CONDITIONS
Leukemia
What is Leukemia?
Leukemia is a type of cancer that affects the blood, characterized by the uncontrollable growth of abnormal blood cells. This growth occurs in the bone marrow, which produces most of the blood in the body. Typically, leukemia cells are immature white blood cells (WBC). The word leukemia is derived from the Greek words for “white” (leukos) and “blood” (haima).
Every year in India, over 20,000 new cases of childhood blood cancer are diagnosed – of which nearly 15,000 are cases of leukemia.
The white blood cells in our body play a crucial role in fighting infections, and they grow and divide as needed. However, individuals with leukemia experience an overproduction of abnormal WBC from the bone marrow that do not perform their intended functions. Unlike most other cancers, leukemia generally does not form a visible tumor that imaging tests like X-rays or CT scans can detect.
How does Leukemia develop?
Leukemia is a blood cancer originating in the bone marrow, the soft and spongy tissue inside bones where blood cells are produced. Normally, blood cells pass through several stages of development before reaching maturity.
- The normal mature blood cells include:
- Red blood cells that transport oxygen and nutrients throughout the body,
- WBC protects against infection,
- Platelets that help in clotting.
Blood cells start as hematopoietic stem cells, which then develop into either myeloid or lymphoid cells. Myeloid cells mature into red blood cells, platelets, and specific types of WBC (basophils, eosinophils, and neutrophils), while lymphoid cells mature into certain types of WBC (lymphocytes and natural killer cells).
However, in the case of leukemia, one of the developing blood cells begins to undergo uncontrolled multiplication. These abnormal cells, called leukemia cells, start taking over the bone marrow space. Consequently, they disrupt the development of healthy red blood cells, white blood cells, and platelets.
What does leukemia do to your body?
Too many leukemia cells and too few normal cells within the bone marrow pose several detrimental effects on the body. With an abundance of leukemia cells crowding in the bone marrow, there is limited space for producing healthy red blood cells. As a result, the body may experience a shortage of functional red blood cells, leading to reduced oxygen-carrying capacity. This can result in fatigue, weakness, shortness of breath, and other symptoms associated with oxygen deprivation.
Insufficient generation and circulation of red blood cells, normal white blood cells, and platelets lead to a deficiency in the supply of oxygen required by the body’s organs and tissues to function optimally. Furthermore, the body’s capacity to fight infections and facilitate blood clotting in crucial situations becomes impaired.
Types
Leukemia can be categorized into four main types:
- Acute lymphocytic leukemia (ALL) is commonly found in children but can affect adults as well
- Acute myeloid leukemia (AML), is more common in older adults but can also occur in children
- Chronic lymphocytic leukemia (CLL), which is a frequent type of leukemia in adults, typically diagnosed during or after middle age
- Chronic myeloid leukemia (CML) usually affects adults during or after middle age.
Causes
Leukemia initiates with a mutation in the DNA of a single cell within the bone marrow. DNA serves as the “instruction code” for cells, guiding their growth, development, and natural cell death. Due to this mutation or coding error, leukemia cells experience uncontrolled multiplication. The cause of this mutation is unknown, but common mutations have been identified in people diagnosed with different types of leukemia.
Symptoms
The symptoms of leukemia may vary depending on the type of leukemia. In some cases, people with chronic leukemia may not show symptoms in the early stages. However, common signs and symptoms of leukemia include
- Fatigue, fever, or night sweats
- Frequent infections
- Shortness of breath
- Pale skin and unexplained weight loss
- Bone/joint pain or tenderness
- Pain or full feeling under the left rib
- Swollen lymph nodes in various parts of the body, such as the neck, underarm, groin, or stomach, an enlarged spleen or liver, and
- Easy bruising and bleeding include nosebleeds, bleeding gums, petechiae, or purplish skin patches.
Are certain people at a higher risk for developing leukemia?
