Leukemia

Leukemia is cancer that starts in the tissue that forms blood. Most blood cells
develop from cells in the bone marrow called stem cells. In a person with
leukemia, the bone marrow makes abnormal white blood cells. The abnormal
cells are leukemia cells. Unlike normal blood cells, leukemia cells don't die when
they should. They may crowd out normal white blood cells, red blood cells, and
platelets. This makes it hard for normal blood cells to do their work. The four
main types of leukemia are:

Acute lymphoblastic leukemia (ALL)

Acute myelogenous leukemia (AML)
Chronic lymphocytic leukemia (CLL)
Chronic myelogenous leukemia (CML)

Etiology: The risk factors of

leukemia.
Physical and chemical
Genetic disorders

Down syndrome
Klinefelter syndrome
Patau syndrome
Ataxia telangiectasia
Shwachman syndrome
Kostman syndrome
Neurofibromatosis
Fanconi anemia
Li-Fraumeni syndrome

Radiation exposure
Nontherapeutic, therapeutic radiation

exposures

BenzeneDrugs such as pipobroman

PesticidesCigarette smoking
Embalming fluids
Herbicides

Chemotherapy

Alkylating agents
Topoisomerase-II inhibitors
Anthracyclines
Taxanes

Epidemiology
Chances of survival of surviving 5 years was 57.2% from

2004 to 2010.
Estimated deaths in 2014 24,090. 4.1% of all cancer deaths
Number of New Cases and Deaths per 100,000: The
number of new cases of leukemia was 13.0 per 100,000 men
and women per year. The number of deaths was 7.0 per
100,000 men and women per year. These rates are ageadjusted and based on 2007-2011 cases and deaths.
Leukemia is most frequently diagnosed among people aged
75-84.

Pathophysiology

 A clone of invasive cells may arise at any stage of cell

maturation and specialization in the lymphoid, myeloid,

or pluripotential stage.
The cause of this clonal development is quite unknown
in most cases, however; it appears to involve the
rearrangement of sequence of bases on DNA molecules.
External and internal factors such as ionizing
radiation and chemicals, as well as chromosomal
abnormalities aid these changes.
The DNA changes will lead to a uncontrollable mitosis
of cells which will give rise to cells that could potentially
be cancerous- some of which are leukemic blasts
(abnormal white blood cells)

 These leukemic blasts infiltrate into the bone marrow

and secrete factors which inhibit normal

hematopoiesis (formation of cellular components of
the blood)
They eventually infiltrate into other organs as well-

such as the spleen, the eye or the liver- and therefore

disrupting their regular processes.
The blood becomes unable to carry out its functions

and the individual affected will experience increased

fatigue, infections and will bruise and bleed more
easily than they usually wouldve.

Immature
white
blood cells

Signs and Symptoms

The symptoms of Acute Leukemia develop very quickly (within a few days or
weeks ) whereas, Chronic Leukemia can go unnoticed for years and is usually
found in a routine blood test.
The following conditions can develop in Leukemia patients

Anemia (a deficiency of
red blood cells and haemoglobin)

shortness of breath

Paleness
Palpitations (rapid

heartbeat)
Weakness, tiredness
Dizziness
Headaches

Thrombocytopenia
(a low blood platelet count)

Easy bleeding
Widespread bruising,

purple patches under the

skin
Frequent nosebleeds
Bleeding gums
Red spots on the skin

Enlarged liver or Spleen

(leukemia cells build up in the liver or spleen )
Can be felt by swelling or discomfort in the abdomen.

