Leukemia--Acute Myeloid (Myelogenous) Overview

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Early Detection, Diagnosis, and Staging TOPICS

How is acute myeloid leukemia found?

At this time, there are no special tests that can find acute myeloid leukemia (AML) early. Report any symptoms to your doctor right away.

People known to have a higher risk of AML because they have 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.

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 the results 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 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 through procedures called bone marrow aspiration and biopsy. These are 2 tests, but they are done together. 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.

Lab tests

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

Imaging tests are ways of taking pictures of the inside of the body. Several kinds of these tests 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

Regular x-rays are not often needed in AML, but a chest x-ray 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 test, 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.

A CT scanner has been described as a large donut, with a narrow table in the middle opening. You will need to lie still on the table while the scan is being done. CT scans take longer than regular x-rays, and you might feel a bit confined by the ring while the pictures are being taken.

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 uses 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. For most ultrasound 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.


Last Medical Review: 06/27/2013
Last Revised: 02/07/2014