At this time, there are no special tests that can find chronic myeloid leukemia (CML) early. The best thing to do is report any symptoms to a doctor right away.

Symptoms of CML

Many people with CML have no symptoms at the time their cancer is found. In these cases, the cancer is often found by blood tests done for some other reason. Even when there are symptoms, they may be very general.

Symptoms of CML can include the following:

• Weakness
• Feeling very tired most of the time (fatigue)
• Night sweats
• Weight loss
• Fever
• Bone pain
• Enlarged spleen (felt as a mass under the left side of the ribs)
• Pain or a sense of "fullness" in the belly (after eating even a small meal)
• Feeling full after eating even a small amount of food

But these symptoms aren't found only in CML. They can be caused by other things, too.

Problems caused by a shortage of blood cells

Many of the symptoms of CML happen because the leukemia cells crowd out the cells that make blood in the bone marrow. As a result, the person does not have enough blood cells and platelets that are working the way they should.

• Anemia is a result of a shortage of red blood cells. It makes you short of breath, tired, and weak.

• Not having enough normal white blood cells increases the risk of infection. People with leukemia may have very high white blood cell counts, but the cells are not normal and do not fight infections.

• Not having enough blood platelets can lead to bruising, bleeding, frequent or severe nosebleeds, and bleeding from the gums. Some patients with CML have too many platelets, but the platelets don't work the way they should.

Types of samples used to test for CML

If symptoms suggest you might have leukemia, you will need certain tests to find out if you have leukemia and, if so, what type it is.

Blood samples: Blood samples for tests for CML are most often taken from a vein in your arm.

Bone marrow samples: A bone marrow aspiration and biopsy are 2 tests that are usually done at the same time. Samples are most often taken from the back of the hip bone, but in some cases they may be taken from the breastbone or other bones.

In bone marrow aspiration, a hollow needle is used to pull out a small amount of liquid bone marrow. The skin and the surface of the bone are first numbed, but the test can still hurt. During a bone marrow biopsy, a small core of bone and marrow (about ½" long) is removed with a slightly larger needle that is twisted as it is pushed into the bone. The biopsy may also cause some brief pain. Once the biopsy is done, pressure and maybe an ice pack will be put over the site to help prevent bleeding.

Both samples are usually taken at the same time. These tests are mostly used to tell how advanced the leukemia is before treatment starts. They are also done during treatment to tell how well the treatment is working.

Lab tests for CML

One or more of these lab tests may be done, either to find CML or to help the doctor figure out how advanced the disease is.

Blood cell counts and blood cell exam

The complete blood count (CBC) is a test that measures the levels of different blood cells, such as red blood cells, white blood cells, and platelets. Most patients with CML have too many white blood cells and sometimes not enough red blood cells or blood platelets. Even though these findings may suggest leukemia, the disease usually is not diagnosed without testing a sample of bone marrow cells.

Blood chemistry tests

These tests measure the amount of certain chemicals in the blood, but they are not used to decide if a person has leukemia. In patients already known to have CML, these tests can help find liver or kidney problems caused by the spread of leukemia cells or due to the side effects of certain drugs used for treatment. These tests also help the doctor decide whether treatment is needed to correct low or high blood levels of certain minerals.

Routine exam under a microscope

Any samples taken (blood, bone marrow, etc.) are looked at under a microscope by a doctor with special training (a pathologist). The doctor looks at the size and shape of the cells as well as other features to divide the cells into specific types. An important goal of this process is to see whether or not the cells look mature. The most immature cells are called blasts. Blasts do not work the way they should, and they can keep on forming new cells, crowding out normal, mature cells.

Doctors may also use other very precise lab tests to diagnose and classify leukemia. You might hear some of the following terms used: cytochemistry, cytogenetics, FISH, and PCR. These tests are explained in our document Leukemia: Chronic Myeloid.

Imaging tests

Imaging tests are ways of taking pictures of the inside of the body. They are not used to find leukemia, but they may be done to help figure out how much the disease has spread.

CT (computed tomography) scans

The CT scan is a special kind of x-ray in which a beam moves around the body, taking pictures from many angles. CT scans are not usually needed to diagnose CML, but may be done if your doctor thinks the leukemia is growing in an organ like your spleen.

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 surrounds the table. You might feel a bit confined while the pictures are being taken.

Often before any pictures are taken, you may be asked to drink 1 to 2 pints of a liquid called "oral contrast." This helps outline the intestine more clearly. You may also have an IV (intravenous) line through which you get a different kind of contrast dye. This helps better outline blood vessels and internal organs.

The IV dye can make you 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. Before the scan, be sure to tell the doctor if you have ever had a reaction to any contrast material used for x-rays

MRI (magnetic resonance imaging)

MRI scans are very helpful in looking at the brain and spinal cord. This test uses powerful magnets and radio waves to make detailed pictures of your insides. They take longer than CT scans, often up to an hour. You may need to lie inside a narrow tube for the test. This can upset people with a fear of enclosed spaces. Newer, "open" MRI machines may help with this problem. The MRI machine makes loud thumps and buzzes that some people may find disturbing. Some places give you headphones to block this out.

Ultrasound

This test uses sound waves to make pictures of internal organs. Ultrasound can look for enlarged organs in the belly (abdomen). This is a very easy test to have done. You lie on a table and a technician moves a small wand (transducer) over the part of the body being looked at.

Chest x-ray

This is a plain x-ray of the chest. It isn't used to tell if someone has CML, but to look for lung problems.

Last Medical Review: 12/01/2009
Last Revised: 12/01/2009