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CLL is often unexpectedly discovered on a routine blood test for an unrelated problem.
Most patients have no symptoms at time of diagnosis (5-10% do have symptoms), but symptoms may develop, especially fatigue, which can be profound.
Fatigue is not a trivial problem and needs to be addressed in a serious manner. The fatigue can be overwhelming. Fortunately, there are several effective treatments for our cancer-related fatigue.
The onset of classic “B symptoms” is a sign that the cancer may be active. Any one of these symptoms demands a thorough work-up. They are also a well-recognized and widely agreed upon as an indication for starting treatment of CLL.
Below is the official list of B symptoms.
- Unexplained weight loss >10% of body weight in the previous 6 months
- Severe fatigue (unable to work or perform usual activities)
- Fevers >38°C or 5°F for at least 2 weeks without evidence of infection
- Drenching night sweats (soaking the bed sheets) for more than a month without evidence of infection
Enlarged Lymph Nodes
Another very common symptom found in more than half of new CLL patients is painless enlarged lymph nodes that wax and wane. They may later become painful or may grow together to form large masses of lymphoid tissue or they may simply be unsightly. Enlarged nodes may be present even in the absence of an elevated white blood cell count.
The number and size of enlarged lymph nodes figure into the diagnosis and management. The term “generalized lymphadenopathy” means enlarged lymph nodes throughout the body. (See “What is a Lymph Node?”)
An enlarged spleen, found in the upper left quadrant (quarter) of the abdomen, can cause abdominal symptoms, including pain and a feeling of fullness. (See “What is the Spleen?”)
An exaggerated response to insect bites such as mosquitoes is a frequent but under recognized problem in CLL.
Anxiety and trouble sleeping are the most common psychological symptoms in CLL patients, but depression and other issues can arise. Talk to your health care team if you are feeling distressed.
Finally, we can experience symptoms from the common complications of our CLL. These tend to occur later in the disease and not at the time of diagnosis.
These secondary symptoms may result from:
- Low blood counts
- Low white blood cells → infections
- Low platelets → easy bleeding or bruising
- Low red blood cells → fatigue, shortness of breath, or light-headedness
- Secondary cancers
- Recurrent Infections (even in the absence of abnormal blood counts)