Leukemia
Leukaemia
Leukemia is cancer of the blood forming tissues that also affects the bone marrow and the lymphatic system. Such a type of cancer causes abnormal development of cells that gradually enter the bloodstream [1].
Presentation
Symptoms of leukemia vary with the type. The common symptoms of the disease include the following [9]:
- Undue weight loss
- Constant felling of tiredness and fatigue
- Pain in bone
- Fever accompanied by chills
- Excessive sweating especially during night hours
- Easy prone to infections
- Bleeding or bruising very easily
- Hepatomegaly
- Splenomegaly
- Swollen lymph nodes
- Development of petechiae
Hematological
Easy Bruising
- Easy bruising or bleeding: People with leukemia may bleed from their gums or noses, or may find blood in their stool or urine. Bruises may develop from very minor bumps. Small spots of discoloration — called petechiae — may form under the skin.[my.clevelandclinic.org]
- Return to top Signs and Symptoms Signs of acute leukemia may include easy bruising or bleeding (as a result of platelet deficiency), paleness or easy fatigue (as a result of anemia), recurrent minor infections or poor healing of minor cuts (because of[web.archive.org]
- So, they experience prolonged bleeding and they also see easy bruising. Okay. And finally, we said that there is fewer white blood cells, which I'm just going to abbreviate as WBCs, right.[khanacademy.org]
- Possible symptoms of childhood ALL include: fever, easy bruising or bleeding, petechiae (flat, pinpoint spots under the skin caused by bleeding), bone or joint pain, painless lumps in the neck, underarm, stomach, or groin, pain or feeling of fullness[serc.carleton.edu]
Immune System
Splenomegaly
- Five features were present in 50% of children: hepatomegaly (64%), splenomegaly (61%), pallor (54%), fever (53%) and bruising (52%).[ncbi.nlm.nih.gov]
- T-cell prolymphocytic leukemia (T-PLL) is the most common type of mature T-cell leukemia and is characterized by a rapidly rising peripheral blood lymphocyte count, bone marrow involvement, and splenomegaly. [1] The disease in most patients follows an[web.archive.org]
- Leukemia is usually associated with anemia, fever, hemorrhagic episodes, and splenomegaly.[icd9data.com]
- Stage II Stage II CLL is characterized by absolute lymphocytosis with either hepatomegaly or splenomegaly with or without lymphadenopathy.[web.archive.org]
Entire Body System
Fever
- Of the 19 febrile patients in the filgrastim-treated group, the median time for the onset of fever in 18 patients was on day 8 (range, day 1 to day 12); 1 patient experienced fever on day 29.[bloodjournal.hematologylibrary.org]
- Five features were present in 50% of children: hepatomegaly (64%), splenomegaly (61%), pallor (54%), fever (53%) and bruising (52%).[ncbi.nlm.nih.gov]
- Chronic myelogenous leukemia most often begins in the 40s; weight loss, low fever, weakness, and other symptoms may not develop immediately. Chemotherapy helps the symptoms but may not prolong life.[web.archive.org]
- This phase of CML is characterized by fever, weakness, and an enlarged spleen.[britannica.com]
- Over 50% of children with leukaemia have palpable livers, palpable spleens, pallor, fever or bruising on diagnosis.[doi.org]
Anemia
- Anemia and thrombocytopenia are the major adverse prognostic variables. CLL has no standard staging system.[web.archive.org]
- Stage A: The patient does not have anemia or low levels of platelets. The leukemia can be felt in fewer than 3 areas of lymph nodes (Rai stages 0, I and II). Stage B: The patient does not have anemia or low levels of platelets.[cancer.net]
- They also crowd out the normal cells in the marrow, causing a decrease in the number of new normal cells made in the marrow and resulting in a low red cell count (anemia).[hopkinsmedicine.org]
- Aplastic Anemia. Only neutropenia is regarded as independent risk factor for severe opportunistic infection in T-LGL patients.[ncbi.nlm.nih.gov]
- They also may get anemia, which is when there's a low number of red blood cells. This happens because leukemia cells crowd the bone marrow. This prevents bone marrow from making the usual amount of oxygen-carrying red blood cells.[kidshealth.org]
