Cancer Guide To Leukemia

December 11, 2020

What is leukemia?
Leukemia is a cancer of the blood cells. It’s about as common today as it was in the 1950s, but new treatments mean you can live longer than ever before, and sometimes even be cured. Although it is the most common cancer in children, more adults get it than children. There are several types. Most start in white blood cells, but how they unfold and the treatment you need can be very different.

Who gets this disease?
We don’t know what causes leukemia, but chemicals like benzene, found in cigarettes and used in some industries, can increase the odds. Cancer treatment with certain types of chemotherapy and radiation may also do this. You’re also more likely to get it if you have certain genetic conditions, such as Down syndrome and Fanconi anemia. If you have a parent, brother, sister, or child with the condition, this means you have a higher chance of getting it, too.

About Your Blood Cells
You have three main types. White blood cells fight disease, red blood cells carry oxygen, and platelets help form blood clots when you are injured. All of these cells start as stem cells in your bone marrow, the spongy tissue at the core of your bones. Your bone marrow makes and releases hundreds of billions of stem cells every day. Under normal circumstances, this is all in good order. Your bone marrow makes and releases hundreds of billions of these cells every day.

What’s going wrong?
All it takes is a change in the DNA of one blood cell. DNA is your body’s recipe book, and a small adjustment can have a big impact. That one cell will divide into two cells with the same mistake, and those two cells will divide again, and pretty soon you’ll have a lot of broken cells that don’t follow the rules. They can’t do their normal job, they take up space in your bone marrow, crowding out healthy cells. This is what causes the symptoms.

Early Signs and Symptoms
There are no obvious signs of leukemia. The symptoms are often vague. At first, it may just look like a cold. Having fewer red blood cells can give you anemia, making you pale, tired, and short of breath. When you have low white blood cells to health, you can’t fight off infections as well. You’ll get sick more often, and the illness lasts longer. With low platelets, you’ll bruise and bleed more easily.

Other Symptoms
You may feel ill and weak, with chills, fever, and night sweats. You may have a nosebleed, small red spots on your skin, and swollen or bleeding gums. You may lose weight for no apparent reason, and your joints and bones may hurt. Cancer cells may accumulate in your lymph nodes, spleen, and liver and cause swelling. If they accumulate in your brain, you may have headaches, confusion, and seizures.

What are the different types of leukemia?
Although leukemia can affect more than one type of blood cell, its name is based on the type of white blood cell (myeloid or lymphocyte) it starts in and the rate at which it worsens (acute or chronic). Acute cancers develop within a few weeks because young white blood cells flood your bone marrow. They are usually found after you have an infection that does not go away. Chronic cancers appear much more slowly. They are usually found with a routine blood test.

Common Types of Leukemia
Acute myeloid leukemia (AML) is the most common acute form in adults. Acute lymphocytic leukemia (ALL) is the most common form in children.

Chronic myeloid leukemia (CML) is one of the few cancers with a direct link to a known defect in DNA.

Chronic lymphocytic leukemia (CLL) causes white blood cells to not die when they should.

The stage or stages of
Unlike other cancers, the stage of leukemia does not describe the extent to which the cancer has spread. Higher stages require a more aggressive approach or are more difficult to treat.CLL may be low, intermediate (or standard) or high risk. Chronic CML has the fewest young white blood cells (called blasts), more white blood cells in the accelerated stage, and more white blood cells in the blast stage. Acute leukemia progresses rapidly, so there is no designated stage.

Diagnostic Tests
The first test you will receive is a complete blood count (CBC). It shows how many types of blood cells you have. Usually, it can tell you almost anything about whether you have leukemia. To confirm the diagnosis and find out more details, you may have a bone marrow biopsy. Your doctor will use a needle, usually in your hip bone, to take a sample of your bone marrow. Both tests can also check how well your treatment is working.

Other Tests
In order to choose the best treatment, you need to learn as much as you can about the cancer. A test called a blood smear can show you how many cancer cells you have and what they look like. Your doctor may do imaging tests such as a CT scan, an MRI, and an ultrasound to check for cancer in your lymph nodes and organs. And you may have a lumbar puncture to see if it has spread to your brain and spinal cord.

