How do people get leukemia and is there a cure for leukemia?

Adult leukemias and lymphomas are diseases that attack the blood and lymph nodes. Although most people consider leukemia to be a childhood cancer, the majority of those who are diagnosed with leukemia are adults. Improvements in treatments over the last decade have made it possible for physicians to treat the disease aggressively and in some cases to cure it. There are several major types of the disease, each with its own set of symptoms and treatments.

Hodgkin's disease is a cancer of the lymph nodes. Once considered fatal, it is now usually curable. Other diseases of the lymph tissues include adult non Hodgkin's lymphomas, some ofwhich are slow growing, while others progress rapidly. Careful planning is necessary to determine the best treatment in each individual case.

Sarcomas, cancers that begin in the body's connective tissue, are usually divided into two groups: bone cancers and soft tissue sarcomas. Surgery, chemotherapy, and radiation are often used in the initial treatment of sarcoma. An expert staff and resources are needed for effective treatment from the very beginning in treating these cancers.

Leukemia 

Those Most Likely to Get Leukemia 

• Whites more often than blacks
• People of Jewish ancestry more often than other whites
• Males more often than females
• For acute leukemias, children and young adults more often than older adults
• For chronic lymphocytic leukemia (CLL), adults over age 50 more often than younger adults
• Those exposed to ionizing radiation
• Those with some genetic abnormalities, such as Down's and Bloom's syndromes and Philadelphia chromosome
• Those who have had long term exposure to certain chemicals and drugs, such as benzene, chloramphenicol, and phenylbutazone, and chemotherapy drugs such as alkylating agents

Symptoms of Leukemia 

• Fever and influenza like symptoms
• Enlarged lymph nodes, spleen, and liver
• Bone or joint pain
• Paleness, weakness
• Tendency to bleed or bruise easily
• Frequent infections Tests for Leukemia
• Blood tests
• Bone marrow biopsy
• Spinal test

What studies is the National Cancer Institute supporting on leukemia? 

The National Cancer Institute's clinical cooperative groups are studying the various kinds of leukemia.

Questions to Ask Your Doctor If You Have Leukemia 

• Exactly what type of leukemia do I have?
• Is it chronic or acute?
• Exactly which cells are affected?
• Can you explain my blood counts to me? What would you consider normal for me?
• Was my type of leukemia difficult to diagnose?
• Has the diagnosis been checked by a hematopathologist?
• What kind of treatment are you planning for me?
• How often will you want to see me?
• What is the usual prognosis for this kind of leukemia?
• Is there a leukemia specialist in the area?

What kind of doctor should I see if I have symptoms of leukemia, Hodgkin's disease, or non Hodgkin's lymphoma? 

Your internist or family physician will usually refer you to an oncologist if he finds evidence of these diseases. It is important that you be under the care of a physician who specializes in these diseases. A hematopathologist should be consulted to properly stage the disease if classification is difficult. If you have lymphoma and the necessary x-ray equipment or radiotherapeutic expertise is not available in your community, you should be referred to the nearest major medical center for high dose, precision radiotherapy.

What is leukemia? 

Leukemia is a cancer of the blood forming tissues characterized primarily by uncontrolled multiplication and accumulation of abnormal white blood cells.

What causes leukemia? 

The cause of leukemia is not known. Certain specific factors, such as excessive exposure to radiation and possibly to certain chemicals, such as benzene, and chemotherapy drugs, such as alkylating agents, have been identified as having some connection to the onset of leukemia. Certain viruses are known to cause leukemia in animals, but this has not been proved so in humans. Some genetic abnormalities, such as Down's syndrome, have also been implicated.

Isn't leukemia a children's disease? 

Though it is thought of by many people as a disease that only strikes children, leukemia actually affects more adults than children. More than half of all leukemias occur in persons over 60 years of age. All is the type of leukemia that appears most often in children and young adults.

Can you tell me more about blood to help me understand leukemia? 

Blood is made up of cells and fluid. The three major types of cells in the blood are red blood cells, known as erythrocytes, white blood cells, known as leukocytes, and platelets, known as thrombocytes. All of these cells are produced in the bone marrow. After the red blood cells, white blood cells, and platelets are made, they remain inside the marrow until they mature and become adult cells. After maturing, the adult cells slowly leak into the blood vessels and become part of the blood. The bones which produce red blood cells include the ribs, the breastbone, the wide top portion of the hipbone, and the spinal vertebrae.

