Pediatricians can help with early detection of childhood leukemia during routine visits. Even though a patient’s signs and symptoms may appear vague, mild or suggestive of more common health conditions, they shouldn’t be ignored. In some cases, doctors reported that ordering a simple blood test led to a cancer diagnosis that otherwise could have remained overlooked.

Many signs and symptoms of leukemia are caused by a shortage of normal blood cells, which happens when leukemia cells crowd out normal blood-making cells in the bone marrow — including red blood cells, white blood cells and platelets. This can cause various symptoms, including:

• Feeling tired
• Feeling weak
• Feeling dizzy or lightheaded
• Shortness of breath
• Pale skin
• Infections
• Bruises (or small red or purple spots, called petechiae) on the skin
• Bleeding, including frequent nosebleeds, or bleeding gums
• Weight loss
• Fever
• Night sweats
• Loss of appetite
• Swelling of the abdomen, due to enlarged liver and spleen
• Enlarged lymph nodes
• Bone or joint pain

“Most signs and symptoms for an acute leukemia are non-specific,” said Jun Zhao, D.O., pediatric hematologist/oncologist and medical director for outpatient and inpatient care at Norton Children’s Cancer Institute, affiliated with UofL School of Medicine. “I would say persistent bone pain or leg pain would certainly be something not to ignore.”

Although it occurs less frequently, leukemia can spread to other organs, which can present additional symptoms.

If leukemia spreads to the brain and spinal cord, it can cause:

• Headaches
• Weakness
• Seizures
• Vomiting
• Trouble with balance
• Facial muscle weakness or numbness
• Blurred vision

If leukemia spreads inside the chest, it can cause fluid buildup and breathing difficulty. Enlarged lymph nodes in the chest can press on the trachea, which can lead to coughing or trouble breathing.

If enlarged lymph nodes in the chest press on the superior vena cava (a vein), it can cause blood to slow down or “back up” in the veins, which can cause swelling in the face, neck, arms and upper chest, sometimes with a bluish-red color. This is known as superior vena cava syndrome (SVCS). SVCS can be life-threatening and requires immediate treatment.

Tests for leukemia that can detect a shortage of normal blood cells include a complete blood count (CBC) and comprehensive metabolic panel (CMP). Additional tests include a bone marrow aspirate and biopsy or a lumbar puncture.

Usually, childhood leukemia is found because a patient exhibits signs or symptoms that prompt a family to schedule an appointment. Currently, there are no widely recommended blood tests or other tests to screen for leukemia before symptoms appear, according to the American Cancer Society. Therefore, paying attention to the signs and symptoms of leukemia is key in early detection.