Leukemia in adults
Leukemia is a type of blood cancer. Although there are different blood cells (white cells, platelets, red blood cells), leukemia generally refers to cancers that affect the white blood cells.
White blood cells are essential to fight infections and build up your immune system. When the white cells don’t function as well, our immune defenses become weakened, and we are more susceptible to getting infections, and becoming more unwell from them.
Leukemia is fairly common among adults, with over 60,000 new cases diagnosed in the US each year. Age is a big factor, with those aged 65-74 years being more commonly diagnosed.
While not many children get cancer, leukemia is one that frequently affects them – it behaves quite differently for them, so we’ll address that elsewhere.
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How do I know if I have leukemia?
Leukemia is a type of blood cancer and the name comes from a Greek word meaning ‘white blood’. Although there are different blood cells (white cells, platelets, red blood cells), leukemia generally refers to cancers that affect the white blood cells. It is very important to know what type of leukemia you have as this affects both the type of treatment required and your long-term outlook.
There are 4 main types of leukemia:
- Acute lymphoblastic leukemia (ALL) - disease that progresses quickly
- Chronic lymphoblastic leukemia (CLL) - persistent or ongoing disease
- Acute myeloid leukemia (AML) - derives from a myeloid stem cell quickly
- Chronic myeloid leukemia (CML) - ongoing illness from a myeloid stem cell
How do I know if I have leukemia?
Leukemia can cause several symptoms. The main ones to be aware of include night sweats or increased sweating, tiredness and fatigue, and weight loss. You can also experience symptoms like mild fever, frequent infections, bleeding and unexplained easy bruising, bone pain and an enlarged liver or spleen.
When leukemia spreads to affect other organs it can cause symptoms such as seizures, headaches, confusion, nausea and vomiting.
What are the risk factors?
Certain factors increase your risk of getting leukemia. Age is a significant risk factor, with the chance increasing as you get older.
Cigarettes contain many toxic chemicals – benzene is one that specifically increases your risk.
Previous treatment with chemotherapy or radiotherapy for other types of cancers can also increase your risk of leukemia. If you have suffered other blood cancer disorders, you are at higher risk, and certain genetic disorders, such as Down syndrome, are linked.
How is leukemia diagnosed?
A doctor will take a detailed history of your symptoms, any particular risk factors, and anything that runs in your family. They will examine your abdomen, heart, and lungs, and anything else of note, such as easy bruising. If they are concerned, they will organize an urgent referral to the hematology team, which looks after blood conditions.
They will arrange blood tests and imaging. They may arrange to take samples (biopsies) of your bone marrow, which is the active tissue inside your bones that makes white blood cells.
Once leukemia is diagnosed, the cells are reviewed under a microscope to see how the cancer cells look, and specifically, whether there are immature cells present. You will have further tests to check if there has been spread to other organs.
How is leukemia treated?
Treatment depends on the type of cancer and how advanced it is. Your treating team will also take into account your lifestyle and your health in general, and discuss with you the best treatment, tailored to you.
The team may pick one treatment option or a combination of chemotherapy (where drugs are used to kill the cancerous cells), and radiotherapy (where high energy radiation damages the cancerous cells to stop them from growing), and stem cell transplantation.
White blood cells are made by stem cells in the bone marrow, and leukemia originates there. Stem cell transplantation is a bone marrow transplant, used in the hope of replacing damaged bone marrow with healthy stem cells to grow into new healthy white blood cells.
There are other types of therapy called biological, targeted, or immune therapy. These are newer to the treatment armamentarium, aimed at boosting your immune system to fight the abnormal cells or targeting vulnerable cancer cells and breaking them down.
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