This guide explains the early signs of leukemia.
Leukemia is a cancer of the blood in which malignant blood cells grow and multiply in place of healthy ones. This uncontrolled growth of abnormal cells starts in the red bone marrow, where blood cells are made through a process called hematopoiesis. In a nutshell, hematopoiesis involves differentiating stem cells (infant cells) into two types of blast cells — myeloblasts and lymphoblasts. Blast cells are immature versions or precursors of specialized cells. Myeloblasts develop into red blood cells and platelets, while lymphoblasts divide into the various types of immune cells.
Leukemia occurs after a critical gene mutation during hematopoiesis causes the affected blast cells to stop differentiating and start to multiply instead. These cancerous cells accumulate in the bone marrow, where they use up valuable resources, compromising hematopoiesis. The immature cells eventually leak into the bloodstream and the lymphatic system and spread throughout the body.
There are two main types of leukemia: myeloid leukemia, which occurs in myeloblasts, and lymphoid leukemia, which affects lymphoblasts. The disease can be either acute or chronic depending on which stage of hematopoiesis the leukemic gene mutation happens. Acute leukemia develops quickly with an abrupt onset of symptoms and often requires prompt treatment. Chronic leukemia, on the other hand, develops gradually and is characterized by subtle symptoms. Treatment and management for chronic leukemia usually span over several years.
Early Signs of Leukemia
Like many other cancers, leukemia symptoms worsen over time as the disease progresses. Lymphoid leukemia goes through five stages — Stage 0 to Stage 4. The Modified RAI Staging System categorizes Stage 0 patients as “Low Risk,” Stage “1 and 2” as “Intermediate Risk,” and Stage “3 and 4” as “High Risk.” The staging of myeloid leukemia is a bit different. It has three stages: the Chronic Phase, the Accelerated Phase, and the Blast Phase.
The very early stages of leukemia, Stage 0 of lymphoid leukemia and the Chronic Phase of myeloid leukemia, are generally asymptomatic, although some patients may present with mild symptoms. Most patients experience leukemic symptoms during the intermediate stage of the disease. Below are the early signs and symptoms of leukemia:
Bone and joint pain
Leukemic cells build up in the red bone marrow, mostly found in flat bones such as the pelvis, sternum, and scapula. This may cause bone or joint pain around the hips, the chest’s midsection, and shoulders. The pain can range from mild discomfort and dull ache to sharp throbbing.
Enlarged lymph nodes (lymphadenopathy)
Lymph nodes are small bean-shaped glands that form part of the lymphatic system. They are responsible for filtering the lymphatic fluid and housing lymphocytes that help neutralize infections. Usually, enlarged lymph nodes are a harmless indication that the body’s immune system is hard at work fighting off pathogens or allergens. But in some cases, lymphadenopathy might signal leukemia.
Cancerous cells can accumulate in the lymph nodes causing them to swell up and form noticeable lumps on the neck, armpits, or groin area. These can be mistaken for a natural response to infection. However, leukemic lymphadenopathy has the following distinctive characteristics:
- The swelling lasts for more than two weeks.
- The glands continue to grow in size over time.
- The nodes feel hard or stiff to the touch.
- There is no noticeable pain, tenderness, warmth, or redness on the swollen nodes.
Abdominal swelling and discomfort
Since the red bone marrow can no longer produce enough healthy blood cells, the liver and spleen pick up the slack and start synthesizing and activating blood cells through extramedullary hematopoiesis (EMH). This response, coupled with the accumulation of cancer cells, causes both the spleen and liver to enlarge and push against the surrounding tissues and organs. While the swelling might not be externally visible at first, some patients experience discomfort or pain around the upper part of the abdomen.
Loss of appetite
As the liver and spleen swell, they constrict part of the stomach and duodenum, leading to early satiety (feeling full after eating only a small amount of food). Consequently, the patient starts to lose appetite and body weight.
Easy bruising and bleeding
When blood vessels are injured, platelets stick together and trap red blood cells to form a sealing clot around the wound. Clotting stops bleeding, promotes healing, and prevents infection. The onset of leukemia causes the platelet level to drop below 100,000 cells per microliter of blood, a condition known as thrombocytopenia. Due to the low platelet count, leukemic individuals are abnormally highly susceptible to bruising and bleeding.
Small red spots under the skin (petechiae)
Petechiae are pinhead-sized red, purple, or brown spots that appear just under the skin’s surface. They form when blood capillaries break and leak blood into the dermis. In most patients, petechiae form in clusters resembling skin rashes. But unlike typical rashes, petechiae do not change color when squeezed or pressed.
The spots can appear anywhere on the patient’s body, either spontaneously or through triggers such as scratching an itch.
Nonspecific symptoms
There are several other symptoms not directly linked to leukemia but its secondary effect on the patient’s body. These are mainly flu-like symptoms brought about by dwindling blood cell levels, inflammation, and splenomegaly (enlargement of the spleen), among other leukemia-related conditions. They include:
- Chronic fatigue
- General body weakness
- Shortness of breath
- Fever and chills
- Night sweats
- Dizziness
- Headaches
When to See a Doctor
Like other types of cancer, leukemia treatment is most effective if the disease is caught in its early stages. So, it’s important to watch out for these symptoms. Unfortunately, signs of leukemia can vary between patients. Also, some leukemia symptoms mimic many other illnesses, especially those related to viral infections and cardiovascular health.
While having any or even all these signs is not absolute proof of leukemia, it’s always advisable to seek expert medical opinion when exhibiting any unusual symptoms. Those experiencing such symptoms for more than two weeks without noticeable improvements should consult a doctor. Symptoms that keep recurring are also worth looking into.
The doctor will run some tests if they find enough cause to suspect leukemia from a patient’s symptoms or routine check-up. Leukemia diagnostic and prognostic exams include:
- Complete blood count (CBC) – This measures the levels of red blood cells, white blood cells, and platelets.
- Blood cell examination – The doctor checks a blood sample for the presence of malignant cells or other markers of leukemia.
- Bone marrow biopsy – A needle is inserted into the red bone marrow, usually in the pelvic bone, to draw a marrow tissue or fluid sample for external examination.
- Imaging – X-ray, CT scan, and MRI images can show bone and tissue damage caused by leukemia, particularly in the sternum.
- Lumbar puncture – The doctor draws a sample of spinal fluid to test for leukemic cells in the nervous system.
Only a clinical exam can accurately diagnose leukemia. But that’s not to say that signs of leukemia should not be ignored. On the contrary, they should be the reason for getting tested in the first place. If the disease is detected, treatment can begin accordingly.
Reach out to Brio-Medical for more information about leukemia diagnosis, treatment, and management. Brio-Medical is a cancer center dedicated to providing professional alternative treatment and care to cancer patients in Scottsdale, Arizona.
