Leukemia

Overview

Leukaemia is a type of cancer of the blood or the bone marrow. Leukaemia occurs when there is an abnormal increase in immature white blood cells, called 'blasts'. The DNA of immature blood cells, mainly white cells, becomes damaged in some way. This abnormality causes the blood cells to grow and divide chaotically. Normal blood cells die after a while and are replaced by new cells which are produced in the bone marrow. The abnormal blood cells do not die so easily, and accumulate, occupying more and more space. As more space is occupied by these faulty blood cells, there is less and less space for the normal cells and the sufferer becomes ill. Quite simply, the bad cells crowd out the good cells in the blood.

Leukaemia is a treatable disease. Most treatments involve chemotherapy, medical radiation therapy, hormone treatments, or bone marrow transplant. The rate of cure depends on the type of Leukaemia as well as the age of the patient. Leukaemia can affect people at any age. About 90% of all Leukaemias are diagnosed in adults.

Symptoms

Like all blood cells, Leukaemia cells travel through the body. The symptoms of Leukaemia depend on the number of Leukaemia cells and where these cells collect in the body. People with chronic Leukaemia may not have symptoms. The doctor may find the disease during a routine blood test.

People with acute Leukaemia usually go to their doctor because they feel sick. If the brain is affected, they may have headaches, vomiting, confusion, loss of muscle control or seizures. Leukaemia also can affect other parts of the body, such as the digestive tract, kidneys, lungs, heart or testes.

Common symptoms of chronic or acute Leukaemia may include:

  • Blood clotting is poor: As immature white blood cells crowd out blood platelets, which are crucial for blood clotting, the patient may bruise or bleed easily and heal slowly.
  • Affected immune system: The patient's white blood cells, which are crucial for fighting off infection, may be suppressed or not working properly. The patient may experience frequent infections, or his immune system may attack other, healthy cells.
  • Anaemia: As the shortage of good red blood cells grows, the patient may suffer from Anaemia which, in turn, may lead to difficult or laboured respiration (dyspnea) and pallor (skin has a pale color caused by illness).

Other symptoms:

  • Nausea
  • Fever
  • Night sweats and tiredness
  • Sudden loss of weight with no obvious reason
  • Headaches
  • Frequent infections
  • Feeling weak or tired
  • Bleeding and bruising easily (bleeding gums, purplish patches in the skin, or tiny red spots under the skin)
  • Swelling or discomfort in the abdomen (from a swollen spleen or liver)
  • Pain in the bones or joints

Most often, these symptoms are not due to cancer. An infection or other health problems may also cause these symptoms. Only a doctor can tell for sure.

Causes

According to doctors different Leukaemias have different causes. The following are known causes:

  • Artificial ionising radiation
  • Viruses - HTLV-1 (human T-lymphotropic virus) and HIV (human immunodeficiency virus)
  • Benzene and some petrochemicals
  • Alkylating chemotherapy agents used in previous cancers
  • Maternal fetal transmission (rare)
  • Hair dyes
  • Genetic predisposition: Some studies, researching family history and looking at twins, have indicated that some people have a higher risk of developing Leukaemia because of a single gene or multiple genes.
  • Down syndrome: People with Down syndrome have a significantly higher risk of developing Leukaemia, compared to people who do not have Down syndrome. Experts say that because of this, people with certain chromosomal abnormalities may have a higher risk.
  • Electromagnetic energy: Studies indicate that there is not enough evidence to show that ELF magnetic (not electric) fields that exist currently might cause Leukaemia. The IARC (International Agency for Research on Cancer) says that studies which indicate there is a risk, tend to be biased and unreliable.
  • Exposure to large amounts of radiation
  • Smoking

    According to doctors different Leukaemias have different causes. The following are some known causes:

  • Artificial ionising radiation
  • Viruses - HTLV-1 (human T-lymphotropic virus) and HIV (human immunodeficiency virus)
  • Benzene and some petrochemicals
  • Alkylating chemotherapy agents used in previous cancers
  • Maternal fetal transmission (rare)
  • Hair dyes
  • Genetic predisposition some studies researching family history and looking at twins have indicated that some people have a higher risk of developing Leukaemia because of a single gene or multiple genes.
  • Down syndrome: People with Down syndrome have a significantly higher risk of developing Leukaemia, compared to people who do not have Down syndrome. Experts say that because of this, people with certain chromosomal abnormalities may have a higher risk.
  • Electromagnetic energy: Studies indicate that there is not enough evidence to show that ELF magnetic (not electric) fields that exist currently, might cause Leukaemia. The IARC (International Agency for Research on Cancer) says that studies which indicate there is a risk tend to be biased and unreliable.
  • Exposure to large amounts of radiation
  • Smoking

Diagnosis

If a patient suffers from symptoms that are associated with Leukaemia, one of the following tests will be recommended:

Physical exam: The doctor will check for swollen lymph nodes, spleen or liver.

Blood tests: The lab does a complete blood count to check the number of white blood cells, red blood cells and platelets. Leukaemia causes a very high count of white blood cells. It may also cause low levels of platelets and haemoglobin, which is found inside red blood cells.

Biopsy: The doctor removes tissue to look for cancer cells. A biopsy is the only sure way to know whether Leukaemia cells are in the bone marrow. Before the sample is taken, local anaesthesia is used to numb the area. This helps reduce the pain. The doctor removes some bone marrow from the hipbone or another large bone. A pathologist uses a microscope to check the tissue for Leukaemia cells.

There are two ways for a doctor to obtain bone marrow. Some people will have both procedures during the same visit:

  • Bone marrow aspiration: The doctor uses a thick, hollow needle to remove samples of bone marrow.
  • Bone marrow biopsy: The doctor uses a very thick, hollow needle to remove a small piece of bone and bone marrow.

OTHER TESTS

The tests that the doctor prescribes depend on the symptoms and type of Leukaemia. One may have other tests:

  • CytogeneticsThe lab looks at the chromosomes of cells from samples of blood, bone marrow or lymph nodes. If abnormal chromosomes are found, the test can show what type of Leukaemia one as. For example, people with CML have an abnormal chromosome called the Philadelphia chromosome.
  • Spinal tap: The doctor may remove some of the cerebrospinal fluid (the fluid that fills the spaces in and around the brain and spinal cord). The doctor uses a long, thin needle to remove fluid from the lower spine. The procedure takes about 30 minutes and is performed with local anaesthesia. One must lie flat for several hours afterward to keep from getting a headache. The lab checks the fluid for Leukaemia cells or other signs of problems.
  • Chest x-ray: An X-ray can show swollen lymph nodes or other signs of disease in the chest.

Treatment

Treatments for Leukaemia include:

Chemotherapy

Chemotherapy is the treatment of disease with chemicals, especially by killing micro-organisms or cancerous cells, which uses powerful medicines to kill cancer cells. This is the main treatment for most types of Leukaemia.

Radiation treatments

Radiation therapy uses high-dose X-rays to destroy cancer cells and shrink swollen lymph nodes or an enlarged spleen. It may also be used before a stem cell transplant.

Stem cell transplant

Stem cells can rebuild the supply of normal blood cells and boost the immune system. Before the transplant, radiation or chemotherapy may be given to destroy cells in the bone marrow and make room for new stem cells. Or it may be given to weaken the immune system, so the new stem cells can get established.

Biological therapy

This is the use of special medicines that improve the body's natural defenses against cancer. 

For some people, clinical trials are a treatment option. Clinical trials are research projects to test new medicines and other treatments. Often, people with Leukaemia take part in these studies.

Specialists


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