Some patients go years without noticing symptoms of this blood cancer.
Leukemia is a type of blood cancer that affects blood stem cells in the bone marrow. Instead of maturing into healthy red blood cells, white blood cells, and platelets, the blood stem cells become leukemia cells that multiply rapidly and crowd out healthy blood cells.
Leukemia can be classified as acute or chronic:
Acute leukemia means the affected stem cells cannot mature at all, and the leukemia progresses and spreads quickly.
Chronic leukemia means the stem cells are able to develop partially, but do not function as effectively as healthy mature blood cells. As a result, chronic leukemia tends to be less severe and spread more slowly than acute leukemias.
The diagnosis also depends on the type of blood stem cell affected. Cancer that begins in the myeloid stem cells is considered acute myeloid leukemia (AML) or chronic myeloid leukemia (CML). Cancer that begins in the lymphocyte stem cells is considered acute lymphocytic leukemia (ALL) or chronic lymphocytic leukemia (CLL). Learn more about the types of leukemia here.
Symptoms of Leukemia
Not all people with leukemia experience symptoms. “With acute leukemia, the cells will multiply very quickly, and therefore the majority of the patients will become symptomatic very early,” says Michal Bar-Natan Zommer, MD, hematologist and oncologist at The Mount Sinai Hospital in New York City. Chronic leukemia cells progress slowly, and many patients are asymptomatic for a long period of time.
Symptoms of leukemia may be vague or non-specific, such as:
- Unintended weight loss
- Loss of appetite
- And night sweats.
Several of the symptoms of leukemia are linked to a lack of healthy blood cells (e.g. anemia). Here are common symptoms of leukemia, according to the American Cancer Society:
- Shortness of breath
- Frequent infections that are hard to treat
- And easy bruising and bleeding.
Leukemia can result in other symptoms if the cancer spreads to other organs, such as a sense of fullness and swelling in the belly (if cancer spreads to the liver or spleen), swollen lymph nodes, joint pain, or coughing and trouble breathing (if cancer spreads to the thymus, an organ behind the breastbone).
How Doctors Diagnose Leukemia
Since not all people with leukemia experience symptoms, catching leukemia early can be a challenge. In those cases, leukemia is often detected during routine blood work, where results may show abnormal counts of red blood cells, white blood cells, or platelets.
These routine blood tests may suggest leukemia, but other tests are necessary to confirm the diagnosis:
A medical history reviews the individual’s symptoms and risk factors for leukemia.
A physical exam may detect swollen organs in which leukemia may have spread (such as lymph nodes or the liver) and signs of infection, bruising, or bleeding.
Blood tests include a complete blood count (which counts each type of blood cell in the blood) and a blood smear (which shows how cells look under a microscope).
Bone marrow tests check a sample for its cellularity, meaning how much of the sample is blood-forming cells. A sample with more blood-forming cells than usual is considered hypercellular, which may indicate leukemia.
Spinal fluid tests take a sample of cerebrospinal fluid, which surrounds the brain and spinal cord, to check if cancer has spread to the central nervous system.
Genetic testing helps look for specific genes or chromosomes linked to leukemia.
Imaging tests do not diagnose leukemia, but they help assess how the leukemia has progressed or spread. CT scans and ultrasounds can show if cancer has spread to the lymph nodes or spleen, and MRIs can see if cancer is affecting the central nervous system (like the brain).
Blood cancers can be complex, and being diagnosed with one may feel overwhelming. Here are questions you should ask your doctor after a blood cancer diagnosis, and here are self-care tips to help cope with blood cancer treatment.
Michal Bar-Natan Zommer, MD, is a hematologist and oncologist at the Mount Sinai Hospital in New York City.
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With leukemia, we usually have some kind
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of a defect in a very early cell
that creates an advantage for
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the cell to multiply more and
this will be called leukemia.
00:00:13,560 --> 00:00:15,840
We have a few different kinds of leukemia.
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With acute leukemia, the cells
are multiplying very quickly, and
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therefore the majority of the patients
will become symptomatic very early.
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With the chronic phase, the cells usually
grow very slowly and accumulate over time.
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And therefore, many of the patients have
no symptoms for a long period of time.
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If you have very few red blood
cells you're going to be anemic.
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People are tired, they are pale,
they have shortness of breath.
00:00:46,690 --> 00:00:50,328
If you don't have white blood cells,
people have infection.
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They can come with fever.
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If you don't have platelets, you can come
with easy bruising or actual bleeding.
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For acute myeloid versus lymphoid
leukemia, it's a different cell.
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The manifestation is usually the same.
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The main infestation being the fact
that you don't have functional
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blood cells in your body.