Chemotherapy
This is the standard treatment for acute leukemia. Chemotherapy uses drugs that attack cancer cells throughout the body. The first round may last a few weeks. Once the cancer is in remission, you will usually get more cycles of chemotherapy, spread over 4-8 months. For some types of cancer, you may need more treatment over the next 2-3 years. You will also get medication to help relieve side effects, such as vomiting.

Stem Cell Transplantation
High doses of chemotherapy can kill more cancer cells, but they can also wipe out healthy cells. At this point, you may need stem cells from a donor to restore your supply. This can be risky, because your body may reject the new cells, so it is mainly used in cases where other treatments have not worked. Sometimes, stem cell transplants can cure cancer, but they can also cause life-threatening damage to your immune system.

Targeted Therapy
These drugs are commonly used in chronic leukemia. They spare healthy cells and attack only the cancer cells, which act differently. Tyrosine kinase inhibitors (TKI’s) basically cure CML, although you have to take them for life. In the case of CLL, drugs called monoclonal antibodies can mark cancer cells so your immune system can destroy them. And kinase inhibitors can stop the growth and division of CLL cells.

Gene Therapy
CAR T is a new type of customized immunotherapy. With each injection, some of your white blood cells are removed and sent to a lab where they are given a new gene that tells them to target and kill specific leukemia cells. These modified T-cells then return to your body to help kill the cancer. This treatment is only available to people younger than 25 years of age and with B-cell ALL, where other treatments have not worked or have returned.

Gene Therapy
CAR T is a new type of customized immunotherapy. With each injection, some of your white blood cells are removed and sent to a lab where they are given a new gene that tells them to target and kill specific leukemia cells. These modified T-cells then return to your body to help kill the cancer. This treatment is only for people younger than 25 years of age and with B-cell ALL; other treatments have not worked or have returned.

Protect your brain and spine
This is a concern for ALL patients. Although this type of cancer does not start in the central nervous system, it will spread there at least half the time. To prevent this from happening, you will have chemotherapy drugs injected directly into your spine. You may need more than one round of treatment.

Watch and wait.
For many types of leukemia, you will start treatment right away. However, for CLL, treatment is usually delayed until you develop symptoms. You will still need regular checkups and routine tests to keep a close eye on your condition. Some people never have any problems and live a normal life. If your white blood cell levels skyrocket, your platelets drop, or you develop symptoms such as swollen lymph nodes, you’ll start treatment.

During treatment
Leukemia and treatments for leukemia can lower the number of healthy blood cells in your body. To help your body survive the disease, you may need blood transfusions for anemia, antibiotics for infections, and platelet transfusions for bleeding problems. Also, because you have a higher chance of infection, you and anyone who comes near you need to wash your hands well and often.

Survival Rate
Remember, many things affect your personal outlook, including the type of leukemia you have, how advanced it is, and your overall health. Survival rates are averages, not your fate. The 5-year relative survival rate for leukemia is about 60%. This means that, on average, 6 out of every 10 people with leukemia are alive at 5 years compared to every 10 people without leukemia.

Childhood Leukemia
About 3 out of 4 children with leukemia have ALL; the rest usually have acute myeloid leukemia. It’s very rare for a child to develop any of the chronic types of disease, and ALL is a great success story, in part because children respond so well to treatment. It may take 2-3 years, but almost all children – about 9 out of 10 – are completely cured. Children also have a much higher success rate than adults in treating acute myeloid leukemia.

Follow-Up Care
Whether you’re in remission, watching and waiting, or undergoing ongoing treatment, regular checkups and tests will be a part of your life. Talk openly and honestly with your doctor about not only changes in symptoms, but also any emotions and daily struggles you may be experiencing. Ask about a survivorship care plan that will address both your medical needs and your overall health.

Preventive Measures
There is not much you can do to prevent leukemia, and there is no special screening method to detect it. What you can do is not smoke, stay away from benzene, and avoid really high levels of radiation. Other than that, the best tool you have is your annual checkup. This gives your doctor an idea of your health status and often includes routine blood tests that can detect disease in the early stages.