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Leukemia can be hard to spot early because the symptoms often look like the flu or other common illnesses. It’s often discovered when routine blood tests show unusual results. If someone sees a doctor for general symptoms, a checkup or blood work may show signs of leukemia. There are no screening tests that can catch leukemia early.
If your doctor thinks you might have leukemia, they may order tests to confirm the diagnosis, find out the type of leukemia, plan treatment, and check for complications.
Each type of leukemia can cause certain symptoms that may lead someone to see a doctor and get diagnosed. Chronic forms of leukemia may not cause any symptoms in early stages. General symptoms that may occur in any type of leukemia include:
With acute leukemia, flu-like symptoms tend to appear suddenly, while chronic leukemia can take years before symptoms become noticeable. The differences are explained in the next section.
Some people may have symptoms that are less common, such as vomiting, pale skin, aches in the limbs or hips, or swelling in the gums, lymph nodes, or abdomen, before leukemia is diagnosed.
Read more about symptoms of leukemia.
There are two major categories of leukemia: acute and chronic. Acute leukemia develops and grows rapidly. Chronic leukemia develops slowly and lasts a long time.
Acute forms of leukemia include acute lymphocytic leukemia (ALL) and acute myelogenous leukemia (AML), also known as acute myeloid leukemia. Chronic forms of leukemia include chronic myelogenous leukemia (CML) — also known as chronic myeloid leukemia — and chronic lymphocytic leukemia (CLL).
Acute leukemia is the most common type of cancer in children. Pediatric leukemia is usually diagnosed early when symptoms cause parents to take their children to see a doctor. Chronic leukemias are most often diagnosed in adults and rarely affect children. There are many subtypes of acute and chronic leukemia.
Read more about types of leukemia.
Doctors may use many different tests when diagnosing leukemia. Some tests may point to leukemia at first, while others confirm the diagnosis and check for genetic mutations (gene changes) that can affect treatment and outcomes.
Your healthcare team will explain more about how to test for leukemia if they think you may have blood cancer.
A doctor may notice enlarged lymph nodes, spleen, or liver during a physical exam. If leukemia is suspected, the doctor will gently press their hands into these areas to check for swelling. They may check to see whether your gums are swollen or bleeding. They may look at your skin to check for a tiny sprinkling of spots that may appear red, brown, or purple, depending on skin tone.
During the process of taking a medical history, the doctor will likely ask you whether you’ve had any of the symptoms listed above and how long you have had them. You may be asked about potential risk factors, such as smoking cigarettes, exposure to industrial chemicals like benzene or formaldehyde, or past treatment for another type of cancer. Although it’s uncommon for leukemia to run in families, your doctor may ask questions about your family history to find out about genetic conditions that could influence the risk.
Learn more about leukemia causes and risk factors.
Leukemia is often discovered when routine blood tests show abnormal results, before symptoms are noticeable. Many different tests can be performed on a blood sample. Keep reading to learn about a few of the most common blood tests that can diagnose leukemia.
A complete blood count (CBC) assesses blood cell counts — the total number of each type of blood cell: red blood cells (RBCs), white blood cells (WBCs), and platelets. A CBC also looks for abnormal levels of hematocrit and hemoglobin, which indicate your red blood cells’ ability to carry oxygen around the body. Typically, people with leukemia show above-normal numbers of WBCs and below-normal numbers of RBCs and platelets, based on age-specific reference ranges.
Since high WBC counts can also indicate that the body is fighting an infection, further testing is required to confirm the cause. A CBC may also include a white blood cell differential test to check the levels of different types of white blood cells.
A blood smear — also called a manual differential — involves examining blood samples under a microscope. A blood smear allows the doctor to see if blood cells have a normal shape and check details about the different types of blood cells. Abnormal cells may indicate leukemia or a different underlying condition.
