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Leukemia is a malignancy (cancer) of blood cells. In leukemia, abnormal blood cells are produced in the bone marrow. Usually, leukemia involves the production of abnormal white blood cells the cells responsible for fighting infection.
However, the abnormal cells in leukemia do not function in the same way as normal white blood cells.
The leukemia cells continue to grow and divide , eventually crowding out the normal blood cells. The end result is that it becomes difficult for the body to fight infections, control bleeding, and transport oxygen.
There are different types of leukemia, based upon how quickly the disease develops and the type of abnormal cells produced. Leukemia is called an acute leukemia if it develops rapidly. Large numbers of leukemia cells accumulate very quickly in the blood and bone marrow, leading to symptoms such as tiredness, easy bruising, and susceptibility to infections. Acute leukemia requires fast and aggressive treatment.
There are around 54,000 new cases of leukemia each year in the U.S. and about 24,000 deaths due to leukemia. Leukemia makes up about 3% of all new cancer cases.
Chronic leukemias develop slowly over time. These leukemias may not cause specific symptoms at the beginning of their course. If left untreated, the cells may eventually grow to high numbers, as in acute leukemias causing similar symptoms. Leukemias are further classified as myeloid or lymphoid, depending upon the type of white blood cell that makes up the leukemia cells. A basic understanding of the normal development of blood cells is needed to understand the different types of leukemia. Normal blood cells develop from stem cells that have the potential to become many cell types.
Myeloid stem cells mature in the bone marrow and become immature white cells called myeloid blasts. These myeloid blasts further mature to become either red blood cells, platelets, or certain kinds of white blood cells. Lymphoid stem cells mature in the bone marrow to become lymphoid blasts. The lymphoid blasts develop further into T or B lymphocytes, special types of white blood cells.
Myeloid leukemias are made up of cells that arise from myeloid cells, while lymphoid leukemias arise from lymphoid cells. Knowing the type of cell involved in leukemia is important in choosing the appropriate treatment.
Common types of leukemia
The four most common types of leukemia are acute lymphocytic leukemia, chronic lymphocytic leukemia, acute myeloid leukemia, and chronic myeloid leukemia.
•Acute lymphocytic leukemia (ALL, also known as acute lymphoblastic leukemia) is the most common type of leukemia in children, but it can also affect adults. In this type of leukemia, immature lymphoid cells grow rapidly in the blood. It affects over 6,000 people per year in the U.S.
•Acute myeloid leukemia (AML, also called acute myelogenous leukemia) involves the rapid growth of myeloid cells. It occurs in both adults and children and affects about 18,000 people each year in the U.S.
•Chronic lymphocytic leukemia (CLL) is a slow-growing cancer of lymphoid cells that usually affects people over 55 years of age. It is estimated to affect about 16,000 people in the U.S. every year. It almost never occurs in children or adolescents.
•Chronic myeloid leukemia
(CML, also known as chronic myelogenous leukemia) primarily affects adults and occurs in about 6,000 people every year in the U.S.
Less common types of leukemia account for about 6,000 cases of leukemia each year in the U.S.
• Hairy cell leukemia is an uncommon type of chronic leukemia.
• Chronic myelomonocytic leukemia (CMML) is another type of chronic leukemia that develops from myeloid cells.
• Juvenile myelomonocytic leukemia (JMML) is a type of myeloid leukemia that usually occurs in children under 6 years of age.
• Large granular lymphocytic leukemia (LGL leukemia) is a type of chronic leukemia that develops from lymphoid cells. It can be slow- or fast-growing.
• Acute promeylocytic leukemia (APL) is a subtype of AML.
There are many different types of blood cancers including leukaemia, lymphoma, myeloma and rarer types such as the myelodysplastic syndromes (MDS) and the myeloproliferative neoplasms (MPN).
Blood cancers can cause many different symptoms. Some are common across all blood cancers, others are more characteristic of particular types of blood cancer. For example, lymphomas can be characterised by swollen lymph nodes and one of the most common symptoms of myeloma is bone pain, especially in the back.
The vagueness and non-specific nature of the symptoms means that blood cancers can be hard to diagnose.
The common symptoms of blood cancers can include:
• Unexplained weight loss
• Feeling weak or breathless
• Easily bruise or bleed
• Enlarged lymph nodes
• Swollen stomach or abdominal discomfort
• Frequent and repeated infections
• Fever/night sweats
• Pain in bones/joints
• Itchy skin
• Bone pain (ribs/back)
If you or anybody you know is experiencing any or all of these symptoms, then we urge you to visit your GP who will refer you for further tests if they suspect you have a blood cancer.
