Leukaemia

There are several types of leukaemia. They are named according to the type of white blood cells (myeloid or lymphoid) that are affected and whether the disease is acute or chronic.

Acute leukaemia
If you have acute leukaemia, symptoms develop quickly and the condition can become life-threatening at an early stage if it's not treated.

The most common type of acute leukaemia in children affects lymphocytes and is called acute lymphoblastic leukaemia (ALL). ALL usually affects children aged between two and 10.

The most common type of acute leukaemia in adults affects myeloid cells and is called acute myeloid leukaemia (AML).

Chronic leukaemia
If you have chronic leukaemia, symptoms develop slowly and your white blood cells are almost fully grown and normal when they leave your bone marrow and enter your bloodstream. They can function, but not as well as they should.

Chronic myeloid leukaemia (CML), affects your myeloid cells. It has two phases, a chronic phase that can last for several years, during which symptoms develop slowly, followed by a more aggressive phase (accelerated phase), where symptoms quickly get worse.

Chronic lymphocytic leukaemia (CLL) affects lymphocytes, and is most common in people aged between 30 and 60.

The exact causes of leukaemia aren't known, although there are some risk factors that increase your chances of developing it. These include:

• a weakened immune system - for example if you have HIV/AIDS or are taking medicines that suppress your immune system
• age - AML and CLL are more common in people over 40
• gender - slightly more men than women are affected by leukaemia
• smoking
• certain genetic conditions, such as Down's syndrome
• other blood disorders, such as aplastic anaemia - a rare condition where your bone marrow fails to produce any of the blood cells
• contact with a chemical called benzene
• autoimmune conditions such as rheumatoid arthritis, autoimmune haemolytic anaemia and ulcerative colitis, although doctors aren't sure if it's the actual condition or the medicines taken for the condition that increases your risk of leukaemia

There is some evidence that there is an increased risk of leukaemia in some families. However, most leukaemias don't have a family link.

The symptoms vary, depending on the exact type of leukaemia you have and how advanced it is. You may have no symptoms in the early stages, especially if you have chronic leukaemia. Your symptoms may be mild at first and then get worse and you may feel as if you have flu. Many of the symptoms are vague, and can include:

• tiredness, breathlessness and pale skin (due to anaemia - a reduction in number of red blood cells)
• fever (high temperature)
• infections that don't get better
• abnormal bruising or bleeding
• red or purple spots on your skin - called a petechial rash
• bone and joint pain (due to the pressure of a build-up of cells in your bone marrow)
• swollen lymph nodes (glands found throughout your body, including your neck, groin and under your arms, that are part of your immune system)
• feeling full or a tender lump on the left side of your tummy due to an enlarged spleen
• loss of appetite and weight loss
• swollen gums, and occasionally, swollen testicles
• headaches and vision problems
• itchy skin
• very rarely, a painful erection that won't go away - this is called priapism

These symptoms aren't always caused by leukaemia but if you have them, see your doctor.

Your doctor will ask you about your symptoms and examine you. If your doctor thinks you may have leukaemia, he or she will refer you to a haematologist (a doctor who specialises in conditions of the blood) who will examine you fully.

You will need to have a blood test. Your blood sample will be sent to a laboratory for testing, to look for deficiencies of normal blood cells and for the presence of abnormal white blood cells. Depending on the results of the blood test, you may need to have further tests, which may include the following.

• Bone marrow biopsy, to examine all the blood cells under a microscope.
• Analysis of the chromosomes and DNA of the abnormal cells found in your blood and bone marrow (cytogenetics).
• Analysis of the antigens present on the leukaemic cells (immunophenotyping).
• CT, MRI, X-ray or ultrasound scans to look for enlarged lymph nodes, an enlarged spleen or other tumours.
• An echocardiogram to check that your heart is healthy.
• Tissue typing of yourself and your siblings to see if you have a suitable bone marrow donor.

Treatment varies considerably, depending on the type of leukaemia you have, but may involve:

• chemotherapy - medicines that destroy cancer cells
• radiotherapy - X-rays that target cancer cells
• a bone marrow or stem cell transplant - transferring somebody else's (preferably your brother or sister) healthy bone marrow or stem cells into your body
• biological therapies, such as a medicine called a tyrosine kinase inhibitor if you have CML
• monoclonal antibody therapy - monoclonal antibodies are medicines that are designed to recognise and target markers that are commonly carried by cancer cells medicines called steroids, if you have ALL or CLL

You may need to have other treatment, possibly including antibiotics, blood transfusions, platelet transfusions and growth factor injections.

How well treatment for leukaemia works depends on the type and stage of the disease. Acute leukaemia often goes into remission. This is when your symptoms go away and the disease is under control, but not necessarily cured. Unfortunately, for many people with acute leukaemia, remission is followed by a relapse - when the disease returns.

You may feel confused and overwhelmed when you're told you have leukaemia. It can be a very distressing time for both you and your family. An important part of cancer treatment is learning how to talk about how you're feeling, and getting support for your physical and emotional symptoms. It's also important to find out as much as possible about your type of leukaemia because this will help you feel more in control.

Once your treatment is over, you may feel frustrated that you can't get back to normal straightaway. Many people feel very tired, even months after their treatment. You need to be realistic about how long it may take you to recover and plan ahead with school or work, perhaps going back part-time at first.

Gentle walking is a good way of easing yourself back into exercise and increasing your energy. Once your appetite returns, try to eat a healthy balanced diet with at least five portions of fruit and vegetables a day.

For more advanced cancer, you can receive extra support known as palliative care. This involves treatment that aims to reduce the severity of your symptoms or slow the disease's progress, rather than providing a cure. Doctors and nurses at hospitals, hospices and pain clinics specialise in providing the support you need, and can also visit you at home.

This information was published by Bupa Group's Health Content Team and has been reviewed by appropriate medical or clinical professionals. To the best of their knowledge the information is current and based on reputable sources of medical evidence, however Bupa (Asia) Limited makes no representation or warranty as to the completeness or accuracy of the Content.

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