Loss 0f appetite
Losing weight without trying
The lower ribs usually cover these organs, but when

they are enlarged, the doctor can feel them

Leukopenia
(A low white blood cell count)
Weak immunity system:

Therefore, a patient will

have more frequent or severe
infections.
Rare Symptoms
Chloroma (granulocytic sarcoma)
a tumour-like collection of
leukemia cells under the skin or in
other parts of the body can occur
Leukemia Cutis: These are skin
lesions that occur in 25% of

Chronic Lymphocytic Leukemia

patients

Other Symptoms
Leukemia can also cause

vomiting, confusion, loss

of muscle control and
seizures.
Swollen Lymph nodes
Fever or Chills
Night Sweating
Joint and bone pain

Leukemia Diagnostic tests

Physical exam. Your doctor will look for
physical signs of leukemia, such as pale skin
from anemia and swelling of your lymph nodes,
liver and spleen.
Blood tests. By looking at a sample of your
blood, your doctor can determine if you have
abnormal levels of white blood cells or platelets,
which may suggest leukemia.
Bone marrow test. Your doctor may
recommend a procedure to remove a sample of
bone marrow from your hipbone. The sample is
sent to a laboratory to look for leukemia cells.

Leukemia treatment
Most treatment plans for acute lymphoblastic leukemia have 3 steps. These are
induction, consolidation, and maintenance.

Induction Therapy: Killing of leukemia cells in the blood and

bone marrow. Treatments include chemotherapy. Induction
usually lasts for 4 weeks.
Consolidation Therapy: Killing of leukemia cells that may be
present even though they dont show up in tests. If these cells are
not killed, they could regrow and could cause a relapse. Treatment
include chemotherapy and may include stem cell transplant
(replacement of damaged bone marrow cells with healthy ones).

Maintenance Therapy: Preventing any remaining leukemia cells

from growing by using low doses of chemotherapy and intravenous
treatment (the infusion of liquid substances directly into a vein).

Prognosis
The Prognosis of a disease predicts the course of development, as well as
life expectancy, based on a large quantity of medical data collected all over
the world.

Lets take a look at the medical prognosis for the different types of
leukemia.

Chronic Myeloid Leukemia

This type affects the lymphoid cells created in the bone marrow. It is classified as
chronic leukemia, because the affected cells carry out some of their normal functions
initially, making it difficult to detect.

The progression of this disease is slow and symptoms show up only in the later
stages.

The prognosis depends on the stage in which the disease has advanced. People in
the early stages may have a life expectancy of 98 months, those in intermediate
stages may be expected to live for 65 months, while last stage patients may be
expected to live for 42 months on an average. The longest recorded survival of a
patient affected by chronic myeloid leukemia has been 117 months. Several drugs,
still in clinical trials may change the picture in the coming years and increase the
survival rate.

Acute Myeloid Leukemia

The more severe form of the disease is acute myeloid

leukemia, which is characterized by faster progression of
the disease. This is the most commonly incident type
among adults. If detected early, statistics show that 20%
to 40% of patients survive for at least 60 months.

Chemotherapy is the recommended treatment method.

Older people in the sixty plus age group, affected by it,
have a very low life expectancy.

Chronic Lymphocytic Leukemia

This type almost never occurs among children and has a

very high incidence rate among people aged more than 60.

Men are more likely to be affected by it, than women.

Progression of this disease is slow.

If the disease has affected the B-cells, then life expectancy

can be anywhere between 10 to 20 years, if treatment
begins early. However, those with T cell chronic
lymphocytic leukemia have a very low life expectancy.

Acute Lymphocytic Leukemia

The most common form of cancer in children is acute lymphocytic leukemia. Onefourth of all cancers in children belong to this type.

It has a high incidence rate among adults, older than 45 years of age. Chemotherapy
is the established treatment method for this disease.

Before chemotherapy and other cancer cure methods were invented, a patient with
acute lymphocytic leukemia could survive for 4 months at the most.

However, thanks to modern treatment methods, about 80% of the affected children
are completely cured. Adults have been seen to have a 40% chance of complete
cure.

The prognosis for this type will vary, depending on the stage of disease progression,
but children in the age group of 3 to 7 seem to have the highest chance of complete
recovery.

The prognosis made previously is based on statistical data

collected all over the world.

The factor that can lengthen life expectancy or increase the

likelihood of the disease going into remission is early
detection and treatment.

The survival rate and chances of complete recovery can only

be determined by an oncologist after he has studied the
biopsy and blood test reports.

It is vital that early symptoms of the disease are recognized

and prompt action is taken immediately, to increase the
chances of recovery.