Symptoms of Leukemia

The symptoms of leukemia may be very subtle at first and could be due to a wide range of causes. That said, some of the warning signs that should be addressed include fatigue and weakness, frequent infections, unexplained fevers, and enlarged lymph nodes. Other symptoms may include abnormal bruising or excessive bleeding (such as frequent nosebleeds or bleeding gums), a fullness in the abdomen, bone and joint pain, and neurological symptoms such as headaches, visual changes, or seizures. Unintentional weight loss may also occur.

Many symptoms overlap, and are not specific to the type of leukemia, while other symptoms may be more characteristic of a particular type of the disease. Leukemia cannot be diagnosed based on symptoms alone, but an awareness of these symptoms can suggest when further evaluation is needed.

Frequent Symptoms

The most common symptoms of leukemia are vague and non-specific. As a result, people tend to explain them away, saying that they feel like they are coming down with something or they’ve been feeling run-down lately. 

Some of the symptoms are easier to understand by talking about the effect leukemia has on specific blood cells produced by the bone marrow, since many of the signs are related to either an excess or deficiency of these different types of blood cells.

Leukemia affects white blood cells, but also frequently affects other cells produced by the bone marrow by interfering with their production or crowding out the bone marrow. Cells manufactured by the bone marrow include:

  • Red blood cells (RBCs): Red blood cells carry oxygen to the tissues of the body. A low red blood cell count is referred to as anemia.
  • White blood cells (WBCs): White blood cells are responsible for fighting off infections with organisms such as bacteria and viruses. A low white blood cell count is referred to as leukopenia. One type of white blood cell, neutrophils, are particularly important in fighting off the bacteria that cause infections such as pneumonia. A deficiency of neutrophils is referred to as neutropenia.
  • Platelets: Platelets or thrombocytes are the cells produced by the bone marrow that are responsible for blood clotting. A low platelet count is referred to as thrombocytopenia.

Fatigue

Excessive tiredness is a very common symptom of leukemia. Though there are many causes of fatigue, cancer fatigue tends to be more dramatic than the ordinary tiredness people feel when they lack sleep. The kind of fatigue associated with cancer often doesn't improve with a good night of rest and interferes with normal daily activities.

Cancer can cause fatigue in many ways. With leukemia, anemia, or a decreased number of red blood cells in the bloodstream is common, but the metabolism of the cancer cells and other reasons may contribute as well. A lack of red blood cells prevents adequate oxygen from being transported to the tissues and muscles leading to both fatigue and weakness. Anemia may also cause shortness of breath, pale skin, and a rapid heart rate.

Frequent Infections

Even when present in normal or increased numbers, cancerous white blood cells (leukemia) may not be able to adequately help your body fight off infection. In addition, the leukemia cells can crowd out other types of white blood cells in the bone marrow, preventing the body from ensuring an adequate supply. As a result, people affected by leukemia are often very prone to developing infections. Common sites of infection include the mouth and throat, skin, lungs, urinary tract or bladder, or the area around the anus.

Enlarged Lymph Nodes

Sometimes, leukemia cells can accumulate in the lymph nodes and cause them to become swollen and tender. People may be able to feel abnormally enlarged lymph nodes (lymphadenopathy) in the neck (axillary lymph nodes), armpit (cervical lymph nodes), or groin, but lymph nodes that can't be directly palpated can also cause symptoms as well. For example, enlarged lymph nodes in the chest (such as mediastinal lymph nodes) cannot be felt but may lead to shortness of breath, wheezing, or a cough.

Unexplained Fevers

Fevers without an obvious source, such as infection, can be a symptom of any cancer, but especially blood-related cancers such as leukemia. A fever of unknown origin is defined as a fever of greater than 101 degrees F (38.3 degrees C) that lasts more than three weeks (or occurs frequently) that does not have an obvious explanation. Fevers associated with leukemia can have a number of possible causes, including underlying infections. In some cases, leukemia cells can cause the body to release chemicals that stimulate the brain to raise body temperature.

Night Sweats

Night sweats can be a symptom of cancer, especially blood-related cancers like leukemia. Unlike the common hot flashes or sweating associated with menopause, night sweats related to leukemia are often dramatic. Instead of "sweating" the symptom may be described as "drenching" and people who experience this symptom often need to change their clothing, as well as bedding, during the night. The term night sweats is actually a bit of a misnomer, as "night sweats" may occur both during the day and at night.

Bruising or Excess Bleeding

When leukemia cells crowd the bone marrow, it can result in a decreased production of platelets. Platelets are actually fragments of cells that clump together to slow or stop bleeding when an injury occurs to a blood vessel. Bleeding due to a low platelet count can take many forms, including easy bruising, the formation of petechiae (tiny red spots on the skin), purpura (larger purple spots on the skin), heavy menstrual periods, nosebleeds, bleeding gums (especially with brushing and flossing), blood in the urine, or blood in the stool.

Abdominal Pain

Abnormal white blood cells may collect in the liver and spleen causing your abdomen to swell and become uncomfortable. This type of swelling can also decrease your appetite, or make you feel full early. Involvement of the spleen often causes pain in the right upper abdomen, whereas liver involvement often causes pain in the left upper abdomen.

Bone and Joint Pain

Bone and joint pain are most common in areas where there is a large amount of bone marrow, such as the pelvis (hips) or breastbone (sternum). This is caused by the crowding of the marrow with excessive numbers of abnormal white blood cells. In children, parent's may notice that a child is limping or not walking normally without any form of injury to explain the symptom.

