How is acute myeloid leukemia found?
At this time, there are no special tests that can find acute myeloid leukemia (AML) early. The best course of action is to report any symptoms to the doctor right away.
People known to be at increased risk of AML because of certain blood problems or syndromes or because they were treated with certain chemotherapy drugs or radiation should have careful, regular medical checkups. They do not usually get leukemia, but they and their doctors should be aware of the possible symptoms of AML.
Signs and symptoms of AML
Patients with AML often have symptoms like weight loss, tiredness (fatigue), fever, night sweats, and loss of appetite. Of course, AML is not the only problem that causes these symptoms; they are most often caused by something other than cancer.
Problems cause low blood cells
Most signs and symptoms of AML come from a shortage of normal blood cells, which happens when the leukemia cells crowd out the normal blood-making cells in the bone marrow. As a result, people do not have enough normal red blood cells, white blood cells, and blood platelets. These shortages show up on blood tests, but they can also cause symptoms.
- Anemia: Anemia is the shortage of red blood cells. It causes a person to feel short of breath, tired (fatigued), cold, and dizzy or lightheaded.
- Shortage of white blood cells: Not having enough normal white blood cells can increase the risk of infection. People with leukemia may have very high white blood cell counts, but the cells are not normal and don't protect against infection. Fevers and other signs of infection are common symptoms.
- Shortage of blood platelets: Not having enough blood platelets can lead to bruising, bleeding, frequent or severe nosebleeds, and bleeding gums.
Symptoms caused by high numbers of leukemia cells
The cancer cells in AML are bigger than normal white blood cells and have more trouble going through tiny blood vessels. These cells can clog up blood vessels and make it hard for normal red blood cells (and oxygen) to get to tissues. Some of the symptoms are like what is seen with a stroke, and include headache, weakness in one side of the body, slurred speech, confusion, and sleepiness. Patients might have problems with shortness of breath, blurry vision or even loss of vision. These problems are rare, but they need to be treated right away.
Bleeding and clotting
Patients with a certain type of AML called acute promyelocytic leukemia (APL) may come in with problems with bleeding and clotting. They may have a nose bleed that won’t stop, or a cut that won’t stop oozing. They may also have calf swelling from a blood clot called a deep venous thrombosis (DVT) or chest pain and shortness of breath from a blood clot in the lung (called a pulmonary embolism or PE).
Bone or joint pain
Some people have pain caused by the buildup of leukemia cells in bones or joints.
Swelling in the belly
Leukemia can also cause swelling of the liver and spleen. This may be noticed as a fullness or swelling of the belly.
Spread to the skin
If leukemia cells spread to the skin, they can cause lumps or spots that may look like common rashes.
Spread to the gums
Certain types of AML are prone to spread to the gums, causing swelling, pain, and bleeding.
Spread to other organs
Sometimes, leukemia cells may spread to other organs. Spread to the central nervous system (the brain and spinal cord) can cause headaches, weakness, seizures, vomiting, trouble with balance, numbness on the face, or blurred vision. Rarely, AML may spread to the eyes, testicles, kidneys, or other organs.
Enlarged lymph nodes
In rare cases, AML may spread to lymph nodes. Nodes in the neck, groin, under arms, or above the collarbone may swell and be felt as lumps under the skin.
Although the symptoms and signs above may be caused by AML, they can also be caused by other things. Still, if you have any of these problems, see a doctor right away so the cause can be found and treated, if needed.
If AML is suspected
As noted, most of the symptoms seen in leukemia can also be caused by other problems like infections. For this reason, your doctor will focus on finding out if you really have leukemia.
Medical history and physical exam
The doctor will want to ask you questions about your health (get a medical history), such as how long you have had symptoms and whether or not you have any risk factors.
The doctor will likely do a physical exam to look for any enlarged lymph nodes, bleeding or bruising, or signs of infection. If there seems to be a problem with blood cell counts, blood tests will be done. If these suggest leukemia, your doctor may refer you to a cancer doctor (an oncologist) or a blood doctor (a hematologist), who may do one or more of the tests described below.
Types of samples used to test for AML
The doctor will need to check samples of cells from the blood and bone marrow confirm that you have cancer. Other tissue and cell samples may also be taken in order to help guide treatment.
Blood samples: Blood samples to check for AML are most often taken from a vein in the arm.
Bone marrow samples: Bone marrow samples are taken by a bone marrow aspiration and biopsy. In bone marrow aspiration, a thin needle and syringe is used to take out a small amount of liquid bone marrow. During a bone marrow biopsy, a small cylinder of bone and marrow (about ½ inch long) is removed with a slightly larger needle.
