Cancer Treatment & Information

Because the symptoms of leukemia are nonspecific and the causes are not clearly defined, one’s health care provider will carry out extensive interviews and any appropriate tests in order to identify the underlying cause.

• The health care provider will ask many questions about symptoms, current medical situations, medications, medical and surgical history, family history, work history, and habits and life style.
• The physical examination includes a thorough evaluation of all symptoms, not merely lymph nodes and/or possible enlargements of the liver and spleen.

Blood tests: Blood is drawn from a vein in order to check the blood cell counts. In most cases of leukemia, the white blood cell count is very high (although it is not uncommon for the white cell count to be normal in many of the childhood acute lymphocytic leukemias) and the platelet and red cell counts are low. This makes the health care provider consider leukemia as the diagnosis. Other tests are performed to check liver and kidney functions and the possible presence of leukemic cells in the spinal fluid.Biopsy: Because other conditions may give rise to atypical white cell counts, the only way to confirm the diagnosis of leukemia is via an aspirate and biopsy of the bone marrow.

• Biopsy means to take a small sample of the relevant tissue to check for abnormal cells. In leukemia, a biopsy of the bone marrow must be taken and examined.
• This procedure is usually performed in the medical office, usually by a specialist trained in the treatment of blood disorders, that is, a hematologist or a hematologist-oncologist. The procedure is brief (less than a few minutes) and preceded by a local injection for relief of pain.
• Samples of both liquid (aspirate) and solid bone marrow (biopsy) are taken, usually from a hip bone.
• The bone marrow is examined under a microscope, where the presence of leukemic cells confirms the suspected diagnosis.

Genetic studies: The chromosomes of the abnormal cells are examined to look for irregularities. This helps in classifying the various types of leukemia.Lumbar puncture (spinal tap): Because the collection of leukemia cells in the central nervous system can affect mental processes, it is extremely important to know whether the fluid surrounding the brain and spinal cord (cerebrospinal fluid) is affected.

• This procedure is referred to as a lumbar puncture or spinal tap and is usually carried out by the blood specialist in the office. After the procedure, the person needs to lie flat for 1-2 hours.
• A small amount of the fluid is removed from the area around the spinal cord by inserting a hollow needle in the back at around the waist level. The needle is inserted in between the bones in the spine following a small injection into the skin over the injection site in order to minimize discomfort.
• The fluid is examined for the presence of leukemia cells.

Lymph node excision: If the lymph nodes are enlarged, a node may require a biopsy if the bone marrow is difficult to interpret for some obscure reason. This is exceedingly uncommon.  Chest x-ray: A chest x-ray film is frequently taken to look for signs of infection or lymph node involvement by leukemia.Staging

Staging is the way cancers are classified. Staging indicates the size or extent of the cancer, the degree to which other parts of the body are affected, and other important details. In general, leukemias are classified rather than staged in order to determine the most appropriate therapy.

All leukemias are classified according to their genotypes, or their unique chromosomal arrangements, which also enables the physicians to determine risk factors. In addiction, chronic myelogenous leukemia is classified by phase. The 3 phases are chronic phase, accelerated phase, and blast phase (or “blast crisis”) and are defined by the number of blasts (leukemia cells) in the blood and bone marrow.

Chronic lymphocytic leukemia is classified by 2 different staging systems, both based on the parts of the body affected by the leukemia.

What are the symptoms of Leukemia?

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:

• Fevers or night sweats
• Frequent infections
• Feeling weak or tired
• Headache
• Bleeding and bruising easily (bleeding gums, purplish patches in the skin, or tiny red spots under the skin)
• Pain in the bones or joints
• Swelling or discomfort in the abdomen (from an enlarged spleen)
• Swollen lymph nodes, especially in the neck or armpit
• Weight loss

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 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.

How is Leukemia diagnosed?

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.

What is Leukemia?

Leukemia is a type of cancer. Cancer is a group of many related diseases. All cancers begin in cells, which make up blood and other tissues. Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place.

Sometimes this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. Leukemia is cancer that begins in blood cells.

     Normal blood cells

Blood cells form in the bone marrow. Bone marrow is the soft material in the center of most bones. Immature blood cells are called stem cells and blasts. Most blood cells mature in the bone marrow and then move into the blood vessels. Blood that flows through the blood vessels and heart is called the peripheral blood. The bone marrow makes different types of blood cells. Each type has a special function:

• White blood cells help fight infection.
• Red blood cells carry oxygen to tissues throughout the body.
• Platelets help form blood clots that control bleeding.
• Leukemia cells

In people with leukemia, the bone marrow produces abnormal white blood cells. The abnormal cells are leukemia cells. At first, leukemia cells function almost normally. In time, they may crowd out normal white blood cells, red blood cells, and platelets. This makes it hard for blood to do its work.

What Causes Leukemia?

The exact cause of leukemia is unknown. As with other cancers, smoking is considered a risk factor for leukemia, but many people who develop leukemia have never smoked, and many people who smoke never develop leukemia. Long-term exposure to chemicals such as benzene or formaldehyde, typically in the workplace, is considered a risk factor for leukemia, but this accounts for relatively few cases of the disease.

Prolonged exposure to radiation is a risk factor, although this accounts for relatively few cases of leukemia. Doses of radiation used for diagnostic imaging such as x-rays and CT scans are nowhere near as prolonged or high as the doses needed to cause leukemia.

Other risk factors for leukemia include the following:

• Previous chemotherapy: Chemotherapy, particularly certain of the alkylating agents and topoisomerase inhibitors, used to treat certain types of cancers, are linked to development of leukemia later. It is likely that radiation treatment adds to the risk of leukemia associated with certain chemotherapy drugs. 
• Human T-cell leukemia virus 1 (HTLV-1): Infection with this virus is linked to human T-cell leukemia.
• Myelodysplastic syndromes: In this unusual group of blood disorders, the net outcome is invariably an acute myelocytic process.
• Down syndrome and other genetic diseases: Some diseases caused by abnormal chromosomes may increase risk for leukemia.
• Family history: Having a first-degree relative (parent, brother, sister, or child) who has chronic lymphocytic leukemia increases one’s risk of having the disease by as much as 4 times that of someone who does not have an affected relative.