Pain: part 3 – Abdominal discomfort

In most cases, the cause of an abdominal discomfort in leukaemia is an enlarged spleen (splenomegaly). This can occur when leukaemia cells begin to accumulate in and around the spleen causing it to swell. In rarer cases, the abdominal pain can also be caused by an enlarged liver (hepatomegaly).

The spleen is an organ (about the size of a fist) on the upper left side of the body, just beneath the ribs. It acts like a filter to remove infectious germs and damaged red blood cells from the blood. The spleen also controls how many white blood cells, red blood cells and platelets (cells that make blood clot) our body produces.

Normally you cannot feel your spleen; however, when it enlarges to a certain size, it can be felt by you or your doctor. This is referred to as a palpable spleen.

“I had a swollen spleen, which felt like laying on a tennis ball when in bed.”

An enlarged spleen is a key presenting symptom of leukaemia in children. As many as 50% of children with acute leukaemia develop splenomegaly and most infants with a very rare form of childhood leukaemia, juvenile myelomonocytic leukaemia (JMML), will show signs of an enlarged spleen. Children may complain of a stomach ache, show signs of a lack of appetite, or a loss of weight. Other key symptoms to look out for in children are complaints of pain in the legs and bruising.

An enlarged spleen doesn’t always cause discomfort. For this reason, the condition is commonly detected during a visit to the doctors. You may not be aware of the spleen swelling, and sometimes a partner may be the first to notice something is wrong.

“I also had pain in my lower back, which I thought was from overdoing things, and swelling on the left-hand side of my abdomen (I couldn’t see it myself, but it was very noticeable to others).”

However, it is also important to look out for the following symptoms:

• Decreased appetite
• You may start to feel full after eating very little food (an enlarged spleen can press upon the stomach, giving your brain a false sensation of “fullness”).

“I lost my appetite and generally started to feel unwell.”

• Weight loss
• A gradual loss of appetite will also mean you start to lose weight if you are eating less than usual.
• Weight loss may also be a direct result of the leukaemia cells. Rapidly dividing leukaemia cells use up energy that your body would otherwise use or store.

“I also noticed a change in my weight and I lost my appetite. I later learned that this was caused by my enlarged spleen which was pressing on my stomach.”

• Feeling of discomfort or pain behind your left ribs 
• If part of the spleen is damaged this may occur as a sharp shooting pain in the left of the abdomen. Otherwise, this might be an ache or general discomfort on the left side.
• Enlargement of the spleen can mean it loses its ability to function properly. It might start to filter out healthy blood cells from the body instead of just the abnormal ones. This can result in:
• Anaemia due to a loss of healthy red blood cells.
• Increased risk of bleeding or bruising due to a reduction of platelets.
• Increased frequency of infections due to a lack of healthy white blood cells.

Any persistent abdominal pain is worth visiting your GP about. With so many organs in the abdomen, there are many different problems that can manifest in abdominal discomfort, including appendicitis, gallstones, ulcers, infections and problems of the GI tract. A doctor will be able to decipher the root cause by using blood tests, an ultrasound, or computerized tomography (CT) scan.

It is important to see a doctor straight away if your abdominal discomfort is affecting your ability to function or if you are experiencing any other symptoms such as loss of appetite, weight loss, fever, nausea, or any seemingly unrelated symptoms such as blurred vision, mouth ulcers or increased bruising and bleeding.