Know the symptoms – Think T.E.S.T
Our symptoms cards are an easy way to remember the common symptoms of blood cancers.
T – Tiredness and exhaustion
E – Excessive sweating
S – Sore bones and joints
T – Terrible bruising and unusual bleeding
What causes leukemia? Is leukemia hereditary?
The exact cause of leukemia is not known, but it is thought to involve a combination of genetic and environmental factors. Leukemia cells have acquired mutations in their DNA that cause them to grow abnormally and lose functions of typical white blood cells. It is not clear what causes these mutations to occur . One type of change in the cells' DNA that is common in leukemias is known as a chromosome translocation. In this process, a portion of one chromosome breaks off and attaches to a different chromosome.
One translocation seen in almost all cases of CML and in sometimes in other types of leukemia is an exchange of DNA between chromosomes 9 and 22, which leads to what is known as the Philadelphia chromosome. This creates an oncogene (cancer-promoting gene) known as BCR-ABL. This change in DNA is not inherited but occurs sometime in the life of the affected individual.
Most cases of leukemia are not believed to be hereditary, but certain genetic mutations and conditions can be passed along to offspring that increase the chances of developing leukemia. A condition known as Li-Fraumeni syndrome is characterized by an inherited mutation in a tumor suppressor gene known as TP53, and individuals with this condition have an increased risk of leukemia and other cancers. Other hereditary conditions that can increase the risk of developing leukemia include Down syndrome, neurofibromatosis type 1, ataxia telangiectasia, and Noonan syndrome.
What are leukemia risk factors?
Exposure to radiation is known to increase the risk of developing AML, CML, or ALL. Increases in leukemia were observed in people surviving atomic bombs. Radiation therapy for cancer can also increase the risk of leukemia. Exposure to benzene, used commonly in the chemical industry, increases the risk of leukemia. Cigarettesmoking is known to increase the risk of developing AML .
Down syndrome, Li-Fraumeni syndrome, and other medical conditions can increase the risk of developing leukemia. Blood disorders known as myelodysplastic syndromes confer an increased risk of developing AML. Human T-cell leukemia virus type 1 (HTLV-1 ) is a virus that causes a rare type of leukemia. Certain chemotherapy drugs for cancer can increase the risk for AML or ALL.
Having risk factors does not mean that a person will definitely get leukemia, and most people with risk factors will not develop the disease. Likewise, not everyone who develops leukemia has an identifiable risk factor.
What is the treatment for leukemia?
There are a number of different medical approaches to the treatment of leukemia. Treatment will typically depend upon the type of leukemia , the patient's age and health status, as well as whether or not the leukemia cells have spread to the cerebrospinal fluid. The genetic changes or specific characteristics of the leukemia cells as determined in the laboratory can also determine the type of treatment that may be most appropriate.
Watchful waiting may be an option for some people with a chronic leukemia who do not have symptoms. This involves close monitoring of the disease so that treatment can begin when symptoms develop. Watchful waiting allows the patient to avoid or postpone the side effects of treatment. The risk of waiting is that it may eliminate the possibility of controlling the leukemia before it worsens.
Treatments for leukemia include chemotherapy (major treatment modality for leukemia), radiation therapy, biological therapy, targeted therapy, and stem cell transplant. Combinations of these treatments may be used. Surgical removal of the spleen can be a part of treatment if the spleen is enlarged.
Acute leukemia needs to be treated when it is diagnosed, with the goal of inducing a remission (absence of leukemia cells in the body). After remission is achieved, therapy may be given to prevent a relapse of the leukemia. This is called consolidation or maintenance therapy. Acute leukemias can often be cured with treatment.
Chronic leukemias are unlikely to be cured with treatment, but treatments are often able to control the cancer and manage symptoms. Some people with chronic leukemia may be candidates for stem cell transplantation, which does offer a chance for cure.
Many patients opt to receive a second opinion before beginning treatment for leukemia. In most cases, there is time to receive a second opinion and consider treatment options without making the treatment less effective.
However, in rare cases of very aggressive leukemias, treatment must begin immediately. Someone should discuss with a doctor the possibility of obtaining a second opinion and any potential delays in treatment. Most doctors welcome the possibility of a second opinion and will not be offended by a patient's wish to obtain one.
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This is a special kind of care given to individuals during pain and help them through it..