Leukemia is the name given to a group of cancers that develop in the bone marrow. Under normal conditions the bone marrow contains a small number of healthy immature blood cells, sometimes called blast cells. These immature blood cells mature and develop into red cells, white cells and platelets, which are eventually released into the blood stream.
Leukemia originates in developing blood cells, which have undergone a malignant (cancerous) change. Instead of maturing properly, these cells grow and multiply in an uncontrolled fashion and interfere with normal blood cell production in the bone marrow. Most cases of leukemia originate in developing white cells. In a small number of cases leukemia develops in other blood-forming cells, for example in developing red cells or developing platelets.
There are several different types and sub types of leukemia.
Acute lymphocytic leukemia (ALL). This is the most common type of leukemia in young children. ALL can also occur in adults.
Acute myelogenous leukemia (AML). AML is a common type of leukemia. It occurs in children and adults. AML is the most common type of acute leukemia in adults.
Chronic lymphocytic leukemia (CLL). With CLL, the most common chronic adult leukemia, you may feel well for years without needing treatment.
Chronic myelogenous leukemia (CML). This type of leukemia mainly affects adults. A person with CML may have few or no symptoms for months or years before entering a phase in which the leukemia cells grow more quickly.
Other types. Other, rarer types of leukemia exist, including hairy cell leukemia, myelodysplastic syndromes and myeloproliferative disorders.
Leukemia symptoms are often mild at first, but slowly worsen over time. Some people with chronic (slow-growing) leukemia don’t notice any symptoms at all, and only find out they have the disease when they have a routine blood test.
The symptoms of leukemia depend on how many abnormal white blood cells are in the body, and where they collect.
In cases of acute (fast-growing) leukemia, abnormal white blood cells multiply rapidly and spill out from the bone marrow into the bloodstream, crowding out healthy blood cells, which can no longer do their job properly.
In chronic leukemia, abnormal white blood cells fail to die, and slowly build up in the bloodstream, bone marrow, and other organs.
Common symptoms of leukemia
Some of the more common symptoms of leukemia include:
Other symptoms of leukemia
Less common symptoms of leukemia can include:
If you notice any of these symptoms, it doesn’t mean you have leukemia, but it’s a good idea to see your doctor for a check-up.
Doctors are not sure what causes leukaemia. It is likely that abnormal genes play a part. One type of leukemia, chronic myeloid leukemia (CML), is often caused by an abnormal chromosome.It is also likely that a person’s chances of getting leukemia are affected by where they live, where they work, what they eat and more.
In acute lymphoblastic; leukemia (ALL), it’s thought that the response of the immune system to certain infections may affect development in some people.
While the exact causes of leukemia are unclear, some things are known to increase the risk of developing leukemia. These are called ‘risk factors’ and include:
Previous cancer treatment: People who’ve had certain types of chemotherapy and radiation therapy for other cancers have an increased risk of developing certain types of leukemia.
Genetic disorders: Genetic abnormalities seem to play a role in the development of leukemia. Certain genetic disorders, such as Down syndrome, are associated with an increased risk of leukemia.
Exposure to certain chemicals: Exposure to certain chemicals, such as benzene — which is found in gasoline and is used by the chemical industry — is linked to an increased risk of some kinds of leukemia.
Smoking: Smoking cigarettes increases the risk of acute myelogenous leukemia.
Family history of leukemia: If members of your family have been diagnosed with leukemia, your risk of the disease may be increased.
You can lower your risk of getting cancer by eating well, exercising regularly, giving up smoking and cutting back on alcohol. But in many cases, there is no known way to prevent leukemia.
In general, leukemia is thought to occur when some blood cells acquire mutations in their DNA — the instructions inside each cell that guide its action. There may be other changes in the cells that have yet to be fully understood that could contribute to leukemia.
