Leukemia is a systemic disease. Unlike cancers of the solid organs, there is no stage in Leukemia. However other tests will have to be done to look for the extent of the disease. This includes:-

• Lumbar puncture: A procedure used to collect cerebrospinal fluid from the spinal column for microscopic examination to look for presence of leukaemic cells. This is done by inserting a needle into the spinal column at the lower back. This procedure is also called an LP or spinal tap.
• Chest x-ray: To look for evidence of enlarged lymph nodes in the chest.
• Testicular biopsy: The removal of cells or tissues from the testicles so they can be viewed under a microscope to check for signs of cancer. This procedure is done only if there seems to be anything unusual about the testicles during the physical exam.

The patient is then stratified into risk groups. This is to enable the doctor to plan treatment in order to achieve the best outome but at reduced toxicity. Several parameters are used to determine risk groups. These include age of patient, total white count at presentation, and involvement of central nervous system, initial response to treatment and presence of certain chromosomes such as the Philiadelphia chromosome.

Risk groups are described as:

• Standard (low) risk.
• Intermediate or moderate risk.
• High risk.

Updated:: 13/09/2021 []