Leukaemia

What is Leukaemia?

Leukemia is a type of cancer that affects the bone marrow and lymphatic tissues. 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. This is known as leukemia where the bone marrow produces abnormal white blood cells that eventually crowd out other cells.

What Causes It?

Doctors cannot always explain why one person develops leukemia and another does not. However, we do know that a person with certain risk factors may be more likely than others to develop leukemia.

Studies have found that individuals who are exposed to very high levels of radiation and industrial chemicals (such as benzene and formaldehyde) are at increased risk of leukemia.

Also, patients who are treated with anti-cancer drugs (such as alkylating agents) sometimes develop leukemia many years later. Additionally, patients who are affected by Human T-cell leukemia virus-I (HTLV-I) are also susceptible. Other risk factors for leukemia include individuals with certain genetic (such as Down’s syndrome) or blood (such as myelodysplastic syndrome) disorders.

Symptoms

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 have a number of common symptoms which may include:

• 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 , especially in the neck or armpit
• Weight loss

Diagnosis

If you have a symptom or screening result that suggests leukemia, your doctor must find out whether it originates from the cancer or other health conditions. You may be required to do some blood tests and diagnostic procedures:

• Physical Examination – The doctor checks for any swelling of the lymph nodes, spleen, and liver.
• Blood Tests – The laboratory checks the level of blood cells. Leukemia causes a very high level of white blood cells and low levels of platelets and hemoglobin, which is found inside red blood cells. The lab also may check the blood for signs of any arising liver and/or kidney problems.

• Biopsy -The doctor removes some bone marrow from the hipbone or another large bone. A pathologist examines the sample under a microscope to look for cancer cells. This is called a biopsy and it is the definitive way to know whether leukemia cells are in the bone marrow.
• Cytogenetics -The laboratory examines the chromosomes of cells from samples of peripheral blood, bone marrow, or lymph nodes.
• Spinal tap -Using, a long thin needle, the doctor carefully removes some of the cerebrospinal fluid (the fluid that fills the spaces in and around the brain and spinal cord).The procedure takes about 30 minutes and is performed under local anesthesia. The patient must lie flat for several hours afterward to keep from getting a headache. The laboratory 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 Treatment is offered?

Chemotherapy

Most patients with leukemia receive chemotherapy. This type of cancer treatment uses drugs to kill leukemia cells. Depending on the type of leukemia, the patient may receive a single drug or a combination of two or more drugs.

People with leukemia may receive chemotherapy in several different ways:

• By mouth
• By injection directly into a vein (or intravenous)
• Through a catheter (a thin, flexible tube) placed in a large vein, often in the upper chest-The nurse injects medicine into the catheter, to minimize the need for multiple injections. This reduces discomfort and/or injury to vein/skin.
• By injection directly into the cerebrospinal fluid – If the pathologist finds leukemia cells in the fluid that fills the spaces in and around the brain and spinal cord, the doctor may order intrathecal chemotherapy. The doctor injects drugs directly into the cerebrospinal fluid. This method is used because drugs given by IV injection or taken by mouth often do not reach cells in the brain and spinal cord.

Biological Therapy

People with certain types of leukemia receive biological therapy to improve the body’s natural defenses against cancer. The therapy is given by an injection via a vein.

For some patients with chronic lymphocytic leukemia, the type of biological therapy used is a monoclonal antibody that binds to the leukemia cells. This therapy enables the immune system to kill leukemia cells in the blood and bone marrow. For others with chronic myeloid leukemia, the biological therapy used is a natural substance called interferon to slow the growth of leukemia cells.

Radiation Therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill leukemia cells. For most patients, a large machine directs radiation at the spleen, the brain, or other parts of the body where leukemia cells may have collected. Some patients receive radiation that is directed to the whole body. (Total-body irradiation usually is given before a bone marrow transplant.)

Stem Cell Transplantation

Some patients with leukemia have stem cell transplantation. A stem cell transplant allows a patient to be treated with high doses of drugs, radiation, or both. The high doses destroy both leukemia cells and normal blood cells in the bone marrow. Later, the patient receives healthy stem cells through a flexible tube that is placed in a large vein in the neck or chest area. New blood cells develop from the transplanted stem cells.

After a stem cell transplant, patients usually stay in the hospital for several weeks. The health care team protects patients from infection until the transplanted stem cells begin to produce enough white blood cells.

What kind of support is available?

CanHOPE, a ParkwayHealth initiative together with the multi-disciplinary team of doctors tries to bring about a holistic approach to cancer care at no extra cost. Counsellors manned its cancer counselling service through a hotline and email to provide emotional and psychosocial support to all patients and caregivers to assist them to cope effectively with cancer. A ‘meet and greet’ service with face-to-face counselling can also be arranged.

Patients, health care professionals & the general public can also receive up-to-date cancer information, its related screening tests, treatment and referral to appropriate cancer services, resources for further rehabilitation and support services, advice on side-effects of cancer treatment, coping strategies, diet and nutrition.

CALL our CanHOPE counsellors: +65 67389333 or e-mail: enquiry@canhope.org