Leukemia is a type of blood cancer that starts in the bone marrow, the soft tissue inside the bones where blood cells are made. In leukemia, blood cells — especially white blood cells, which help fight infections — multiply too quickly and crowd out healthy cells. This overcrowding of abnormal cells causes symptoms that may develop gradually or resemble common illnesses, like a cold or flu. Many people don’t notice symptoms at first, and leukemia symptoms often change or worsen as the disease progresses.

Common symptoms of leukemia may also be side effects of its treatments. Your doctor can help you understand the cause of your symptoms and discuss ways to manage them.

Symptoms Vary by Type of Leukemia

Doctors classify leukemia by the type of white blood cells involved and by how fast it progresses. If it develops rapidly, it’s called acute leukemia, which comes on suddenly and requires treatment right away. If it develops more slowly, it’s called chronic leukemia, which progresses gradually and may allow for different treatment approaches. These differences mean that each type of leukemia can cause unique symptoms.

The four main types of leukemia are outlined below.

Acute Lymphoblastic Leukemia

Many symptoms of acute lymphoblastic leukemia (ALL) are caused by low levels of healthy blood cells. ALL reduces the number of white blood cells (important for fighting infection), red blood cells (which carry oxygen), and platelets (necessary for blood clotting). This reduction in healthy cells often leads to symptoms of ALL.

In ALL, leukemia cells can spread to other parts of the body and cause symptoms, but this is rare. Symptoms of ALL spreading that don’t overlap with common symptoms of leukemia include the following:

• In the brain and spinal cord (central nervous system), 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.

Although this is rare, ALL can sometimes spread to other areas, such as the skin, testes, eyes, ovaries, or kidneys.

Acute Myeloid Leukemia

Acute myeloid leukemia (AML) is also known as acute myelogenous leukemia. Similar to ALL, AML can also cause anemia and thrombocytopenia (low levels of platelets), which are associated with most AML symptoms.

Additionally, AML can cause leukostasis, which occurs when AML causes high numbers of immature white blood cells called blasts to clog the blood vessels. Rare but dangerous, leukostasis requires emergency medical attention. Symptoms of leukostasis that aren’t common symptoms of leukemia include:

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

Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma

Chronic lymphocytic leukemia (CLL) is the most common kind of leukemia among adults in Western countries. CLL and small lymphocytic lymphoma (SLL) are cancers of the same type of blood cell, known as lymphocytes. In CLL, the cancer cells are mostly in the bone marrow. In SLL, they are mostly in the lymph nodes. Some types of CLL move quickly, while others progress very slowly. The type of cancer you have will determine your best treatment options.

Chronic Myeloid Leukemia

Chronic myelogenous leukemia (CML) is also known as chronic myeloid leukemia. Symptoms associated with CML aren’t often specific, 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. Despite all of the possible symptoms, most cases of CML are found when those without any symptoms have a high white blood cell count. Many people with CML will have an enlarged spleen, which is often noticed due to abdominal pain and loss of appetite.

Common Signs of Leukemia in Adults and Children

Each person’s body is unique, so people with leukemia may experience their symptoms in different ways. Keep reading to learn about some of the most common symptoms of leukemia, including mild and less obvious signs.

1. Symptoms Associated With Anemia

Anemia occurs when the body has low levels of red blood cells. It’s associated with all four types of leukemia. People with anemia may experience:

• Fatigue
• Shortness of breath
• Weakness
• Dizziness
• Pale skin
• Feeling cold all the time
• Frequent headaches

People with anemia can have a range of symptoms. Some may have all the symptoms, while others might only have one or two.

2. Fever

Fevers are another common symptom of all types of leukemia. Most of the time, fevers from leukemia are caused by other infections, especially in children.

3. Weight Loss

Another common symptom of all types of leukemia is weight loss. People with ALL, AML, CLL/SLL, and CML may lose weight. Note that this specifically refers to weight loss that you can’t explain. If you’re losing weight without trying or losing more weight than is healthy for your body although you’re eating normally, it may be a symptom of leukemia.

4. Splenomegaly

People sometimes wonder how leukemia affects the digestive system. Those with any of the four types of leukemia, especially CML, may experience spleen swelling, known as splenomegaly. Although the spleen isn’t part of the digestive system, splenomegaly can cause abdominal discomfort, including a feeling of fullness after just a few bites or a sense of pressure in the abdomen.

5. Swollen Lymph Nodes

All four types of leukemia can cause swollen lymph nodes, especially in the neck, although this is less common in CML than in other types. In CLL/SLL, swollen lymph nodes are most likely to appear in the neck rather than other areas.

6. Night Sweats

Night sweats are common in both CLL and CML, though they can also occur with other types of leukemia. Most people who experience night sweats wake up drenched in sweat during the night. It may happen every night or multiple times a night, but it can also be scattered across several nights over weeks or months.

7. Bruising or Bleeding Easily

People with any of the four types of leukemia may bruise or bleed more easily than they used to, along with other related symptoms. This bruising or bleeding usually happens because there are too few platelets in the blood and may look like:

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

Bleeding is most common in those with acute promyelocytic leukemia (APL), a subtype of AML where immature white blood cells build up in the bone marrow and interfere with blood clotting. In contrast, people diagnosed with CML may, in some cases, have too many platelets, which can lead to other symptoms, including abnormal clotting.

8. Bone and Joint Pain

Bone or joint pain is associated with all the different types of leukemia. Across leukemia types, about 20 percent of people have bone or joint pain before they are diagnosed. This pain usually occurs because abnormal white blood cells are filling the bone marrow, causing swelling and pain.

9. Frequent Infections

Infections may be more likely in all types of leukemia. However, they are particularly common in people with AML because it causes a shortage of healthy white blood cells, which function in the immune system to fight viruses and bacteria. Abnormal cells cannot fight infection.

People with CLL/SLL and CML may also be more likely to experience infections because of low levels of healthy white blood cells. As a result, people with CLL/SLL may develop infections in the skin, kidneys, and lungs.

10. Depression and Anxiety

Approximately 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 anxiety, stress, and worry that arise as a result of living with a chronic condition.

Treating depression can benefit people living with cancer and may even lead to better outcomes. Treatments for depression may include antidepressant medication and psychotherapy techniques, such as cognitive behavioral therapy. 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.

What Are the First Signs of Leukemia?

Most of the symptoms in the list above qualify as early signs of leukemia. Symptoms associated with anemia are common, as is unusual bleeding or bruising. If you notice any of these, it’s time to talk to your health care provider. They can help you decide if you should be tested for leukemia.

Leukemia Symptom or Treatment Side Effect?

It can be difficult to tell the difference between the symptoms of leukemia and the side effects of chemotherapy, radiation therapy, stem cell transplantation, or other treatments used to fight it. Some signs 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.

Find Your Team

On MyLeukemiaTeam, the social network for people with leukemia and their caregivers, more than 20,000 members come together to ask questions, give advice, and share their experiences with others who understand life with different forms of leukemia.

If you or a loved one has been through leukemia treatment, what symptoms or side effects have been the most surprising or challenging to manage? Share your experience in the comments below, or start a conversation by posting on your Activities page.