Diagnosis, Treatments and Causes of Leukemia
Leukemia is cancer of the blood-forming tissues and it strikes all ages and both sexes. Leukemia is a term given to a group of malignant diseases of the bone marrow and lymphatic system. In a person with leukemia, the bone marrow makes abnormal white blood cells (Wong, 2007). The abnormal cells are leukemia cells, unlike normal blood cells; leukemia cells don't die when they should. They may crowd out normal white blood cells, red blood cells, and platelets. This makes it hard for normal blood cells to do their work (Wong, 2007). This can lead to serious problems such as anemia, bleeding, and infections. Leukemia cells can also spread to the lymph nodes or other organs and cause swelling or pain. This paper examines how leukemia is diagnosed, the main types of treatment of leukemia and possible causes of leukemia (Bhojwani, 2009).
Diagnosis of Leukemia
Leukemia may be acute or chronic. Acute leukemia gets worse very fast and will make a person feel sick right away. Chronic leukemia gets worse slowly and may not cause symptoms for years. Doctors typically find leukemia after a routine blood test, when a patient has symptoms that suggest leukemia. Symptoms may depend on what type of leukemia a person has, but common symptoms are fever and night sweats, headaches, bruising or bleeding easily, bone or joint pain, a swollen or painful belly from an enlarged spleen, swollen lymph nodes, feeling very tired or weak, losing weight and not feeling hungry. The acute types of leukemia, Acute lymphocytic leukemia (ALL) and Acute myeloid leukemia (AML), symptoms are seen more quickly than in the chronic types of leukemia, Chronic lymphocytic leukemia (CLL) and Chronic myeloid leukemia (CML) , where symptoms do not necessarily appear right away (Katz, 2010). There are a variety of test that are performed to diagnose leukemia (Wong, 2007). One such test is a physical exam in which a doctor checks for swollen lymph nodes, spleen, or liver. The next test might be a blood test in which the lab does a complete blood count to check the number of white blood cells, red blood cells, and platelets. Leukemia causes a very high level of white blood cells. It may also cause low levels of platelets and hemoglobin, which is found inside red blood cells. Another way to diagnose is with a biopsy; in which a doctor removes tissue to look for cancer cells. A biopsy is the only sure way to know whether leukemia cells are in your bone marrow. The doctor removes some bone marrow from the hipbone or another large bone. A pathologist uses a microscope to check the tissue for leukemia cells (Klepin, 2009). The two ways a doctor can obtain bone marrow is through bone marrow aspiration and bone marrow biopsy. In a bone marrow aspiration the doctor uses a thick, hollow needle to remove samples of bone marrow and a bone marrow biopsy the doctor also uses a very thick, hollow needle but removes a small piece of bone and bone marrow (Klepin, 2009).
Treatment of Leukemia
Specialists who treat leukemia include hematologists, medical oncologists, and radiation oncologists. People with leukemia have many treatment options, which are chemotherapy, radiation therapy, biological therapy, surgery and stem cell transplant (Fitzgerald, 2008). The treatment depends mainly on the type of leukemia (acute or chronic), the patient’s age, and whether leukemia cells were found in the cerebrospinal fluid. It also may depend on certain features of the leukemia cells (Fitzgerald, 2008). The goal of treatment is to bring a patient into remission by destroying signs of leukemia in the body. Chemotherapy is the use of drugs that either kill cancer cells or prevent the cells from dividing. Chemotherapy can be given in a variety of ways, with IV infusion and pill being the most common. Radiation therapy is the use of certain types of energy, radiation is used to kill cancer cells and shrink tumors. This energy can be waves or particles like protons, electrons, x-rays and gamma rays. Biological therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy. Surgical removal of the spleen is also a treatment option for chronic leukemia. The spleen collects leukemia cells and this allows the spleen to enlarge. “A bone marrow transplant is a procedure to replace bone marrow that has been destroyed by treatment with high doses of anticancer drugs or radiation. Transplantation may be autologous (an individual's own marrow saved before treatment), allogeneic (marrow donated by someone else), or syngeneic (marrow donated by an identical twin” (Fitzgerald, 2008). Stem cell transplants offer some people with chronic leukemia the chance for cure. The strategy of treatment is to control bone marrow and systemic disease while offering specific treatment for the central nervous system. Consolidation and/or "maintenance" treatments may be given to prevent