Signs and Symptoms of Acute Lymphocytic Leukemia (ALL)

Acute lymphocytic leukemia (ALL), also known as acute lymphoblastic leukemia, can cause many different signs and symptoms. Most of these happen in all kinds of ALL, but some are more common with certain subtypes of ALL.

ALL symptoms caused by low numbers of blood cells

Most signs and symptoms of ALL are caused by a shortage of normal blood cells. This happens when leukemia cells crowd out normal blood-making cells in the bone marrow.

These shortages show up on blood tests, but they can also cause symptoms, including:

• Feeling tired or weak
• Feeling dizzy or lightheaded
• Shortness of breath
• Pale skin (harder to see in darker skin tones)
• Infections (including fevers) that don’t go away or keep coming back
• Bruises (or small red or purple spots) on the skin
• Bleeding, such as frequent or severe nosebleeds, bleeding gums, or heavy menstrual bleeding in women

General symptoms of ALL

People with ALL might also have some other, nonspecific symptoms, including:

• Fever
• Night sweats
• Loss of appetite
• Weight loss

Symptoms of ALL in specific parts of the body

ALL sometimes affects specific parts of the body.

Swelling in the abdomen (belly)

Leukemia cells can build up in your liver or spleen, making them larger. You might notice this as:

• Fullness or swelling of your belly
• A feeling of being full after eating only a small amount

Your lower ribs usually cover these organs, but when the organs are enlarged, a doctor can feel them.

Enlarged lymph nodes

If ALL spreads to lymph nodes close to the surface of your body,  you might notice lumps under your skin in areas such as your groin, the sides of your neck, or your underarms.

Lymph nodes inside your chest or abdomen may also swell, but these can only be detected by imaging tests such as CT or MRI scans.

Bone or joint pain

Sometimes leukemia cells build up near the surface of the bone or inside the joint, leading to pain in these areas.

Spread to other organs

Less often, ALL spreads to other organs:

• Brain or spinal cord: If ALL spreads to these organs, it can cause headaches, weakness, seizures, vomiting, trouble with balance, facial muscle weakness or numbness, or blurred vision.
• Inside the chest: This can cause fluid buildup and trouble breathing.
• Less common spread: Rarely, ALL may spread to the skin, eyes, testicles, ovaries, kidneys, or other organs.

Symptoms from an enlarged thymus

The T-cell subtype of ALL often affects the thymus. This is a small organ in the middle of your chest behind your sternum (breastbone) and in front of your trachea (windpipe).

• An enlarged thymus can press on your trachea, leading to coughing or trouble breathing.

SVC syndrome

The superior vena cava (SVC) is a large vein that carries blood from your head and arms back to your heart. It passes next to your thymus. If your thymus is enlarged, it may press on the SVC, causing blood to “back up” in your veins.

This is known as SVC syndrome. It can be life-threatening, and it needs to be treated right away.

SVC syndrome can cause:

• Swelling in your face, neck, arms, and upper chest (sometimes with a bluish-red color)
• Headaches
• Dizziness
• Changes in consciousness, if it affects the brain

Tell your doctor about possible ALL symptoms

Any of the symptoms and signs above may be caused by ALL, but they can also be caused by other conditions. Still, if you have any of these problems, especially if they get worse or don't go away, it’s important to see a doctor so the cause can be found and treated if needed.