Leukemia, commonly known as blood cancer, is a broad term for cancer of white blood cells. It usually starts with abnormal white blood cells in bone marrow, a cavity inside the bones that produce blood cells.
White blood cells provide the first line of defense against infections from microbes, and when leukemia occurs, the ability of the body to fight infections diminishes.
It is common cancer in the young population compared to the old population.
Leukemia Epidemiology
It is the 10th most common cancer in the world. Each year there are approximately 61000 new cases in the USA. Leukemia generally happens in children. However, some types are more common among adults. Men are affected more than females, and the reason is unknown for this.
Leukemia Causes
The exact reason for leukemia is unknown. However, a mix of genetic and environmental factors has been known to predispose this condition.
- Genetic mutation in DNA due to radiation exposure: certain mutations activate the cancer-causing oncogenes and suppress the tumor suppressor genes, leading to abnormally uncontrollable cell multiplication.
- Genetic disorders: like Down's syndrome Genetics: Family history of this condition
- Some viruses like HTLV-1 (human T lymphocyte virus)
- Benzene exposure: benzene is found in gasoline and dyes, a potentially carcinogenic compound.
- Immune deficiency factors like smoking
Leukemia Signs and Symptoms
- extreme fatigue for longer periods
- excessive sweating during the night
- pain in muscles and bones
- extreme weight loss without any underlying cause
- swollen lymph nodes in neck and armpits
- petechiae or tiny pinkish spots on the skin
- frequent bruises
- frequent infections
- unexplained fever, chills, and body ache
- swelling of spleen and liver
- if it spreads to the brain, then seizures, frequent headaches, vomiting, and confusion are common
Different Types of Leukemia
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Acute myeloid leukemia (AML)
A rare type of leukemia impacting the adult population. It occurs more commonly in men. It isn't very pleasant and occurs due to smoking and exposure to chemicals like benzene.
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Acute lymphocytic leukemia (ALL)
Most common in children under five years and adults under 40. It is common in the White population. Previous cancer treatments, radiation exposure, and genetics play a vital role in the development of ALL.
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Chronic myeloid leukemia (CML)
This cancer develops in very old patients over 65 years of age. However, it is common in men. Philadelphia chromosome has been attributed to the formation of CML. It creates a new gene that leads to abnormal blood cells.
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Chronic lymphocytic leukemia (CLL)
Most common among older adults, especially men. It causes excess and abnormal lymphocytes formation. It is again a rare condition mostly found in the white population.
Other types of leukemia are very rare like
- Hairy cell leukemia
- Lymphocytic leukemia
- Erythroleukemia
- Megakaryocytic leukemia
Leukemia Risk factors
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Age
leukemia affects both children and adults. However, leukemias are more common in the young population.
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Genetics
People having a history of leukemia in their family
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Radiation exposure
High ionizing radiations can cause irreversible cell damage and abnormal cell formation by DNA alteration
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Smoking Status
People who smoke ( benzene exposure) are likely to develop leukemia, especially AML
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Chemotherapy
Chemotherapeutic drugs usage due to other cancer treatments may lead to leukemia later.
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Rare Genetic Diseases
Down syndrome, bloom's syndrome, and ataxia-telangiectasia can lead to leukemia.
Staging of Leukemia
Leukemia is a blood cancer that is staged differently than other tumors. Its staging is based on the number of abnormal white blood cells. Each subtype of leukemia is staged differently than others.
Leukemia Diagnosis
Leukemia can be diagnosed through various tests, which includes
After taking the patient's history, the doctor will check for cardinal signs of cancer, including palpating lymph nodes in the neck and armpits, spleen, gums, etc. If any swelling is found, other tests will be recommended.
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Complete Blood Count (CBC)
It provides a picture of different blood cells like RBCs, WBCs, and platelets. In the case of leukemia, the cells will have dysplasia which means they will be in abnormal shape and sizes.
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Bone marrow Examination or Biopsy
If the CBC tests are abnormal, the doctor will take a bone marrow sample using a long needle to draw out the bone marrow sample. It will be analyzed, and leukemia will be diagnosed if there is the presence of immature white blood cells.
Other tests which are needed are
- Chest X-ray
- Lumbar puncture to check the spread in the brain and spinal cord
- Computerized tomography ( CT scans)
- Magnetic resonance imaging (MRI) scan
- Cytogenetic testing
Leukemia Treatment
The treatment of leukemia varies according to the type and other factors like age or coexisting disease. The treatment starts with an intense phase to a maintenance phase running across 42 months.
Common Treatment Modalities Include
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Bone marrow transplantation:
is also known as stem cell transplantation or hematopoietic stem cell transplantation. Healthy stem cells are placed into the patient's body to replace cancerous cells in this treatment. A bone marrow transplant can come from your own body (autologous transplant) or another donor's body (allogeneic transplant).
Different chemotherapeutic medications are used to treat different types of leukemia. There might be a single or combination of different drugs that can be used to treat leukemia. It is the preferred treatment for AML.
This treatment uses immune cells to kill the cancerous cells. For example, chimeric antigen receptor therapy (CAR-T)
This treatment involves targeting the abnormal mutated cells directly and sparing the body's normal cells. It has been used in CML and ALL types of Leukemias.
Leukemia Prognosis
Different factors contribute to the prognosis of leukemia, such as the stage at which it is diagnosed, spread, type of leukemia, mutations, and treatment response. The five-year survival rate of Leukemias is approximately 61%. The younger patients have a better survival rate than older ones.
Leukemia Complications
Leukemia compromises the ability of the body to fight infections seriously. Due to lack of healthy WBCs, the body becomes susceptible to infections like pneumonia, urinary tract infections, and various types of skin infections
Pulmonary hemorrhage and brain hemorrhage
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A transition toward a more aggressive form of leukemia.
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