disease recurrence once remission has been achieved (Fitzgerald, 2008). If a patient has Chronic Myelogenous Leukemia (CML) their treatment should start as soon as the diagnosis is confirmed (Katz, 2010). Typically a person is given a drug, Gleevec (imatinib mesylate), which blocks the BCR-ABL cancer gene. Gleevec stops the CML from getting worse, but does not cure it. There are other drugs, such as Sprycel (dasatinib) and Tarigna (nilotinb), which also block the BCR-ABL cancer gene (Parmar, 2011). Patients who have not had success with Gleevec are usually given Sprycel and Tarigna. All three drugs are taken orally. A bone marrow transplant is the only current way of curing a patient with CML (Parmar, 2011). The younger the patient is the more likely the transplant will be successful. Patients with Chronic Lymphocytic Leukemia (CLL) may not receive any treatment for a long time after diagnosis (Katz, 2010). Those who do will normally be given chemotherapy or monoclonal antibody therapy. Some patients with CLL may benefit from allogeneic stem cell transplantation (Parmar, 2011). All leukemia patients, regardless of what type they have or had, will need to be checked regularly by their doctors after the cancer has gone in remission. They will undergo exams and blood tests. The doctors will occasionally test their bone marrow. As time passes and the patient continues to remain free of leukemia the doctor may decide to lengthen the intervals between tests.
Suspected Causes of Leukemia
Most blood cells mature in the bone marrow and then move into the blood vessels. Blood flowing through the blood vessels and heart is called the peripheral blood. In a person with leukemia, the bone marrow makes abnormal white blood cells. The abnormal cells are leukemia cells. Unlike normal blood cells, leukemia cells don't die when they should. They may crowd out normal white blood cells, red blood cells, and platelets. This makes it hard for normal blood cells to do their work. When you have leukemia, the bone marrow starts to make a lot of abnormal white blood cells, called leukemia cells. They don't do the work of normal white blood cells, they grow faster than normal cells, and they don't stop growing when they should. Over time, leukemia cells can crowd out the normal blood cells. This can lead to serious problems such as anemia, bleeding, and infections. Leukemia cells can also spread to the lymph nodes or other organs and cause swelling or pain.
No one knows exactly what causes leukemia. Some studies have shown that exposure to high-energy radiation increases chances of contracting leukemia. Such radiation was produced in the atomic bombing of Japan during World War II. Some research shows that exposure to electric magnetic fields, such as power lines, is a possible risk factor (Ball, 2008). Exposure to some chemicals is also suspected to be a risk factor. Environmental factors, such as increased pollution, seem to influence the risk of developing leukemia. Some studies researching family history and looking at twins have indicated that some people have a higher risk of developing leukemia because of a single gene or multiple genes. People with Down syndrome have a significantly higher risk of developing leukemia, compared to people who do not have Down syndrome (Ball, 2008). Experts say that because of this, people with certain chromosomal abnormalities may have a higher risk. Tobacco smokers are more susceptible to certain leukemia’s than nonsmokers. Research also suggests that prolonged exposure to radiation, various chemicals in the home and work environments. This can be benzene containing products, petroleum products, and hair dye, but there is no definitive proof (Ball, 2008).
Conclusion
Leukemia is a cancer of blood-forming cells in the bone marrow. These cells crowd out other types of blood cells produced by the bone marrow, including red blood cells, which carry oxygen to tissues throughout your body, and platelets, which help form blood clots (Ball, 2008). Leukemia cells can spread to the lymph nodes or other organs causing swelling and/or pain and can also collect in the kidney, liver and spleen, causing enlargement of these organs. Leukemia is diagnosed after a routine blood test, physical examines, and biopsy (Fitzgerald, 2008). The treatment of Leukemia depends mainly on the type of leukemia, the patient’s age, and whether leukemia cells were found in the cerebrospinal fluid. There is no single known cause for all of the different types of leukemia. Studies have linked exposure to petrochemicals, such as benzene, and hair dyes to the development of some forms (Klepin, 2009). Until the cause or causes are found, there is no known way to prevent the occurrence of the disease. The more we understand the disease, how we treat the disease and the causes of the disease, the more advances can be made in eradication of Leukemia.