HEALTH - LEUKEMIA (CANCER OF THE BLOOD) SYMPTOMS & TREATMENT
What is Leukemia?
Leukemia is a malignant disorder, a form of cancer that involves the bone marrow and blood systems. Leukemia results in the uncontrolled growth of abnormal (leukemic) white blood cells. As a result of the uncontrolled growth of leukemic cells in the bone marrow, there is inadequate space in the bone marrow for normal blood production (hematopoiesis) to occur. The lack of normal blood growth results in the lack of normal white blood cells (increasing the risk of infection, the lack of red blood cells resulting in fatigue, weakness, and anemia and the lack of normal platelet production increasing the health risk of bleeding.
Your white blood cells are potent infection fighters — they normally
grow and divide in an orderly way, as your body needs them. But in
leukemia, your bone marrow produces a large number of abnormal white
blood cells, which don't function properly.
The bone marrow may become severely impaired and unable to maintain production of sufficient levels of red blood cells and platelets. At the same time, white blood cell production becomes so rapid that these cells do not reach the level of maturity necessary to perform their infection-fighting functions.
Leukemic cells infiltrate all the major organs of the body, sometimes causing these organs to malfunction or fail. The kidneys may become impaired. The liver and spleen may become enlarged.
Normally, the spleen acts as a filter for the blood, screening out aging red cells and platelets. When the spleen becomes enlarged, it can actually start doing its job too well, removing perfectly healthy red cells and platelets, further reducing the number of these already scarce cells.
As leukemia progresses, the entire blood system may become flooded with immature blast cells. If this disease is left untreated, a person with leukemia becomes increasingly susceptible to fatigue, excessive bleeding and infections until, finally, the body becomes virtually defenseless, making every minor injury or infection very serious health wise.
Leukemia may be fatal. People may die from internal bleeding which would have been prevented by the platelets. Or, more often, they may die from infections which start with a virus or bacteria that would ordinarily have been wiped out by healthy white blood cells. The exact course leukemia takes, and the speed with which it takes that course, varies with the type and age of the white cells initially affected.
A diagnosis of leukemia can cause you a great deal of concern, and
treatment can be complex — varying on the type of leukemia and other
health factors. But there are strategies and resources that may make your road
easier. Leukemia isn't just a
children's disease. It has four main types and many subtypes — and only
some are common among children.
Health: Symptoms of Leukemia (blood cancer)
Like all blood cells, leukemia cells travel through the body. Depending on the number of abnormal cells and where these cells collect, patients with leukemia may have a number of symptoms.
Common symptoms of leukemia are:
- Fever and chills
- Persistent fatigue, weakness
- Frequent infections
- Loss of appetite or weight
- Swelling or discomfort in the abdomen (from an
enlarged spleen or liver)
- Easy bleeding or bruising
- Shortness of breath when you're physically active, as while climbing steps
- Tiny red spots in your skin (petechiae)
- Excessive sweating, especially at night
- Bone pain or tenderness
- Headache
- Swollen lymph nodes, especially in the neck or armpit
The severity of signs and symptoms depends on the number of abnormal
blood cells and where they collect. You may overlook early symptoms of
leukemia because they may resemble symptoms of the flu and other common
illnesses.
Such symptoms are not sure signs of leukemia. An infection or another problem also could cause these symptoms. Anyone with these symptoms should see a doctor as soon as possible. Only a doctor can diagnose and treat the problem.
In the early stages of chronic leukemia, the leukemia cells function almost normally. Symptoms may not appear for a long time. Doctors often find chronic leukemia during a routine health checkup—before there are any symptoms. When symptoms do appear, they generally are mild at first and get worse gradually.
In acute leukemia, symptoms appear and get worse quickly. People with this disease go to their doctor because they feel sick. Other symptoms of acute leukemia are vomiting, confusion, loss of muscle control, and seizures. Leukemia cells also can collect in the testicles and cause swelling. Also, some patients develop sores in the eyes or on the skin. Leukemia also can affect the digestive tract, kidneys, lungs, or other parts of the body.
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Health: Causes of Leukemia (blood cancer)
Scientists don't understand the exact causes of leukemia. It seems to develop from a combination of genetic and environmental factors. Doctors can seldom explain why one person gets this disease and another does not. However, research has shown that people with certain risk factors are more likely than others to develop leukemia.