Fatigue
- The exercise protocol used increased cardiovascular endurance, reduced fatigue and depression scores, and maintained quality of life.[doi.org]
- A 21-year-old woman who presented fatigue had a new diagnosis of acute lymphoblastic leukemia underwent FDG PET/CT. The images demonstrated extramedullary infiltration in multiple organs, including the liver, pancreas, kidney and the bone.[ncbi.nlm.nih.gov]
- An additional eight features were present in a third to a half of children: recurrent infections (49%), fatigue (46%), limb pain (43%), hepatosplenomegaly (42%), bruising/petechiae (42%), lymphadenopathy (41%), bleeding tendency (38%) and rash (35%).[ncbi.nlm.nih.gov]
- (including ‘weakness’, ‘fatigue’, ‘weakness/fatigue’), malaise/fatigue (including ‘malaise’ and ‘malaise/fatigue’) and infections (including ‘infection’ and ‘recurrent infections’).[doi.org]
- Fatigue and weakness iStock/FangXiaNuo Fatigue and weakness are the most common leukemia symptoms, according to Mark Levis, MD, PhD, the director of the leukemia program at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center.[rd.com]
Down Syndrome
- […] in Down syndrome children with ALL.[haematologica.org]
- Case Study A 6-year-old boy who has Down syndrome presents with a 2-day history of fever (temperature to 39.0 C) and a painful limp and favoring of his right leg.[dx.doi.org]
- Down syndrome : People with Down syndrome appear to have a higher risk, possibly due to certain chromosomal changes.[medicalnewstoday.com]
- Some people with Down syndrome or blood disorders such as polycythemia vera External (a disease in which there are too many red blood cells in the bone marrow and blood, causing the blood to thicken) may be more likely to develop leukemia.[cdc.gov]
Weight Loss
- Abdominal symptoms such as anorexia, weight loss, abdominal pain and abdominal distension are common. Musculoskeletal symptoms such as limp and joint pain also feature prominently.[ncbi.nlm.nih.gov]
- These were petechiae/purpura (category derived from ‘petechiae’, ‘purpura’ and ‘petechiae/purpura’), mucosal bleeding (including ‘mucosal bleeding’ and ‘bleeding gums’), anorexia/weight loss (including ‘anorexia’, ‘weight loss’ and ‘anorexia/weight loss[doi.org]
- Symptoms Symptoms of leukemia include fatigue, tiredness, unexplained weight loss, fever and chills, frequent nose bleeds, excessive sweating and bone pain along with tenderness.[symptoma.com]
- Chronic myelogenous leukemia most often begins in the 40s; weight loss, low fever, weakness, and other symptoms may not develop immediately. Chemotherapy helps the symptoms but may not prolong life.[web.archive.org]
- Other symptoms : There may be nausea, fever, chills, night sweats, flu-like symptoms, weight loss, bone pain, and tiredness. If the liver or spleen becomes enlarged the person may feel full and will eat less, resulting in weight loss.[medicalnewstoday.com]
Respiratoric
Dyspnea
- Difficulty breathing (dyspnea). With T-cell ALL, these leukemia cells tend to clump together around the thymus, a small organ just behind the breastbone.[stanfordchildrens.org]
- Finally, the red blood cell deficiency leads to anemia, which may cause dyspnea and pallor. Some people experience other symptoms, such as feeling sick, having fevers, chills, night sweats, feeling fatigued and other flu-like symptoms.[en.wikipedia.org]
Jaw & Teeth
Bleeding Gums
- Symptoms can include: Fever, chills, night sweats, and flu-like symptoms Weakness and fatigue Swollen or bleeding gums Headaches Enlarged liver and spleen Swollen tonsils Bone pain Paleness Weight loss 8.[everydayhealth.com]
- Thrombocytopenia (not having enough of the blood platelets needed for plugging holes in damaged blood vessels) can lead to excessive bruising, bleeding, frequent or severe nosebleeds, and bleeding gums.[web.archive.org]
- These were petechiae/purpura (category derived from ‘petechiae’, ‘purpura’ and ‘petechiae/purpura’), mucosal bleeding (including ‘mucosal bleeding’ and ‘bleeding gums’), anorexia/weight loss (including ‘anorexia’, ‘weight loss’ and ‘anorexia/weight loss[doi.org]
Liver, Gall & Pancreas
Hepatomegaly
