It can be a nervous time to wait after your GP recommends a haematologist referral. Our hope is that this information can help you feel more prepared for your appointment.
It may be your first time learning about haematology or blood cancers and it can be a lot to take in. Hearing the word ‘cancer’ is often very upsetting – please know that there are often effective treatments available.
When you see a haematologist, you can share your worries and ask them to explain anything you don’t understand. They’ll support you with the information you need.
Your GP or other specialist should have told you why they recommend an appointment with a haematologist.
Reasons for referral to a haematologist to investigate blood cancer:
- further investigation of biopsy or imaging results
- blood test results that aren’t normal
- you are experiencing symptoms that can happen with blood cancers.
Haematologists also treat blood disorders that are not cancer, such as blood clots.
What to expect at your first appointment
Before your appointment, your haematologist receives all test results from your GP. At the appointment, they will ask you about your medical history and symptoms to understand your individual situation. They order a range of tests to assess what is happening inside your body.
An important part of a diagnosis is making sure your symptoms or test results aren’t caused by another reason. You won’t receive a blood cancer diagnosis until your haematologist has ruled out other conditions.
Tests to diagnose blood cancer
Your haematologist uses their expertise and investigations to make an accurate diagnosis. The tests you have will depend on your symptoms and type of suspected blood cancer. Your experience may not involve every test listed below.
How is lymphoma diagnosed?
A lymphoma diagnosis requires blood tests, tissue/bone marrow biopsy and imaging.
Test results help determine the stage of lymphoma a person has. Lymphoma is diagnosed from stage 1 to stage 4, which describe where it has spread in the body.
Blood tests: These check for signs of the effect of lymphoma on your body
Biopsy: Biopsies allow us to collect cells from areas with suspected lymphoma for testing. This is generally in the lymph nodes because lymphoma cells collect here.
You have local anaesthetic to numb the biopsy area. Depending on the location of the biopsy, you may need surgery with general anaesthetic (where you are unconscious).
Types of biopsies used for lymphoma
- Lymph node resection: All or some of a lymph node is removed for testing. Removing a lymph node is the best way to confirm and diagnose lymphoma. This requires an operation.
- Lymph node core needle biopsy: A needle is inserted into a lymph node to take out a sample of lymph tissue and cells. This happens in the radiology department.
- Bone marrow biopsy: Blood cells are made in the bone marrow, inside bones. For a bone marrow biopsy, a doctor inserts a needle into the bone at the back of the pelvis.
- Lumbar puncture (spinal tap): A needle is inserted in the lower back to take a sample of spinal fluid for testing. This test is less common.
Physical examination: Some people with lymphoma have swollen lymph nodes or other physical symptoms. An examination allows the doctor to check these signs.
Imaging and scans: These include a chest X-ray, PET scan or CT scan. The purpose of these scans is to see the exact location of lymphoma in the body.
Analysis of cancer cells and DNA: Lymphoma has more than 80 types. Looking closely at cancer cells can tell us more information. These tests include flow cytometry and genomic testing.
How is leukaemia diagnosed?
A leukaemia diagnosis requires blood tests and bone marrow biopsy. Leukaemias are acute or chronic, and this can change the tests used for diagnosis.
For diagnosis of leukaemia, tests include:
Blood tests: These check for signs of disease and a reduced number of blood cells.
Bone marrow biopsy: Blood cells are made in the bone marrow, inside bones. For a bone marrow biopsy, a doctor inserts a needle into the bone at the back of the pelvis to take out samples. Tests then check if leukaemia cancer cells are in the bone marrow.
Analysis of cancer cells and DNA: Looking closely at cancer cells is important for accurate diagnosis. Tests for acute leukaemias include flow cytometry, cytogenetics and genomic testing.
Physical examination: An examination allows the doctor to check for signs of leukaemia such as swelling in the lymph nodes, spleen and other areas.
How is myeloma diagnosed?
A myeloma diagnosis requires blood and urine tests, biopsy and imaging.
- Blood tests: These check for signs of disease, myeloma proteins and electrolytes.
- Urine test: This is to check for abnormal protein made by myeloma.
- Bone marrow biopsy: Blood cells are made in the bone marrow, inside bones. For a bone marrow biopsy, a doctor inserts a needle into the bone at the back of the pelvis to take out samples for testing. Tests then check if myeloma cancer cells are in the bone marrow.
- Imaging and scans: These include an X-ray, PET scan, CT scan and spine MRI. The purpose of these scans is to see if myeloma is present in the body. It can also check for bone damage from myeloma.
- Analysis of cancer cells and DNA: Tests including flow cytometry, cytogenetics and genomic testing allow us to find more detail about specific myeloma cells in the body.
Referral for diagnosis
If you’re worried about symptoms, speak to your general practitioner (GP) first. They can assess symptoms, order tests and refer you to a blood cancer specialist (haematologist) if recommended.
Ask your GP for a referral to one of our leading Epworth haematologists in East Melbourne, Box Hill, Geelong and Richmond through the Epworth Centre for Immunotherapies and Snowdome Laboratories, a blood cancer centre of excellence.
Learn more about blood cancer care at Epworth and referrals for patients.