What Is Leukemia? Symptoms, Causes, Diagnosis, and Treatment
Leukemia is a type of cancer that affects the blood cells and bone marrow, a soft spongy tissue inside the bones where blood cells are made. Your blood contains three key types of cells that are made in your bone marrow:
When you have leukemia, your bone marrow makes abnormal cells that can’t accomplish what normal cells can. As the disease progresses, more and more abnormal cells crowd out normal cells, and can even inhibit their production. How fast this happens depends on which type of leukemia you have. (3,4)
Leukemia is classified by how quickly it grows and the type of blood cell it affects.
There are two main categories of leukemia:
Leukemia is further classified by the type of white blood cell that gives rise to the cancerous cells. Here, too, there are two main categories:
There are four main types of leukemia, which are grouped based on which blood cells they affect and whether they are acute or chronic:
Rarer forms of leukemia (such as hairy cell leukemia) and preleukemic diseases (such as myelodysplastic syndromes and myeloproliferative disorders) also exist. A subset of the preleukemic disorders progress to AML. (4)
Your doctor can run certain tests to help determine what type of leukemia you have. Being educated about your specific type of cancer can empower you to make better decisions about your care.
Learn More About Leukemia Types
Acute lymphocytic leukemia (ALL) causes your bone marrow to produce large amounts of abnormal B and T cells, which don’t leave any room for healthy cells. ALL makes up 2 percent of leukemias, is more common in men and white people, and is the most common cancer type in children, according to StatPearls. People with ALL may be prone to easy bruising and bleeding, fatigue, and frequent infections. ALL can spread to different parts of the body, like your lymph nodes, liver, spleen, brain, spinal cord, and testicles. This type of leukemia can be treated with two to three years of chemotherapy and stem cell transplants.
Acute myeloid leukemia is a fast-growing cancer that begins in the bone marrow — a spongy tissue inside certain bones. It affects myeloid cells in the bone marrow, which normally give rise to red blood cells, white blood cells, and platelets. Typical symptoms of the disease include fatigue, weakness, pale skin, shortness of breath, and bruising. Treatments range from chemotherapy and stem cell transplantation to targeted therapies.
Learn More About Acute Myeloid Leukemia
Of all the leukemias diagnosed in adulthood, CLL is the most common, affecting nearly 21,000 people each year. This form of leukemia rarely occurs in children and tends to be diagnosed most commonly in older adults. A variety of treatments are used to fight CLL, depending on the pace at which it is progressing. They range from chemotherapy and immunotherapy to a watch-and-wait approach. Small lymphocytic leukemia (SLL), a variant of CLL, is treated in a similar fashion, but in SLL, most of the cancerous cells live in the lymph nodes instead of the bone marrow and blood.
Learn More About Chronic Lymphocytic Leukemia
Chronic myelogenous leukemia is much less common than other forms, only making up 15 percent of leukemia cases, according to the American Cancer Society (ACS). Also originating in the bone marrow, CML cells quickly fill that space and begin to spill into the blood. CML is most common in older adults and rare in children. This form of leukemia can come with no symptoms, and is often found through routine blood tests. The firstline treatment for CML is targeted therapy and many people experience long remissions.
This rare form of leukemia accounts for 1 to 2 percent of all cases of adult leukemia. Like other leukemias, it begins in the bone marrow, where blood cells are made. It affects B cells (a type of lymphocyte), a white blood cell that, when normal, helps the body fight infection. When cancerous, these B cells develop a distinctive hairy appearance. Though this form of leukemia is considered incurable, it is highly treatable and symptoms can be easily controlled with therapy. Some diagnosed with the disease may even be asymptomatic and, if they’re able to maintain a normal blood count, will not require therapy, according to the National Cancer Institute (NCI).
Leukemia occurs more often in adults who are older than 55 years of age. But it’s also the most common cancer in children younger than 15. (2) ALL is the most common type of childhood cancer. It typically affects kids ages 3 to 5. Boys are diagnosed with ALL at a slightly higher rate than girls, and the disease is most common in Hispanic children. (11)
With the exception of ALL, the risk for most types of leukemia typically increases with age. Men are more likely than women to develop CML, CLL, and AML. (12)
RELATED: What Is Childhood Leukemia?
The exact cause of leukemia isn’t known, but certain risk factors can up your chances of acquiring the cancer.
Children with Down syndrome are up to 30 times more likely to develop ALL, according to Leukaemia Care. Other inherited conditions, blood disorders, and even some common viruses like HIV or Epstein-Barr virus may raise a person’s risk for leukemia.
Environmental triggers are another possible culprit. Exposure to radiation, chemicals, pesticides, and cigarette smoke are linked to specific types of leukemia. Being treated with certain chemotherapy drugs can also increase your likelihood of later developing leukemia.
While there’s no way to completely evade leukemia, avoiding preventable risk factors may help you lower your chances of developing the disease.
Signs and symptoms vary depending on the type of leukemia you have. Some people with chronic leukemia don’t have symptoms for a while, whereas those with acute forms of the disease usually notice problems much sooner. Leukemia is sometimes hard to spot because the signs are vague and not specific.
Many of the general symptoms that people with leukemia experience overlap with those of common illnesses:
Sometimes leukemia, or its treatment, can lead to complications, which come with their own set of symptoms:
See your doctor if you have any complaints that are unusual, severe, or don’t go away. Your physician can help you find out what’s wrong and determine if your symptoms are caused by leukemia.