What is the function of red blood cells? 

Red blood cells act as a transportation system. They carry oxygen from the lungs to the other cells of the body and bring back waste products or carbon dioxide. If there are too few red blood cells, anemia results and the body cannot get enough oxygen to do its work.

What do white blood cells do? 

White blood cells defend your body against illness. They capture, destroy, and remove germs. They prevent infection. If you have too few white blood cells, you are more likely to develop an infection and less able to fight an infection. There are several kinds of white blood cells. Granulocytes fight infections by engulfing bacteria. Lymphocytes play a role in producing antibodies. Leukocytes is a general term used to include all white cells.

The Chronic Leukemias | Cancer in the Bone Marrow and The Blood Stream


What is the role of platelets? 

Platelets work by clotting your blood after an injury or cut. They act as "stoppers" which keep the blood from leaking out. If you have too few platelets, your blood clots more slowly and bleeding may be prolonged following an injury.

What are the symptoms of leukemia? 

In some varieties of leukemia, there are no symptoms and leukemia is found during the course of a routine physical examination, pointing up the need for physical examinations on a regularly scheduled basis. As with all other cancers, the earlier the illness is diagnosed, the better the chances of a cure. Fatigue, fever, weight loss, bone pain, easy bruising, or abdominal discomfort may indicate the presence of leukemia. In some forms of leukemia, patients will experience night sweats or abnormal perspiration.

Is leukemia difficult to diagnose? 

While leukemia is usually not difficult to diagnose, certain preleukemic states and poorly defined types of leukemia may make it difficult for the doctor to classify the illness. The various classifications have been modified and renamed as greater understanding of leukemia has come about through the medical advances in the last 15 years. A blood picture resembling leukemia may appear with some infections such as mononucleosis, tuberculosis, and whooping cough.

How is leukemia classified? 

Leukemia is classified as acute (progressing rapidly) or chronic (progressing slowly). In acute leukemia, there is abnormal growth of immature cells called blasts. In chronic leukemia, there are some abnormal immature cells but there are also some mature cells, indicating that some cells are still behaving normally. Leukemia is also classified according to the type of white cell that predominates in each form of the disease. Thus, a diagnosis of lymphocytic leukemia indicates that there are an excessive number of abnormal lymphocytes, the white blood cells formed in the lymph nodes. In granulocytic (myelocytic) leukemia, there are abnormal quantities of granulocytes, the white cells produced in the bone marrow.

What is Leukemia?

What are the types of acute leukemia? 

Acute leukemias are broken down into two categories: acute lymphocytic leukemia (ALL) and acute nonlymphocytic leukemia (ANLL).

What is ALL? 

Persons with acute lymphocytic leukemia, or ALL, have an abnormal number of immature lymphocytes in their blood and bone marrow. This form of leukemia, which is also known as acute lymphoblastic leukemia, acute lymphatic leukemia, or childhood leukemia, accounts for 85 percent of leukemia in children and about 15 percent of leukemia in adults.

What is ANLL? 

Other forms of acute leukemia are grouped under the heading acute nonlymphocytic leukemia (ANLL). The most common of these forms is acute myelocytic leukemia (AML), also called acute granulocytic leukemia or acute myelogenous leukemia. AML is the most common form of acute leukemia in adults. Other rare forms of acute nonlymphocytic leukemia include monocytic leukemia, promyelocytic leukemia, erythroleukemia, and myelomonocytic leukemia. Treatment for these forms of acute leukemia is similar to that for acute myelocytic leukemia.

What is smoldering leukemia or preleukemia? 

Several bone marrow disorders, called preleukemia and smoldering leukemia, may, in a small percentage of cases, precede the onset of acute nonlymphocytic leukemia (ANLL) by months or years. Persons with preleukemia are generally older and have a deficiency of white cells, red cells, and platelets in their blood, with signs of red and white cell abnormalities. Smoldering leukemia is a form of acute myelocytic leukemia that begins slowly and, scientists believe, involves abnormal changes in more than one cell line. Generally, chemotherapy for these conditions is not begun until the disease begins to progress.

What are the types of chronic leukemia? 

Chronic leukemias are also broken down into two categories: chronic lymphocytic leukemia (CLL) and chronic myelocytic leukemia (CML).

