Symptoms of chronic lymphocytic leukemia (CLL) progression or relapse

Symptoms of CLL progression or relapse

In 50% to 75% of new CLL diagnoses, the person has no symptoms. It can take several yearsTrusted Source from the time of diagnosis for symptoms of this type of cancer to occur.

Once symptoms start to appear, an individual or doctor may mistake them for symptoms of other conditions. They will not appear in any particular order.

The following are some of the common symptoms indicating that a person may have CLL or that the cancer has progressed enough to manifest:

Enlarged spleen or liver

Over time, CLL can lead toTrusted Source the enlargement of the spleen or liver. This can cause a person to always have a feeling of fullness or pain in the abdomen.

An enlarged spleen can also cause the person to feel satiated after consuming a small amount of food, because the spleen pushes against the stomach.

Unexplained weight loss

Unexplained weight loss is a common symptom of several conditions. People with CLL can also experience this kind of weight loss.

They may experience it in combination with a loss of appetite.

Shortness of breath and other anemia symptoms

CLL can lead toTrusted Source a drop in a person’s red blood cell count. Doctors refer to having a low level of red blood cells as anemia.

Symptoms of anemia include:

• fatigue
• faintness
• dizziness
• a rapid heart rate
• shortness of breath
• fast breathing
• pain in the chest
• trouble walking up stairs or engaging in other everyday activities
• paleness of the skin, mouth, gums, or nail beds
• swelling in the feet and hands

Night sweats

Night sweats are episodes of heavy sweating that a person experiences during sleep. Various conditions, side effects of medications, and menopause can cause night sweats to occur.

Night sweats are also a common symptom of CLL.

Low blood pressure

Some CLL treatment options, such as chemotherapy, can lower a person’s blood pressure.

ResearchTrusted Source has also shown that having a low red blood cell count, which CLL can causeTrusted Source, can also reduce a person’s blood pressure.

A drop in blood pressure, along with other physical changes, may indicateTrusted Source that a person is entering the later stages of the condition.

Metastasis

As CLL progresses, it can start to spread to other tissues in the body. Health experts call this metastasis.

Metastasizing CLL may spread to areas such as the:

• skin
• gastrointestinal tract
• eye socket
• lungs
• mucous membrane that lines the inside of the eyelids
• pleura, the membrane that lines the chest
• heart

Stages and speed of CLL progression

CLL is a slow-progressing form of cancer. It can take several yearsTrusted Source for symptoms to occur.

Doctors and researchers in the United States typically follow the Rai staging system for CLL, which classifies the condition into five stagesTrusted Source, ranging from 0 to 4.

In general, the higher the stage, the shorter a person’s life expectancy due to the increased speed of progression associated with later stages.

Stage 0

At stage 0, a person will not likely have any noticeable symptoms or clinical signs.

Their red blood cell and platelet counts will often appear normal on a blood test. They will not experience enlargement of the liver, spleen, or lymph nodes.

However, a blood test will reveal lymphocytosis, which is when there are too many lymphocytes in a person’s blood.

A person with lymphocytosis has an absolute lymphocyte count of more than 4,000 lymphocytes per microliterTrusted Source.

Stage 1

At stage 1, a person will also not have many noticeable symptoms.

However, they will likely experience enlarged lymph nodes. They may also have slightly lower red blood cell and platelet counts.

A person with stage 1 CLL may start to experience increased fatigue.

As with stage 0, they will have lymphocytosis.

Stage 2

At stage 2, a person will continue to have elevated lymphocytes in their blood. Their levels of both red blood cells and platelets will still be close to normal.

They will likely have an enlarged spleen. They may or may not experience enlargement of their liver or lymph nodes.

A person may also experience new or worsening fatigue.

Stage 3

At stage 3, a person will typically start to have low red blood cell counts.

This can lead to anemia. For the symptoms of this condition, see the “Shortness of breath and other anemia symptoms” section above.

The lymph nodes, spleen, or liver may or may not be enlarged, and platelet counts will be close to normal. A person will continue to have high lymphocyte counts.

Stage 4

Stage 4 is the last stage of CLL. Like the other stages, it is associated with high lymphocyte counts.

A person will have enlargement of the lymph nodes, spleen, or liver. Their red blood cell counts may be low or close to normal.

However, they will likely have thrombocytopenia (a low platelet count), which can causeTrusted Source:

• frequent nosebleeds
• bleeding gums
• easy bruising
• heavy menstrual bleeding
• blood in stools or urine
• easy bleeding, even for small injuries

A person may also experience:

• headaches
• night sweats
• fatigue
• more frequent infections
• unexpected weight loss

Learn more about the staging systems for CLL.

End of life symptoms

In a person’s final days of life, they may go through some physical changes and show new or worsening symptoms.

According to the National Cancer Institute (NCI)Trusted Source, these symptoms may include:

• increased weakness or tiredness
• infrequent urination or darker urine
• heart rate changes
• cold or blotchy hands and feet
• irregular breathing or shortness of breath
• drops in blood pressure
• a lack of interest in food or drink
• unresponsiveness to others
• delirium
• pain
• constipation
• coughing
• fever
• difficulty swallowing
• muscle jerks
• hemorrhage (excessive bleeding)

Treatment at this stage involves making a person as comfortable as possible. It may be helpful for an individual to receive palliative or hospice care.

Learn about palliative and hospice care.

CLL turning into lymphoma

In 2% to 10%Trusted Source of CLL cases, CLL may go through what health experts refer to as Richter’s transformation (RT). This occurs when the small cells associated with CLL transform into larger, more aggressive cells.

In most cases, the cells transform into large B cell lymphoma, a more aggressive form of non-Hodgkin’s lymphoma. Rarely, CLL can transform into Hodgkin’s lymphoma, another aggressive cancer type.

RT does not typically occur in the early stages of CLL, so it is not generally possible for doctors to diagnose it early. Health experts do not know the cause of RT.

Symptoms of RT from CLL may include:

• enlarged lymph nodes
• unexplained weight loss
• night sweats
• fever

How to slow the progression of CLL

There is currently no cure for CLL. However, individuals with the condition can extend their life span by taking steps to support their overall health.

It is best for people to work closely with a doctor, even during the “watchful waiting” phase, which involves closely monitoring a person’s condition but not giving treatment until symptoms appear. It is important to attend all medical appointments and closely follow treatment advice.

The following may also help improve a person’s quality of life:

• getting exercise
• eating a balanced diet
• connecting with local support groups

A doctor may be able to provide support group recommendations. Alternatively, people can use the American Cancer Society’sTrusted Source support group finder.

Summary

Chronic lymphocytic leukemia (CLL) is a common form of leukemia in adults. Individuals often receive a diagnosis after a routine blood test and may not experience any symptoms for several years following diagnosis.

The appearance of symptoms can indicate that a person’s condition is worsening. Treatment may help with alleviating these symptoms and extending a person’s life span.