What Is Leukemia

Chronic fatigue, persistent infections, and increased bleeding and bruising are symptoms commonly associated with various illnesses, however, they are also the key indicators of Leukaemia.¹ While being diagnosed with Leukaemia can be physically and mentally challenging, there are a number of treatment and management plans available to improve prognoses and quality of life. To engage with treatment, it is essential to recognise and acknowledge the primary signs and risks associated with Leukaemia. This article aims to explain the causes, symptoms, and treatments for Leukaemia, as well as address commonly asked questions associated with its incidence, prevention, and diagnosis.

Overview

Blood is constantly travelling around your body, it is responsible for a variety of functions including; transporting oxygen and nutrients to the body, transporting carbon dioxide for waste removal, and fighting infections. To carry out these roles, a variety of host of blood cells with distinct functions are required, including red blood cells, white blood cells, and platelets. The term “Leukaemia” refers to a group of blood cancers that primarily affect blood cells, or the cells that develop and mature into blood cells. This usually involves white blood cells, which are highly specialised cells crucial for immune responses that act as one of the body’s major defence mechanisms available to fight infections and diseases.

White blood cells are formed from less specialised cells known as stem cells- which are located within the bone marrow, these cells normally grow, divide, and develop in a highly ordered manner depending on the bodily demand. However, in Leukaemia the production of white blood cells from bone marrow is uncontrolled, resulting in excessive or non-functional white blood cells entering the circulating blood.² As a result, the regular function of blood cells can be “overpowered” by these cancerous white blood cells causing low immune system function.³ Unlike other cancers, Leukaemia does not form a primary tumour mass, but instead impairs and reduces the overall effectiveness of blood cell function. 

Causes of leukaemia

Leukaemia, like most other cancers, begins with changes known as mutations to healthy cell DNA. Cellular DNA is essential for programming and instructing cells what to do, this includes control of cell production and death. In healthy cells, the rate of cell production and death is kept steady and is limited to specific stages of a cell’s life cycle. The accumulation of mutated DNA causes cells to ignore these signals and grow at a rapid and uncontrolled rate, resulting in immature white blood cells with little to no function known as leukaemia cells. These abnormal white blood cells are unable to fight infection and impair the production of red blood cells and platelets from bone marrow.⁴ 

Signs and symptoms of leukaemia

The signs of leukaemia can be difficult to spot due to the overlap of common symptoms with other illnesses. Symptoms can often be mistaken for other illnesses, and appear mild at first. Symptoms tend to vary among individuals It is therefore crucial to know the signs and symptoms of leukaemia, with the primary indicators being:

1. Persistent fatigue
2. Repeat infections
3. Increased bleeding and bruising
4. Unexplained weight loss
5. Fever

Other less frequent symptoms include:

1. Bone and joint pain
2. Headaches
3. Enlarged lymph nodes, liver or spleen
4. Vomiting
5. Blurred vision
6. Skin rashes

Although these symptoms may not always lead to the diagnosis of leukaemia, it is important to contact your doctor if you experience these symptoms persistently  over an extended period of time.⁵ Detecting early-stage leukaemia can help improve the efficacy of treatment and further improve prognosis. 

Management and treatment for leukaemia

The primary treatment for leukaemia is chemotherapy. This method employs medicinal chemicals to eradicate leukaemia cells. The specific type of leukaemia determines whether you'll be administered a singular medication or a mix of them. These medications can be taken orally or injected into a bloodstream.

FAQs

How is leukaemia diagnosed?

The common tests for leukaemia are:

1. Blood tests- A sample of blood is collected via a needle and analysed to determine if you have abnormal levels of red or white blood cells or platelets. A high number of white blood cells or a low blood count can be indicative of leukaemia
2. Bone marrow biopsy- A needle is used to remove a small sample of liquid bone marrow from the hip bone and examined under a microscope. Depending on the case, a small piece of bone marrow may also be removed. The procedure should last between 20-30 minutes. You will not feel any pain while the procedure is carried out however some pressure and discomfort may be experienced when the sample is taken
3. Imaging tests- X-Rays may be used to produce images of the inside of your body. Regular chest X-rays are carried out to check for lung infections. Other imaging methods such as Magnetic Resonance Imaging (MRI), Computed Tomography (CT), and Positron Emission Tomography (PET) scans may be carried out to observe enlarged lymph nodes, liver, or spleen. These methods may also be used to assess whether the cancer has spread to your organs
4. Genetic testing- Some forms of Leukaemia, such as Acute Myeloid Leukaemia (AML) are thought to have a genetic origin. Genetic testing can be used to assess whether DNA and chromosomal mutations are present. This can help doctors decide the most appropriate form of treatment

How can I prevent leukemia?

There is no definitive way to prevent leukaemia, but evidence suggests avoiding key triggers may reduce your risk of developing leukaemia.

1. Quit smoking
2. Avoid exposure to pesticides and industrial chemicals
3. Avoid exposure to high doses of radiation
4. Maintain a healthy body weight and lifestyle

Who is most at risk of leukemia?

Your risk of developing leukaemia may be higher if:

• You are over the age of 65. However, the majority of acute lymphocytic leukaemia cases are diagnosed in individuals under the age of 20
•  You have a blood disorder 
• You have a family history of CLL
• You have a congenital syndrome such as Down syndrome, Bloom syndrome, Ataxia-Telangiectasia
• You have previously undergone chemotherapy or radiation therapy
• You have been exposed to high-energy radiation and chemicals over a long period of time

How common is leukemia?

Recent figures suggest 474,519 cases of Leukaemia were diagnosed in 2020, making Leukaemia the 13th most common cancer worldwide.⁷ In the UK, leukaemia is the 12th most common cancer with an average of 9,900 new cases diagnosed each year.⁸

What are the types of leukaemia?

There are 4 main types of leukaemia. They are classified according to the type of white blood cell affected (myeloid or lymphocyte) and further sub-categorised based on if they are acute or chronic. The 4 types of leukaemia are:

1. Acute Lymphoblastic Leukaemia (ALL)
2. Acute Myeloid Leukaemia (AML)
3. Chronic Lymphocytic Leukaemia (CLL)
4. Chronic Myeloid Leukaemia (CML)

When should I see a doctor?

You should see your doctor if you notice a change that isn’t normal for you, or are experiencing long-term symptoms. 

Summary

Leukaemia is a cancer of the blood and primarily affects the function and growth of white blood cells. This, in turn, can lead to reduced function of red blood cells and platelets resulting in the overall compromise of immune system function. Frequent infections are therefore a key symptom presented upon diagnosis. While no exact cause is known, the risk of developing leukemia can be reduced by minimising exposure to radiation and chemicals, avoiding smoking, and maintaining a healthy lifestyle.

Chemotherapy and radiation therapy are two of the main treatment options available for Leukaemia, with the use of either dependent on the type of Leukaemia. Recent studies have shown a more personalised treatment may be available in the future as a number of anti-cancer drugs specific to one form of Leukaemia are currently undergoing clinical trials. If you are concerned that you may have Leukaemia, it is important to contact your doctor.