An analysis of blood chemistry looks at substances in the blood such as proteins, hormones, vitamins, and electrolytes. Blood chemistry results can indicate how severe the leukemia is and how well the kidneys, liver, or other organs are working. High levels of a substance in the blood called serum lactate dehydrogenase (LDH) can show that cells are breaking down quickly. This is often linked to a poorer outlook in different types of leukemia.
Blood or bone marrow samples can be processed through a highly sensitive device called a flow cytometer to get specific information about cells. For example, it’s important to know the ratio of blasts (immature white blood cells) to mature cells. Flow cytometry can also help pinpoint a subtype of leukemia during diagnosis and catch early indications of relapse after cancer treatment.
Some diagnostic tests for leukemia need a sample of bone marrow. Because blood cells develop in the bone marrow, analyzing this tissue can provide doctors with vital insight into the nature and extent of the disease.
Bone marrow aspiration is a technique used to obtain a sample of liquid bone marrow. A bone marrow biopsy collects a small amount of bone and solid bone marrow tissue.
Both aspiration and biopsy are performed using a hollow needle. Bone marrow samples are generally taken from the hip bone. Before a bone marrow biopsy, you’ll be given a local anesthetic to numb the site. You can ask for a mild sedative to help you stay relaxed. You may experience pain at the site of the biopsy for a few days after the procedure.
Cancer is the result of genetic mutations in specific cells. Cytogenetic testing helps doctors predict the course of the disease and which treatments are most likely to be effective.
Cytogenetic testing of leukemic cells analyzes changes to the chromosomes or genes. Cytogenetic testing is an important part of leukemia diagnosis. Types of cytogenetic testing that may be used in the process of diagnosing leukemia include conventional or molecular cytogenetics, also known as fluorescence in situ hybridization (FISH). These are described below.
FISH can identify genetic changes to blood cancer cells in samples of blood or bone marrow. It may be used during diagnosis to help choose the best treatment plan. FISH can help with diagnosis and, in some cases, with follow-up, but routine monitoring is often done with molecular tests such as polymerase chain reaction (PCR), depending on the type of leukemia.
A karyotype test creates a map of the chromosomes in cancer cells to determine specific changes. Karyotyping provides further details that may be used to create a tailored treatment plan.
Some people with leukemia develop complications that affect the lungs, gastrointestinal system, and brain, among other parts of the body. If your doctor suspects you have developed complications of leukemia or leukemia treatments, they may order imaging tests, including:
Imaging scans are generally painless, though some tests involve an injection of contrast or a radiotracer. These scans can help identify problems in other areas of the body. Doctors use these scans to see if leukemia is affecting your organs or causing complications.
Your doctor may order a lumbar puncture to check for leukemia cells in the cerebrospinal fluid, which is found in the brain and spinal cord. During a lumbar puncture, also known as an LP or spinal tap, a doctor will insert a needle between two vertebrae in the spine to collect a sample of cerebrospinal fluid from the spinal canal.
Doctors now use special lab tests, called molecular tests, to help diagnose leukemia, see how it may develop, and choose the best treatment. Tests such as PCR and next-generation sequencing can find genetic changes linked to leukemia. These changes may be there when the disease is first found or may appear later as the disease progresses.
This approach is part of what’s called personalized medicine. By looking at a person’s specific gene changes, doctors can choose treatments that are more likely to work. For example, in AML, finding changes in the IDH1 or IDH2 genes may mean that a person could benefit from medicines called IDH inhibitors.
If you’ve noticed symptoms that worry you, like ongoing fatigue or frequent infections, don’t ignore them. Reach out to your doctor and let them know what you’re experiencing. They can order the right tests, explain the results, and guide you toward the best next steps. Getting answers early can bring peace of mind and help you feel more in control of your health.
On MyLeukemiaTeam, people share their experiences with leukemia, get advice, and find support from others who understand.
Which tests did your doctor order before diagnosing leukemia? Let others know in the comments below.
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Thank you. Information is exactly what you need. I needed it not knowing what to expect is scary stuff. Hopefully someone else will read this. I had some symptoms a yr before it showed up in blood… read more
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