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Leukemia - Cancer of the Blood

What is Leukemia?
Leukemia is cancer of the blood and occurs when white blood cells acquire mutations in their DNA – the instructions inside each cell that guides its action. When this happens, the cells become weakened and go about robbing other healthy cells to remain stable. This causes rapid cell division which increases weak cells, and over time (the time - depending on the type of Leukemia) causes a decrease in the healthy cells. The increase of the unhealthy white cells is when a lot of people find out they have the disease when a routine blood test shows an abnormally high white count.

Our Immune System
Our immune system is our body’s defense mechanism. When it works in a healthy manner it will fight off a range of various illnesses most of the time without us knowing it. For example, a person with a wintertime case of the flu or even tonsillitis might notice a discomfort behind their ear which is a swollen gland, called a lymph node. Lymph nodes are scattered all throughout the body in clusters around our vital organs, or sometimes in smaller groups. Attached to our water system called the lymphatics, these nodes catch enemy cells so that the immune system can wipe them out before they can make their way into the bloodstream. When working properly, this system is a marvel and a wonder at all times. The lymphatic system and bone marrow are both blood forming systems, and the bone marrow is where most of our white blood cells are made. This is important in understanding why leukemia is so devastating. When white blood cells get a “bad signal”, (and scientists still don’t understand how it happens), and start to change and divide rapidly, our defense system is actually being attacked at ground zero, or at the point of origin. There is really no other way for the body to defend itself, which is why treatment for leukemia is usually so aggressive.

Signs and Symptoms
These are the normal signs and symptoms of leukemia:

Fever/chills
Frequent infection
Weight loss (unintended)
Swollen lymph gland
Enlarged liver/spleen
Easy bruising/bleeding
Red spots in the skin
Excessive sweating (usually at night)
Bone pain, tenderness

When to See Your Doctor
If one of several of these symptoms is present, it would be good to make an appointment with your family physician. As you can see many of these symptoms mimic common non-life threatening illness such as cold and flu, or even menopause, and because of this leukemia is often over-looked as a cause.

Your doctor will ask you some questions about which symptoms you are having and about how long you’ve been having them. The doctor should order a blood test, which will show if the white count is abnormally high. If so, you will more than likely be referred to a Hematologist, which is a doctor that specializes in diseases of the blood.

Types of Leukemia
There are four main types of leukemia:

ALL – Acute Lymphocytic leukemia
The most common type in young children, usually under the age of 5, but can also occur in adult.
AML – Acute myelogenous leukemia
Occurs in children and adults, but most common acute adult leukemia
CLL – Chronic lymphocytic leukemia
This type is the most common chronic adult leukemia
CML – Chronic myelogenous leukemia
Mainly affects adults. Few/no symptoms for years before entering a phase in which cells grow more rapidly.
There are more types, but the above are the most common four.

Risk Factors
Risk factors for leukemia to occur are:

Previous treatment for cancer
Genetic disorders (i.e. Downs Syndrome)
Blood disorders
Exposure to high levels of radiation (i.e. nuclear reactor plants)
Exposure to chemicals such as benzene, gasoline
Smoking

Interestingly, most people with risk factors don’t get it, while those that have none of the risk factors often get leukemia.

Treatments
Treatments and drugs will depend on age, overall health, type, and if the disease has spread. Further diagnostic tests from a specialist – or several, should show this. Both chemotherapy and radiation are both used to treat leukemia. Newer treatments such as Targeted Therapy and Biological Therapy may also be used. Both of these treatments work directly within the cell, altering it in some way. Targeted Therapy uses drugs to attack specific vulnerabilities within cancer cells to inhibit activity. Biological Therapy helps the immune system recognize and attack leukemia cells. In other words, it is a more direct way to “manipulate” the cell. These new cell therapies are very expensive, and you should check with your insurance company before even considering treatment to make sure that they will cover payment.

Bone marrow transplants are also a form of treatment if the disease is not responding to any other treatment. Bone marrow can be from a donor, or sometimes from a person’s own body. Radiation is usually given beforehand to kill as much of the leukemia as possible, then the patient is infused with the new marrow to replenish the body with healthy cells. However, sometimes a body will reject even perfect match bone marrow.

When this happens, Biological Therapy drugs are used in a class called immune-suppressants, a well-known one being a steroid. These cellular therapies can cause devastating side-effects. Several of these are: antiphylaxis (allergic shock), re-emergence of tuberculosis, serum-sickness (response to the medication “down-the-road”), muscular dystrophy (MS), and lymphoma.

More children are diagnosed (age 5 and under) but fewer die. Whereas less adults are diagnosed but more die from the disease. It is speculated that the children are more able to endure the harsh and aggressive treatment, than say 50 year olds - which makes sense. However, whether it is a child or adult, as you can see above, those treatments would be rough regardless.

Coping
If you have been diagnosed with the disease, find out as much as you can about you options. I have found this helps me to feel in control. Then, try your best to stay calm, eat well, prepare for down times and set limits, so that you can reserve your strength to combat fatigue and anxiety. You may want to sit down with your family and have a discussion about the situation at home, or even schedule a visit for counseling. Do whatever it takes to help you or the one you love to cope.

Resources: American Cancer Society, National Cancer Institute, Mayo Clinic






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