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Questions to Ask Your Doctor About Your Cancer
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Signs and Symptoms

The first indications of leukemia often are nonspecific or vague. They may occur with other cancerous as well as noncancerous disorders. Although signs and symptoms vary for each type of leukemia, there are some general features. Broad symptoms of leukemia may include:

• Fatigue
• Malaise (vague feeling of bodily discomfort)
• Abnormal bleeding
• Excessive bruising
• Weakness
• Reduced exercise tolerance
• Weight loss
• Bone or joint pain
• Infection and fever
• Abdominal pain or "fullness"
• Enlarged spleen, lymph nodes, and liver

Chronic leukemia often goes undetected for many years until it is identified in a routine blood test. In fact, nearly one in five chronic leukemia patients have no symptoms at the time of their diagnosis. Most symptoms of acute leukemia are caused by a lack of normal blood cells. This is due to overcrowding of the blood-forming bone marrow by leukemia cells.

Signs of Blood Abnormalities

Once the patient's blood is tested, signs of specific blood abnormalities may be noted, such as:

• Anemia - a low number of erythrocytes (red blood cells) within the blood. Anemia can cause fatigue, "pale" skin coloration, and respiratory difficulties such as shortness of breath.
• Leukopenia - a low number of normal leukocytes (white blood cells) that may increase the risk of infection.
• Neutropenia (granulocytopenia) - too few mature neutrophils, the mature bacteria-destroying white blood cells that contain small particles, or granules.
• Thrombocytopenia - a low number of blood-clotting platelets that can result in excessive bruising, abnormal bleeding, or frequent bleeding of the nose or gums.
• Thrombocytosis - a high number of platelets. Some patients, especially those with chronic myelogenous leukemia (CML), may exhibit thrombocytosis, although their platelets may not clot properly, causing bruising and bleeding difficulties.

Because leukemia may cause enlarged spleen (splenomegaly) and enlarged liver hepatomegaly (enlarged liver), the overgrowth of these organs may appear as belly "fullness" or swelling. Such fullness may be palpated (felt) by the physician during physical examination. Lymph node enlargement may or may not be apparent, although imaging studies should be able to confirm any lymphatic disease.

Leukemia that has spread to the brain may produce central nervous system effects, such as headaches, seizures, weakness, blurred vision, balance difficulties, or vomiting.

Certain forms of leukemia produce more distinct symptoms. For example, acute myelogenous leukemia (AML), particularly the M5 monocytic form, may generate tell-tale symptoms such as:

• swollen, painful, and bleeding gums - if AML has spread to the oral tissue;
• pigmented (colored) rash-like spots - if AML has spread to the skin; or
• chloromas (granulocytic sarcomas; collections of tumorous cells within the skin or other body parts) - if AML has
• spread to the skin or other organs.

The T-cell variety of acute lymphocytic leukemia (ALL) may cause the thymus to enlarge and press on the trachea (windpipe). Such pressure may lead to:

• shortness of breath,
• coughing, or
• suffocation.

If the overgrown thymus presses upon the superior vena cava (SVC), the large vein that carries blood from the head and arms back to the heart, this may produce SVC syndrome (swelling of the head and arms). SVC involvement of the brain can be fatal.

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