Leukemia Symptoms
Leukemia is a cancer of the blood and bone marrow that affects the production of healthy blood cells. While symptoms vary depending on the type of leukemia, many share common warning signs. These result from changes in the number and function of red blood cells, white blood cells and platelets.
Acute leukemias (like acute lymphoblastic leukemia or acute myeloid leukemia) usually cause symptoms quickly and severely, while chronic leukemias (such as chronic lymphocytic leukemia or chronic myeloid leukemia) may progress slowly with few or no early signs.
Early signs and symptoms of leukemia
In early stages, symptoms can be subtle and can mimic viral illnesses or fatigue from daily life. Early signs may include:
- Unexplained fatigue or weakness
- Mild fever or chills
- Pale skin (anemia)
- Frequent or lingering infections
- Nosebleeds or bleeding gums
- Easy bruising
- Shortness of breath with light activity
- Occasional night sweats
- General malaise or feeling “off” (flu-like symptoms)
Late signs and symptoms of leukemia
As leukemia advances or blood cell levels drop further, symptoms tend to worsen:
- Persistent, extreme fatigue
- High or recurring fevers
- Frequent infections that are severe or don’t go away
- Heavy or prolonged menstrual bleeding
- Bone or joint pain
- Petechiae (small red or purple skin spots)
- Enlarged lymph nodes (neck, armpits, groin)
- Swelling or discomfort in the upper abdomen (enlarged spleen)
- Feeling full after eating a small amount
- Significant, unexplained weight loss
- Headaches, dizziness, or blurred vision (in some cases)
Distinct symptoms of specific types of leukemia
While many symptoms overlap, certain signs are more typical of specific types:
Acute lymphoblastic leukemia (ALL)
- Most common in children, but also affects adults
- Bone pain, especially in legs or arms, that does not resolve on its own
- Swollen lymph nodes, liver, or spleen
- Frequent bruising or bleeding, including nosebleeds
- In rare cases: headaches, seizures, or vision changes if cancer spreads to the central nervous system
Acute myeloid leukemia (AML)
- Gum swelling or overgrowth (especially with monocytic subtypes)
- More likely to cause serious infections early on
- May cause chloromas (skin nodules or eye masses – rare)
- Rapid onset of symptoms, often severe
Chronic lymphocytic leukemia (CLL)
- Often found during routine blood work before symptoms start
- Swollen lymph nodes without pain or infection
- Recurrent sinus or respiratory infections
- Can trigger autoimmune complications like hemolytic anemia
Chronic myeloid leukemia (CML)
- Often presents with very high white blood cell counts
- Enlarged spleen causing a full feeling or abdominal pressure
- May cause night sweats, bone pain, or intense itching
- Early symptoms may be minimal or vague
What does leukemia feel like?
Patients often report:
- A chronic sense of fatigue that doesn’t improve with rest
- Feeling run-down or more ill than expected for a mild illness
- Repeated and prolonged infections that don’t respond to antibiotics
- Shortness of breath, especially when climbing stairs or walking
- Persistent low-grade fevers and night sweats
- Bone discomfort or aches in joints
These symptoms are not unique to leukemia, but they are often the reason someone decides to see a doctor.
Other conditions with similar symptoms
Leukemia shares symptoms with other illnesses, including:
- Viral infections (e.g., flu, mono)
- Anemia
- Autoimmune disorders (e.g., lupus)
- Other blood cancers (e.g., lymphoma, multiple myeloma)
- Chronic infections
- Thyroid disorders
- Immunosuppressive infections like HIV/AIDS
Persistent symptoms that don’t resolve with standard treatments may require further evaluation to rule out leukemia.
Risk factors for leukemia
Leukemia can occur without any clear cause, but certain factors increase risk:
- Genetic disorders (e.g., Down syndrome, Li-Fraumeni syndrome, Fanconi anemia)
- Previous cancer treatment (chemotherapy or radiation)
- Exposure to chemicals like benzene
- Smoking (linked to some types)
- Viral infections (e.g., HTLV-1)
- Older age (especially for chronic leukemias)
Genetic counseling may be recommended if you or a family member has a known risk factor or history of leukemia in more than one family member.
When to see a doctor
Contact your doctor if you experience:
- Persistent fatigue, fever, or infections
- Unexplained bruising or bleeding
- Swollen lymph nodes or bone pain
- Significant weight loss or night sweats
- Unusual bleeding or menstrual changes
- Symptoms that linger or worsen over time
Early evaluation and diagnosis are key to successful treatment, especially for acute forms of leukemia.
Some cases of leukemia can be passed down from one generation to the next. Learn more about the risk to you and your family on our genetic testing page.
What types of cancer can cause itchy skin?
Your skin can itch for many reasons, such as allergies, insect bites and dry skin. The itch, called pruritus, will usually go away once you treat what’s causing it. But sometimes an itch can be chronic, meaning it lasts six weeks or longer. This is known as chronic pruritus.
