Many people with chronic lymphocytic leukemia (CLL) do not have any symptoms when it is diagnosed. The leukemia is often found when their doctor orders blood tests for some unrelated health problem or during a routine checkup. Even when there are symptoms, they are often vague and non-specific.

Symptoms of CLL can include the following:

• weakness
• fatigue
• weight loss
• fever
• night sweats
• enlarged lymph nodes (felt as lumps under the skin)
• pain or a sense of "fullness" in the belly (especially after eating a small meal), which is caused by an enlarged spleen

But these symptoms aren't found only in CLL. They can also occur with other cancers, as well as many non-cancerous conditions.

Many of the signs and symptoms of advanced CLL occur because the leukemia cells replace the bone marrow's normal blood-making cells. As a result, people do not make enough red blood cells, properly functioning white blood cells, and blood platelets.

• Anemia is a shortage of red blood cells. It can cause tiredness, weakness, and shortness of breath.
  
• A shortage of normal white blood cells (leukopenia) increases the risk of infections. A common term you may hear is neutropenia, which refers specifically to low levels of neutrophils (a type of granulocyte). Although patients with CLL may have very high white blood cell counts due to excess numbers of lymphocytes (lymphocytosis), the leukemia cells do not protect against infection the way normal white blood cells do.
  
• A shortage of blood platelets (thrombocytopenia) can lead to excess bruising, bleeding, frequent or severe nosebleeds, and bleeding gums.

People with CLL are at higher risk for infections. This is mainly because their immune systems are not working as well as they should. CLL is a cancer of B lymphocytes, which normally make antibodies that help fight infection. But in CLL, these antibody-making cells don't work as they should, so they can't fight infections well. Infections may range from simple things like frequent colds or cold sores to pneumonia and other serious infections.

CLL may also affect the immune system in other ways. In some people with CLL, the immune system cells make abnormal antibodies that attack normal blood cells. This is known as autoimmunity. It can lead to hemolytic anemia (if the antibodies attack red blood cells), thrombocytopenia (if they attack the cells that make platelets), or leukopenia (if they attack white blood cells).

CLL often causes the liver or spleen to become enlarged. If these organs are enlarged, you may notice fullness or swelling of the belly. The spleen is on the left side, while the liver is on the right. These organs are usually covered by the lower ribs but when they are larger than normal, your doctor can feel them.

CLL will often invade the lymph nodes. If the nodes are close to the surface of the body (for instance, on the sides of the neck, in the groin, in the underarm area, or above the collarbone), you or your doctor may notice the swelling as a lump under the skin. Lymph nodes inside the chest or abdomen may also become swollen, but these can be found only by imaging tests such as a computed tomography (CT) scan.