Leukemia

Leukemia is cancer of the blood-forming tissues, including the bone marrow and the lymphatic system. Usually, leukemia results in abnormally high number of white blood cells.

Your white blood cells help to fight infection. But in leukemia, abnormal white blood cells are produced which cannot function properly. Out of many types of leukemia, some are common in children while some in adults. Treatment for leukemia usually depends on the type of leukemia and other factors.

Different types of leukemia have different symptoms. The common signs and symptoms include:

• Fever or chills
• Persistent weakness
• Extreme tiredness
• Severe infections that come often
• Unexplained weight loss
• Swollen lymph nodes
• Enlarged liver or spleen
• Easy bleeding or bruising
• Frequent nosebleeds
• Petechiae (tiny red spots in your skin)
• Excessive sweating, particularly at night
• Bone pain or tenderness

When to see a Doctor?

If you experience any persistent signs and symptoms that concern you, see your doctor immediately. Since symptoms of leukemia often resemble that of flu and are ambiguous, people often neglect the symptoms.

The causes of leukemia have not been explained yet. Leukemia is believed to develop when blood cells undergo mutations in their DNA. Such abnormalities cause rapid cell growth and multiplication. Also, these abnormal cells continue to live longer than normal cell and crowd out healthy blood cells over time. Signs and symptoms of leukemia become noticeable when the number of healthy white blood cells, red blood cells and platelets is significantly low. Leukemia is classified on the basis of disease progression and the type of cells involved.

On the basis of its speed of progression leukemia is classified as:

• Acute Leukemia: The abnormal blood cells, in acute leukemia, are immature blood cells (blasts). The blasts can't carry out normal functions and divide rapidly causing the disease to get worsened. Hence, aggressive and timely treatment is necessary.
• Chronic Leukemia: It involves more mature blood cells. These blood cells replicate gradually and can perform their functions normally for a certain period of time. There are many forms of chronic leukemia which either produce too many cells or too few cells. Some forms of leukemia may not produce signs and symptoms at early stage and hence, can go undiagnosed for years.

Leukemia, on basis of the type of WBCs affected, is classified as:

• Lymphocytic leukemia: This type of leukemia affects the lymphoid cells (lymphocytes). Lymphocytes form lymphoid or lymphatic tissue which is an integral part of your immune system.
• Myelogenous leukemia: This type of leukemia affects the myeloid cells. Myeloid cells produce red blood cells, white blood cells and platelet-producing cells.

Types of leukemia:

• Acute lymphocytic leukemia (ALL): This is the most common type of leukemia in young children. However, ALL can also occur in adults.
• Acute myelogenous leukemia (AML): AML is a common type of leukemia occurring in children and adults. AML is the most common acute adult leukemia.
• Chronic lymphocytic leukemia (CLL): With CLL, the most common chronic adult leukemia, you may not need treatment for years.
• Chronic myelogenous leukemia (CML): This type of leukemia mainly affects adults. Initially, the cells divide slowly and then enter a phase in which cells start to grow rapidly.

Other rarer types of leukemia are hairy cell leukemia, myelodysplastic syndromes and myeloproliferative disorders

Make an appointment with your doctor if you experience signs and symptoms of leukemia to receive a diagnosis. If leukemia is suspected, you may be referred to a hematologist (specialist in disease of blood and bone marrow).

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful.

List out all the symptoms.

Write down your key medical information.

Write down the names of all your medications, vitamins or supplements.

Ask a trusted friend or family member to accompany you.

Make a list of the questions to ask your doctor. Some typical questions can be:

• Do my symptoms indicate leukemia? If yes, what type?
• Do I need more tests?
• Does my leukemia need immediate treatment?
• What are the treatment options for my leukemia and what are the possible side effects of each treatment option?
• Is my leukemia curable?
• Will treatment affect my daily life?
• Can I continue working or going to school?

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor. Your doctor might ask you typical questions like:

• When did you first experience the symptoms?
• Are your symptoms continuous or occasional?
• How severe are your symptoms?
• Does anything relieve or worsen your symptoms?
• Have you ever had abnormal blood test results?

If doctors find abnormal blood counts in a routine blood test or if you have signs and symptoms indicative of leukemia, you are likely to undergo following examinations:

• Physical exam: Physical signs like pale skin due to anemia, swelling of your lymph nodes and enlargement of your liver and spleen are examined.
• Blood tests: A sample of blood drawn from your body can be analyzed to determine if you have abnormal levels of white blood cells or platelets.
• Bone marrow test: A sample of bone marrow from your hipbone is drawn using a long, thin needle. The sample is then analyzed to determine if you have leukemia.

Some additional tests might be recommended by your doctor to confirm the diagnosis as well as to determine the stage and type of leukemia.

Treatment options for leukemia is dependent on your age, general health status, stage and type of leukemia you have. Your treatment options could be:

• Chemotherapy: Mostly chemotherapy is first approach used for treating leukemia. Chemotherapy uses drugs to kill leukemia cells. Chemotherapy, either alone or in combination, may be given orally or injected into vein.
• Biological therapy: Biological therapy stimulates or restores the ability of your immune system to recognize and attack leukemia cells.
• Targeted therapy: Targeted therapy attacks particular abnormalities within cancer cells. For instance, the drug imatinib blocks the action of a protein within the leukemia cells and helps control the disease.
• Radiation therapy: Radiation therapy uses ionizing radiations to kill the leukemic cells. The radiation may be directed to a precise point in your body or to your whole body. Radiation therapy is used prior to stem cell transplant.
• Stem cell transplant: In this process, your cancerous bone marrow is replaced by healthy bone marrow. Your diseased bone marrow, before a stem cell transplant, is destroyed by high doses of chemotherapy or radiation therapy. Then, your doctor will infuse blood-forming stem cells that help to rebuild your bone marrow. In few cases, you may be able to use your own stem cells while in most of the cases you may receive stem cells from a donor.

Lifestyle modifications are necessary in order to cope with leukemia.

Being diagnosed with leukemia can be overwhelming. Following tips may be helpful to cope up with the anxiety and stress:

• Learn about leukemia: Discuss with your doctor about your leukemia, treatment options and prognosis which helps you boost confidence in making decisions about you care.
• Stay close to family and friends: Talking to a trusted friend or a family member can help you obtain essential supports you need.
• Join support group: Learn about a support group in your area and be a part of it. Being with people similar to you may motivate you and have a positive view of life.

There are several risks associated with leukemia, which include:

• Previous cancer treatment: People who have received chemotherapy or radiation therapy earlier have high risk of certain leukemia.
• Genetic disorder: People with certain genetic disorder, such as Down syndrome, are at an increased risk of developing leukemia.
• Exposure to certain chemicals: Exposure to chemicals, such as benzene which is found in gasoline and used by chemical industry, is associated with higher chances of having certain types of leukemia.
• Smoking: You are at increased risk of acute myelogenous leukemia if you smoke.
• Family history of leukemia: You have higher chances of developing leukemia if any members of your family have been diagnosed with leukemia.