Leukemia is a type of blood cancer in which blood stem cells develop abnormally and excessively in the bone marrow. Leukemia causes symptoms when abnormal white blood cells begin to crowd out healthy blood cells and spread. Leukemia is closely related to other types of blood cancer, such as lymphoma, myeloma, and myeloproliferative neoplasms (MPNs).

Many people experience no symptoms of leukemia when they are first diagnosed. Some symptoms of leukemia can resemble those of a common virus such as a cold or the flu. Leukemia symptoms may change or worsen over time as the cancer progresses.

Some common symptoms of leukemia are also typical side effects of leukemia treatments. Your doctor can help you understand where symptoms are coming from and how best to manage them.

Common Leukemia Symptoms

Symptoms of leukemia can vary by your age and type of leukemia. Still, some symptoms are common across leukemia types. In general, the most common symptoms of leukemia are:

• Fatigue
• Shortness of breath
• Fever
• Night sweats
• Bruising or bleeding easily
• Bone pain
• Joint pain
• Frequent infections

Symptoms by Type of Leukemia

Doctors classify leukemia by the type of white blood cells involved and by whether the cancer progresses quickly (acute leukemia) or more slowly (chronic leukemia). Because of these differences, each type of leukemia can cause different symptoms.

The four main types of leukemia are:

• Acute lymphoblastic leukemia (ALL)
• Acute myeloid leukemia (AML)
• Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL)
• Chronic myeloid leukemia (CML)

Symptoms of Acute Lymphoblastic Leukemia

Many symptoms of ALL are caused by low levels of healthy blood cells. For instance, anemia (low levels of red blood cells) can cause fatigue, weakness, pale skin, dizziness, and shortness of breath because the tissues of the body are not getting enough oxygen.

Similarly, ALL can also cause thrombocytopenia, or low levels of platelets, the blood cell fragments necessary for blood to clot effectively. Low levels of platelets can lead to ALL symptoms including:

• Bruising easily
• Petechiae (tiny red or purple spots on the skin)
• Nosebleeds
• Bleeding gums
• Heavier-than-normal menstrual bleeding

ALL can cause swelling in the lymph nodes or spleen (known as splenomegaly). Splenomegaly may cause abdominal discomfort or a feeling of fullness after only a few bites.

Rarely in ALL, leukemia cells can spread to other parts of the body and cause symptoms. Symptoms of ALL spreading may include the following:

• In the brain and spinal cord (central nervous system or CNS), ALL can cause headaches, seizures, balance problems, and blurred vision.
• In the chest, ALL may cause fluid to build up, resulting in breathing trouble.
• In the thymus (a small organ in the chest), ALL can cause coughing, difficulty breathing, and swelling in the face and upper body.

In rare cases, ALL can also affect the skin, testes, eyes, ovaries, or kidneys.

Symptoms of Acute Myeloid Leukemia

AML is also known as acute myelogenous leukemia. Similar to ALL, AML can also cause anemia. Anemia may result in:

• Fatigue
• Weakness
• Pale skin
• Feeling cold
• Dizziness
• Headaches
• Shortness of breath

Infections are common in people with AML since they often have a shortage of healthy white blood cells, which function in the immune system to fight viruses and bacteria. Abnormal cells cannot fight infection.

Low levels of platelets may result in abnormal bleeding, bruising, and heavy menstrual periods.

AML can cause splenomegaly. This swelling in the lymph nodes and spleen can cause abdominal discomfort and feeling full early in a meal. AML can also spread to the CNS, testes, kidneys, gums, and skin.

Leukostasis occurs when AML causes high numbers of abnormally large white blood cells called blasts to clog the blood vessels. Rare but dangerous, leukostasis requires emergency medical attention. Symptoms of leukostasis include:

• Headache
• Confusion
• Drowsiness
• Slurring words
• Weakness on one side of the body

Symptoms of Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma

People with CLL/SLL may experience unexplained weight loss, mild fevers, and night sweats. The low levels of red blood cells characteristic of anemia can cause fatigue and shortness of breath. Low levels of healthy white blood cells make it harder for the immune system to fight off infections. As a result, people with CLL/SLL may experience infections in the skin, kidneys, and lungs.

Lymph nodes may become enlarged, especially the lymph nodes located in the neck. The spleen may also become swollen, causing sensations of abdominal pressure or fullness.

Symptoms of Chronic Myeloid Leukemia

CML is also known as chronic myelogenous leukemia. Symptoms associated with CML are often nonspecific, and it may be unclear what is causing them. Like in other types of leukemia, many symptoms are directly caused by abnormal levels of healthy blood cells.

• Anemia causes fatigue, weakness, and shortness of breath.
• Leukopenia and neutropenia (low white blood cell counts) leave the immune system weakened and lead to infections.
• Abnormal bleeding, clotting, or bruising can be caused by problems with platelets — either too few or too many.

Other symptoms of CML can include:

• Bone or joint pain caused by cancer cells spreading out of the bone marrow
• Abdominal pain or a feeling of fullness caused by an enlarged spleen
• Night sweats
• Weight loss
• Fever

Despite the above possible symptoms, the majority of cases of CML are detected by an elevated white cell count in people without any symptoms.

Depression and Anxiety

Between 15 percent and 25 percent of those living with cancer are affected by depression. According to the National Institute of Mental Health, the risk factors for depression are higher in people with chronic illnesses. Depression may be triggered by feelings of anxiety, stress, and worry that arise as a result of living with a chronic condition.

There is some evidence that treating depression has benefits for people living with cancer, and may even improve outcomes. Treatments for depression may include antidepressant medication and psychotherapy techniques, such as cognitive behavioral therapy (CBT). Having an active support system, whether family members, friends, a spiritual community, or online or in-person support groups, can make it easier to cope with these challenges.

Leukemia Symptom or Treatment Side Effect?

It can be difficult to tell the difference between symptoms of leukemia and side effects of chemotherapy, radiation therapy, stem cell transplantation, or other treatments used to fight it. Some manifestations are more likely to be side effects of treatment options rather than symptoms directly caused by leukemia. These include:

• Hair loss
• Diarrhea
• Constipation
• Mouth sores

Symptoms of leukemia and side effects from treatments are likely to be different for each person, depending on many factors. Be sure to report any new or worsening symptoms or side effects to your doctor. Many symptoms and side effects can be managed with medications or lifestyle changes.

Leukemia Condition Guide

• Leukemia — An Overview
• What Causes Leukemia?
• Types of Leukemia
• Treatments for Leukemia
• Leukemia — The Path to Diagnosis
• Conditions Related to Leukemia