In rare cases, chronic pruritus can be a sign of cancer. Here, I’ll explain what types of cancers may cause itchy skin, what the itch feels like and when you should see a doctor.
What types of cancer can cause itchy skin?
Itching can be a sign of several types of blood cancers.
Lymphoma
- Cutaneous T cell lymphoma is a skin lymphoma that starts in the T lymphocytes.
- Hodgkin lymphoma and non-Hodgkin lymphoma both start in the lymphatic system.
Leukemia
- Acute lymphocytic leukemia is a rare, aggressive type of blood cancer that starts in the bone marrow.
- Chronic lymphocytic leukemia and chronic myeloid leukemia are slow-growing types of blood cancer that mostly affect adults over age 55.
- Polycythemia vera is a chronic blood disorder in which the bone marrow produces too many red blood cells. People with polycythemia vera who experience itching have a higher chance of the disease developing into myelofibrosis and acute myeloid leukemia.
- Myelodysplastic syndrome is a group of diseases in which the bone marrow doesn’t make enough healthy blood cells. Some cases develop into acute myeloid leukemia.
Itching can also be a sign of the following cancers:
- Liver cancer
- Bile duct cancer
- Non-small cell lung cancer
- Metastatic stomach cancer
- Pancreatic cancer
- Melanoma: Itching has been reported in 22% of primary melanoma skin lesions.
- Basal cell carcinoma
- Squamous cell carcinoma
Where on the body does the itching occur?
Itching can occur anywhere on the body, including the scalp and genitalia. The most common sites are the lower legs and the trunk – that is, your chest, abdomen, pelvis and back.
How would you describe an itch that might indicate cancer?
There aren’t specific characteristics to look for. What I mean is the itch can be:
- Localized (affecting one area of the body) or generalized (affecting the entire body)
- Constant or intermittent
- Mild to severe
Pruritus may be an associated symptom of cancer. That means it is often an additional symptom of the cancer itself. It’s not necessarily a predictor of cancer. So, if you have itchy skin, it doesn’t mean you will develop cancer.
Itching associated with pancreatic cancer
Itching can happen when pancreatic cancer causes a blockage in the bile duct, which can also lead to jaundice. In these cases, itching tends to be generalized. But I have seen pancreatic cancer patients with intense itching only on their trunk area, or/and only on the arms and legs.
Aquagenic itch can be a sign of certain cancers
Aquagenic itch describes an itch that develops minutes after contact with water of any temperature with no visible skin rash. Aquagenic itch is commonly seen in people with polycythemia vera. Some people who have aquagenic itch develop cutaneous T cell lymphoma or myelodysplastic syndrome several years later.
How we classify pruritus and cancer
We divide cancer patients with pruritus into three categories:
- Patients who experienced itching before being diagnosed with cancer: A cancer diagnosis may come months to years after the itching begins.
- Patients who have an existing cancer and experience itching
- Patients who have itching indirectly related to cancer: This is usually due to the growth of a tumor affecting internal organs, such as invasive liver tumors.
Cancer treatment can cause itchy skin
Sometimes, cancer treatment can cause rashes and itchy skin. Chemotherapy, opioids, aspirin and antibiotics may cause itching.
What other conditions can cause itchy skin?
Chronic pruritus can be caused by:
- Diabetes
- Chronic kidney failure
- Liver disease
- HIV infection
- Allergic reactions to food, medicine and insect bites
- Thyroid disorders
- Multiple sclerosis
- Anxiety
- Obsessive-compulsive disorder
- Depression
- Pregnancy
Remember: there are many reasons your skin may itch. Most of the time, it is not because of cancer.
When should you see a doctor for itchy skin?
See a doctor if you have itchy skin that:
- is all over the body, especially during pregnancy,
- starts suddenly,
- lasts for several weeks or longer,
- does not improve with moisturizer use,
- is persistent in the same spot,
- disrupts your sleep or distracts from your daily routine and/or
- is associated with other symptoms, such as weight loss, fever, night sweats, loss of appetite, jaundice, fatigue, cough or visible lumps.
If your doctor cannot find the reason for the itch, they may do a workup to check for other possible causes, including cancer. This workup includes a comprehensive review of your medical history and a physical examination, with particular attention to the lymph nodes. Your doctor will test your complete blood count, liver function, kidney function and thyroid function.
What else should readers know about itchy skin and cancer?
Itchy skin can be frustrating, especially if you don’t know what’s causing it. Itching can be a sign of internal disease, including cancer. We know that patients with certain cancers, namely lymphomas and leukemias, often have associated pruritus, but we have limited data indicating that itchy skin is a predictor of cancer. So, itchy skin alone does not mean you will get cancer.
See a doctor if you have persistent itchy skin and you develop other concerning symptoms. They can figure out what’s causing the symptoms and get you the proper treatment.
Ana Ciurea, M.D., is a dermatologist at UT MD Anderson.
Request an appointment at UT MD Anderson online or call 1-877-632-6789.