Leukemia

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Leukemia is cancer of the blood cells. To understand leukemia, it helps to know about normal blood cells and what they do, and then what happens to them when leukemia develops.

The blood is made up of fluid called plasma and three types of cells:

1. White blood cells

2. Red blood cells

3. Platelets

Each type has special functions. White blood cells (leukocytes) help the body fight infections and other diseases. Red blood cells (erythrocytes) carry oxygen from the lungs to the body's tissues and take carbon dioxide from the tissues back to the lungs. The red blood cells give blood its color. Platelets (thrombocytes) help form blood clots that control bleeding. Blood cells are formed in the bone marrow, the soft, spongy center of the bones. New (immature) blood cells are called blasts. Some blasts stay in the marrow to mature. Some travel to other parts of the body to mature. Normally, blood cells are produced in an orderly, controlled way, as the body needs them. This process keeps us healthy.

When leukemia develops, the body produces large numbers of abnormal blood cells. In most types of leukemia, the abnormal cells are white blood cells. The leukemia cells usually look different from normal blood cells, and they do not function properly.

There are several types of leukemia, and they are grouped in two ways:

1. By how quickly the disease develops and worsens.

2. By the type of blood cell affected.

Leukemia is either acute or chronic. In acute leukemia, the abnormal blood cells are blasts that remain immature and cannot carry out their normal functions. The number of blasts increases rapidly, and the disease worsens quickly. In chronic leukemia, some blasts are present, but in general, these cells are more mature and can carry out some of their normal functions. Also, the number of blasts increases less rapidly than in acute leukemia. As a result, chronic leukemia worsens gradually.

The types of white blood cells involved in acute leukemia are generally grouped into myeloid cells and lymphoblasts: hence the terms acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). Similarly, there are two general cellular divisions of chronic leukemia: chronic myelogenous leukemia (CML) and chronic lymphocytic leukemia (CLL).

The incidence of all forms of leukemia in the United States, in males and females, across all ages and races, is about 12 per 100,000. The peak incidence of ALL is between 3 and 7 years old, though it's also seen in adults. AML is usually seen in adults of a median age around 50 years old, though it's also seen in young adults and children. Ninety percent of CLL cases occur after age 50, while most CML cases occur in early middle age.

• Fever, chills and other flulike symptoms
• Weakness and fatigue
• Frequent infections
• Loss of appetite and/or weight
• Swollen or tender lymph nodes, liver or spleen
• Easy bleeding or bruising
• Tiny red spots (called petechiae) under the skin
• Swollen or bleeding gums
• Sweating, especially at night
• Bone or joint pain

To find the cause of a person's symptoms, the doctor asks about the patient's medical history and does a physical exam. In addition to checking general signs of health, the doctor feels for swelling in the liver, spleen and lymph nodes under the arms, as well as in the groin and neck.

Blood tests also help in the diagnosis. A sample of blood is examined under a microscope to see what the cells look like and to determine the number of mature cells and blasts. Although blood tests may reveal that a patient has leukemia, they may not show what type of leukemia it is. A hematologist, oncologist or pathologist examines a sample of bone marrow under a microscope. The doctor withdraws the sample by inserting a needle into a large bone (usually the hip) and removing a small amount of liquid bone marrow. This procedure is called bone marrow aspiration. A bone marrow biopsy is performed with a larger needle and removes a small piece of bone and bone marrow. If leukemia cells are found in the bone marrow sample, the patient's doctor orders other tests to find out the extent of the disease - for instance, a spinal tap (lumbar puncture) or chest X-rays.

Treatment for leukemia varies for all patients. It depends not only on the type of leukemia, but also on certain features of the leukemia cells, the extent of the disease and whether the leukemia has been treated before. It also depends on the patient's age, symptoms and general health. Whenever possible, patients should be treated at a medical center that has doctors experienced in treating leukemia. Acute leukemia needs to be treated right away; the goal is to bring about a remission. When there is no more evidence of the disease, more therapy may be given to prevent a relapse. Many people with acute leukemia can be cured.

Most leukemia patients are treated with chemotherapy. Some patients also have radiation therapy and/or bone marrow transplantation or biological therapy. In some cases, surgery to remove the spleen may be part of the treatment plan.

Research suggests that lifestyle modication with regard to patterns of diet, exercise and tobacco use, among other factors, is the best way to prevent any form of cancer, including leukemia. It's also good to be aware of the possible symptoms, as described above, and to alert your doctor if you notice them.