Studies have found the following risk factors for leukemia:
Two types of classification for Leukemia:
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 work, and they multiply rapidly, so the disease worsens quickly. Acute leukemia requires aggressive, timely treatment.
- Chronic leukemia. This type of 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 symptoms and can go unnoticed or undiagnosed for years.
- Lymphocytic leukemia. This type of leukemia affects the lymphoid cells or lymphocytes, which form lymphoid or lymphatic tissue. This tissue is the main component of the immune system and is found in various places throughout your body, including your lymph nodes, spleen and tonsils.
- Myelogenous (MI-uh-loj-uh-nus) leukemia. This type of leukemia affects the myeloid cells. The myeloid cell line includes cells that later develop into red blood cells, white blood cells and platelet-producing cells.
People exposed to very high levels of radiation are much more likely than others to develop leukemia. Very high levels of radiation have been caused by atomic bomb explosions (such as those in Japan during World War II) and nuclear power plant accidents (such as the Chernobyl [also called Chornobyl] accident in 1986).
Medical treatment that uses radiation can be another source of high-level exposure. Radiation used for diagnosis, however, exposes people to much lower levels of radiation and is not linked to leukemia.
These factors place you at an increased risk of developing some types of leukemis:
Cancer therapy. People who've had certain types of chemotherapy and radiation therapy for other cancers have a slightly greater risk of developing certain types of leukemia many years later.
Genetics. Genetic abnormalities seem to play a role in the development of leukemia. Certain genetic diseases, such as Down syndrome, are associated with increased risk of leukemia.
Exposure to radiation and certain chemicals. People exposed to very high levels of radiation, such as survivors of an atomic bomb blast or a nuclear reactor accident, have an increased risk of developing leukemia. Exposure to certain chemicals, such as benzene — which is found in unleaded gasoline and tobacco smoke and used by the chemical industry — also is linked to greater risk of some kinds of leukemia. However, most people with known risk factors don't get leukemia. And many people with leukemia have none of these risk factors.
In the past, some studies suggested exposure to electromagnetic fields as another possible risk factor for leukemia. Electromagnetic fields are a type of low-energy radiation that comes from power lines and electric appliances. However, results from recent studies show that the evidence is weak for electromagnetic fields as a risk factor.
Most people who have known risk factors do not get leukemia. On the other hand, many who do get the disease have none of these risk factors. People who think they may be at risk of leukemia should discuss this concern with their doctor. The doctor may suggest ways to reduce the risk and can plan an appropriate schedule for checkups.
Health: Diagnosis of Leukemia (blood cancer)
If a person has symptoms that suggest leukemia, the doctor may do a physical exam and ask about the patient's personal and family medical history. The doctor also may order laboratory tests, especially blood tests.
The exams and tests may include the following:
- Physical exam—The doctor checks for swelling of the lymph nodes, spleen, and liver.
- Blood tests—The lab checks the level of blood cells. Leukemia causes a very high level of white blood cells. It also causes low levels of platelets and hemoglobin, which is found inside red blood cells. The lab also may check the blood for signs that leukemia has affected the liver and kidneys.
- Biopsy—The doctor removes some bone marrow from the hipbone or another large bone. A pathologist examines the sample under a microscope. The removal of tissue to look for cancer cells is called a biopsy. A biopsy is the only sure way to know whether leukemia cells are in the bone marrow.
There are two ways the doctor can obtain bone marrow. Some patients will have both procedures:
- Bone marrow aspiration: The doctor uses a needle to remove samples of bone marrow.
- Bone marrow biopsy: The doctor uses a very thick needle to remove a small piece of bone and bone marrow.
Local anesthesia helps to make the patient more comfortable.
- Cytogenetics—The lab looks at the chromosomes of cells from samples of peripheral blood, bone marrow, or lymph nodes.
- Spinal tap—The doctor removes some of the cerebrospinal fluid (the fluid that fills the spaces in and around the brain and spinal cord). The doctor uses a long, thin needle to remove fluid from the spinal column. The procedure takes about 30 minutes and is performed with local anesthesia. The patient must lie flat for several hours afterward to keep from getting a headache. The lab checks the fluid for leukemia cells or other signs of problems.
