Overview
The word Leukemia comes from the Greek leukos which means "white" and aima which means "blood". It is cancer of the blood or bone marrow (which produces blood cells). A person who has leukemia suffers from an abnormal production of blood cells, generally leukocytes (white blood cells).
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 and 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.
In order to better understand what goes on we need to have a look at what the bone marrow does.
Types of Leukemia
Leukemia can be divided into four different types. It is first classified as acute or chronic.In chronic leukemia, the leukemia cells come from mature, abnormal cells. The cells thrive for too long and accumulate. These type of cells slowly multiply.
Acute leukemias, on the other hand, develop from early cells, called "blasts," which are young cells that divide frequently. In acute leukemia cells, they don't stop dividing like their normal counterparts do.
Myelogenous vs Lymphocytic
After being classified as acute or chronic, it is then classified by the type of cells in which the leukemia started from. It can either be myelogenous or lymphocytic.Myelogenous leukemia develops from myeloid cells. The disease can either be chronic or acute, referred to as chronic myelogenous leukemia (CML) and acute myelogenous leukemia (AML). There are several types of myelogenous leukemia.
Lymphocytic Leukemia
Lymphocytic leukemia develops from cells called "lymphoblasts" or "lymphocytes" in the blood marrow. The disease can be acute or chronic, referred to as chronic lymphocytic leukemia (CLL) and acute lymphocytic leukemia (ALL). There are several types of lymphocytic leukemia.Risk Factors for Leukemia
While research continues on this issue, currently it is difficult to determine what causes leukemia. Age is not a factor in that both children and adults can get leukemia, although the various forms vary with frequency in different age groups. According to the National Cancer Institute there will be over 44,000 citizens in the United States alone diagnosed with leukemia this year.Leukemia most often affects those over 60 years old. Both AML and CLL are more often seen in adults while ALL is commonly seen in children. Risk factors are behaviors and environments that can increase the likelihood an individual will develop leukemia. Being a risk factor, it does not mean an individual will develop the disease just because they are at risk.
These factors are: -
- chemotherapies - Individuals using this treatment for other forms of cancer are at risk for developing leukemia.
- Down syndrome or other genetic diseases
- Benzene- This is usually associated with unsafe work environments where prolonged exposure can occur.
- tobacco
- radiation
What causes leukemia?
Leukemia Causes
The exact cause of leukemia is unknown.- As with other cancers, smoking is considered a risk factor for leukemia, but many people who develop leukemia have never smoked, and many people who smoke never develop leukemia.
- Long-term exposure to chemicals such as benzene or formaldehyde, typically in the workplace, is considered a risk factor for leukemia, but this accounts for relatively few cases of the disease.
- Prolonged exposure to radiation is a risk factor, although this accounts for relatively few cases of leukemia. Doses of radiation used for diagnostic imaging such as x-rays and CT scans are nowhere near as prolonged or high as the doses needed to cause leukemia.
Other risk factors for leukemia include the following: -
- Revious chemotherapy : - Chemotherapy, particularly certain of the alkylating agents and topoisomerase inhibitors, used to treat certain types of cancers, are linked to development of leukemia later. It is likely that radiation treatment adds to the risk of leukemia associated with certain chemotherapy drugs.
- Human T-cell leukemia virus 1 (HTLV-1) : -Infection with this virus is linked to human T-cell leukemia.
- Myelodysplastic syndromes : - In this unusual group of blood disorders, the net outcome is invariably an acute myelocytic process.
- Down syndrome and other genetic diseases : - Some diseases caused by abnormal chromosomes may increase risk for leukemia.
- Family history : - Having a first-degree relative (parent, brother, sister, or child) who has chronic lymphocytic leukemia increases one’s risk of having the disease by as much as 4 times that of someone who does not have an affected relative.
Symptoms of leukemia
- 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 - he may also develop petechiae (a small red to purple spot on the body, caused by a minor hemorrhage).
- 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 good body cells.
