What is Leukaemia?
Leukaemia is the result of the rapid overproduction of abnormal white blood cells. It affects close to 45,000 people in the United States each year.
Leukaemia is the most common type of blood cancer in people older than 55. But, it’s also the most common cancer in children under 15.
What Causes Leukaemia?
Leukaemia occurs when abnormal white blood cells in the bone marrow quickly increase and destroy normal blood cells. This leaves a person prone to infection.
Treatment approaches for leukaemia depend on the type of white blood cell affected and whether the disease is acute or chronic.
Acute leukaemia forms rapidly and becomes severe quickly. Chronic leukaemia grows more slowly and takes longer to advance.
Types of Leukaemia
The four most common types of leukaemia are:
• Acute lymphocytic leukaemia
• Acute myeloid leukaemia
• Chronic lymphocytic leukaemia
• Chronic myeloid leukaemia
Acute lymphocytic (lymphoblastic) leukaemia (ALL)
ALL is more common in children.
This type of leukaemia begins in the B or T lymphocytes, which are immature white blood cells. Lymphocytes are the building blocks of the lymphoid tissues that make up the immune system.
ALL can affect the bone marrow all over the body.
It can also spread to the:
• Lymph nodes
Doctors further sub-classify ALL based on the variety and developmental stage of the lymphocyte involved.
Acute myeloid leukemia (AML)
AML is the most common type of acute leukemia in adults.
It tends to progress quickly. It can affect any component of the blood and there are many subtypes of AML.
Blood stem cells in the bone marrow form into either:
• Lymphoid cells, which become white blood cells.
• Myeloid cells, which can become red blood cells, white blood cells, or platelets.
In AML, myeloid stem cells usually mature into abnormal myeloblasts, or white blood cells. But, they sometimes become abnormal red blood cells or platelets.
As they multiply, they overwhelm the normal cells in the bone marrow and blood. The cancer cells can also spread to other parts of the body.
Chronic lymphocytic leukaemia (CLL)
CLL accounts for about a third of leukemia diagnoses. It usually affects older adults.
One form of CLL progresses slowly. Symptoms may not appear until years after onset. Another form of CLL grows very quickly.
CLL begins in the B lymphocytes. As the abnormal cells proliferate, they crowd out the normal cells.
More subtypes of CLL exist that affect other types of cells.
Chronic myeloid leukaemia (CML)
This type of leukaemia is rare. Only 10 percent of leukaemias are CML.
Adults are more likely than children to get CML.
CML occurs when a genetic change turns the myeloid cells into immature cancer cells. These cells then grow slowly and overwhelm the healthy cells in the bone marrow and blood.
A subtype of CML can form very quickly. This type is hard to treat.
Hairy cell leukaemia
A rare type called hairy cell leukaemia (HCL) — because of how it looks under a microscope — affects fewer than 6,000 people each year.
HCL grows slowly. Some people live with the disease for many years before symptoms appear.
Prognosis — or chance of recovering from leukaemia — depends on many factors.
Leukaemia subtypes fall along a continuum for projected outcomes, but individual cases can deviate from these predictions.
Chromosome abnormalities and your response to treatment make a difference, as does age. People under 50 usually fare better.
A lower white blood cell count at the time of diagnosis is predictive of a better outcome.
Links to lower survival rates include a history of radiation exposure or previous chemotherapy for a different type of cancer.
Many people with leukaemia have no symptoms. The symptoms tend to be mild at first and worsen slowly.
The main symptoms include:
• tiredness and/or anaemia (pale complexion, weakness and breathlessness)
• repeated infections (mouth sores, sore throat, fevers, sweats, coughing, frequent passing of urine with irritation, infected cuts and scratches, and boils)
• increased bruising and bleeding.
Other less common symptoms include:
• bone pain
• swollen, tender gums
• skin rashes
• vision problems
• enlarged lymph glands
• enlarged spleen that may cause pain or discomfort
• chest pains.
Leukaemia Risk Factors
Common risk factors for leukemia include:
• Benzene exposure — benzene is a carcinogen that often makes up other chemicals, such as plastics and rubbers. People who work in industries that use benzene may be at increased risk.
• Radiation exposure — people exposed to high levels of radiation (from treatment for other cancers or from nuclear weapons) are at increased risk.
• Smoking — smoking increases leukemia risk.
How is Leukaemia Diagnosed?
No screening exams exist for leukemia.
Doctors often discover that a person has chronic leukemia through routine blood testing. They may also rely on their experience and current knowledge of the disease.
If your doctor suspects you may have a form of leukaemia, you will have one or more of the following tests to help diagnose, and determine the type of leukaemia:
- Blood tests
An initial blood test will show if leukaemia cells are present in the blood or if the levels of blood cells are different to what would be expected in a healthy person.
- Bone marrow biopsy
A small amount of bone marrow is removed from the hip bone (pelvic bone) using a long needle. As the procedure can be uncomfortable and even painful, a local anaesthetic will be used to numb the area and you may be given some pain-killers. It is common for children to have a general anaesthetic.
- Chest x-ray
A chest x-ray is taken to check the heart and lungs, and to see whether there are enlarged lymph nodes in the chest.
- Lumbar puncture
This test shows if any leukaemia cells have travelled to the fluid around your spine.
Fluid is removed with a thin needle from a space between the bones in the lower back. This takes a few minutes, but as it can be uncomfortable, your doctor will use a local anaesthetic to numb the area.
After the diagnosis of leukaemia
After a diagnosis of leukaemia it is normal to experience a range of emotions such as anxiety, distress, uncertainty, sadness and confusion. At the same time treatment decisions will need to be made.