- Five features were present in 50% of children: hepatomegaly (64%), splenomegaly (61%), pallor (54%), fever (53%) and bruising (52%).[ncbi.nlm.nih.gov]
- Stage II Stage II CLL is characterized by absolute lymphocytosis with either hepatomegaly or splenomegaly with or without lymphadenopathy.[web.archive.org]
- […] symptoms of the disease include the following: Undue weight loss Constant felling of tiredness and fatigue Pain in bone Fever accompanied by chills Excessive sweating especially during night hours Easy prone to infections Bleeding or bruising very easily Hepatomegaly[symptoma.com]
- […] means there are high levels of lymphocytes in the blood Lymphadenopathy, meaning a patient has enlarged lymph nodes Splenomegaly, which is an enlarged spleen Anemia, meaning low levels of red blood cells Thrombocytopenia, meaning low levels of platelets Hepatomegaly[cancer.net]
Hepatosplenomegaly
- An additional eight features were present in a third to a half of children: recurrent infections (49%), fatigue (46%), limb pain (43%), hepatosplenomegaly (42%), bruising/petechiae (42%), lymphadenopathy (41%), bleeding tendency (38%) and rash (35%).[ncbi.nlm.nih.gov]
- Stage I Stage I CLL is characterized by absolute lymphocytosis with lymphadenopathy without hepatosplenomegaly, anemia, or thrombocytopenia.[web.archive.org]
Musculoskeletal
Bone Pain
- So, it's more generalized bone pain. So, if a patient starts showing signs and symptoms of leukemia, a doctor will often start off by getting a blood test, and if they get a blood test, the first thing that you will see is this picture over here.[khanacademy.org]
- Symptoms Symptoms of leukemia include fatigue, tiredness, unexplained weight loss, fever and chills, frequent nose bleeds, excessive sweating and bone pain along with tenderness.[symptoma.com]
- pain, sometimes associated with swelling of the joints Weight loss or loss of appetite Enlarged lymph nodes The signs and symptoms of ALL can be the same as more common children’s illnesses and some children are treated for those other illnesses before[curesearch.org]
- Some patients have bone pain or joint pain caused by leukemic cells spreading from the marrow cavity to the surface of the bone or into the joint.[web.archive.org]
Arthralgia
- Other side effects included rashes in 4%, arthralgias in 5%, and fatigue in 3%. The preliminary phase II studies of nilotinib in accelerated and blastic phase CML post Gleevec failure were also encouraging.[web.archive.org]
Skin
Petechiae
- Where considered clinically appropriate, features that the authors considered similar were aggregated (eg, ‘petechiae’, ‘purpura’ and ‘petechiae/purpura’ were combined into a single category, ‘petechiae/purpura’).[doi.org]
- An additional eight features were present in a third to a half of children: recurrent infections (49%), fatigue (46%), limb pain (43%), hepatosplenomegaly (42%), bruising/petechiae (42%), lymphadenopathy (41%), bleeding tendency (38%) and rash (35%).[ncbi.nlm.nih.gov]
- Small red dots on your skin—a condition known as petechiae—could also result from leukemia, she adds. "Petechiae usually appears on the lower extremities," Wadleigh adds.[prevention.com]
- Petechiae (small red spots under the skin caused by bleeding) iStock/lzf Dr. Crilley describes petechiae as “like someone painted little red dots with a pen.”[rd.com]
- Constant felling of tiredness and fatigue Pain in bone Fever accompanied by chills Excessive sweating especially during night hours Easy prone to infections Bleeding or bruising very easily Hepatomegaly Splenomegaly Swollen lymph nodes Development of petechiae[symptoma.com]
Urticaria
- Urticaria was seen in 9 patients (23%) but was usually mild and transient. No patient experienced significant fluid retention.[bloodjournal.org]
Purpura
- Where considered clinically appropriate, features that the authors considered similar were aggregated (eg, ‘petechiae’, ‘purpura’ and ‘petechiae/purpura’ were combined into a single category, ‘petechiae/purpura’).[doi.org]
- Citing Literature Number of times cited according to CrossRef: 46 Anselm Chi-wai Lee, Idiopathic Purpura With Gray Platelets, Journal of Pediatric Hematology/Oncology, 10.1097/MPH.0000000000001334, 41, 1, (47-50), (2019).[doi.org]