Certain abnormalities cause the cell to grow and divide more rapidly and to continue living when normal cells would die. Over time, these abnormal cells can crowd out healthy blood cells in the bone marrow, leading to fewer healthy white blood cells, red blood cells and platelets, causing the signs and symptoms of leukemia.
Doctors classify leukemia based on its speed of progression and the type of cells involved.
The first type of classification is by how fast the leukemia progresses:
Acute leukemia: In acute leukemia, the abnormal blood cells are immature blood cells (blasts). They can’t carry out their normal functions, and they multiply rapidly, so the disease worsens quickly. Acute leukemia requires aggressive, timely treatment.
Chronic leukemia: There are many types of chronic leukemias. Some produce too many cells and some cause too few cells to be produced. Chronic leukemia involves more mature blood cells. These blood cells replicate or accumulate more slowly and can function normally for a period of time. Some forms of chronic leukemia initially produce no early symptoms and can go unnoticed or undiagnosed for years.
The second type of classification is by type of white blood cell affected:
Lymphocytic leukemia: This type of leukemia affects the lymphoid cells (lymphocytes), which form lymphoid or lymphatic tissue. Lymphatic tissue makes up your immune system.
Myelogenous leukemia. This type of leukemia affects the myeloid cells. Myeloid cells give rise to red blood cells, white blood cells and platelet-producing cells.
Many of the symptoms of leukaemia are quite general and can be caused by a range of illnesses. To make a definite diagnosis of leukaemia, a number of tests need to be done.
Your doctor will most likely give you a physical examination and take a sample of your blood so it can be examined under a microscope. If the blood test shows large numbers of abnormal white blood cells, and low numbers of healthy blood cells, more tests will be done to confirm the diagnosis.
Tests for leukemia
There are several tests that can be done to confirm a diagnosis of leukemia, and to work out which type it is:
Bone marrow biopsy – a syringe is used to take a sample of bone marrow, usually from your hip bone, for examination under the microscope and genetic testing.
Lumbar puncture – this is sometimes called a spinal tap. A needle is put into the space between the bones of your lower back and fluid from around the spinal cord is removed for examination under the microscope to look for abnormal white blood cells.
Lymph node biopsy – if you have swollen or tender lymph nodes, a sample may be removed for examination under the microscope.
Treatment for your leukemia depends on many factors. Your doctor determines your leukemia treatment options based on your age and overall health, the type of leukemia you have, and whether it has spread to other parts of your body, including the central nervous system.
Common treatments used to fight leukemia include:
Chemotherapy: Chemotherapy is the major form of treatment for leukemia. This drug treatment uses chemicals to kill leukemia cells.
Depending on the type of leukemia you have, you may receive a single drug or a combination of drugs. These drugs may come in a pill form, or they may be injected directly into a vein.
Biological therapy: Biological therapy works by using treatments that help your immune system recognize and attack leukemia cells.
Targeted therapy: Targeted therapy uses drugs that attack specific vulnerabilities within your cancer cells.
For example, the drug imatinib (Gleevec) stops the action of a protein within the leukemia cells of people with chronic myelogenous leukemia. This can help control the disease.
Radiation therapy: Radiation therapy uses X-rays or other high-energy beams to damage leukemia cells and stop their growth. During radiation therapy, you lie on a table while a large machine moves around you, directing the radiation to precise points on your body.
You may receive radiation in one specific area of your body where there is a collection of leukemia cells, or you may receive radiation over your whole body. Radiation therapy may be used to prepare for a stem cell transplant.
Stem cell transplant: A stem cell transplant is a procedure to replace your diseased bone marrow with healthy bone marrow.
Before a stem cell transplant, you receive high doses of chemotherapy or radiation therapy to destroy your diseased bone marrow. Then you receive an infusion of blood-forming stem cells that help to rebuild your bone marrow.
You may receive stem cells from a donor, or in some cases you may be able to use your own stem cells. A stem cell transplant is very similar to a bone marrow transplant.
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