Symptoms and diagnosis of acute myeloid leukaemia (AML)

Symptoms

The symptoms of AML can be vague at first and appear like flu. Other symptoms include:

  • Tiredness (fatigue)
  • Anaemia (fewer red blood cells)
  • Shortness of breath
  • Recurrent infections
  • Bleeding and unexplained bruising
  • Aching bones and joints
  • Weight loss
  • Loss of appetite
  • Swollen gums
  • High temperature

Even though these symptoms can be caused by conditions other than leukaemia, do have them checked by your family doctor (GP).

Screening

Testing for cancer when you have no symptoms is called screening. There is no national leukaemia screening programme in Ireland or anywhere else in the world. If you are worried about developing leukaemia, contact the National Cancer Helpline 1800 200 700 or speak to your GP.

Diagnosis

Visit your family doctor (GP) first if you are worried about any symptoms. He or she will examine you and arrange blood tests if needed. If your blood test is abnormal, you may be referred to a specialist called a haematologist, who treats abnormal changes to blood and bone marrow. At the hospital, some of the following tests may be done to diagnose AML:

  • Physical exam
  • Blood tests, such as a full blood count
  • Bone marrow biopsy
  • Lumbar puncture
  • Chromosome studies (cytogenetics)
  • Immunophenotyping

A bone marrow biopsy involves taking a small sample of marrow from the inside of your hip or breastbone and examining it under a microscope. Special tests can also be done on blood or bone marrow samples. For example, the number and shape of chromosomes in your blood cells, especially the lymphocytes, can be examined. These are then compared to normal cells. Sometimes in AML, part of one chromosome is moved to another chromosome and a new one formed. This is called the Philadelphia chromosome. Immunophenotyping can check what kind of proteins or markers are on the surface of the leukaemia cells.

Other tests

  • Chest X-Ray
  • CT scan
  • MRI scan
  • Lymph gland biopsy

The above scans can help to stage the cancer.

Learn more about the above tests

How acute myeloid leukaemia is classified

Most types of cancer are given a numbered stage, which describes their extent in the body. This depends on the size of the tumour and if it has spread in the body.

However acute myeloid leukaemia does not usually forms solids tumours but can involve the bone marrow and in some cases other organs such as the liver and spleen. Therefore the staging system for AML is different as it looks at different information about your cancer. Knowing the stage of your cancer allows your doctor to decide on the best treatment for you.

There are two systems used to classify AML into subtypes. These are the French-American-British (FAB) classification and the World Health Organisation (WHO) classification.

French-American-British (FAB) classification

The FAB classification divides acute myeloid leukaemia into subtypes M0 through to M7. It is based on how the leukaemia cells look under the microscope. It does not refer to how severe your cancer is.

M0: acute myeloid leukaemia with little myeloid differentiation

M1: acute myeloid leukaemia without maturation

M2: acute myeloid leukaemia with maturation

M3: acute promyelocytic leukaemia (APL)

M4: acute myelomonocytic leukaemia

M5: acute monocytic/monoblastic leukaemia

M6: acute erythroleukaemia

M7: acute megakaryoblastic leukaemia

World Health Organisation (WHO) classification

The WHO classification system divides AML into several broad groups by the type of abnormal myeloid cell and if:

  1. There are genetic changes in the cells.
  2. The leukaemia developed from a blood disorder.
  3. The leukaemia developed after chemotherapy and radiotherapy.
  4. More than one type of blood cell has abnormal changes.

Your doctor will also take other factors into account when deciding on the best treatment for you. These include:

  • Chromosome abnormalities
  • Gene mutations
  • Your age
  • Your white blood cell count
  • Previous blood disorders

Leukaemia cells in the central nervous system

Call our National Cancer Helpline

Freephone 1800 200 700 to talk to a specialist cancer nurse
It's open Monday-Thursday from 9am to 7pm and Friday from 9am to 5pm