Neurologic
Headache
- Pounding headaches iStock/AZarubaika Although not common, frequent pounding headaches may be a sign of leukemia-related anemia or even a life-threatening case of bleeding in the head. These are the signs of cancer men are most likely to ignore .[rd.com]
- […] effects of Besponsa include low levels of platelets (thrombocytopenia), low levels of certain white blood cells (neutropenia, leukopenia), infection, low levels of red blood cells (anemia), fatigue, severe bleeding (hemorrhage), fever (pyrexia), nausea, headache[fda.gov]
- I have no energy and I just lie down all the time with headaches .[emedicinehealth.com]
- Chemotherapy Down Syndrome A strong family history of leukemia Symptoms vary depending on the type and stage of leukemia, but they can include the following: Fever, chills, night sweats and other flu-like symptoms Weakness and fatigue Swollen or bleeding gums Headaches[hematology.org]
Peripheral Neuropathy
- Peripheral neuropathy – Peripheral neuropathy, or numbness, tingling or pain in the hands and feet, can last months after therapy with agents such as Oncovin.[hopkinsmedicine.org]
Workup
The following are the various diagnostic procedures for detecting leukemia [10]:
- A preliminary physical examination will be carried out for studying the various signs and symptoms of leukemia.
- Blood tests such as complete blood count provide a useful insight for diagnosis of the condition.
- Bone marrow test forms an important part of the diagnostic procedure. In this a sample of the bone marrow is derived from the hip bone and studied for the presence of leukemia cells.
Treatment
Treating leukemia is a complex process as it would greatly depend on the stage of the disease and the type of leukemia present. Some of the common treatment methods employed for treating the condition are explained below [11]:
- Chemotherapy: It is the method of choice for treating leukemia [11].
- Biological therapy: In this method, therapies are targeted towards making the immune system recognize the cancer cells as invaders and attack them.
- Radiation therapy: Radiation therapy employs high beam radiation to kill the target cells and arrest their growth.
- Targeted therapy: In this form of therapy, drugs are administered that attack specific component of the leukemia cells thereby preventing their growth and multiplication.
- Stem cell transplant: In this, the affected bone marrow is transplanted with a healthy one. The prognosis of the disease is favorable with this kind of method [12]. Prior to this method, the patient is given chemotherapy in combination with radiation therapy to completely destroy the diseased bone marrow.
Prognosis
Prognosis of the disease condition depends on the type of leukemia and the stage at which the condition was diagnosed. If leukemia is diagnosed in its early stages then the prognosis is favorable with timely initiation of treatment and regular follow up checkups [8].
Etiology
The factor that triggers the development of leukemia is yet to be figured out. However, a combination of various factors such as environment and heredity are known to play foul. In addition, various types of risk factors such as exposure to chemical compounds such as benzene, tobacco smoking, ionizing radiation and prior treatment with chemotherapy can also predispose an individual to develop leukemia [3] [4].
Epidemiology
Leukemia is a widespread problem affecting the male and female population equally. It has been estimated that every year about 13.0 per 100,000 fresh cases of leukemia are diagnosed. Statistics also reveal that there were about 7.0 per 100,000 cases of death due to leukemia every year. Researchers have also established statistical data which state that in the year 2014, there would be 52,380 new cases of leukemia. Of these, 24,090 cases of death due to leukemia would also occur in the same year. Statistical data has also confirmed that leukemia accounts for 4.1% of all cancer deaths. This form of cancer is also widely prevalent amongst the pediatric population [5] [6]. It has been estimated that each year in US about 2500 – 3500 new cases are diagnosed [1].
