In case there are doubts about the presence of hairy cell leukemia then the doctor would be observant for the following three signs:

• Spleen enlargement.
• Lower count of all the types of blood cells.
• Presence of hairy cell leukemia in the blood.

In order to look out for these indicators the doctor would carry out several tests and examinations that would comprise of:

• Physical Examination
  The doctor would palpate the ellipsoidal-shaped organ placed to the left side of the upper part of the abdomen to check whether there is any kind of enlargement. An enlargement in the spleen could lead to feeling full in the abdomen that could cause discomfort during eating. The doctor might additionally look out for any enlargement in the lymph nodes that could point to the presence of cancer.
• Blood Analysis
  The blood sample collected is tested for CBC or complete blood count for gauging the blood count as those individuals with hairy cell leukemia have depleted counts of all kinds of blood cells namely red blood cells, white blood cells and platelets. Another type of blood test known as peripheral blood smear is conducted for checking the presence of hairy cell leukemia cells in the blood sample.
• Biopsy of the bone marrow
  During the course of a bone marrow biopsy, a minuscule quantity of bone marrow is extracted from the hip region. This sample is analysed for the presence of hairy cell leukemia and for keeping a watch on the normal, healthy blood cells.
• Computerised Tomography or CT or CAT scan
  A CAT scan reveals in-depth imagery of the internal parts of the body. The doctor would recommend undergoing a CAT scan for detecting whether the spleen and lymph nodes are having any kind of enlargement.

Possible Complications:

Hairy cell leukemia has a slow progression rate and at times, stay stabilised for several years. Hence due to this aspect there are fewer complications occurring. But, when not treated, hairy cell leukemia could advance and cause grave complications, like:

• Susceptibility to infection
  Depleted white blood cell count could make one more vulnerable to infections as the body’s infection combating capability is hindered due the presence of the disease.
• Easy Bruising and Blood clotting Problems
  Lowered platelet count could obstruct blood clotting. Hence, in case one is having a slightly lower platelet count, then one might observe being bruised more easily. Depleted platelet count could lead to unprompted blood loss from the nose or the gums.
• Low Haemoglobin Count
  A sapped red blood cell count would translate to lesser presence of cells for transporting oxygen all through the body leading to anemia that is known to cause immense weariness.
• Splenic Burst or Rupture
  A ruptured spleen could turn out to be a life-threatening situation the needs urgent surgical intervention for removal of the spleen. Hairy cell leukemia could inundate the spleen leading to its enlargement. Ultimately, the surplus cells lead to the spleen rupturing; however this kind of complication is quite atypical.

Surgery

Surgery is the most prevalent form of treatment for Wilms’ tumor wherein the doctor might remove the cancerous growth employing one of the below stated procedures.

• Partial Nephrectomy – This procedure is conducted for removal of the cancer and a section of the kidney that is situated around it.  It usually is done in just rare cases when there is damage done to the other kidney or has previously been taken out.
• Simple Nephrectomy – This procedure involves the complete removal of the kidney. The other kidney would then take on the role of purifying the blood.
• Radical Nephrectomy – In this procedure there is total removal of kidney, adjoining tissues and some of the lymph nodes.

Chemotherapy

Chemotherapy is the usage of drugs administered in either pill form or intravenously for annihilating cancer cells. Chemotherapy is also known as systemic treatment as the drugs on entry into the bloodstream, pass through the body and can stamp out cancer cells all through the body .When chemotherapy is offered as a post-operative procedure then it is known as adjuvant therapy.

In case elevated doses of chemotherapy are employed for killing the cancer cells, then the high doses could mar the blood-producing tissue present in the bones or bone marrow. If elevated doses of chemotherapy are required for treating the cancer, then the bone marrow might be extracted from the bones prior to therapy and kept in the freezer till its need arises. Subsequent to chemotherapy, the bone marrow is intravenously reinstated. This is known as autologous bone marrow reinfusion.

Radiation Therapy

Radiation therapy makes use of X-rays or other forms of high-power rays for annihilating cancer cells and shrinking the tumors. Radiation done for treating Wilms’ tumor generally is given through a machine located outside the body, also known as radiation therapy. Radiation might either be employed prior to or following surgery and chemotherapy.

Some patients tend to develop a second, altered form of the cancer after several years due to the outcome of being treated with chemotherapy and radiation. On-going clinical trials are intended at ascertaining whether chemotherapy and radiation could be employed in lower doses.

Stage-Wise Treatment

Treatment offered is dependent on the stage of the tumor, cell type or histology and the child’s overall health condition and age. A standardised treatment is adopted on the basis of its efficacy in several patients in earlier studies or investigational. The doctor might suggest that the child partake in a clinical trial – a research project that involves new investigational treatments. Several patients do not seem to be cured using standard therapy and there may be undue number of side effects experienced with some of the standard treatments. Due to these reasons, clinical trials are intended for testing novel, better treatment alternatives.