If your annual blood work comes back suggestive of leukemia, or you have been experiencing symptoms associated with this cancer, your healthcare provider will prescribe some further testing. Depending on your specific situation, your provider may order blood tests, imaging, or a biopsy to determine the type and stage of leukemia. This will allow better, more targeted treatment.
Since leukemia is a cancer of the blood cells, your blood offers valuable clues to what’s going on. Your provider may prescribe one of these common blood tests:
Leukemias start in your bone marrow, so a biopsy of this area will often give your provider most of the information they need to know about your leukemia. During a bone marrow aspiration, you lie on a table on your side or stomach. The area is numbed, then a needle is placed into the bone to pull out (aspirate) a small amount of liquid bone marrow. After this, a larger needle is placed to remove a small piece of bone and marrow. Most patients feel a brief pain when marrow is removed, but some only feel pressure.
Leukemias can spread to the fluid around the brain and in the spinal cord, called cerebrospinal fluid, or CSF. A lumbar puncture, also known as a spinal tap, removes a small amount of CSF to check for leukemia cells.
Chromosome tests allow your health team to examine the long strands of DNA in your cells. Pieces of chromosomes can sometimes mutate or even switch places. One such genomic alteration, called the “Philadelphia chromosome” appears in the majority of CML and some ALL cases, according to the Abramson Cancer Center.
Imaging tests like X-rays, CT scans, and MRI scans allow your provider to see more clearly what’s going on in your body. Because leukemia rarely forms tumors, this method of diagnosis may not be used as frequently.
This diagnostic test is rarely needed in leukemias, as diagnosis is mostly done via bone marrow. But if needed, a small incision is made to remove the lymph node for testing. If the node is shallow, the biopsy can be done with local anesthesia, but for deeper nodes, general anesthesia is used.
Staging cancer is a way for doctors to identify the extent of the disease. Most cancers are staged by the size and spread of the tumors. Because leukemia occurs in blood cells, it’s staged differently.
Staging leukemia depends on the type you have, but doctors often consider the following factors when determining the stage and prognosis:
Leukemias are categorized or staged using different tools. For ALL, no staging tool is used. Instead, practitioners use test results to put it into subgroups like B-cell ALL and T-cell ALL.
AML has no standard staging system, but is classified by new diagnosis, in remission, refractory (didn’t respond to treatment), and recurrent. Subtypes of AML can be identified via two classification methods:
CLL is staged using a different tool depending on where you live:
Finally, CML is staged by measuring levels of blast (immature) cells in the blood and bone marrow:
Treatment options vary and depend on the type of leukemia you have, your age, your health status, and how advanced the cancer is.
Common approaches include the following treatments:
In some cases of CLL, specifically, doctors will recommend a “watch and wait” approach until the cancer grows more. CLL is most often diagnosed in older adults, with an average age of 70 at diagnosis, according to the ACS. As its name implies, chronic lymphocytic leukemia is not a fast-moving cancer in most people. One study, published in February 2020 in Nature, suggests early treatment doesn’t necessarily lead to longer survival times for all CLL cases.
Complementary and supportive therapies can help you deal with the side effects of harsh treatments. Clinical trials are also an option if you want to try an experimental therapy that isn’t available as a mainstream option.
Choosing a treatment regimen isn’t always easy. That’s why it’s important to work with a doctor you trust.
The goal of leukemia treatment is to kill cancer cells, but many treatments involve some collateral damage. As healthy cells get taken out by cancer treatment, the following side effects can emerge:
If leukemia cell counts get very high, they can block the red blood cells carrying oxygen to your organs, which can cause headache, weakness, slurred speech, and confusion. This buildup can also cause joint and bone pain and abdominal swelling.
For many leukemia survivors, the struggle isn’t over when treatment ends.
Adults and children with this cancer often face physical and psychological issues months or even years after going into remission. The most common physical symptom in remission is fatigue, which sometimes lingers for months to years, according to the ACS. Some also report “chemo brain” which causes difficulties with memory during and after treatment. In remission, some experience symptoms of depression, anxiety, and insomnia.
Your risk of developing long-term effects from treatment depends on the type of therapy you received, your age, your overall health, your gender, and the duration of your treatment.
Regular follow-up appointments with your primary care physician and oncologist are vital for spotting any issues that could become serious.
Taking care of yourself, finding a good support system, and utilizing available resources can also help you optimize your daily life as a survivor.
Treatment outcomes, or prognosis, for leukemia varies widely depending on leukemia type and stage. Overall, leukemia’s five-year survival rates have spiked, from 33.4 percent in 1975 to 70.9 percent in 2015, according to the NCI.
Almost 90 percent of adults diagnosed with ALL go into remission with treatment. Although remission rates are high, 20 to 40 percent experience relapses. ALL has about a 70 percent five-year survival rate across all stages and patient ages.
The five-year survival rate for AML is about 30 percent, according to the Leukemia and Lymphoma Society, but on an individual level, survival depends on a collection of factors:
CLL claims a survival rate of 88 percent, according to the NCI, which is higher than any other leukemia type. And the earlier CLL is caught, the higher your chance for survival.
CML survival rates have spiked since targeted therapies were introduced as a first-line treatment in 2003. Since then, five-year survival rates have climbed from 33 percent to more than 90 percent, and 10-year survival has reached approximately 84 percent, according to StatPearls.
A hematologist-oncologist is a doctor who treats people with blood cancers. You can find a blood cancer specialist by asking your primary care physician for a recommendation or by contacting your community cancer center.
Additionally, the Leukemia and Lymphoma Society offers several resources to help you locate a specialist in your area. (8)
You might want to ask the following questions when deciding on a doctor:
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