Signs and Symptoms

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Signs and Symptoms
UCSF Children's Hospital

Last updated May 5, 2008

Leukemia
Signs and Symptoms

Two general categories of leukemia are acute and chronic. In acute leukemia, symptoms appear quickly and worsen quickly. This form of leukemia may develop over a short period of days to weeks. Abnormal white blood cells may collect in the brain or spinal cord. The result may be headaches, vomiting, confusion, loss of muscle control and difficulty seeing. Some patients develop sores in the eyes or unusual skin rashes. Leukemia also can affect the lungs and other parts of the body.

In chronic leukemia, symptoms may not appear for months or years. Doctors may find chronic leukemia during a routine exam before any symptoms arise. This form of leukemia may develop over longer periods covering months or years before symptoms are apparent. When symptoms do appear, they tend to be mild and worsen gradually. Abnormal white blood cells may gradually collect in various parts of the body, affecting areas such as the skin, central nervous system, digestive tract, kidneys and testicles.

The two primary types of childhood leukemia are acute lymphocytic leukemia (ALL) and acute myelogenous leukemia (AML). These two acute forms of leukemia can develop over a short period of days to weeks. A third chronic form, chronic myelogenous leukemia (CML), is rare among children.

* Acute Lymphocytic Leukemia (ALL) — Acute lymphocytic leukemia — also called lymphoblastic or lymphoid leukemia — accounts for about 75 percent to 80 percent of childhood leukemia. In this form of the disease, the lymphocyte cells, which normally fight infection, are affected. When acute lymphocytic leukemia occurs, the bone marrow makes too many lymphocyte cells that do not mature correctly. The lymphocyte cells overproduce, crowding out other blood cells. Immature blood cells or blasts don't work properly to fight infection. Chromosome abnormalities, or extra chromosomes and structural changes in the chromosome material, are present in the majority of ALL patients.

* Acute Myelogenous Leukemia (AML) — Acute myelogenous leukemia — also called granulocytic, myelocytic, myeloblastic or myeloid leukemia — accounts for about 20 percent of childhood leukemias. Acute myelogenous leukemia is a cancer of the blood in which too many granulocytes, a type of white blood cell that normally fights infection, are produced in the marrow and they don't mature correctly. The immature blood cells or blasts don't work properly to fight infection. The excessive number of these abnormal cells crowd out other healthy blood cells. Children with certain genetic syndromes, including Fanconi anemia, Bloom syndrome, Kostmann syndrome and Down syndrome, have a higher risk of developing AML.

* Chronic Myelogenous Leukemia (CML) — Chronic myelogenous leukemia is the more slowly developing form of myelogenous leukemia and is rare among children. It may develop over a period of months or years. Children with CML have a chromosome rearrangement. Part of chromosome No. 9 breaks off and attaches itself to chromosome No. 22, creating an exchange of genetic material. This rearrangement changes the position and function of certain genes, causing uncontrolled cell growth. Other chromosome abnormalities also can occur.

Like all blood cells, leukemia cells travel throughout the body. Depending on the number of abnormal cells and where these cells collect, patients with leukemia may have a number of symptoms.

Here are some general leukemia symptoms:

* Anemia — Children with leukemia often have fewer than normal healthy red blood cells and platelets. They lack enough red blood cells to carry oxygen through the body, which causes a condition called anemia. Children with anemia may look pale, feel weak and tired and bleed and bruise easily.

* Recurrent Infections — Although children with leukemia may have a high number of white blood cells, these white blood cells are immature and don't fight infection. Children may experience repetitive viral or bacterial infections. They often have symptoms of infection such as fever, runny nose and cough.

* Bone and Joint Pain — Pain in bones and joints is another common symptom of leukemia. This pain is usually a result of the bone marrow being overcrowded and "full."

* Abdominal Distress — Abdominal pain also may be a symptom. Leukemia cells can collect in the kidney, liver and spleen, causing enlargement of these organs. Pain in the abdomen may cause a loss of appetite and weight.

* Swollen Lymph Nodes — Lymph nodes under the arms, in the groin, chest and neck may become swollen when leukemia cells collect in the nodes. Lymph nodes filter the blood.

* Difficulty Breathing or Dyspnea — With T-cell acute lymphocytic leukemia, leukemia cells tend to clump together around the thymus gland. This mass of cells present in the middle of the chest can cause pain and difficulty breathing. Wheezing, coughing or painful breathing requires immediate medical attention.

Reviewed by health care specialists at UCSF Children's Hospital.

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