What is Leukemia?

Leukemia

Leukemia literally means ‘many white cells in the blood’.

CLL Blood Smear

The white cells are part of the body’s immune system, and there are several sub-groups of white cells that have different sorts of roles in recognising and dealing with ‘invaders’ such as bacteria and viruses as well as other types of foreign protein. All of the blood cells originate in the bone marrow and leukemia (blood cancer) is a disease where the bone marrow produces large numbers of abnormal white cells. This means that the normal marrow is pushed into smaller and smaller areas. This results in fewer normal cells being produced and gives rise to some of the symptoms. There are many types of leukemia, each of which is classified according to the exact cell type affected by the disease. We will cover both chronic and acute leukemias.

Types of Cells in the Blood

Chronic Lymphocytic Leukemia (CLL)

CLL is a slowly progressive form of leukaemia and tends to involve more mature cell types. It may not need treatment immediately, but if treatment is required it is usually chemotherapy.

What are the symptoms of chronic leukemia?

  • It is possible to have chronic leukemia for months or even years without knowing it.
  • tiredness (due to anaemia)
  • bruising easily (often without having had any blow or fall)
  • repeated infections
  • enlarged lymph glands
  • weight loss
  • night sweats
  • fever
  • painless enlargement of the lymph glands especially in the neck, armpits and groin.
  • lymph glands in deeper parts of the body may need special scans for diagnosis.
  • sometimes an enlarged spleen (located in the left upper quadrant of the abdomen) may cause discomfort or pain.

What is chronic lymphocytic leukemia?

It is estimated that 16,060 men and women (9,490 men and 6,570 women) will be diagnosed with and 4,580 men and women will die of chronic lymphocytic leukemia in 2012. It is a form of chronic leukaemia characterized by an increased number of lymphocytes, which make up one of the main sub-groups of white cells in the blood. Despite their increased numbers these lymphocytes lack the normal ability of responding to infection by the production of antibodies, so compromising the immune system of the affected person. There are no obvious causes known for CLL.

How is chronic lymphocytic leukemia diagnosed?

Often the condition is diagnosed by chance when blood tests are being performed forother reasons. Although a blood test may give doctors the diagnosis, a bone marrow biopsy is usually done to confirm the diagnosis. Other testing is performed on samples to help classify the leukemia. PET and CT scans may also be performed in order to help doctors decide on the best treatment.

How is chronic lymphocytic leukemia treated?

Treatment is not always required and the patient may just be followed up as an outpatient on a regular basis, sometimes for many years, with no need for further action. Older people with early stage CLL have a normal life expectancy. Treatment in the form of chemotherapy will be required for those who are unwell or who have many enlarged lymph glands, or who become significantly anaemic. Sometimes the spleen, which is also part of the body’s immune system swells up so much in CLL that it gives rise to pain, or it causes a type of anaemia to develop in which the red cells of the blood (oxygen-carrying cells) become fragile, leading to further anaemia. These problems may justify the surgical removal of the spleen.

Acute Lymphocytic Leukemia (ALL)

ALL is rapidly progressive if not treated and involves more immature cells. It develops rapidly from the earliest forms of cells in the immature bone marrow cells (blasts). It requires urgent medical treatment but is generally responsive to chemotherapy. Acute leukemia is a rare disease that is more common in children and young people. However, their survival rate is better than in older people.

What are the symptoms of acute leukemia?

  • Sudden appearance of symptoms.
  • An unnaturally pale complexion (anaemia).
  • Fatigue.
  • Pain in the joints. When children are affected, this is sometimes mistaken for growing pains.
  • Repeated infections, such as sore throats.
  • Acute leukaemia is also usually accompanied by nosebleeds and bruising easily, often without any kind of blow or fall.
  • If any of the above symptoms develop, it is advisable to consult a doctor. Parents are understandably afraid of leukemia, but fortunately, the diagnosis often turns out to be something else entirely, as many other diseases have similar symptoms.

How is acute leukemia diagnosed?

  • Many forms of leukemia can be diagnosed by blood tests. Commonly, the acute leukaemia cell (blasts) can be seen circulating in the blood.
  • A bone marrow test will also be performed to diagnose the type of cells involved, as this can help doctors decide on the best choice of treatment.
  • Acute leukaemia is usually easy to diagnose.

How is acute leukemia treated?

Most patients with acute leukemia will be referred to specialist units for investigation and treatment. These days, medical treatments are extremely effective and an ever-increasing number of children and young people recover completely. Treatment is usually with chemotherapy given through the veins. In most cases, chemotherapy is given in courses over four to six months. Each course lasts four to five days. Chemotherapy kills fast dividing cells and this includes normal body cells as well as cancer cells. The normal bone marrow is sensitive to chemotherapy and the blood counts may drop, making the patient vulnerable to infection and bleeding. This generally means that the patient has to remain in hospital for weeks following chemotherapy. However the blood counts will recover over time. Blood transfusions are likely to be given during this vulnerable period.

Sometimes a bone marrow transplant will also be recommended by the doctor. This is a way of giving larger doses of treatment. It is a very aggressive form of treatment and so is only recommended for young, fit patients. The cells used for this sort of treatment may be the patient’s own, donated by a brother or sister or by an unrelated donor.

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