Leukemia

Introduction:

Cancer that results from the abnormal growth of the blood-forming tissues, bone marrow, and lymphatic system is called leukemia. There are many types of leukemia, amongst which some are more common in children, and others occur mostly in adults. Most types of leukemias affect the white blood cells, which fight infections in the body. But in leukemia, the bone marrow produces abnormal white blood cells, which do not function like normal WBC (white blood cells). It is the most common cancer affecting children below 15 years of age. The treatment is complex, and it depends on the type of leukemia. It can also be fatal.

What Causes Leukemia?

The exact cause is still unknown, but scientists believe that a combination of genetic and environmental factors plays a role.

How Does Leukemia Affect the Body?

The blood has three cells, namely white blood cells (WBC), red blood cells (RBC), and platelets. WBCs fight infections, RBCs help supply oxygen to the body, and platelets help in blood clotting. These cells are made in the bone marrow every day. In leukemia, the bone marrow produces large amounts of abnormal white blood cells, even more than RBC. WBCs are of two types, which are lymphoid cells and myeloid cells, and this cancer can affect either type of cell.

These abnormal WBCs do not function like the healthy ones and thus cannot fight infections. As the number of WBCs increase in the blood, it starts affecting the functions of important organs in the body. In later stages, there are insufficient RBCs, platelets, and normal WBCs in the blood to carry oxygen, clot the blood, and fight infections. This results in anemia and easy bruising.

How Is Leukemia Classified?

Leukemia is classified either by its speed of progression or the type of cell affected.

The classification based on the type of cell affected is:

• Lymphocytic Leukemia - The lymphoid cells (lymphocytes), which form the lymphatic tissue, are affected.

• Myelogenous Leukemia - The myeloid cells, which produce red blood cells, white blood cells, and platelet-producing cells, are affected.

The classification based on the speed of progression is:

• Acute Leukemia - This type of leukemia spreads and worsens quickly. Here, the blood cells are immature and cannot carry out their normal functions but multiply rapidly. It requires aggressive treatment.

• Chronic Leukemia - This type progresses very slowly and goes undiagnosed for years. The blood cells are more mature, so they function normally for some time and do not replicate and spread quickly. There are many types of chronic leukemia.

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What Are the Types of Leukemia?

There are many types of leukemia, and the common ones are:

• Acute Lymphocytic Leukemia (ALL) - It is the most common childhood cancer but can also affect adults.

• Acute Myelogenous Leukemia (AML) - It is the most common type of acute leukemia affecting both children and adults.

• Chronic Lymphocytic Leukemia (CLL) - It is the most common chronic leukemia in adults.

• Chronic Myelogenous Leukemia (CML) - It is mostly seen in grown-ups.

• Hairy Cell Leukemia - It is a rare and chronic type of leukemia that affects the B cells (lymphocytes).

• Myelodysplastic Syndromes - It is a group of conditions that result when the bone marrow produces immature blood cells.

What Are the Signs and Symptoms Seen In Leukemia?

The early signs of leukemia are:

• Tiredness or fatigue.

• Unintentional weight loss.

• Fever.

• Chills.

• Frequent infections.

The other signs and symptoms of leukemia are:

• Enlarged lymph nodes.

• Swollen liver or spleen.

• Easy bruising.

• Frequent nosebleeds.

• Petechiae (red spots on the skin).

• Night sweats.

• Bone pain.

• Anemia.

Leukemia can spread to other parts like the lungs, gastrointestinal tract, kidneys, etc., and cause symptoms. The presence of headaches, confusion, nausea, and seizures are signs of cancer spreading to the central nervous system.

What Are the Risk Factors for Leukemia?

The factors that increase the risk of leukemia are:

• Family history.

• Smoking.

• Genetic or chromosomal disorder.

• Blood diseases.

• Chemotherapy.

• Radiation therapy.

• Radiation exposure.

• Chemical exposure.

How Is Leukemia Diagnosed?

Chronic leukemia does not produce many symptoms, so it is diagnosed during a routine blood test. And in acute leukemia, if the doctor suspects leukemia after taking a complete medical history, he or she will look for signs of anemia, swollen lymph nodes, and enlarged spleen or liver. The doctor will tell the patient to get the following tests done:

• Blood Test - To check for abnormal levels of red or white blood cells or platelets.

• Bone Marrow Test - A sample of bone marrow from the hip bone is taken using a long and thin needle. Leukemia cells are detected in this sample. Other tests are performed on these cancer cells, which reveal certain characteristics and are used to determine treatment options.

• Genetic Test - To check for chromosomal and genetic changes.

What Are the Treatment Options for Leukemia?

The treatment depends on the type and stage of the disease and the patient's general health. The treatment options include:

1. Chemotherapy - The cancer cells are destroyed using drugs. The drug is either injected into the vein, muscle, or CSF (cerebrospinal fluid) or can be taken orally.

2. Radiation Therapy - High-energy X-rays are used to destroy cancer cells to prevent them from multiplying. Only a specific part of the body or the entire body might be exposed to this radiation.

3. Immunotherapy or Biologic Therapy - Here, medicines that boost the body’s immune response are administered. Interleukins and interferon are used.

4. Targeted Therapy - Drugs like Imatinib are used to block genes or proteins needed for cancer cell growth. It can either block the signals the cells send to grow, cut the blood supply to these cells or kill them.

5. Stem Cell Transplant - Here, cells in the bone marrow are destroyed through chemical or radiation therapy, then replaced with stem cells. The new stem cells are infused into one of the patient’s veins, which grow into healthy blood cells. The stem cells are either taken from a donor or the patient’s body.

6. Surgery - Splenectomy, which is the surgical removal of the spleen, is done if it is filled with cancer cells and affects nearby organs.

Conclusion:

The prognosis differs depending on the type of leukemia. People under remission must undergo regular tests to ensure cancer does not recur. There is no cure for it, but this does not mean people cannot achieve long-term remission. Nevertheless, the survival rate of patients with leukemia has increased over a period of time.