Both samples are usually taken at the same time from the back of the hipbone (but sometimes other bones are used instead). The patient usually lies on his or her side or belly and the area is cleaned with a special soap. Before the sample is taken, the doctor uses a long, thin needle to put medicine near the back of the hipbone to numb it. Then the doctor makes a small cut in the skin in order to put in the wider needle. The needle is pushed into the bone with a twisting motion. Sometimes the needle going into the bone hurts, but it only lasts a short time. The sucking out of the marrow often hurts for a moment, too.
These tests are used to tell whether leukemia is present and-- if you are having treatment-- they are used to see how well treatment is working.
Spinal fluid: This fluid is obtained by a test called a spinal tap (lumbar puncture). It is done to look for leukemia cells in the fluid around the brain and spinal cord (cerebrospinal fluid or CSF). The doctor first numbs a place in the lower part of the back over the spine. A small needle is placed between the bones of the spine in the lower back to draw out some of the fluid. The fluid is looked at for leukemia cells. This test is not usually done for people with AML. It may be done if the doctor suspects that the leukemia has spread to the CSF based on certain symptoms, and to treat it if it has already spread there.
One or more of these lab tests may be done on the samples to tell if you have AML and to learn the exact type.
Blood cell counts and exams: Changes in the numbers of different blood cell types and how the cells look under a microscope can suggest leukemia. Most people with AML will have too many white blood cells, not enough red cells, and not enough platelets. Also, many of the white cells will be blasts, a type of immature cell not normally found in the bloodstream. These cells don't work the way they should.
People already known to have leukemia will have tests done to measure the amount of certain chemicals in the blood. These tests can help tell how well their kidneys and liver are working.
A doctor with special training in blood diseases looks at the biopsy samples (bone marrow, blood, and cerebrospinal fluid) under a microscope. The doctor looks at the size and shape of the cells as well as other features to classify the cells into different types. An important goal of this process is to see whether the cells look mature. The most immature cells are called blasts. The number of blasts in the bone marrow is important in telling whether a person has leukemia.
Other lab tests: Other special tests which look at blood, bone marrow, and even DNA, help the doctor decide which type of leukemia a person has. You might hear some of the following terms: cytochemistry, cytogenetics, PCR, FISH, and immunocytochemistry. These are complex medical and chemical tests. Your doctor can tell you which of these might be done need and why.
Imaging tests are ways of taking pictures of the inside of the body. There are several kinds of these tests that might be done in people with leukemia. They are done most often to look for infections or other problems rather than for the leukemia itself.
X-rays: Chest x-rays might be done if the doctor thinks there could be a lung infection.
CT (computed tomography) scan: A CT scan is a type of x-ray that gives a detailed picture of the inside of your body. This test can help tell whether any lymph nodes or organs in your body are swollen. This test is not often needed in people with AML.
Before the scan, you may have a contrast dye put into a vein, or you may be asked to drink a special liquid to better outline blood vessels and organs. The injection can cause you to feel flushed or warm, in the face or elsewhere. Some people get hives (itchy bumps). A few may have more serious allergic reactions like trouble breathing, feeling dizzy, or passing out. Be sure to tell the doctor before the scan if you have ever had a reaction to any contrast material used for x-rays.
CT scans take longer than regular x-rays. You need to lie still on a table while they are being done. During the test, the table moves in and out of the scanner, a ring-shaped machine that goes all the way around the table. You might feel a bit confined while the pictures are being taken. There are also machines that combine CT and PET scans.
MRI (magnetic resonance imaging) scan: Like CT scans, MRI scans make detailed pictures of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. MRI scans help look at the brain and spinal cord. But they are not often needed in people with AML.
MRI scans take longer than CT scans. Also, you may be placed inside a narrow tube, which can bother some people. Special, "open" MRI machines may be another choice for people with a fear of closed spaces. The MRI machine makes loud buzzing and thumping noises that you may find disturbing. Some places will give you headphones to block this out.
Ultrasound: Ultrasound is the use of sound waves to make pictures of organs inside your body. It can be used to look at lymph nodes near the surface of the body or to look for enlarged organs inside your belly, such as the kidneys, liver, and spleen.
This is an easy test to have done. For most scans, the part of your body that is being looked at is smeared with gel, a kind of wand is moved around, and the picture can be seen on a computer screen.
Gallium scans and bone scans: These tests are not often done for AML, but they may be useful if there is bone pain that might be caused by an infection or cancer in the bones. The tests involve putting a slightly radioactive chemical into the blood. The chemical collects in places of cancer or infection, called "hot spots" where it can be seen by a special camera.
Last Medical Review: 03/28/2012
Last Revised: 01/24/2013