Cancers and Tumors

Leukemia Symptoms and Diagnosis

Symptoms of Leukemia

Signs and symptoms of leukemia - both acute lymphocytic leukemia (ALL) and acute myelogenous leukemia (AML) - are nearly the same because in both types the cancer cells crowd out healthy blood cells. The same symptoms can also be caused by other problems that are not leukemia. So it's important for a child with symptoms like these to see a doctor to find out the cause.

  • Fever, which may be a sign of infection. Risk of infection is greater if white blood cell levels are low.
  • Easy bruising or bleeding, even from small injuries. This may be a sign of low platelets.
  • Pinpoint spots of blood under the skin caused by tiny broken blood vessels (petechiae). This is another sign of low platelets.
  • Bone or joint pain, from cancer cells building up there.
  • Painless lumps in the neck, underarm, stomach, groin and around the eyes.
  • Pain and fullness under the ribs, from enlarged liver and spleen.
  • Weakness and fatigue, which may be a sign of low red blood cells (anemia).
  • Loss of appetite.
  • Shortness of breath or coughing, from swelling of lymph nodes in the chest or swelling of the thymus (a gland in the neck that is part of the immune system).

If leukemia has spread to the brain, there may be other symptoms, like headaches or problems with vision, balance or muscle control.

In AML, leukemia cells may also go to the skin and cause spots that look like a rash.

Symptoms of acute leukemia tend to appear over a matter of days or weeks and to get worse quickly. Symptoms of chronic leukemia tend to appear over months or years.

Leukemia Diagnosis

To find out whether your child has leukemia, your child's doctor will start with a thorough exam and ask about your child's health background. Next the doctor will do a series of blood tests to tell whether any blood cells are unhealthy and, if so, which type.

Blood tests for leukemia

Common blood tests to check for leukemia include:

  • Complete Blood Count (CBC) - Used to tell how many cells of each type are moving through the bloodstream
  • Peripheral Blood Smear - Used to see how the blood cells look
  • Blood Chemistry - Used to look for chemicals in the blood that may signal cancer

Doctors may do other blood tests to find out more details about the type of cells that are unhealthy. These tests detect proteins on the surface of the cancer cells and look at the chromosomes in the cancer cells.

Bone marrow tests

Doctors may need to perform a bone marrow aspiration to tell whether your child has leukemia.

A lumbar puncture, also called a spinal tap, may be done to remove cerebrospinal fluid (CSF) from the spinal column using a needle.

If there are cancer cells in the fluid, doctors know there may be cancer in the brain and spinal cord. A chest X-ray can provide a view into the chest area. A tissue sample, taken during a biopsy procedure, from the testicles, ovaries or skin helps doctors tell whether the cancer has spread there.

Leukemia Risk Levels

With ALL, the treatment is based on the child's age, white blood count, the type of cancer cell (T cell or B cell), the chromosomes in the cancer cells and the response to treatment.

There are three main risk groups in ALL:

Standard risk

This applies to children ages 1 through 10 whose white blood cell count is less than 50,000 per cubic millimeter when the cancer is diagnosed.

High risk

This applies to children who are 10 or older, to children whose white blood cell count is 50,000 or more and to children who have T-cell ALL.

Very high risk

This applies to infants, children with some abnormal chromosomes in the leukemia cells and those whose disease does not go into remission quickly.

With AML, doctors do not assign risk groups when they diagnose the disease. Certain features can make the disease higher risk. These features include poor response to first treatment and some abnormal chromosomes in the cancer cells.