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• Q & A

LEUKEMIA

• Symptoms
• Diagnosis
• Treatment

Leukemia is cancer of the blood cells and bone marrow. When leukemia develops, the body produces uncontrolled numbers of abnormal blood cells. In most types of leukemia, the abnormal cells are white blood cells. These leukemia cells look different and do not function as they should.

There are four major types of leukemia:

• Acute Myelogenous Leukemia
• Acute Lymphocytic Leukemia
• Chronic Myelogenous Leukemia
• Chronic Lymphocytic Leukemia

The terms myelogenous and lymphocytic denote the cell type involved. Acute leukemia is a rapidly progressing disease where there is an accumulation of immature, functionless cells in the marrow and blood. When the marrow can no longer produce enough normal red blood cells, white blood cells and platelets the effects of leukemia are evident. Without enough white blood cells, the body can’t fight off infection.

Chronic leukemia progresses more slowly and allows greater numbers of more mature, functional cells to be made.

Symptoms

Leukemia cells travel through the body. Depending on the number of abnormal cells and where these cells collect, patients with leukemia can have a number of symptoms.

These are some of the common 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 under the skin
• Swollen or bleeding gums
• Sweating, especially at night
• Bone or joint pain

In acute leukemia, symptoms appear and worsen quickly, but in chronic leukemia, symptoms may not appear for a long time. When symptoms do appear, they generally are mild at first and get worse gradually. Doctors often find chronic leukemia during a routine checkup, before there are any symptoms.

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Diagnosis

There are many tests to help doctors diagnose leukemia. A general checkup and family medical history is the first place to start. The doctor can feel for swelling in the liver, spleen, lymph nodes under the arm, in
the groin and in the neck.

If leukemia is considered a possibility, further tests can help diagnose and discover the degree of the disease.

• Blood tests can determine the number of mature cells and blasts
• Bone marrow sample lets doctors take a small sample of bone marrow tissue to determine a diagnosis and/or what type of leukemia the patient has
• Lumbar puncture checks for leukemia cells in the fluid that fills the spaces in and around the brain and spinal cord
• Chest x-rays can reveal signs of disease in the chest

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Treatment

Treatment for leukemia can be complex because it varies depending
on the type of leukemia, 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.

The first 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. Acute leukemia needs to be treated right away while 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.

Different treatment options are available and patients should discuss all options available to them with their doctor.

• The preferred treatment for leukemia is chemotherapy, which is given in doses of a treatment period followed by a recovery period.
• Radiation therapy is used along with chemotherapy for some kinds of leukemia. Radiation therapy can be administered in two ways. It can be directed at one specific area where there is a collection of leukemia cells or directed to the whole body. This is called total-body irradiation and is usually administered before a bone marrow transplant.
• Bone marrow transplant is where the patient’s leukemia cell producing marrow is destroyed by high doses of chemotherapy and radiation and then replaced by healthy bone marrow. This new bone marrow can come from donors or from bone marrow removed from the patient. Bone marrow transplants require a two week stay in the hospital to help ward off infection while the bone marrow begins to produce enough new white blood cells.
• Biological therapy involves treatment with substances that affect the immune system's response to cancer. Interferon is a form of biological therapy that is used for some types of leukemia. Of course with any treatment, there is the possibility of side effects. Those side effects can be moderate or severe. In a bone marrow transplant, patients who received donated bone marrow can suffer from graft-versus-host disease (GVHD) where the donated marrow reacts against the patient’s tissues. It can occur at any time after the transplant, even years later. Drugs are given to reduce the risk and treat the problem.

Other side effects from treatments can include any of the following:

• Nausea
• Altered taste of food
• Loss of appetite
• Infertility
• Menopausal type symptoms in women
• Dry, red, itchy skin
• Fatigue
• Mouth sores

Coping with these side effects and all aspects of leukemia is difficult. That’s why we offer complete support care to get you and your family through the trying times of treatment so you can look forward to brighter days ahead.

One thing to remember is to always take care of your body because it aids in the healing process. Proper nutrition and exercise give patients more energy and a general overall well being. It also helps ease the stress associated with the circumstances.

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