Leukemia

What is leukemia?
Leukemia is the cancer of bone marrow and blood. The body produces abnormal blood cells, typically white blood cells. When this happens, the blood cells are not able to do their job. Leukemia can be either acute (rapidly progressing) or chronic (slowly progressing). Leukemia is categorized as myelogenous or lymphocytic, which denotes the cell type involved. There are four major types of leukemia.
> Acute Myelogenous Leukemia
> Acute Lymphocytic Leukemia
> Chronic Myelogenous Leukemia
> Chronic Lymphocytic Leukemia

What are the risk factors for leukemia?
While it is not know what causes leukemia, there are certain risk factors. These risk factors do not explain most cases.
> Very high levels of radiation – People exposed to very high levels of radiation are much more likely than others to develop leukemia. Very high levels of radiation have been caused by atomic bomb explosions (such as those in Japan during World War II) and have nuclear power plant accidents (such as Chernobyl, also called Chornobyl, accident in 1986.) Medical treatment that uses radiation can be another source of high-level exposure. Radiation used for diagnosis, however, exposes people to much lower levels of radiation and is not linked to leukemia.
>Working with certain chemicals – Exposure to high levels of benzene in the workplace can cause leukemia. Benzene is used widely in the chemical industry. Formaldehyde is also used by the chemical industry. Workers exposed to formaldehyde also may be at a greater risk for leukemia.
> Chemotherapy – Cancer patients treated with certain cancer-fighting drugs sometimes later develop leukemia. For example, drugs known as alkylating agents are associated with the development of leukemia many years later.
> Down syndrome and certain other genetic diseases – Some diseased caused by abnormal chromosomes may increase the risk of leukemia.
> Human T-cell leukemia virus-I (HTLV-I) – This virus causes a rare type of chronic lymphocytic leukemia known as human T-cell leukemia. However, leukemia does not appear to be contagious.

Is screening available?
There are no screening tests or screening guidelines for leukemia.

What are the symptoms of leukemia?
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 may have a number of symptoms. These symptoms are not a sure sign of leukemia. An infection or another problem also could cause these symptoms. Anyone with these symptoms should see their health care provider as soon as possible. Only a doctor can diagnose and treat the problem.
> Fevers or night sweats
> Frequent infections
> Feeling weak or tired
> Headache
> Bleeding and bruising easily (bleeding gums, purplish patches in, or tiny red spots under, the skin)
> Pain in the bones or joints
> Swelling or discomfort in the abdomen (from an enlarged spleen)
> Swollen lymph nodes, especially in the neck or armpit
> Weight loss

How is leukemia diagnosed?
The exams and tests for leukemia may include:
> Physical exam – the doctor checks for swelling of the lymph nodes, spleen and liver.
> Blood tests – The lab checks the level of blood cells. Leukemia causes a very high level of white blood cells. These white blood cells can be analyzed by flow cytometry studies to determine characteristics of the leukemia, including the type of leukemia. Leukemia can also cause low levels of platelets and hemoglobin, which is found inside red blood cells. The lab also may check the blood for signs that leukemia has affected the liver and kidneys.
> Biopsy – The doctor removes some bone marrow from the hipbone or another large bone. A pathologist examines the sample under a microscope. The removal of tissue to look for cancer cells is called a biopsy. A biopsy is the only sure way to know whether leukemia cells are in the bone marrow.

What are treatment options?
Treatment depends on a number of factors, including the type of leukemia, the patient’s age, whether leukemia cells are present in the cerebrospinal fluid, and whether the leukemia has been treated before. It also may depend on certain features of the leukemia cells. The doctor also takes into consideration the patient’s symptoms and general health.

What are clinical trials?
Clinical trials are studies that seek to find better ways to prevent, screen, diagnose and treat a disease such as cancer. Clinical trials test new approaches to treatment, such as, new drugs, new approaches to surgery or radiation therapy, or a combination of treatments.
Learn more about clinical trials.

What questions should I ask my doctor?
It is often helpful to make a list of questions before an appointment. This will help to remember what the doctor says. Patients and care givers can write notes or ask if they may use a tape recorder. Sometimes it is helpful to have a family member or friend at the appointment to take notes, ask questions or just listen. Below are a few suggested questions a patient may ask their doctor.

Will you please write down the type of cancer that I have?
What are my treatment options?
What treatment do you recommend and why?
What are the risks and benefits of each treatment?
What are possible side effects of treatment?
How will you help manage my side effects?
How will treatment affect my normal activities?
Are there specific things I must do to get ready for treatment?
Are there other things I can be doing to help with my treatment, such as diet and exercise?
What resources can I use to learn more about my cancer and help me deal with it?

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Resources
ACOR Leukemia Links
American Cancer Society – 1-800-ACS-2345
Childhood Leukemia Center
Children’s Oncology Group
Leukemia Research Foundation - www.leukemia-research.org/
National Cancer Institute – 1-800-4CANCER
National Children's Leukemia Foundation – 1-800 GIVE HOPE
The Leukemia & Lymphoma Society