All about blood cancer (leukemia, leukemia) in adults and children and its treatment
The causes of blood cancer are not known, but scientists suggest that the development of leukemia can contribute to radiation exposure, smoking, exposure to certain chemicals and taking certain medications.
The main symptoms of leukemia are: unexplained and prolonged fever, frequent infectious diseases, lymphadenopathy, pains in the bones and joints, nosebleeds, increased bleeding gums, etc.
Depending on how fast the disease progresses, acute and chronic leukemia is distinguished. Symptoms of acute leukemia appear very early, and the disease itself progresses rapidly, leading to the development of serious complications in the coming months. Chronic leukemia can be asymptomatic for years, but the disease progresses steadily, leading to the same complications as acute leukemia.
In the diagnosis of leukemia, the following methods are used: general blood analysis, aspiration and bone marrow biopsy, cytogenetic studies, etc. Treatment depends on the type of leukemia and includes chemotherapy (drug treatment), radiotherapy (irradiation) and, in some cases, bone marrow transplantation.
The prognosis for survival in leukemia depends on its type, the correctness of the prescribed treatment, the age of the person and some other factors.
Normally, all cells in the body divide, mature, perform their functions and die in accordance with the program laid down in them. The dead cells are destroyed, and in their place come the young cells.
Cancer is a disease in which there is a violation of the program of division and life of cells that leads to their uncontrolled growth and reproduction.
Leukemia is the cancer of cells located in the bone marrow. In healthy people, these cells give rise to blood cells (that is, red blood cells and white blood cells (red and white blood cells)).
In people who have contracted blood cancer because of the violation of the processes of division and maturation of blood cells in the bone marrow, a large number of immature white blood cells (white blood cells) enter the blood, which can not perform their functions. Unlike healthy cells, cancer cells do not die at the right time, but continue to circulate in the blood and prevent healthy cells from doing their work.
Leukemia and leukemia are synonyms that denote blood cancer. Leukemia and leukemia are more correct names of the disease, while the term "blood cancer" is incorrect from a medical point of view and is more often used by patients.
Depending on how aggressively the disease proceeds, distinguish between acute and chronic leukemia:
With acute leukemia, a large number of immature cancer cells are found in the blood, which do not fulfill their functions. Symptoms of leukemia appear early, and the disease is rapidly progressing.
In chronic leukemia, cancer cells still retain the ability to function as normal cells, so the disease lasts for a long time without symptoms. Chronic leukemia is often detected accidentally, during a preventive examination and a blood test. Chronic leukemia is not as aggressive as acute, but progresses over time, as the number of cancer cells in the blood is constantly increasing.
Depending on what type of leukocytes are involved in the malignant process, several types of leukemia are also distinguished:
Chronic lymphocytic leukemia (chronic lymphocytic leukemia, chronic lymphocytic leukemia) is a cancer of the blood, in which the division and maturation of lymphocytes in the bone marrow is disturbed.
Chronic myelocytic leukemia (chronic myelocytic leukemia, chronic myelogenous leukemia) is a cancer of the blood in which the division and maturation of bone marrow cells, which are precursors of younger leucocytes, platelets and erythrocytes, is disturbed.
Acute lymphoblastic leukemia (acute lymphoblastic leukemia, acute lymphocytic leukemia) is a cancer of the blood, in which the division and maturation of lymphocytes in the bone marrow is disturbed.
Acute myeloblastic leukemia (acute myeloblastic leukemia, acute myelogenous leukemia) is a cancer of the blood in which the division and maturation of bone marrow cells, which are precursors (younger forms) of leukocytes, platelets and erythrocytes, is disturbed. Depending on the degree of disruption of cell maturation and the type of cells involved in the process, several types of acute myelogenous leukemia are distinguished: myeloblastic leukemia without cell maturation, myeloblastic leukemia with incomplete cell maturation, promyeloblastic leukemia, myelomonoblastic leukemia, monoblastic leukemia, erythroleukemia, megakaryoblastic leukemia.
Why does blood cancer (leukemia) develop?
The exact causes that lead to the development of leukemia are not currently known. Nevertheless, according to researchers, the development of this disease can contribute to:
Radiation: people who have been exposed to high doses of radiation, have
t greater risk of developing acute myelogenous leukemia, chronic myelocytic leukemia, or acute lymphoblastic leukemia.
Smoking increases the risk of acute myeloblastic leukemia.
Long-term contact with benzenes, which are widely used in the chemical industry, increases the risk of developing certain types of leukemia. Benzenes are also found in cigarette smoke and in gasoline.
Chemotherapy of various types of cancer can provoke the development of leukemia in the future.
