risk groups below.

Stage 0: Low risk

Stages 1 and 2: Intermediate risk

Stages 3 and 4: High risk

Each case is unique. A patient’s medical team may address questions about staging and what it means for individual health outcomes.

Read more to learn about leukemia diagnosis and stages by type:

  • American Cancer Society (2023, July 21). Tests for Acute Myeloid Leukemia (AML). 

  • American Society of Clinical Oncology (2022, September). Understanding Your Complete Blood Count (CBC) Tests. 

  • National Cancer Institute. Leukemia—Patient Version. 

  • American Cancer Society (2018, October 17). Risk Factors for Acute Lymphocytic Leukemia (ALL). 

  • American Society of Clinical Oncology (2017, October). Leukemia - Chronic Lymphocytic - CLL: Stages.