- Chest x-ray—The x-ray can reveal signs of disease in the chest.
Natural Alternative Treatment: CANCER
_______________________________________________________________________________________________________
Health: Conventional Treatment of Leukemia (blood cancer)
How is Leukemia treated?
Many people with leukemia want to take an active part in making decisions about their medical care. They want to learn all they can about their disease and their treatment choices. However, the shock and stress after a diagnosis of cancer can make it hard to think of everything to ask the doctor. Often it helps to make a list of questions before an appointment. To help remember what the doctor says, patients may take notes or ask whether they may use a tape recorder. Some also want to have a family member or friend with them when they talk to the doctor—to take part in the discussion, to take notes, or just to listen.
The doctor may refer patients to doctors who specialize in treating leukemia, or patients may ask for a referral. Specialists who treat leukemia include hematologists, medical oncologists, and radiation oncologists. Pediatric oncologists and hematologists treat childhood leukemia.
Whenever possible, patients should be treated at a medical center that has doctors experienced in treating leukemia. If this is not possible, the patient's doctor may discuss the treatment plan with a specialist at such a center.
Getting a second opinion
Sometimes it is helpful to have a second opinion about the diagnosis and the treatment plan. Some insurance companies require a second opinion; others may cover a second opinion if the patient or doctor requests it. There are a number of ways to find a doctor for a second opinion:
- The patient's doctor may be able to suggest a doctor who specializes in adult or childhood leukemia. At cancer centers, several specialists often work together as a team.
- The Cancer Information Service, at 1-800-4-CANCER, can tell callers about nearby treatment centers.
A local or state medical society, a nearby hospital, or a medical school can usually provide the names of specialists.
- The American Board of Medical Specialties (ABMS) has a list of doctors who have met certain education and training requirements and have passed specialty examinations. The Official ABMS Directory of Board Certified Medical Specialists lists doctors' names along with their specialty and their educational background. The directory is available in most public libraries. Also, ABMS offers this information on the Internet at http://www.abms.org. (Click on "Who's Certified.")
Preparing for treatment
The doctor can describe treatment choices and discuss the results expected with each treatment option. The doctor and patient can work together to develop a treatment plan that fits the patient's needs.
Treatment depends on a number of factors, including the type of leukemia, the patient's age, whether leukemia cells are present in the cerebrospinal fluid, and whether the leukemia has been treated before. It also may depend on certain features of the leukemia cells. The doctor also takes into consideration the patient's symptoms and general health.
|
These are some questions a person may want to ask the doctor before treatment begins:
|
People do not need to ask all of their questions or understand all of the answers at one time. They will have other chances to ask the doctor to explain things that are not clear and to ask for more information.
Methods of treatment
The doctor is the best person to describe the treatment choices and
discuss the expected results. Depending on the type and extent of the disease,
patients may have chemotherapy, biological therapy, radiation therapy, or
bone marrow transplantation. If the patient's spleen is enlarged, the doctor may
suggest surgery to remove it. Some patients receive a combination of treatments.
People with acute leukemia need to be treated right away. The goal of treatment is to bring about a remission. Then, when signs and symptoms disappear, more therapy may be given to prevent a relapse. This type of therapy is called maintenance therapy. Many people with acute leukemia can be cured.
Chronic leukemia patients who do not have symptoms may not require immediate treatment. The doctor may suggest watchful waiting for some patients with chronic lymphocytic leukemia. The health care team will monitor the patient's health so that treatment can begin if symptoms occur or worsen. When treatment for chronic leukemia is needed, it can often control the disease and its symptoms. However, chronic leukemia can seldom be cured. Patients may receive maintenance therapy to help keep the cancer in remission.
A patient may want to talk to the doctor about taking part in a clinical trial, a research study of new treatment methods. The section on "The Promise of Cancer Research" has more information about clinical trials.
In addition to anticancer therapy, people with leukemia may have treatment to control pain and other symptoms of the cancer, to relieve the side effects of therapy, or to ease emotional problems. This kind of treatment is called symptom management, supportive care, or palliative care.
Most patients with leukemia receive chemotherapy. This type of cancer treatment uses drugs to kill leukemia cells. Depending on the type of leukemia, the patient may receive a single drug or a combination of two or more drugs.