Pathophysiology
Leukemia begins with attacking the white blood cells of the body. As a result of this, the infection fighting ability of the white blood cells is greatly diminished making the body more prone to contract infectious diseases. Leukemia also affects the bone marrow as a result of which abnormal cells are produced which fail to function in the normal way. Such sequence of events causes the abnormal cells to affect other body organs such as the liver, eye and the spleen. There are basically 4 types of leukemia, namely: Acute lymphocytic leukemia, acute myelogenous leukemia, chronic lymphocytic leukemia and chronic myeloid leukemia. Other rare types of leukemia are myeloproliferative disorders, hairy cell leukemia and myelodysplastic syndromes [7].
Prevention
It is practically not possible to prevent leukemia. However, the spread of the disease can be prevented if detected on time and timely initiation of treatment.
Summary
There are several forms of leukemia; some which affect the children and some which affect the adult population. Leukemia usually begins by primarily attacking the white blood cells which are essential for warding off infections. But, when the cancer affects the white blood cells, these are no longer capable of safeguarding the body against infections. The underdeveloped white blood cells are known as blasts or leukemia cells [2]. Treatment of leukemia is a complex process that needs to be designed keeping in mind several factors.
Patient Information
Definition
Leukemia is the cancer of the white blood cells that also affects the lymphatic system and the bone marrow. It is a common condition affecting the children as well as the adult population.
Cause
The exact factor that triggers the abnormal development of cells is not clearly understood. However, interplay of environment and genetic factors are known to play foul in causation of leukemia.
Symptoms
Symptoms of leukemia include fatigue, tiredness, unexplained weight loss, fever and chills, frequent nose bleeds, excessive sweating and bone pain along with tenderness.
Diagnosis
Diagnosis of leukemia is done by blood tests to determine complete blood count which would give an idea about the white blood cell count. In addition to this, bone marrow test is also done to analyze for the presence of leukemia cells.
Treatment
Treatment of leukemia consists of chemotherapy and radiation therapy which targets the cancer cells and destroys them. In addition, stem cell transplant is also the method of choice wherein the diseased bone marrow is replaced with a healthy one. Patients suffering from leukemia are also given targeted therapy which works by destroying specific components of the leukemia cells.
References
Article
- Ward E, DeSantis C, Robbins A, et al. Childhood and adolescent cancer statistics, 2014. CA Cancer J Clin 2014; 64:83.
- Rootman J, Gudauskas G. Treatment of ocular leukemia with local chemotherapy. Cancer Treat Rep. Jan 1985;69(1):119-22
- Kincaid MC, Green WR. Ocular and orbital involvement in leukemia. Surv Ophthalmol. Jan-Feb 1983;27(4):211-32.
- Buffler PA, Kwan ML, Reynolds P, Urayama KY. Environmental and genetic risk factors for childhood leukemia: appraising the evidence. Cancer Invest 2005; 23:60
- Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin 2014; 64:9.
- Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. Mar-Apr 2005;55(2):74-108. [Medline]. Galton DA. The pathogenesis of chronic lymphocytic leukemia. Can Med Assoc J 1966; 94:1005.
- Harris NL, Jaffe ES, Diebold J, et al. World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting-Airlie House, Virginia, November 1997. J Clin Oncol 1999; 17:3835.
- Jonsson OG, Sartain P, Ducore JM, Buchanan GR. Bone pain as an initial symptom of childhood acute lymphoblastic leukemia: association with nearly normal hematologic indexes. J Pediatr 1990; 117:233.
- Kaufman M, Rubin J, Rai K. Diagnosing and treating chronic lymphocytic leukemia in 2009. Oncology (Williston Park). Nov 15 2009;23(12):1030-7.
- Harnett AN, Plowman PN. The eye in acute leukaemia. 2. The management of solitary anterior chamber relapse. Radiother Oncol. Nov 1987;10(3):203-7.
- Kerty E, Vigander K, Flage T, Brinch L. Ocular findings in allogeneic stem cell transplantation without total body irradiation. Ophthalmology. Jul 1999;106(7):1334-8.
- Rootman J, Gudauskas G. Treatment of ocular leukemia with local chemotherapy. Cancer Treat Rep. Jan 1985;69(1):119-22.