- Anemia - As the shortage of good red blood cells grows the patient may suffer from anemia - this may lead to difficult or labored respiration (dyspnea) and pallor (skin has a pale color caused by illness).
- Other symptoms - Patients may also experience nausea, fever, chills, night sweats, flu-like symptoms, and tiredness. If the liver or spleen becomes enlarged the patient may feel full and will eat less, resulting in weight loss. Headache is more common among patients whose cancerous cells have invaded the CNS (central nervous system).
- Precaution - As all these symptoms could be due to other illnesses. A diagnosis of leukemia can only be confirmed after medical tests are carried out.
Diagnosing Leukemia
Physical Exam. During a physical exam, a doctor may look for lumps, other abnormalities or symptoms of leukemia. A thorough medical history will be taken and the patient can report a history of leukemia or any symptoms or risk factors.Blood Tests. Blood tests, such as complete blood count (CBC) can detect leukemia. A CBC determines the number of red blood cells, white blood cells and platelets. It also can count the number of red blood cells that make up the blood sample and the amount of hemoglobin in the blood.
Other blood tests that may be used to diagnose leukemia include: -
- peripheral blood smear - determines the presence of blast cells and reveals the type and quantity of white blood cells
- cytogenic analysis - is a blood test in which a sample of blood is examined to check for changes in the chromosomes of the lymphocytes
- other various blood tests - other blood tests may be ordered to see how organs are functioning and if they are being affected by leukemia
Biopsy. A biopsy is a procedure in which a sample of cells are removed from the body to be examined for cancer. Bone marrow biopsy is used to diagnose leukemia. A large bore needle is inserted in to the hip or, rarely, the breast bone and a sample of the bone is removed and bone marrow is then aspirated. The material is then examined by a pathologist. A lymph node biopsy may also be performed depending on the type of leukemia suspected.
Lumbar Puncture/Spinal Tap. A lumbar puncture or spinal tap may be done to diagnose leukemia. Under an anesthetic, a small amount of spinal fluid is removed from the spaces between the vertebrae in the spine. The fluid is then examined by a pathologist.
Treatments for leukemia
As the various types of leukemias affect patients differently, their treatments depend on what type of leukemia they have. The type of treatment will also depend on the patient's age and his state of health.In order to get the most effective treatment the patient should get treatment at a center where doctors have experience and are well trained in treating leukemia patients. As treatment has improved, the aim of virtually all health care professionals should be complete remission - that the cancer goes away completely for a minimum of five years after treatment.
Treatment for patients with acute leukemias should start as soon as possible - this usually involves induction therapy with chemotherapy, and takes place in a hospital.
When a patient is in remission he will still need consolidation therapy or post induction therapy. This may involve chemotherapy, as well as a bone marrow transplant (allogeneic stem cell transplantation).
If a patient has Chronic Myelogenous Leukemia (CML) his treatment should start as soon as the diagnosis is confirmed. He will be given a drug, probably Gleevec (imatinib mesylate), which blocks the BCR-ABL cancer gene. Gleevec stops the CML from getting worse, but does not cure it. There are other drugs, such as Sprycel (dasatinib) and Tarigna (nilotinb), which also block the BCR-ABL cancer gene. Patients who have not had success with Gleevec are usually given Sprycel and Tarigna. All three drugs are taken orally. A bone marrow transplant is the only current way of curing a patient with CML. The younger the patient is the more likely the transplant will be successful.
Patients with Chronic Lymphocytic Leukemia (CLL) may not receive any treatment for a long time after diagnosis. Those who do will normally be given chemotherapy or monoclonal antibody therapy. Some patients with CLL may benefit from allogeneic stem cell transplantation (bone marrow transplant).
All leukemia patients, regardless of what type they have or had, will need to be checked regularly by their doctors after the cancer has gone (in remission). They will undergo exams and blood tests. The doctors will occasionally test their bone marrow. As time passes and the patient continues to remain free of leukemia the doctor may decide to lengthen the intervals between tests.
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