The #1 Early Leukemia Sign Most People Miss

Any cancer diagnosis—or just the idea of one—is scary. Leukemia can be especially scary because it's a bit confusing. Unlike liver or breast cancer, the word doesn't specify where the cancer originates. 

"Leukemia is a general diagnosis that describes a cancer of the blood," explains Dr. David Chitty, DO, a New York-based medical oncologist with Northwell Health's R.J. Zuckerberg Cancer Center. "There are chronic leukemias and acute leukemias. Chronic leukemias are generally more indolent whereas acute leukemias require urgent intervention."

"Early detection is key" is a common refrain with cancers. However, Dr. Chitty says the early signs of leukemia can be almost silent.

"Most leukemias are not associated with lumps or masses or pain," Dr. Chitty says. "We often make a diagnosis of leukemia in patients who feel fine and are in disbelief."

However, three experts who treat patients with leukemia agree that one commonly missed sign is worth flagging with your doctor.

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What Is Leukemia?

Leukemia has many forms with a key similarity. "Leukemia is a broad term that describes many types of cancer that originate from the body’s blood-forming tissues like the bone marrow and lymphatic system," says Dr. John Molina, MD, MEd, a leukemia specialist at Cleveland Clinic. "The word leukemia comes from the Greek 'leukos,' meaning white, and 'haima,' which means blood, and it was originally used to represent an abnormal level of white blood cells."

Healthcare providers often classify leukemia based on the progression of the disease. 

"Leukemia can be either acute, defined by a rapid increase in immature white blood cells, or chronic, which is a build-up of more mature but abnormal white blood cells," Dr. Molina says.

From there, doctors classify the type of blood cell affected— lymphoid or myeloid. 

"Lymphoid cells mature into B and T-cells, which are cells of the immune system and fight infections," Dr. Molina says. "Myeloid cells mature into red blood cells, platelets and other forms of white blood cells like neutrophils, our bacteria-fighting cells."

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The Most Commonly Missed Early Leukemia Sign

All three experts agreed: "One commonly missed sign of leukemia is fatigue or extreme tiredness," says Dr. Nadia Bambace, MD, a hematologic oncologist with Miami Cancer Institute, part of Baptist Health South Florida.

Dr. Molina has seen it play out in his office too many times.

"Often, patients remark that they have not been not been feeling well for weeks or months prior to their diagnosis," Dr. Molina says.

Of course, everyone feels tired from time to time. The type of fatigue associated with leukemia is different.

"Rapidly progressive fatigue is not normal and is often associated with worsening anemia," says Dr. Chitty. "Often, this will present with pallor, which is loss of color in the skin. [It] can be an important associated sign."

Why Is It So Easy To Miss Fatigue as an Early Leukemia Sign?

Fatigue is so common that it's easy to write it off as anything but a flag for leukemia.

"Life can get hectic," Dr. Bambace says. "It is easy to rationalize fatigue and attribute its presence to a variety of causes, such as stress, lack of sleep or other less serious medical conditions. It is not uncommon for both patients and healthcare providers to initially attribute the fatigue to lifestyle factors, work stress or other non-malignant medical issues."

To be clear, fatigue may not be a sign of leukemia at all. You could just be tired—though fatigue is also a common symptom of other underlying conditions worth looking into ASAP.

"Fatigue can also be associated with cardiovascular issues, and so it is important to see a primary doctor right away in cases of worsening fatigue in a short period, [as in] days or weeks," Dr. Chitty says.

What Are Other Signs of Leukemia?

Fatigue isn't the only potential leukemia sign to bring up with a provider. Dr. Molina says that other leukemia symptoms include:

• Decreased exercise tolerance

• Increased bruising

• Unusual bleeding

• Recurrent infections

• Unexpected weight loss

• Night sweats

• Unexplained fevers

• Abdominal pain on the left side

• Blurry vision

• Enlarged—but not tender—lymph nodes

Unfortunately, Dr. Molina says, "Other times, patients may have no symptoms at all and are found on routine blood work or incidentally went being evaluated for a separate problem."

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What Are the Risk Factors for Leukemia?

Dr. Chitty says some of the more common risk factors for developing leukemia include prior chemotherapy, radiation or radiation exposure. Smoking can also increase a person's risk. Avoiding smoking or quitting can help reduce your risk.

However, leukemia doesn't usually have risk factors.

"The vast majority of leukemias are the result of a genetic error in the bone marrow stem cells that happens spontaneously over the course of one’s life," Dr. Molina says.

How Is Leukemia Treated?

It depends on the type.

"For example, Acute Myeloid Leukemia (AML) and Acute Lymphoblastic Leukemia (ALL) require intensive chemotherapy and possibly a bone marrow transplant for cure," Dr. Molina explains. "Chronic Myeloid Leukemia (CML) can be treated with a daily pill that allows most patients to have the same life expectancy as the general population, as well as the possibility to even stop the medication based on how well they respond."

What To Do if You're Concerned About Leukemia

Experts agree on this one too: Talk to your doctor about any adverse symptoms or concerns you have.

"If a person has signs concerning for leukemia, they should undergo primary evaluation with their primary medical doctor who can initiate screening tests," Dr. Chitty says. "[Primary medical doctors] are on the front-line of screening, and if there are concerning lab results, they refer to a hematologist/oncologist."

Dr. Chitty says the specialist will do any necessary work-ups to ensure all is well or help you navigate a diagnosis like leukemia.

Next up: The #1 Early Liver Cancer Sign Most People Miss

Sources

• Dr. David Chitty, DO, a New York-based medical oncologist with Northwell Health's R.J. Zuckerberg Cancer Center

• Dr. John Molina, MD, MEd, a leukemia specialist at Cleveland Clinic

• Dr. Nadia Bambace, MD, a hematologic oncologist with Miami Cancer Institute, part of Baptist Health South Florida.