Leukemia can affect anyone, but some factors may increase the risk of developing the disease. These factors include
- Previous cancer treatment involving radiation or chemotherapy
- Exposure to industrial chemicals like benzene and formaldehyde: Benzene and formaldehyde are considered carcinogenic, and found in various building materials and household products. Benzene is utilized in the production of plastics, rubbers, dyes, pesticides, drugs, and detergents. Formaldehyde can be found in building materials as well as common household items like cleaning products
- Smoking
- Genetic disorders such as Klinefelter syndrome, Down syndrome, etc.
Research has also suggested that certain types of leukemia may run in families, but having a family member with leukemia does not always mean that others in the family will develop the disease. Healthcare providers can recommend genetic testing to assess your risk if you have a family history of leukemia or a genetic condition.
Diagnosis
The following are some of the diagnostic exams and tests that healthcare providers may conduct to determine the presence of leukemia:
- Physical examination: The healthcare provider will take a detailed medical history, including symptoms, previous illnesses, and exposure to risk factors. A physical examination will also be conducted to assess signs of leukemia, such as enlarged lymph nodes, spleen, or liver.
- Complete blood count (CBC): Blood samples are taken to assess the number and appearance of blood cells. Complete blood count (CBC) is a common blood test that provides information about the levels of red blood cells, white blood cells, and platelets. Abnormal cell counts or cell characteristics may indicate the presence of leukemia.
- Bone marrow biopsy (bone marrow aspiration): A small sample of bone marrow is obtained from the hipbone or sternum using a thin needle. This procedure, known as a bone marrow aspiration and biopsy, is performed under local anesthesia. The sample is examined under a microscope to assess the presence of leukemia cells and determine the type of leukemia.
- Imaging and other tests: Imaging studies, such as X-rays, CT scans, or MRI scans, may be conducted to evaluate the extent of leukemia and detect any organ enlargement or complications.
- Lumbar puncture (spinal tap): To determine whether leukemia has spread to the spinal fluid surrounding your brain and spinal cord, a healthcare provider may analyze a sample of spinal fluid.
Treatment
The following are some of the typical treatments used to treat leukemia, usually given in combination:
- Chemotherapy: This involves using chemicals to kill leukemia cells or prevent their multiplication and is the most common therapy used.
- Immunotherapy (biologic therapy): This treatment uses specific drugs to stimulate the immune system, which aids in fighting leukemia. Immunotherapy assists the immune system in identifying cancer cells and generating additional immune cells to fight them.
- Targeted therapy: Targeted therapies may prevent leukemia cells from multiplying, disrupt the cells’ blood supply, or kill them. Targeted therapy is less likely to damage normal cells. Monoclonal antibodies and tyrosine kinase inhibitors are examples of targeted therapy drugs.
- Radiation therapy: Uses strong energy beams or X-rays to kill leukemia cells or prevent their growth. Dispersion of radiation throughout the body may occur before a hematopoietic cell transplant.
- Stem cell or bone marrow transplant: This treatment involves replacing damaged or diseased bone marrow with healthy stem cells. These healthy stem cells can come from the individual themselves or from a compatible donor.
- Clinical Trials: Enrolling in a clinical trial offers individuals with leukemia the opportunity to access new and potentially innovative cancer treatments. However, it is crucial to carefully consider the potential benefits and risks associated with participating in a clinical trial. These considerations should be thoroughly discussed with your healthcare provider.
Can leukemia be cured?
Leukemia currently has no cure. The prognosis and treatment options depend on several factors, including the specific type of leukemia, its stage, the age, and the overall health of the individual.
Treatment for leukemia typically involves chemotherapy, radiation therapy, targeted therapy, immunotherapy, or stem cell transplantation. The goal of treatment is to eliminate cancer cells, achieve remission, and prevent the recurrence of the disease.
Advances in medical research and treatments have significantly improved the survival rates for leukemia patients, and many individuals are able to achieve long-term remission. However, it is important to note that each case is unique, and the outcome can vary from person to person. Regular follow-up care and monitoring are necessary to ensure early detection of any potential relapse.
