LEUKEMIA

When leukemia develops, the body produces large numbers of abnormal blood cells. In most types of leukemia, the abnormal cells are white blood cells. The leukemia cells usually look different from normal blood cells, and they do not function properly.

What is Leukemia?

Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of blood cells to be produced and enter the bloodstream.

What are the Types of Leukemia?

There are several types of leukemia. They are grouped in two ways. One way is by how quickly the disease develops and gets worse. The other way is by the type of blood cell that is affected.

Leukemia is either acute or chronic. In acute leukemia, the abnormal blood cells are blasts that remain very immature and cannot carry out their normal functions. The number of blasts increases rapidly, and the disease gets worse quickly. In chronic leukemia, some blast cells are present, but in general, these cells are more mature and can carry out some of their normal functions. Also, the number of blasts increases less rapidly than in acute leukemia. As a result, chronic leukemia gets worse gradually.

Leukemia can arise in either of the two main types of white blood cells -- lymphoid cells or myeloid cells. When leukemia affects lymphoid cells, it is called lymphocytic leukemia. When myeloid cells are affected, the disease is called myeloid or myelogenous leukemia.

What are the Symptoms of Leukemia?

• Fever, chills, and other flu-like symptoms
• Weakness and fatigue
• Frequent infections
• Loss of appetite and/or weight
• Swollen or tender lymph nodes, liver, or spleen
• Easy bleeding or bruising
• Tiny red spots (called petechiae) under the skin
• Swollen or bleeding gums
• Sweating, especially at night
• Bone or joint pain

How is Leukemia Diagnosed?

To find the cause of a person's symptoms, the doctor asks about the patient's medical history and does a physical exam. In addition to checking general signs of health, the doctor feels for swelling in the liver; the spleen; and the lymph nodes under the arms, in the groin, and in the neck.

Blood tests also help in the diagnosis. A sample of blood is examined under a microscope to see what the cells look like and to determine the number of mature cells and blasts. Although blood tests may reveal that a patient has leukemia, they may not show what type of leukemia it is.

To check further for leukemia cells or to tell what type of leukemia a patient has, a hematologist, oncologist, or pathologist examines a sample of bone marrow under a microscope. The doctor withdraws the sample by inserting a needle into a large bone (usually the hip) and removing a small amount of liquid bone marrow. This procedure is called bone marrow aspiration. A bone marrow biopsy is performed with a larger needle and removes a small piece of bone and bone marrow.

If leukemia cells are found in the bone marrow sample, the patient's doctor orders other tests to find out the extent of the disease. A spinal tap (lumbar puncture) checks for leukemia cells in the fluid that fills the spaces in and around the brain and spinal cord (cerebrospinal fluid). Chest x-rays can reveal signs of disease in the chest.

What is the Treatment for Leukemia?

Treatment for leukemia is complex. It varies with the type of leukemia and is not the same for all patients. The doctor plans the treatment to fit each patient's needs. The treatment depends not only on the type of leukemia, but also on certain features of the leukemia cells, the extent of the disease, and whether the leukemia has been treated before. It also depends on the patient's age, symptoms, and general health.

Acute leukemia needs to be treated right away. The goal of treatment is to bring about a remission. Then, when there is no evidence of the disease, more therapy may be given to prevent a relapse. Many people with acute leukemia can be cured.

Chronic leukemia patients who do not have symptoms may not require immediate treatment. However, they should have frequent checkups so the doctor can see whether the disease is progressing. When treatment is needed, it can often control the disease and its symptoms. However, chronic leukemia can seldom be cured.

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