Listed below are some frequently asked questions about leukemia.
Q: What is leukemia?
A: Leukemia is cancer of the bone marrow, which most often affects white blood cells. When a person has leukemia, the body makes too many blood cells, and they aren’t normal. Most often the abnormal cells are white blood cells. Two types of white blood cells can turn into leukemia. They are the lymphoid cells and the myeloid cells. When leukemia is in the lymphoid cells, it is called lymphocytic leukemia. When it is in the myeloid cells, it is called myeloid (or myelogenous) leukemia. Leukemia cells can travel with the blood all over the body. That means they can reach almost any organ. Therefore, leukemia can be present in many different ways, depending on which organs are involved.
Q: What are normal blood cells, and what do they do?
A: Blood has several parts.
The liquid part is called plasma. Blood cells are made in the soft center of bones, which is called bone marrow. There are three kinds of cells in blood. They are white blood cells, red blood cells, and platelets. Each kind of cell has a special task. Less mature forms of new blood cells are called blasts. As cells mature in the bone marrow, they become smaller and more compact. They are better able to perform their special job. Some new blood cells stay in the bone marrow to grow. Some move to other parts of the body to grow. Your body produces blood cells at a faster rate when your body needs them. This process helps you stay healthy. It helps to understand the role of each kind of blood cell:
White blood cells. These help the body fight infection. If you have a bacterial infection, your body produces larger numbers of white blood cells to help fight the infection. But if your white blood cell count is too low, your risk for infection increases.
Red blood cells. These give your blood its color. They carry oxygen from your lungs to your tissues. They also take carbon dioxide from your tissues to your lungs. When you don’t have enough red blood cells, other cells may not get enough oxygen. This can cause fatigue, dizziness, weakness, headaches, and irritability.
Platelets. These help form blood clots and control bleeding. If your number of platelets is abnormally low, it may lead to easy bruising or excessive bleeding from wounds or in mucous membranes.
Q: Can leukemia be prevented?
A: For many types of cancer, certain things make you more likely to get it. These are known as risk factors. So changing your lifestyle to avoid those risks can decrease your chance of getting the disease. But most people with leukemia have no known risk factors. There is no absolute way to prevent leukemia. Smoking has been associated with an increased risk of developing acute myeloid leukemia (AML). So stopping smoking may lower your risk of developing leukemia. Quitting smoking also decreases the risks of getting lung, head, neck, esophagus, stomach, bladder, and some other cancers.
Q: What are the symptoms of leukemia?
A: People with leukemia do not have enough healthy blood cells. They may not have enough red blood cells to carry oxygen through the body. This may cause them to look pale and feel weak and tired. People who do not have a lot of platelets may bruise and bleed very easily. And a lack of healthy white blood cells may lead to infections that don’t go away. However, some people with chronic types of leukemia may not have any symptoms.
These are other common symptoms of leukemia:
Fever with chills and sweating, which is a sign of infection
Weakness or fatigue, which can be signs of anemia
Tiny red spots and bruises under the skin
Sore or bleeding gums
Swollen lymph nodes, liver, or spleen
Pain in the bones or joints
Cough, shortness of breath, and pains in the chest
Loss of appetite and weight loss
See a health care provider if these symptoms persist. These symptoms are not specific to leukemia. Many of them are more likely to be caused by less serious conditions. Special tests of your blood and bone marrow are needed to confirm a diagnosis of leukemia.
Q: What’s the difference between chronic and acute leukemia?
A: Leukemia is grouped in two ways. It may be acute or chronic, depending on how fast the cells grow and progress to more advanced phases of the disease and how much the leukemia cells resemble normal cells. The disease is also lymphoid or myeloid, depending on the type of blood cell that has turned into cancer. Here is more information about acute and chronic types of leukemia:
Acute leukemia. The cancer cells are immature blood cells, called blasts, which cannot do their job. The number of these cells increases fast. The disease will quickly get worse unless it is treated.
Chronic leukemia. Some young blood cells are present, but the body also makes more mature, functional cells. The number of blasts grows slowly. It takes a longer time for the disease to get worse. Sometimes the disease remains stable for many months or even years, even without treatment.
Q: What are the different types of leukemia?
A: Leukemia is labeled as either acute or chronic. And it grows in either the myeloid cells or the lymphoid cells. This gives four combinations, which are the main types of leukemia:
Acute lymphocytic leukemia (ALL). This is the most common kind of leukemia in children. It can also occur in adults with increasing incidence as age increases.