Down's syndrome and other congenital chromosomal diseases increase the risk of developing acute leukemia.
Heredity does not play a big role in the development of leukemia. Cases where several members of the same family are affected by blood cancer are very rare. If this happens, then, as a rule, we are talking about chronic lymphocytic leukemia.
If you were exposed to one or even several risk factors, this does not mean that you will necessarily get leukemia. Many people who have these risk factors never develop blood cancer.
What are the signs and symptoms of blood cancer (leukemia)?
The manifestations of leukemia depend on the number of cancer cells in the body and how widely they spread throughout the body. So, with chronic leukemia at an early stage, the number of cancer cells is small, so for a long time the disease does not lead to any symptoms. Chronic leukemia is often detected accidentally, during preventive examinations. In acute leukemia, the symptoms, on the contrary, appear early.
The main symptoms of acute or chronic leukemia are:
Enlargement of lymph nodes, more often in the neck or armpits. Lymph nodes in leukemia, as a rule, are painless.
Increased body temperature for no apparent reason and excessive sweating at night.
Frequent infectious diseases: bronchitis, pneumonia, herpes, etc.
Weakness, increased fatigue.
Violation of blood clotting: bleeding gums, nasal bleeding, the appearance of bruises and red dots under the skin.
A feeling of heaviness in the left or right hypochondrium may appear with an increase in the spleen or liver.
Pain in the bones and joints.
Because of the accumulation of cancer cells in certain areas of the body, the following symptoms may appear:
Confusion of consciousness.
Violation of coordination of movements.
Cramps in various parts of the body.
Nausea and vomiting.
Painful swelling in the arms, in the groin area.
Swelling and pain in the scrotum in men.
It is important to understand that the appearance of these symptoms is characteristic not only of leukemia, but also of some other diseases. Only a specialist can distinguish leukemia from diseases that cause similar symptoms.
If you notice a similar symptom - see a doctor as soon as possible!
Individual types of leukemia may have some peculiarities, so we will consider the symptoms characteristic of each type of leukemia separately.
Symptoms and signs of acute lymphoblastic leukemia
Acute lymphoblastic leukemia is the most common type of blood cancer in children. As a rule, the disease develops at the age of 3 to 7 years. The main symptoms of acute lymphocytic leukemia are:
Weakness, fatigue, drowsiness.
A prolonged increase in body temperature, not associated with infectious diseases.
Pain in the bones, in the lower back, in the back.
Pain in the joints.
Increased bleeding gums, bleeding from the nose.
The appearance of rashes on the skin in the form of red or dark blue dots, or the rapid formation of bruises with minor bruises.
An increase in the size of the abdomen appears with an increase in the spleen.
Symptoms and signs of acute myeloblastic leukemia
Acute myeloblastic leukemia can develop at any age, but most often the disease is detected in people older than 55-60 years. As a rule, the symptoms of acute myelogenous leukemia appear gradually. The earliest symptom of the disease is malaise, which may appear several months before the development of other symptoms:
Prolonged rise in body temperature, excessive sweating at night.
Infectious diseases (tonsillitis, bronchitis, pneumonia, etc.)
The appearance of bruises for no apparent reason, or as a result of minor bruises.
Frequent bleeding from the nose, bleeding gums, uterine bleeding, etc.
Pain in the bones.
Symptoms and signs of chronic myelocytic leukemia
This disease, as a rule, occurs in people older than 30-50 years. Men suffer from chronic myelocytic leukemia more often than women. In children, the disease is extremely rare.
Chronic myelogenous leukemia for a long time is asymptomatic and is often detected accidentally, during a preventive examination. The first signs of the disease can appear only after 1-3 years after the onset of the disease. Symptoms of chronic myelogenous leukemia:
Weakness, increased fatigue.
Dyspnoea with physical exertion or at rest.
An increase in the size of the spleen, which is often observed with chronic myelocytic leukemia, leads to the appearance of pain and a feeling of heaviness in
left hypochondrium. Due to the expressed blood thickening, it is possible to develop a spleen infarction. With a spleen infarction, there are sharp severe pain in the left hypochondrium, an increase in body temperature, nausea, vomiting.
A thickening of the blood can cause a violation of the blood supply to the brain, which is manifested by severe headaches, dizziness, impaired orientation and coordination of movements.
As the disease progresses, there are pains in the bones and joints, weight loss, frequent infectious diseases.
Symptoms and signs of chronic lymphocytic leukemia
Chronic lymphatic leukemia for a long time is asymptomatic, and progresses very slowly (usually, for years). As the disease progresses, the following symptoms appear:
The increase in the size of the lymph nodes may appear for no apparent reason, or against the background of infectious diseases (angina, bronchitis, etc.)