People with leukemia may receive chemotherapy in several different ways:
- By mouth
- By injection directly into a vein (IV or intravenous)
- Through a catheter (a thin, flexible tube) placed in a large vein, often in the upper chest—A catheter that stays in place is useful for patients who need many IV treatments. The health care professional injects drugs into the catheter, rather than directly into a vein. This method avoids the need for many injections, which can cause discomfort and injure the veins and skin.
- By injection directly into the cerebrospinal fluid—If the pathologist finds leukemia cells in the fluid that fills the spaces in and around the brain and spinal cord, the doctor may order intrathecal chemotherapy. The doctor injects drugs directly into the cerebrospinal fluid. This method is used because drugs given by IV injection or taken by mouth often do not reach cells in the brain and spinal cord. (A network of blood vessels filters blood going to the brain and spinal cord. This blood-brain barrier stops drugs from reaching the brain.)
The patient may receive the drugs in two ways:
- Injection into the spine: The doctor injects the drugs into the lower part of the spinal column.
- Ommaya reservoir: Children and some adult patients receive intrathecal chemotherapy through a special catheter called an Ommaya reservoir. The doctor places the catheter under the scalp. The doctor injects the anticancer drugs into the catheter. This method avoids the discomfort of injections into the spine.
Patients receive chemotherapy in cycles: a treatment period, then a recovery period, and then another treatment period. In some cases, the patient has chemotherapy as an outpatient at the hospital, at the doctor's office, or at home. However, depending on which drugs are given, and the patient's general health, a hospital stay may be necessary.
Some people with chronic myeloid leukemia receive a new type of treatment called targeted therapy. Targeted therapy blocks the production of leukemia cells but does not harm normal cells. Gleevec, also called STI-571, is the first targeted therapy approved for chronic myeloid leukemia.
Biological therapy
People with some types of leukemia have biological therapy. This type of treatment improves the body's natural defenses against cancer. The therapy is given by injection into a vein.
For some patients with chronic lymphocytic leukemia, the type of biological therapy used is a monoclonal antibody. This substance binds to the leukemia cells. This therapy enables the immune system to kill leukemia cells in the blood and bone marrow.
For some patients with chronic myeloid leukemia, the biological therapy is a natural substance called interferon. This substance can slow the growth of leukemia cells.
|
Patients may want to ask these questions about chemotherapy or biological therapy:
|
Radiation therapy (also called radiotherapy) uses high-energy rays to kill leukemia cells. For most patients, a large machine directs radiation at the spleen, the brain, or other parts of the body where leukemia cells have collected. Some patients receive radiation that is directed to the whole body. (Total-body irradiation usually is given before a bone marrow transplant.) Patients receive radiation therapy at a hospital or clinic.
|
These are some questions a person may want to ask the doctor before having radiation therapy:
|
Stem cell transplantation
Some patients with leukemia have stem cell transplantation. A stem cell transplant allows a patient to be treated with high doses of drugs, radiation, or both. The high doses destroy both leukemia cells and normal blood cells in the bone marrow. Later, the patient receives healthy stem cells through a flexible tube that is placed in a large vein in the neck or chest area. New blood cells develop from the transplanted stem cells.
There are several types of stem cell transplantation:
- Bone marrow transplantation—The stem cells come from bone marrow.
- Peripheral stem cell transplantation—The stem cells come from peripheral blood.
- Umbilical cord blood transplantation—For a child with no donor, the doctor may use stem cells from umbilical cord blood. The umbilical cord blood is from a newborn baby. Sometimes umbilical cord blood is frozen for use later.
Stem cells may come from the patient or from a donor:
- Autologous stem cell transplantation—This type of transplant uses the patient's own stem cells. The stem cells are removed from the patient, and the cells may be treated to kill any leukemia cells present. The stem cells are frozen and stored. After the patient receives high-dose chemotherapy or radiation therapy, the stored stem cells are thawed and returned to the patient.
- Allogeneic stem cell transplantation—This type of transplant uses healthy stem cells from a donor. The patient's brother, sister, or parent may be the donor. Sometimes the stem cells come from an unrelated donor. Doctors use blood tests to be sure the donor's cells match the patient's cells.
- Syngeneic stem cell transplantation—This type of transplant uses stem cells from the patient's healthy identical twin.
