Leukemia

Leukemia is a type of cancer that happens when cells in your bone marrow grow abnormally and out of control. These cells can spread to other parts of your body.

There are several different types of leukemia. In general, leukemia is grouped by how fast it gets worse and what kind of white blood cell it affects.

• It may be acute or chronic. Acute leukemia gets worse very fast and may make you feel sick right away. Chronic leukemia gets worse slowly and may not cause symptoms for years.
• It may be lymphocytic or myelogenous. Lymphocytic (or lymphoblastic) leukemia affects white blood cells called lymphocytes. Myelogenous leukemia affects the other type of cells that normally become granulocytes, red blood cells, or platelets. The four main types of leukemia are:
  • Acute lymphoblastic leukemia, or ALL.
  • Acute myelogenous leukemia, or AML.
  • Chronic lymphocytic leukemia, or CLL.
  • Chronic myelogenous leukemia, or CML.

There are less common leukemias, such as hairy cell leukemia. There are also subtypes of leukemia, such as acute promyelocytic leukemia (a subtype of AML).

Experts don't know what causes leukemia in most people. But they think that most leukemia happens because of things in the environment and in a person's genes.

Some things may increase the risk, such as having certain genetic conditions or being exposed to large amounts of radiation or certain chemicals.

Symptoms of acute leukemia depend on how much the cancer has grown. They may include:

• A new lump or swollen gland in your neck, under your arm, or in your groin.
• Frequent nosebleeds, bleeding from the gums or rectum, more frequent bruising, or very heavy menstrual bleeding.
• Frequent fevers.
• Night sweats.
• Bone pain.
• Unexplained appetite loss or recent weight loss.
• Feeling tired a lot without a known reason.
• Swelling and pain on the left side of the belly.

The chronic forms of leukemia often cause no symptoms until much later in the disease. And when symptoms appear, they usually appear gradually.

If your doctor suspects leukemia, he or she may:

• Ask about your medical history.
• Check for enlarged lymph nodes in your neck, underarm, or groin.
• Check for an enlarged liver or spleen.
• Do a complete blood count (CBC) and a blood chemistry. These tests let your doctor look into symptoms such as fatigue, weakness, fever, bruising, or weight loss.
• Do a bone marrow aspiration and biopsy. This is the key to diagnosing most leukemias and helps determine the type.
   

If your blood work points to possible leukemia, your doctor will want to find out what kind you might have. Your treatment plan will depend on the specific kind of leukemia that you have.

• A blood test is usually enough to find signs of chronic lymphocytic leukemia (CLL).
• Tests that look closely at unusual cells, chromosomes, or proteins on cells can show what type or subtype of leukemia you have. These tests include:
  • A test that looks for certain changes in the cell chromosomes from a sample of blood or bone marrow (cytogenetic analysis).
  • A test that compares cancer cells to normal blood cells to find the specific kind of leukemia (immunophenotyping).
  • A test to look for genes that are "turned on" in several types of leukemia, such as acute myelogenous leukemia (AML). This test is called a reverse transcription-polymerase chain reaction test, or RT-PCR.

These tests can help guide treatment. Sometimes they can help your doctor and you know whether your leukemia is likely to go into remission or come back. In some cases, the tests can predict survival rates.

Your doctor may also order other tests, including:

• Chest X-rays, to find out if leukemia or an infection is the cause of lung problems such as persistent coughing, coughing up blood, chest pain, or trouble breathing.
• CT scan of the head, chest, and belly, to find out if leukemia has spread there.
• Lumbar puncture, to find out if leukemia cells are in your cerebrospinal fluid (CSF).
• MRI of the brain, to look into symptoms such as confusion, paralysis, numbness, vision problems, vertigo, or headaches. Those symptoms could mean that leukemia has spread to the brain.
• A biopsy of a lymph node or other tissues, to look for leukemia cells.
   

The goal of treatment for leukemia is to destroy the leukemia cells and allow normal cells to form in your bone marrow. Treatment decisions are based on the kind of leukemia you have, its stage, and your age and general health.

You can do things at home to help manage your side effects. If your doctor has given you instructions or medicines to treat these symptoms, be sure to follow them. In general, healthy habits such as eating a balanced diet and getting enough sleep and exercise may help control your symptoms.

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