Pain in the left and right hypochondrium appear with an increase in the size of the spleen or liver.
Because of the decrease in immunity, frequent infectious diseases appear: pneumonia, bronchitis, cystitis, pyelonephritis, shingles, etc.
Due to disruption of the immune system, autoimmune diseases occur when immune cells begin to fight their own cells. Autoimmune processes lead to the destruction of erythrocytes and platelets, with the development of jaundice, increased bleeding gums, nasal bleeding, etc.
When should I see a doctor?
The first symptoms of blood cancer may resemble signs of other diseases, so it's important to consult a doctor in time and find out the cause of the problems that have arisen. Seek medical attention if you experience any of the following symptoms:
A rise in body temperature that lasts more than a week, the cause of which you do not know.
Unexplained weight loss.
The appearance of edema on the arms, neck, in the groin.
Pain in the bones, back, abdomen.
Headaches, impaired coordination of movements, balance, inability to concentrate attention.
Frequent infectious diseases that do not pass for a long time, despite adequate treatment.
Enlargement of lymph nodes.
These symptoms do not always speak of blood cancer and can occur in other diseases. Nevertheless, you need an additional examination to clarify the diagnosis.
What tests and examinations need to be done to identify blood cancer (leukemia)?
In order to identify leukemia the doctor can prescribe the following tests and examinations:
1. A general blood test is the simplest method of diagnosing leukemia. Often, blood cancer is detected by accident, during a preventive blood test. Typically, with leukemia in the blood there is an excessively high number of white blood cells (white blood cells) and a very low number of platelets, as well as a decreased hemoglobin.
With acute lymphocytic leukemia, an increased amount of white blood cells is found in the blood test, which exceeds 10.0 × 109, and sometimes 100 × 109 See. All about the increase and decrease of leukocytes in the analyzes.
In acute myelogenous leukemia, an increased amount of leukocytes (more than 10.0 × 109) is found in the general blood test, and young forms of blood cells appear that normally should not be in the blood.
In a general blood test for chronic myelocytic leukemia, a large number of leukocytes (more than 10.0 × 109) is detected, and in later stages of the disease the number of leukocytes in the blood can exceed 200-500.0 × 109.
In the early stages of chronic lymphocytic leukemia, an increase in the number of leukocytes and lymphocytes in the blood is found in the general blood test. The diagnosis is confirmed by aspiration and bone marrow biopsy.
2. Aspiration of the bone marrow is a fence of bone marrow cells, which is located in the center of some bones. Aspiration uses a special needle, which the doctor pierces the upper layer of bone, reaching the bone marrow. The procedure is performed under local anesthesia. The cells of the bone marrow are then sent to the laboratory for study under a microscope.
3. A bone marrow biopsy is the second method of studying bone marrow cells. During this procedure, the doctor removes a small piece of bone with the bone marrow. A biopsy is performed under local anesthesia. The obtained bone marrow sample is also studied under a microscope. Aspiration and bone marrow biopsy do not always replace each other, so if necessary, you can carry out both procedures. With the help of bone marrow aspiration and biopsy, it is possible not only to clarify the diagnosis of leukemia, but also to establish its type (to find out which type of cells is involved in the oncological process).
4. Genetic examination (cytogenetics) is the study of genetic material (chromosomes) in cancer cells of the blood. With the help of a cytogenetic examination, the type of leukemia is specified. For example, the presence of an abnormal Philadelphia chromosome is found only in chronic myelogenous leukemia.
5. Puncture of cerebrospinal fluid is performed in order to detect possible spread of cancer cells
but the central nervous system. For the puncture, the doctor introduces a thin long needle between the vertebrae of the lumbar spine. The entire procedure is performed under local anesthesia. The resulting cerebrospinal fluid is examined for the presence of cancerous blood cells.
6. Additional examinations, such as chest X-ray, ultrasound of the abdominal organs, biochemical blood test, etc., are performed in order to determine the extent of the spread of blood cancer to other organs.
How is blood cancer treated? How effective can it be?
Above we have already said that there are several different types of blood cancer (leukemia). Clinical studies have found that different types of cancer can be treated differently (some are more successful, others are less successful), and in some cases require different treatments.
In this regard, below we will present data on treatment and its effectiveness separately for each type of leukemia.
Acute lymphatic leukemia: treatment and prognosis for survival
In the treatment of acute lymphocytic leukemia, drug treatment (chemotherapy) is used. Chemotherapy, as a rule, is carried out by a combination of 3 medicines and lasts for several years. Treatment is carried out in 3 stages:
Induction of remission is the first stage, which is aimed at the destruction of cancer cells in the blood and in the bone marrow.
