Leukemia Warning Signs and Symptoms

Adam Berry/Stringer/Getty Images News/Getty Images

Leukemia starts in the bone marrow, where white blood cells are produced and where all of the blood-forming cells reside. Think of the bone marrow as your body’s factory for producing all of its blood cells—red cells, white cells and clot-forming platelets.

To use the example of a car factory, you might start out with a basic shell or frame of a car that slowly gets put together on the assembly line to eventually become a brand-new car.

If the employees in charge of making the basic car frame go overboard, depending on how excessively productive they have been, you’ll have lots of extra car frames piling up, and this mess might even slow production of the finished, completely assembled new cars.

In leukemia, there is an overproduction of white blood cells that are abnormal or “stuck” in an early stage of development—they are often like your basic car frames that never got fully assembled into new cars. These leukemia cells may not be able to do the job of the healthy, mature white blood cells. In addition, their presence in the bone marrow is apt to crowd out and prevent normal blood-forming cells from meeting their production quotas. Both the production of these abnormal cells and the effect of crowding out of the normal tissue contribute to the signs and symptoms of leukemia.

Types of Leukemia

There are two types, or main categories, of leukemia that are named for how the leukemia usually behaves in the body—acute, and chronic.

There are also two types, or main categories, of leukemia based on “which assembly line” in the bone marrow you are talking about: Are you building a Jaguar or a Lexus? That is, are you making a myelogenous blood cell or a lymphoblastic blood cell?

The terms acute, chronic, myelogenous and lymphocytic/blastic are used and combined to give you the four basic types of leukemia:

  • Acute lymphoblastic leukemia (ALL)
  • Acute myelogenous leukemia (AML)
  • Chronic lymphocytic leukemia (CLL)
  • Chronic myelogenous leukemia (CML)

So, you could say that there are two basic types of acute leukemia (ALL and AML) and two basic types of chronic leukemia (CLL and CML); or, you could say that there are two basic types of lymphoid leukemias (ALL and CLL) and two basic types of myeloid leukemias (AML and CML). Stated either way, you’d be correct.

Overview of Signs and Symptoms

In many cases, symptoms from leukemia may be very subtle. That said, some of the warning signs that bring patients with leukemia to medical attention more promptly include: weakness and fatigue; unexplained fevers and infections; abnormal bruising or excessive bleeding (bleeding gums, red spots under skin, nosebleeds); fullness in the abdomen, pain in the hips or breastbone; symptoms that involve the nervous system such as headaches, visual changes, nausea/vomiting; and sometimes lymph node swelling.

Leukemia is not diagnosed based on symptoms, alone. Many symptoms overlap, or are not specific to either disease, while some other symptoms may be more characteristic of one disease or the other.

When acute leukemia is diagnosed, usually there are already a large number of rapidly growing leukemia cells present.

Signs and symptoms may have been present for less than three months or even just a few days. On the other hand, chronic leukemia develops more slowly and produces cells that tend to function more normally in doing their jobs than the immature cells of acute leukemia.  As such, the signs and symptoms of chronic leukemia may be absent at first, or may take years to develop. In fact, many cases of chronic leukemia are found by chance during routine check-ups.

Most Common Symptoms

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

Cases of acute and chronic leukemia can produce very different initial symptoms, however. The most common symptoms of leukemia (both acute and chronic, combined) include the following:

  • Feeling Weak, Tired, or Generally Unwell. In most cases, this is caused by a decreased number of red blood cells in the bloodstream or anemia. This prevents adequate oxygen being transported to your tissues and muscles, leaving your body feeling fatigued and weak.
  • Frequent Infections. Leukemia cells may not be able to adequately help your body fight off infection. What is more, the leukemia can crowd out other cells in the bone marrow, preventing the body from ensuring an adequate supply of white blood cells. As a result, people affected by leukemia are 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.
  • Unexplained Fevers. In some cases, leukemia cells can cause your body to release chemicals that stimulate your brain to raise your body temperature. Fevers can also be caused by an infection.
  • Abnormal Bruising or Excessive Bleeding. Leukemia cells causing crowding in the bone marrow prevent the production of red blood cells white blood cells and platelets. The platelets are fragments of cells that clump together and stop or slow bleeding when an injury occurs to a blood vessel. When there are insufficient platelets, called thrombocytopenia, bleeding may occur in the form of nosebleeds, heavy menstrual bleeding, bleeding gums, bruises and tiny red spots under the skin called petechiae.
  • 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.
  • Enlarged Lymph Nodes. Sometimes, leukemia cells can accumulate in the lymph nodes and cause them to become swollen and tender.
  • Abdominal Discomfort. Abnormal white blood cells can also 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.
  • Headaches and Other Neurological Complaints. Headaches and other neurologic symptoms such as seizures, dizziness, visual changes and nausea and vomiting may occur when leukemia cells invade the fluid surrounding your brain and spinal cord, or cerebrospinal fluid. This type of central nervous system involvement is most common in acute lymphocytic leukemia (ALL).

Symptoms of Certain Leukemia Types

  • Symptoms of Acute Leukemia in Children: Find out more about the symptoms, which can include anemia, bruising or bleeding, frequent infections, bone or joint pain and swollen lymph nodes.
  • Acute Promyelocytic Leukemia (APL): This type of leukemia has some characteristic symptoms involving bleeding and clotting in addition to the usual non-specific symptoms.
  • Acute Lymphocytic Leukemia (ALL): This type of leukemia mostly strikes children. In addition to the usual non-specific symptoms, it can have neurological symptoms if it penetrates into the cerebrospinal fluid of the brain and spinal cord.
  • Chronic Myelogenous Leukemia (CML): As many as 40 percent of CML patients had no symptoms at all—it was found on a routine checkup or visit for another ailment.

Diagnosis and Testing

Doctors use a variety of testing methods to diagnose blood cancers, stage them, and determine their response to various treatments.

  • You can expect blood tests such as the complete blood count and peripheral blood smear.
  • Often other tests such as bone marrow tests are required.
  • Initial diagnosis of leukemia requires a biopsy specimen in many cases. This might be a bone marrow smear and biopsy. In some cases, especially with CLL, a bone marrow sample is not required for diagnosis, as the abnormal cells are easily found in the blood, however it may be done before starting treatment for CLL. Additional testing of the cells is often performed with descriptive reporting, including microscopic appearance but also results of testing for specific markers and genes.
  • Depending on the type of leukemia, spinal fluid may also be tested; there may also be chest x-rays, PET/CT scans and other tests as well.

A Word From Verywell

It is very important to note that these signs and symptoms can also be caused by many other, non-cancerous conditions. If you are worried about any symptoms you are experiencing, you should always seek assistance from a qualified healthcare provider.

Leukemia cannot be diagnosed and fully evaluated based on the presence of signs and symptoms alone. There are a number of tests and procedures that must be completed to confirm a suspected case of leukemia.

Sources:

Arber DA, Orazi A, Hasserjian R, et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood. 2016 May 19;127(20):2391-405.

Swerdlow SH, Campo E, Pileri SA, Harris NL, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood. 2016 May 19;127(20):2375-90.

Continue Reading