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So often the patient comes with
the same symptoms of fatigue, anemia,
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fever, feeling unwell.
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For many of the patients with chronic
lymphocytic leukemia, what we call CLL,
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the cells are growing very slowly; the
majority of the patients are asymptomatic.
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And in the beginning,
we do not even treat them.
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We just watch them, because many of
them will never need treatment for
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For chronic myeloid leukemia,
the cells are from the myeloid origin,
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however it grows very slowly and
it is functional.
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So many of the patients
have this disease for
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a long period of time
before they discover it.
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Some patients can have symptoms
if it's very progressive.
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Symptoms such as abdominal pain,
early satiety, they can be fatigued.
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If it's very progressive, they can have
anemia, they can have fever or infections.
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Each leukemia has its own difference, and
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since the origin of the cell is different,
the treatments are very different.
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And therefore it's very important to know
which kind of leukemia somebody has.
Acute lymphoblastic leukemia. Rye Brook, NY: Leukemia & Lymphoma Society. (Accessed on November 9, 2018 at https://www.lls.org/leukemia/acute-lymphoblastic-leukemia?src1=27336&src2=20032.)
Acute myeloid leukemia. Rye Brook, NY: Leukemia & Lymphoma Society. (Accessed on November 9, 2018 at https://www.lls.org/leukemia/acute-myeloid-leukemia.)
Birbrair A, Frenette PS. Niche heterogeneity in the bone marrow. Ann NY Acad Sci. 2016 Apr;1370(1):82-96.
Chronic lymphocytic leukemia. Rye Brook, NY: Leukemia & Lymphoma Society. (Accessed on November 9, 2018 at https://www.lls.org/leukemia/chronic-lymphocytic-leukemia.)
Chronic lymphocytic leukemia/small lymphocytic lymphoma. New York, NY: Lymphoma Research Foundation. (Accessed on November 9, 2018 at https://www.lymphoma.org/aboutlymphoma/cll/.)
Chronic myeloid leukemia. Rye Brook, NY: Leukemia & Lymphoma Society. (Accessed on November 9, 2018 at https://www.lls.org/leukemia/chronic-myeloid-leukemia?src1=27336&src2=20032.)
Leukemia - patient version. Rockville, MD: National Cancer Institute. (Accessed on November 9, 2018 at https://www.cancer.gov/types/leukemia.)
NCI dictionary of cancer terms: blood stem cell. Rockville, MD: National Cancer Institute. (Accessed on November 9, 2018 at https://www.cancer.gov/publications/dictionaries/cancer-terms/def/blood-stem-cell.)
NCI dictionary of cancer terms: white blood cell. Rockville, MD: National Cancer Institute. (Accessed on November 9, 2018 at https://www.cancer.gov/publications/dictionaries/cancer-terms/def/white-blood-cell.)
Signs and symptoms of acute lymphocytic leukemia (ALL). Atlanta, GA: American Cancer Society. (Accessed on November 9, 2018 at https://www.cancer.org/cancer/acute-lymphocytic-leukemia/detection-diagnosis-staging/signs-symptoms.html.)
Signs and symptoms of chronic myeloid leukemia. Atlanta, GA: American Cancer Society. (Accessed on November 9, 2018 at https://www.cancer.org/cancer/chronic-myeloid-leukemia/detection-diagnosis-staging/signs-symptoms.html.)
Tests for acute myeloid leukemia (AML). Atlanta, GA: American Cancer Society. (Accessed on November 9, 2018 at https://www.cancer.org/cancer/acute-myeloid-leukemia/detection-diagnosis-staging/how-diagnosed.html.)
Tests for chronic myeloid leukemia. Atlanta, GA: American Cancer Society. (Accessed on November 9, 2018 at https://www.cancer.org/cancer/chronic-myeloid-leukemia/detection-diagnosis-staging/how-diagnosed.html.)
What is acute lymphocytic leukemia? Atlanta, GA: American Cancer Society. (Accessed on November 9, 2018 at https://www.cancer.org/cancer/acute-lymphocytic-leukemia/about/what-is-all.html.)
What is chronic lymphocytic leukemia? Atlanta, GA: American Cancer Society. (Accessed on November 9, 2018 at https://www.cancer.org/cancer/chronic-lymphocytic-leukemia/about/what-is-cll.html.)
What is acute myeloid leukemia? Atlanta, GA: American Cancer Society. (Accessed on November 9, 2018 at https://www.cancer.org/cancer/acute-myeloid-leukemia/about/what-is-aml.html.)
What is chronic myeloid leukemia? Atlanta, GA: American Cancer Society. (Accessed on November 9, 2018 at https://www.cancer.org/cancer/chronic-myeloid-leukemia/about/what-is-cml.html.)