Consolidation of remission is the second stage of treatment aimed at destroying the remaining cancer cells, which are currently not active, but can cause a return (relapse) of leukemia.
The maintenance of remission is the final stage of treatment aimed at the destruction of the remaining cancer cells.
Radiotherapy (radiotherapy) is used in the treatment of leukemia much less often, but may be necessary for the treatment and prevention of central nervous system lesions in leukemia (neuroleukemia).
Details of how to conduct radiotherapy is described in the article Radiotherapy.
A bone marrow transplant is a method of treatment that is carried out in two stages. At the first stage, bone marrow cancer cells are destroyed with the help of chemotherapy (less often, radiotherapy), and in the second stage the destroyed bone marrow is replaced with stem cells taken from the donor. A bone marrow transplant is most often used if after initial treatment the leukemia returned (recurred).
Details of how this treatment is performed is described in the article "Bone marrow transplantation."
The prognosis for survival in acute lymphoblastic leukemia depends on the age, the level of leukocytes in the blood at the time of detection of the disease and on how correctly the treatment is prescribed. Children from 2 to 10 years of age have a high chance of achieving a long-term remission (no symptoms of the disease), provided that the treatment is correct. It is noted that the higher the level of leukocytes in the blood at the time of detection, the less chance of a full recovery.
Acute myelogenous leukemia: treatment and prognosis for survival
Treatment of acute myelogenous leukemia also includes 3 stages: induction of remission, consolidation and maintenance of remission (see above).
The treatment uses drugs that destroy cancer cells in the bone marrow and in the blood. Chemotherapy for acute myeloblastic leukemia involves a combination of several drugs. The choice of medication depends on the type of leukemia and age of the patient. Sometimes bone marrow transplantation is used to treat acute myelogenous leukemia.
The prognosis for survival in acute myelogenous leukemia depends on the person's age, the type of blood cells involved in the disease, and on how correctly the treatment is prescribed. With the use of modern standard treatment schemes, approximately 30-35% of adults under the age of 60 live 5 years or more and are considered cured.
The higher the age of a person, the worse the prognosis. In people over 60, the probability of living for at least 5 more years after the discovery of the disease is about 10%.
Chronic myelogenous leukemia: treatment and prognosis for survival
Treatment of chronic myelogenous leukemia depends on the stage of the disease, the age of the person, and the presence of complications of leukemia. The earlier treatment is started, the higher the chances of achieving remission of the disease.
In the treatment of chronic myelogenous leukemia, Imatinib (Glivec) is currently used. Regular intake of this drug can slow the progression of chronic myelogenous leukemia and prolong the life of the patient for several years. Other chemotherapeutic drugs such as hydroxyurea, busulfan (myelosan), interferon alfa, etc. can also be used in the treatment.
The prognosis for survival in chronic myelocytic leukemia depends on the stage of the disease. Chronic myelogenous leukemia progresses more slowly than acute leukemia.
In 85% of people with chronic myelocytic leukemia, 3-5 years after the disease is detected, a marked deterioration of the condition occurs, which is called blast crisis. A blasted crisis is the last stage of chronic myelogenous leukemia, in which a large number of immature blood cells appear in the blood and bone marrow. Symptoms and course of the disease becomes the same as
and with acute leukemia.
Subject to correct and timely treatment, a person can survive another 5-6 years after the discovery of chronic myelogenous leukemia. Modern methods of treatment can extend life up to 10 years from the time of detection of the disease.
Chronic lymphocytic leukemia: treatment and prognosis for survival
Treatment of chronic lymphocytic leukemia depends on the stage of the disease, symptoms, the level of leukocytes in the blood and bone marrow, the age of the person.
In the early stages of the disease, your doctor can apply expectant management, in which treatment is not prescribed until signs of disease progression (such as weight loss, severe weakness, fever, marked lymph node enlargement, etc.) appear.
If these symptoms are not present, then chemotherapy can only worsen the course of chronic lymphocytic leukemia. Some people with chronic lymphocytic leukemia do not need treatment for another 5-10 years after the disease is diagnosed.
Chemotherapy, prescribed for chronic lymphatic leukemia, includes several drugs at once. With increased destruction of blood cells and a decrease in the level of erythrocytes and platelets in the blood, the spleen is removed.
Details of how this treatment is performed is described in the article Chemotherapy.
The prognosis for survival in chronic lymphocytic leukemia can vary considerably. Some patients die within 2-3 years after the discovery of the disease due to the development of complications. But most people live for at least 5-10 years until the disease goes to the terminal stage.
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