What is CLL?

 CLL is the most common of the chronic leukemias. It is characterized by an abnormal increase in lymphocytes. Scientists think that the lymphocytes of CLL are produced in the lymph nodes and spleen rather than in the bone marrow. The average age of onset for CLL is 60.

Besides CLL, are there other forms of chronic leukemia that start in the lymphocytes? 

Yes. There are several rare forms, including hairy cell leukemia and adult T-cell leukemia/lymphoma.

What is hairy cell leukemia? 

Hairy cell leukemia is a rare form of chronic leukemia. It is called hairy cell because of the unique, hairy like appearance of the leukemic cell under the microscope. Scientists believe that hairy cell leukemia originates in the B cells (the antibody producing lymphocytes).

What is adult T-cell leukemia/lymphoma? 

It is a rare human leukemia which is now known to be caused by a virus. This disease, which has a rapid clinical course, has been found in southern Japan, parts of the Caribbean, and the southeastern part of the United States as well as in other parts of the world. This human T-cell leukemia has no association with the more common, wellknown types of leukemia. Instead, human T-cell leukemia more closely resembles rare T-cell cancers that begin in the skin such as mycosis fungoides and Sezary syndrome. In the human T-cell leukemia patients observed so far, the disease usually progresses rapidly and is often characterized by enlarged liver, spleen, and lymph nodes. Researchers believe the virus can only be spread by prolonged intimate contact and is not contagious like influenza or other common viral diseases. The virus, HTLV-I is believed to be distantly related to the HTLV-IH virus that causes AIDS.

Acute myeloid & lymphoblastic leukemia - causes, symptoms & pathology

Who is at highest risk to get leukemia? 

In the United States, there is slightly more leukemia among whites than among blacks, and there is a somewhat higher incidence among people of Jewish descent than among other groups. The male to female ratio overall is about 1.7 to 1, and men develop CLL almost two times more frequently than do women.

What causes leukemia? 

The answer to that question is not fully known. The leukemias appear to be caused by a number of factors that act alone or in combination. Some are human factors such as genetic traits and immune status; others are environmental factors such as radiation, chemicals, or viruses. A number of family clusters of leukemia have been investigated at various times in this country, but so far there is very little clear evidence of a family predisposition for the disease. The near absence of CLL among Orientals, on the other hand, argues for a genetic resistance to it among them. Leukemias are associated in some instances with abnormal chromosome patterns, such as the so called Philadelphia chromosome found in the bone marrow cells of persons with CML. Leukemia is also about twenty times more common than usual in persons with Down's syndrome. And it occurs more often in persons with rare conditions, some of them hereditary, that are characterized by increased chromosome breakage. In addition, some anticancer drugs are believed to cause leukemia.

What chemotherapy drugs used to treat other cancers cause leukemia?

 Long-term exposure to certain chemicals and drugs has been linked with a higher risk of developing various forms of leukemia. Despite their effectiveness in treating cancer, some anticancer drugs are believed to be cancer causing agents themselves. A number of studies have shown an association between some drugs used to treat cancer and the development of second cancers years later. For example, a class of anticancer drugs called alkylating agents has been linked with the later development of acute leukemia in some patients treated for Hodgkin's disease or ovarian cancer. The risk of leukemia, estimated by most studies at around 5 percent 10 years after treatment, seems highest in patients age 40 and over who have been treated with intensive chemotherapy alone or in combination with intensive radiotherapy. These findings do not suggest that patients should stop or avoid the use of alkylating agents or other chemotherapy treatments, since the benefits of drugs capable of curing diseases that would otherwise be fatal, far exceed their risks. The findings do suggest caution in using chemotherapy for the treatment of cancer patients at low risk of relapse and for patients with noncancerous conditions.

Do cats get leukemia? 

Yes, cats can get leukemia and can transmit it to other cats. There is no evidence that humans can develop leukemia from exposure to cat leukemia virus. This conclusion is based on National Cancer Institute studies ofblood samples from pet owners, veterinarians, and research workers who handle the viruses, as well as cancer patients, and healthy humans. None has shown evidence of infection by cat leukemia virus. There is also a new vaccine to prevent leukemia and related fatal diseases in cats. The vaccine is not designed to treat or prevent leukemia in humans.

What is CML? 

