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Diagnosis and tests

Symptoms of ALL

The related article (“ALL: symptoms and diagnosis”) explains the blood smear. This topic looks closely at the symptoms of acute lymphoblastic leukaemia (ALL): how it shows up in children and in adults.

Last updated: ~1 min read
A child resting on a sofa.
Figure 1.Tiredness and knee pain in a child.

01Short answer

The symptoms of ALL resemble those of AML, because both fill the bone marrow: tiredness and paleness (anaemia), bruising and bleeding (low platelets), and fever and infections (too few working neutrophils). But some features are more common in ALL. Bone and joint pain may show up in children as limping or refusing to walk. Lymph nodes, the liver and the spleen can enlarge. In T-cell ALL, a mass in the middle of the chest (the mediastinum) can cause breathlessness or cough. If leukaemia reaches the fluid around the brain and spine, there may be headache, vomiting or nerve symptoms; rarely, boys have a swollen testicle. Symptoms usually develop over weeks.

02Simple explanation

Marrow symptoms: anaemia, bleeding, infection.

Bone pain: especially in children.

Nodes, a chest mass.

03Scientific explanation

Mediastinal mass: in T-ALL, a mass near the thymus can press on the airways and blood vessels; this also affects anaesthesia planning.

CNS: CNS involvement at diagnosis is uncommon, which is why it is checked with a lumbar puncture (“Lumbar puncture and cerebrospinal fluid”).

04What happens in the body?

Tiredness and pain in a child

A child may play less, limp or complain of pain on waking.

Lymph nodes

Painless swellings in the neck, armpits and groin.

A neck with highlighted nodes.
Figure 2.Enlarged lymph nodes in the neck.

A chest mass

In T-ALL, a mass in the middle of the chest can affect breathing.

The highlighted middle of the chest.
Figure 3.A chest mass in T-ALL.

05Symptoms of ALL

Four steps.

Less play — Tiredness.1Less playTiredness.
Pain — Bones and joints.2PainBones and joints.
Nodes — Swellings.3NodesSwellings.
Test — A blood test.4TestA blood test.

06Symptom and cause

SymptomCause
Tiredness, palenessAnaemia
Bruising, bleedingLow platelets
Fever, infectionToo few working neutrophils
Bone pain, limpingExpansion in the marrow
Breathlessness, facial swellingMediastinal mass (urgent)

07Key terms

Lymph node
A small organ where immune cells gather.
Mediastinum
The area in the middle of the chest.
Splenomegaly
An enlarged spleen.
CNS involvement
Leukaemia reaching the brain and spinal cord.
Thymus
An organ in the chest where T cells mature.

08Key points

  • ALL causes marrow symptoms.
  • Bone pain is common in children.
  • Nodes and spleen can enlarge.
  • T-ALL may cause a chest mass.
  • The CNS is checked.
  • Breathlessness is urgent.

09Frequently asked questions

Is my child’s leg pain just “growing pains”?

Often yes, but if the pain comes with tiredness, paleness and bruising, see a doctor.

Are symptoms different in adults?

They are similar; in adults, tiredness and infections may be more prominent.

Are the nodes painful?

Usually not.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. Is my child’s leg pain just “growing pains”?

  2. Are symptoms different in adults?

  3. Are the nodes painful?

My questions

12Sources

  1. National Cancer Institute (NCI). Adult ALL treatment (PDQ), patient version
  2. MedlinePlus. Blood smear
  3. MedlinePlus. Cerebrospinal fluid (CSF) analysis
  4. National Cancer Institute (NCI). NCI Dictionary of Cancer Terms: cytogenetic analysis
  5. National Cancer Institute (NCI). NCI Dictionary of Cancer Terms: translocation
  6. National Human Genome Research Institute (NHGRI). Talking Glossary of Genomic and Genetic Terms: Karyotype
  7. National Human Genome Research Institute (NHGRI). Fluorescence In Situ Hybridization Fact Sheet
  8. Testing.com. Karyotyping Test: What It Measures and How It Works
  9. National Cancer Institute (NCI). NCI Dictionary of Cancer Terms: germline mutation
  10. National Human Genome Research Institute (NHGRI). Polymerase Chain Reaction (PCR) Fact Sheet
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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