Blood Cancer (Leukemia)

Reviewed By:   Anil Ghimire, MD

Introduction

Blood cancer encompasses cancers that originate in the bone marrow (organ that produces blood cells). Most of the blood cancers involve white blood cells (cells that fight infection) and are called leukemia. Cancers can also develop in the red blood cells (cells that carry oxygen) and platelets (cells that help stop bleeding). When these abnormal white blood cells grow out of control in the bone marrow, it spills into the blood causing abnormally high circulating white blood cells which are incapable of fighting infection. In addition, too many white blood cells in the bone marrow displace other normal red blood cells and platelets and resulting in anemia and bleeding tendencies.

Based on the type of white blood cells involved, leukemia can be classified as lymphocytic or myelocytic. Each of these types can be either acute (rapid progression) or chronic (slow progression). Here are the four broad types of leukemia:

  • Acute lymphocytic leukemia (ALL)
  • Chronic lymphocytic leukemia (CLL)
  • Acute myelocytic leukemia (AML)
  • Chronic myelocytic leukemia (CML)

 

Within these broad categories there are subtypes of leukemia.

Blood cancer can occur at any age. Some type of blood cancer are more common in children (ALL) while others are more common in adults (AML, CML, CLL). Blood cancer, unlike other cancers, usually does not produce a mass.

 

Risk Factors
The exact factors producing leukemia are not yet well-known. Research suggests that a combination of genetic and environmental factors  may play a role for leukemia such as the following:

  • Chemotherapy: Certain types of chemotherapy (for other cancer) increase risk of blood cancer.
    Exposure to industrial chemicals like benzene.
  • Radiation: Exposure to high-level radiation may lead of greater chance of having blood cancer
  • Certain genetic disease like Down’s syndrome
  • A family history of leukemia

 

Not all people who develop leukemia will have these risk factors. Furthermore people with theses risk factors may not develop leukemia.

 

Symptoms

  • Fever, chills due to infections as white blood cells that fight infection are abnormal
  • Tiredness, dizziness or breathlessness because of anemia
  • Easy bleeding because of low platelets, recurrent nose bleeding
  • Tiny red spots, bruises under the skin
  • Fever, night sweats
  • Bone and joint pain
  • Loss of appetite, weight loss
  • Enlarged lymph nodes

 

When to see a doctor

As symptoms of blood cancer are often vague and nonspecific, you should seek medical attention if these symptoms are persistent and worry you. If you had cancer and were in remission and develop above symptoms, it might be an indication that the cancer might have come back and you should call your doctor.

 

Diagnosis

Depending on the type of leukemia, it may be diagnosed based on the signs and symptoms and a blood test or if the leukemia is of chronic in nature it might be picked up during a routine blood test as these slow growing leukemia can be asymptomatic.

Physical exam will reveal enlarged lymphnodes in neck, armpit, and enlarged liver and spleen (organs in abdomen).
Blood test will show high number of abnormal blood cell. Finally a bone marrow aspiration and biopsy is needed to confirm the diagnosis that shows abnormal white blood cells.
Specialized molecular and genetic tests are performed on cancer cells to further subtype the leukemia that may be helpful in guiding treatment options.

 

Treatment

There are different ways to treat leukemia depending on specific type of blood cancer, age, extent of spread and the risk category.

 

Leukemia is treated by one or more of the following

  • Chemotherapy: This means drugs are used to kill cancer cells. These are given in cycles over a long period of time. Chemotherapy has the potential to damage normal cells in our body and produce side effects like hair fall, repeated infections, liver damage etc.
  • Targeted immunologic and biologic therapy: these drugs only target the abnormal cancer cell sparing patient from side effects of killing normal cells.
  • Radiation therapy: A particular strength of radiation is used to kill the cancer cells.
  • Bone marrow transplant: This is an advanced method of treating blood cancer by replacing cells in the bone marrow that are killed by chemotherapy or radiation therapy
  • Surgery: In some cases enlarged spleen is removed by surgery.

 

While treating leukemia, the doctor will ask you to do regular follow up. It is necessary to examine and test for different side effects of the drug or radiation. You have to report your doctor or nurse about any problems that occur in between. You have to follow your doctor’s instructions on hygiene, diet and follow up to make sure that you avoid complications. Some complications can be so serious that you may need hospitalization, transfusion of blood products and sometimes may even be life-threatening.

The doctor will also look for signs or test reports that indicate the cancer has come back. If the cancer comes back you may need more aggressive chemotherapy, radiation therapy or sometimes bone marrow transplantation.

As with any cancer therapy, you and your family should talk to your doctor or nurse about following aspects of your treatment before you embark on treatment path:

  • Benefits of the treatment you are receiving
  • Problems or side effects associated with the treatment
  • Other options besides this treatment
  • Risk of not receiving the treatment

 

A fatal disease until the 1960’s, people with leukemia live longer these days. Ninety percent of children with acute lymphocytic leukemia achieve remission and nearly half are cured with current treatments. While adults with leukemia have a better chance of survival than before it is less favorable compared to children.

 

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