Acute myeloid leukemia (AML). This type affects adults and, less often, children. It is also called acute nonlymphocytic leukemia (ANLL).
Chronic lymphocytic leukemia (CLL). This type is mostly seen in adults older than age 55. It is sometimes seen in younger adults but almost never in children.
Chronic myeloid leukemia (CML). This type is seen mostly in adults. Very few children get this type.
Q: How is leukemia treated?
A: A person usually has a combination of different types of treatment. The most common types of treatment for leukemia are chemotherapy, radiation therapy, targeted therapy, bone marrow or peripheral blood stem cell transplant, biologic therapy, and surgery. Each is described below:
Chemotherapy. Most people with leukemia (especially acute leukemia) are treated with chemotherapy. This treatment uses drugs to kill cancer cells. People may take two or more drugs. Some of the drugs are taken as a pill, but most are given intravenously (IV). This treatment is considered systemic, meaning it destroys cancer cells throughout the entire body.
Radiation therapy. The goal of radiation is to kill cancer cells using X-rays. This treatment is sometimes used in combination with chemotherapy or with a bone marrow transplant. You can receive radiation over the whole body, called total-body irradiation (TBI). Or you may receive radiation to just one part where more leukemia cells have gathered. Sometimes radiation is used to treat leukemia in the brain or to prevent it from spreading there.
Targeted therapy. This is a newer type of treatment. It uses drugs to attack specific factors that make cancer cells different from normal cells. This treatment affects mainly leukemia cells, not normal cells. That means it may cause fewer side effects than other treatments. It is usually the first treatment used for CML.
Stem cell transplant. The goal of this treatment is to kill as many of the cancer cells as possible by treating the body with very high doses of chemotherapy and radiation. Normally, the body would not be able to handle such high doses because it would kill the stem cells in the bone marrow. Therefore, after a person is treated with these high doses, the blood needs to be rescued with healthy, new stem cells. The new stem cells can come from the blood or bone marrow of a donor. Then it's called an allogeneic transplant. Or the stem cells can come from the person's own blood or bone marrow, called an autologous transplant. In the case of autologous transplants, the stem cells are collected and stored before the treatment with high-dose chemotherapy. Stem cell transplants are done in centers that specialize in this form of treatment.
Biologic therapy. The goal of this treatment is to help your immune system fight the leukemia.
Surgery. This is used less often for leukemia. In some cases, your doctor will do surgery to remove a swollen spleen.
Q: Should everyone get a second opinion for leukemia?
A: Many people with cancer get a second opinion from another doctor. There are many reasons to do this. Here are some:
A person is not comfortable with the treatment decision.
The cancer is a rare type.
There is more than 1 way to treat the cancer.
A person is not able to see a cancer expert.
Q: How can someone get a second opinion for leukemia?
A: Here are ways to find someone for a second opinion:
The person’s primary doctor may be able to recommend a specialist, such as a hematologist, medical oncologist, or radiation oncologist. Sometimes these doctors work together at cancer centers or programs.
The Cancer Information Service at 800-4-CANCER (800-422-6237) tells callers about treatment facilities, including cancer centers and other programs supported by the National Cancer Institute.
People can get names of doctors from their local medical society, a nearby hospital, a medical school, or local cancer advocacy groups, as well as from other people who have had that type of cancer.
Contact other support organizations, such as the American Cancer Society, the Leukemia and Lymphoma Society, or the National Comprehensive Cancer Network.
Q: Should I consider a clinical trial for leukemia?
A: Clinical trials are people-based studies. Among other things, they help show which types of treatment work best and which don’t. Deciding whether to participate is not easy. It’s a personal decision. No one can tell you whether a clinical trial is right for you. But it will help to discuss the risks and benefits of clinical trials with your doctor. Being open to a trial, for example, may give you access to treatment that would otherwise not be available. On the other hand, the new treatment can have unknown risks and side effects that are difficult to manage. The main thing to determine is whether the potential benefits outweigh the risks for you. This might be true if the leukemia doesn’t respond to the standard types of treatment. If you decide to participate in a clinical trial, be sure to get all your questions answered first.
March 30, 2020
Alteri, Rick, MD, Freeborn, Donna, PhD, CNM, FNP