Symptoms Of Leukemia.

The early symptoms of leukemia are vague and much like those of many less serious medical problems. Leukemias of all cell types, whether acute or chronic, first make themselves known with remarkably similar characteristics. The common symptoms of the leukemias do not seem to be a direct result of the increase and spread of leukemia cells throughout the patient's body. Instead, the majority arise because the functioning of the remaining normal elements of the blood and bone marrow is impaired. The other organs of the body the liver, heart, kidney, brain, and digestive system continue to function quite well, even with a high degree of infiltration and invasion by leukemia cells.

Early detection of leukemia is difficult if not impossible, and usually occurs by accident rather than by design. For example, chronic lymphocytic leukemia is often found in people over sixty-five who are being examined routinely or for other medical problems. Acute leukemia can come on very suddenly, especially in children, and seem like a cold or flu. The symptoms progress rapidly, however, and most people seek medical help quickly. Chronic leukemia, if symptom less, can develop so slowly that the patient may not be able to estimate the date of its onset.

Fever, weight loss, fatigue, and a decline of well-being are the general symptoms of leukemia. Since these are vague symptoms associated with many illnesses, they do not necessarily raise a suspicion of leukemia. Easy bleeding, pallor, and repeated infections are also associated with leukemia and point more directly to the diagnosis.

Fever may be the most common symptom. It is usually caused by an infection of the skin, lung, or urinary tract, but it also may be due directly to the leukemia itself or to the release of compounds by the abnormal white cells. Many cancers are known to cause fever even in the absence of infection, because of the so-called hypermetabolic state that accompanies diseases marked by rapid progression and tissue breakdown. Infections are frequent because the leukemic white cells cannot protect against invasion by bacteria or other organic causes of disease, and too few normal white cells remain to do so. The leukemia produces a general depression of the immune system.

Fungal and viral infections that are rare in healthy people are frequently seen in leukemia patients, as are infections by bacteria that normally are not sufficiently aggressive to cause disease. Chemotherapy exacerbates this susceptibility to infection. Specialists in infectious disease are commonly asked to consult about the diagnosis and proper treatment of infection in the "compromised host," as the debilitated patient with a poorly functioning immune system is called. Infection becomes a more and more difficult problem as the leukemia progresses.

Weight loss, fatigue and paleness, largely caused by anemia, occur in most patients at the same stage of leukemia. These symptoms can be present for some time before a leukemia is identified as the basic problem. The situation was more of an enigma before doctors recognized that the prodrome the very early symptom complex that can precede the fully developed disease for some months or years of a leukemia can take this form.

Up to one third of all patients with cancer in the blood have normal or low circulating white blood cell counts. This "aleukemic" condition can occur in any form of leukemia and means that the bone marrow is crowded with extremely high numbers of cancerous white cells that, for some reason, do not migrate out into the bloodstream.

Bleeding problems are not serious early in the course of leukemia, but they can become severe later. Bleeding is usually mild at first, with only small patches of black and blue discoloration under the skin. Later, the suppression of the platelet-forming cells in the bone marrow reduces the number of platelets produced. This, combined with a deficiency of the clotting mechanism, can lead to serious bleeding problems. There may be hemorrhage into the lungs or bleeding into the brain, causing a stroke. Bleeding in the joints is also common. Prior bleeding problems, such as an ulcer or even a hemorrhoid, will be made worse and potentially life-threatening.

Enlargement of the lymph nodes, liver, and spleen is especially prevalent in the chronic leukemias. Pain in the joints and bones sometimes occurs but, overall, pain is not itself a major problem or common direct effect of leukemia.