After a stem cell transplant, patients usually stay in the hospital for several weeks. The health care team protects patients from infection until the transplanted stem cells begin to produce enough white blood cells.
These are some questions a person may want to ask the doctor before having a stem cell transplant:
- What kind of stem cell transplant will I have? If I need a donor, how will we find one?
- How long will I be in the hospital? What care will I need when I leave the hospital?
- How will we know if the treatment is working?
- What are the risks and the side effects? What can we do about them?
- What changes in normal activities will be necessary?
- What is my chance of a full recovery? How long will that take?
- How often will I need checkups?
Health: Life After Treatment of Leukemia (blood cancer)
Supportive care
Leukemia and its treatment can lead to other health problems. Patients receive supportive care to prevent or control these health problems and to improve their comfort and quality of life during treatment.
Because people with leukemia get infections very easily, they may receive antibiotics and other drugs to help protect them from infections. The health care team may advise them to stay away from crowds and from people with colds and other contagious diseases. If an infection develops, it can be serious and should be treated promptly. Patients may need to stay in the hospital for treatment.
Anemia and bleeding are other problems that often require supportive care. Patients may need transfusions of red blood cells to help them have more energy. Platelet transfusions can help reduce the risk of serious bleeding.
Dental health care also is very important. Leukemia and chemotherapy can make the mouth sensitive, easily infected, and likely to bleed. Doctors often advise patients to have a complete dental exam and, if possible, undergo needed dental care before chemotherapy begins. Dentists show patients how to keep their mouth clean and healthy during treatment.
Nutrition
Patients need to
eat well during cancer therapy. They need enough calories to maintain a good
weight and protein to keep up strength. Good nutrition often
helps people with cancer feel better and have more energy.
But eating well can be difficult. Patients may not feel like eating if they are uncomfortable or tired. Also, the side effects of treatment, such as poor appetite, nausea, or vomiting, can be a problem. Foods may taste different.
The doctor, dietitian, or other health care provider can suggest ways to maintain a healthy diet. Patients and their families may want to read the National Cancer Institute booklet Eating Hints for Cancer Patients, which contains many useful ideas and recipes. The "National Cancer Institute Booklets" section tells how to get this publication.
Followup care
Followup care after treatment for leukemia is an important part of the overall treatment plan. Regular checkups ensure that any changes in health are noted. The doctor can find problems and treat them as soon as possible. Checkups may include a careful physical exam, blood tests, x-rays, bone marrow aspiration, or spinal tap. The doctor can explain the followup plan—how often the patient must visit the doctor and what tests are needed.
The NCI has prepared a booklet for people who have completed their treatment to help answer questions about followup health care and other concerns. Facing Forward Series: Life After Cancer Treatment provides tips for getting the most out of medical visits. It describes the kinds of help people may need.
Support for people with leukemia
Living with a serious disease such as leukemia is not easy. Some people find they need help coping with the emotional and practical aspects of their disease. Support groups can help. In these groups, patients or their family members get together to share what they have learned about coping with the disease and the effects of treatment. Patients may want to talk with a member of their health care team about finding a support group. Groups may offer support in person, over the telephone, or on the Internet.
People living with cancer may worry about caring for their families, keeping their jobs, or continuing daily activities. Concerns about treatments and managing side effects, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the health care team can answer questions about treatment, working, or other activities. Meeting with a social worker, counselor, or member of the clergy can be helpful to those who want to talk about their feelings or discuss their concerns. Often, a social worker can suggest resources for financial aid, transportation, home care, or emotional support.
_______________________________________________________________________________________________________
Disclaimer: This information is not presented by a medical practitioner. Therefore any content of this site is strictly intended for educational and informational purpose only. Any access to this site is strictly on a voluntary basis and at the sole discretion of the user. No content of this site is intended as a substitute for medical advice, diagnosis or treatment, nor constitute the practice of any medical profession or health care provider. The information provided on this site is here to educate visitors on health issues that may affect their lives. Otherwise, always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition. And never disregard professional medical advice or delay in seeking it because of something you have read.
Sources: NIH News In Health/National Institutes of Health/National Library of Medicine/Dept of Health and Human Services_______________________________________________________________________________________________________
<<Previous (Home Page) Next>>