Headaches and Other Neurological Symptoms

Headaches and other neurologic symptoms such as seizures, dizziness, visual changes and nausea and vomiting may occur when leukemia cells invade the fluid surrounding the brain and spinal cord ( cerebrospinal fluid). 

Unintentional Weight Loss

Unexplained weight loss may be a sign of leukemia, especially chronic leukemia. Unintentional weight loss is defined as a loss of five percent of body weight or more over a period of 6 months to 12 months.

Symptoms Related to Specific Types of Leukemia

While the symptoms above may be found with nearly any type of leukemia, there are some symptoms that are more common with different types of the disease. Acute leukemias are comprised of young white blood cells that do not function properly (like a toddler, or in some cases teenager), and therefore symptoms related to lack of function of these cells are common. With chronic leukemia, the white blood cells present may do their job, at least to a degree. Symptoms, in this case, are often due to the large number of cells present (in areas such as the spleen) as well as the crowding out of the bone marrow so that new blood cells cannot be produced. Symptoms related to the different subtypes of leukemia include:

Acute Lymphocytic Leukemia (ALL)

The symptoms of acute lymphocytic leukemia often develop rapidly over the course of days or a few weeks. If ALL spreads to the central nervous system, symptoms such as headaches, blurry vision, dizziness, and sometimes seizures may occur. When ALL spreads to the chest, shortness of breath and a cough may occur. With T cell ALL, enlargement of the thymus gland may lead to symptoms. The thymus gland lies behind the breastbone and in front of the trachea. Compression of the trachea may lead to difficulty breathing. Compression of the large vein returning blood from the upper body to the heart (the superior vena cava) may cause symptoms referred to superior vena cava syndrome. This syndrome can include marked swelling of the face, neck, upper arms, and upper chest.

Chronic Lymphocytic Leukemia (CLL)

The first symptom of chronic lymphocytic leukemia is often enlarged, painless lymph nodes in the neck, armpit, and groin. Other symptoms may come on very gradually and can include what are known as the 
"B symptoms," including fevers, chills, night sweats, and weight loss. In roughly 5 percent of people, CLL transforms to an aggressive lymphoma (Richter transformation) with marked enlargement of lymph nodes and tumors of white blood cells in other regions of the body.

Acute Myeloid Leukemia (AML)

Acute myeloid leukemia, like ALL, often comes on rapidly with the symptoms discussed above. AML is somewhat unique in that the immature white blood cells (blast cells) can clog blood vessels, something called leukostasis. This can result in symptoms similar to a stroke, with visual changes or weakness of one side of the body. Greenish-tinged rashes may occur called chloromas, due to the spread of AML cells under the skin. A condition called Sweet's syndrome may also occur. This syndrome is characterized by recurrent fevers and a build-up of white blood cells in the dermal layer of the skin, resulting in painful skin lesions scattered on the head, arms, neck, and chest.

Acute Promyelocytic Leukemia

Acute promyelocytic leukemia accounts for around 10 percent of AML cases and is distinctive in that the most prominent symptoms usually involve both excessive bleeding and excessive blood clotting. This may include nosebleeds, heavy periods, and bruising, but also leg and calf pain and swelling (due to deep vein thrombosis) and the sudden onset of chest pain and shortness of breath that can accompany pulmonary emboli (blood clots that break off in the legs and travel to the lungs).

Chronic Myeloid Leukemia (CML)

Chronic myeloid leukemia is most often suspected before any symptoms are present when the results of a complete blood count (CBC) are abnormal. Even after diagnosis, people with CML may have few if any symptoms for a lengthy period of time (months or years) before the leukemia cells begin to grow more quickly and cause symptoms. 

Chronic myelomonocytic leukemia (CMML)

Chronic myelomonocytic leukemia often affects many parts of the body, not just the bone marrow. Collections of monocytes in the spleen lead to enlargement (splenomegaly) which can cause pain in the left upper abdomen and fullness with eating. Collections of monocytes can cause enlargement of the liver (hepatomegaly) resulting in pain in the right upper abdomen as well.

Complications

There are many possible complications of leukemia, with several of these related to the deficiency of the different types of white blood cells. A few of the more common concerns include:

Severe Infections

A reduced level of white blood cells reduces the body's ability to fight infections, and even relatively minor infections may become life-threatening. Infections such as urinary tract infections, pneumonia, and skin infections can rapidly progress to sepsis and septic shock (a widespread infection often accompanied by a drop in blood pressure and reduced level of consciousness).

During treatment, other infections, such as the fungal infection pulmonary aspergillosis, or systemic (widespread) infections with the chickenpox virus or cytomegalovirus, are also potentially serious and life-threatening complications of the disease.

Serious Bleeding

While bleeding is common when the platelet count is low, bleeding in certain regions of the body can be life-threatening. This includes:

  • Intracranial hemorrhage: Bleeding into the brain can result in the rapid onset of confusion or unconsciousness.
  • Pulmonary hemorrhage: Bleeding in the lungs may result in severe shortness of breath, and coughing up blood.
  • Gastrointestinal hemorrhage: Bleeding into the stomach and/or intestines can result in vomiting large amounts of blood and a rapid drop in blood pressure.

Sources:

Centers for Disease Control and Prevention. Leukemia. Updated 06/12/18.