Stage I – In case the tumor bears a ‘favourable’ cell type or the child is having anaplastic Wilms’ tumor, then surgery for removal of cancer would be the probable line of treatment followed by chemotherapy. Surgery and subsequently radiation therapy and chemotherapy would be the probable line of treatment in case the child is having either clear cell sarcoma of the kidney or rhabdoid tumor.

Stage II – In case the tumor bears a ‘favourable’ cell type, the treatment would mostly involve surgery for removal of cancer, after which chemotherapy would be given. In case the child is having an ‘unfavourable’ cell type like anaplasia, clear cell sarcoma or rhabdoid tumor of the kidney, then the treatment might include surgery that would be followed by radiation therapy and chemotherapy.

Stage III – The treatment would possibly be surgery after which radiation therapy and chemotherapy would be given. At times, it is not possible to remove the cancer via surgery as it is located in close proximity to vital organs or blood vessels or due to its overbearingly large size. In such situations, only biopsy is conducted following which chemotherapy might be suggested that may or may not include radiation. Subsequent to the cancer being minimised by treatment, surgery would be conducted, that would be followed by further chemotherapy and radiation therapy sessions.

Stage IV – The line of treatment would generally be surgery that would be followed by radiation therapy and chemotherapy. In case there has been cancer metastasis or the cancer spreading to the lungs, then further chemotherapy sessions might be given.

Stage V – If cancer has metastasized to both the lungs, generally it is unfeasible to remove both the kidneys. A portion of the cancer from both the kidneys and adjacent lymph nodes might be removed for checking the presence of cancer. Subsequent to surgery, chemotherapy is conducted for shrinking the tumor. Following reduction of the cancer, a second operative procedure might be conducted for removing major parts of the cancer, while attempting to leave as much part of the kidneys as possible. Surgery might be followed by additional chemotherapy and radiation therapy.

Persistent – In case the cancer has relapsed in the child, the treatment offered would depend on the treatment previously offered, the amount of time transpired following the last treatment, the type of the cancer cells and the location of its re-emergence. Based on these factors, treatment would comprise of surgery, radiation therapy and chemotherapy.

Clinical trials, investigative projects that involve patients, aid in assessing novel treatments, like chemotherapy drugs, novel blends of treatments and bone marrow reinfusion.

How the Test is conducted

The test procedure is carried out in the operation theater in a hospital or in an outpatient-basis surgical facility. The sample could be taken in the following two ways, namely:

• Needle biopsy.
• Open biopsy.

Needle biopsy – In this procedure, a needle is inserted inside the dubious lymph node. The patient is required to lie down on the inspection table. A thorough cleansing of the biopsy spot is done, following which the health care provider would administer a local anesthetic injection that would lead to deadened sensation in that area. The biopsy needle is then introduced into the node, and a sample is taken out. Localized pressure is applied on the spot to bring the bleeding to a halt and a dressing is done on the site.

Open biopsy – This is a form of surgical intervention for total or partial removal of the lymph node. One would be required to lie down on the inspection table. A tranquilizer might be administered to put the patient under sedation, if needed. A careful cleaning of the biopsy spot would be carried out followed by a local anesthetic injection administered to numb the area. Sometimes, general anesthesia is given that would put one to sleep and make the procedure pain-free. A tiny surgical incision would be made through which the entire lymph node or a section of it is removed. The site is sutured and a dressing done.

Subsequent to the sample being drawn, it is sent for lab analysis.

Preparation for the Test

One needs to keep one’s health care provider informed in case of the presence of any of the following:

• Pregnancy.
• Any form of drug allergy.
• Bleeding issues.
• The kind of medications being consumed inclusive of any form of supplements or herbal medicines.

One would be required to sign an assent form.

The experience of undergoing the Test

Subsequent to the administration of the local anesthesia, a jab mark and slight stinging sensation is felt in that area. The biopsy spot would continue to remain tender and painful for the next few days following the testing procedure.

Reasons for Performing the Test

The test is conducted to assist in determining the reason behind the swelling in the lymph glands. It might be conducted to detect whether the lymph node has either a malignant (cancer-forming) or benign (non-cancer forming) nature.

Normal Outcome

A swelling in the lymph nodes might be due to the presence of varied conditions that could range from mild version to cancer-forming kinds.

Deciphering an Abnormal Outcome

An irregular test result could be because of the presence of a host of conditions that might lie between quite mild to cancerous.

For instance, an enlargement in the lymph nodes might be because of:

• Hodgkin’s lymphoma – A cancer affecting the lymph tissue originating in the lymph nodes, spleen, liver, bone marrow and other locations.
• Infection.
• Non-Hodgkin’s lymphoma – A lymphoid tissue cancer that involves the lymph nodes, spleen and other immune system organs.
• Sarcoidosis – a disease of unidentified cause leading to inflammation due to the development of lumps known as granulomas that have a major effect on the different organs of the body.

Possible Risks

• Bleeding.
• Chances of infection.
• An injury to the nerve in case the biopsy is conducted on a lymph node in close proximity to the nerves.