CML, also known as chronic granulocytic leukemia, chronic myelogenous leukemia, or chronic myelosis, is characterized by abnormal granulocytes which accumulate in the bone marrow and bloodstream. The average age of CML patients at diagnosis is 40 years.

What is the Philadelphia chromosome? 

The Philadelphia chromosome is an abnormal chromosome. About 90 percent of patients with CML have the Philadelphia chromosome. The median age ofonset for patients with chronic myelogenous leukemia with the Philadelphia chromosome is 40 to 45. For those without the Philadelphia chromosome, it is 50 to 65.

How is leukemia staged? 

Staging systems differ among the different types of leukemia. Acute leukemia (ALL and ANLL) has three stages: untreated, in remission, and relapsed. CML can go through five phases: chronic, accelerated, blastic, meningeal and relapsed. CLL follows a regular staging system: Stage through Stage IV.

What kind of treatment is used in arresting leukemia? 

Specific treatment varies depending on the type of leukemia diagnosed so do not try to compare your treatment with that of another leukemia patient, since a great many factors enter into the type of treatment you will receive. Most acute leukemias (ALL or ANLL) are being treated with the administration of two or more drugs, although radiation therapy and bone marrow transplants may also be used. CML is most commonly treated with the drug bulsulfan in early stages of the disease. Other chemotherapy drugs as well as bone marrow transplants may also be used. CLL may be left untreated until there is evidence of further progression of the illness.

The Diversity Of Blood Cancer

Just to give me some handle on what the doctor is talking about, what is the meaning of some of the tests he does? 

It is important to remember that averages mean that "normal" varies a great deal from person to person. The average ranges given here are broad. More important is your change from what is normal for you. If you wish to know, ask your doctor exactly what your counts are and how they relate to your case.

Why all the emphasis on blood tests? 

When you have leukemia, blood tests become a part of your life. Since leukemia means that there is an abnormality in the production of blood, the blood counts tell the doctor about the state of your disease. His blood checks help him determine how you are progressing.

What are petechiae? 

These are little spots on the skin due to tiny hemorrhages. The spots may form a red or brown rash. They are a result of a low platelet count and decreased clotting function. They should be reported to the doctor.

What is thrombocytopenia? 

It is a decreased number of platelets (those substances that along with plasma help blood to clot). There are different causes of thrombocytopenia. Leukemia is one of them.

Is the white blood cell count always high in leukemia? 

No. The white blood cell count may be high or low. The more reliable diagnostic indicator is the proportion of immature or leukemic white cells present.

What happens when the platelet count is low? 

If there are too few platelets, your blood clots more slowly and bleeding may be prolonged following an injury. Blood may "leak" out of the small blood vessels near the skin and cause spots called petechiae. Extra care should be taken to avoid bleeding. Avoid situations where you might be injured. Use an electric razor rather than a blade for shaving. Use toothette swabs instead of a toothbrush for cleaning your teeth. Do not take aspirin at this time, because aspirin may increase your tendency to bleed. If you cut yourself or have to have an injection or shot while your platelet count is low, make sure pressure is applied for 5 or 10 minutes to stop the bleeding.

What is a remission? 

A remission is the goal of therapy for acute leukemia. It means that the abnormal immature blood cells have disappeared from your bone marrow and bloodstream, allowing normal red blood cells, white blood cells, and platelets to form. Remissions can last for any length of time from a few days to years. Remission, however, is not considered a cure. Rather, it is a healthy state brought about by treatment. A patient in remission can go about living his or her normal life, though it will be necessary for the doctor to continue to follow progress with regular blood and bone marrow testing.

What does the term bone marrow depression mean? 

It refers to the inability of the bone marrow to produce a sufficient number of blood cells often the result of treatment with medication for leukemia or other kinds of cancer.

What is the meaning of induction therapy? 

Induction therapy is the initial aggressive course of chemotherapy which is designed to wipe out abnormal cells and allow the regrowth of normal cells. At the time of this initial treatment, the patient is extremely susceptible to infection, since normal cells which fight infection are destroyed along with the abnormal cells. Two or three courses of therapy may be necessary before a complete remission is obtained.

What is consolidation therapy? 

This is the treatment given after remission has been obtained in an attempt to prolong the duration of remission. It is a slightly less intensive course of chemotherapy given after the initial induction has been achieved. It is used in hope of improving the results of maintenance therapy.


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