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Leukemia

Leukemia is cancer that originates in blood-forming tissue. The disease is characterized by the uncontrolled growth of blood cells, usually white blood cells (leukocytes), in the bone marrow. White blood cells are a fundamental component of the body’s immune response. The leukemia cells crowd out and replace normal blood and marrow cells.

Types of leukemia

There are four main types of leukemia:

  • Acute myeloid leukemia (AML)
  • Chronic myeloid leukemia (CML)
  • Acute lymphocytic leukemia (ALL)
  • Chronic lymphocytic leukemia (CLL)

Another type of leukemia, hairy cell leukemia, is a rare subtype of chronic lymphocytic leukemia (CLL). It is caused by an increased number of lymphocytes and progresses very slowly. It is called “hairy” because of the appearance of the leukemia cells under a microscope.

The primary differences between the four main types of leukemia have to do with their rates of progression and where the cancer develops. "Chronic" leukemia cells do not mature all the way, so they are not as capable of defending against infections as normal lymphocytes. "Acute" leukemia cells begin to replicate before any immune functions have developed.

Leukemia symptoms

Some general symptoms of leukemia include:

  • Fever, chills
  • Fatigue, weakness
  • Loss of appetite, weight loss
  • Night sweats
  • Bone/joint pain
  • Abdominal discomfort
  • Headaches
  • Shortness of breath
  • Frequent infections
  • Easy bruising or bleeding
  • Petechiae (small red spots under the skin)

Other potential symptoms of leukemia

Because some conditions coincide with the presence of the disease, the following may be signs of leukemia:

  • Anemia: A low red blood cell count. Red blood cells carry oxygen around the body. This condition may contribute to weakness, fatigue or shortness of breath.
  • Leukopenia: A low white blood cell count. A decrease in the production of functional leukocytes (white blood cells) weakens the body’s immune defense, which can make you more prone to infections.
  • Thrombocytopenia: A low blood platelet count. Platelets are the blood cells responsible for blood clotting. A shortage of bloods platelets may lead to easy bruising or bleeding.
  • Swollen lymph nodes: In some cases, the signs of leukemia may include noticeable swelling of the neck, armpit or groin. This occurs when leukemia has spread to the lymph nodes.
  • Enlarged liver or spleen: The build-up of abnormal blood cells in the liver or spleen may cause a feeling of fullness (loss of appetite) or swelling in the upper left side of the abdomen.

Myelodysplastic syndrome (MDS) and leukemia

Myelodysplastic syndrome (MDS) is a condition in which the bone marrow does not produce enough normal blood cells for the body. Some cases of MDS may, over time, progress to leukemia (generally AML).

Leukemia risk factors

GENERAL

  • Gender: Men are more likely to develop CML, CLL and AML than women.
  • Age: The risk of most leukemias, with the exception of ALL, typically increases with age.

GENETICS

  • Family history: Most leukemias have no familial link. However, first degree relatives of CLL patients, or having an identical twin who has or had AML or ALL, may put you at an increased risk for developing the disease.
  • Genetic diseases: Certain genetic abnormalities, such as Down syndrome, may play a role in the development of leukemia.

LIFESTYLE

  • Smoking: Although smoking may not be a direct cause of leukemia, smoking cigarettes does increase the risk of developing AML.

EXPOSURES

  • Exposure to high levels of radiation: Exposure to high-energy radiation (e.g., atomic bomb explosions) and intense exposure to low-energy radiation from electromagnetic fields (e.g., power lines).
  • Chemical exposure: Long-term exposure to certain pesticides or industrial chemicals like benzene is considered to be a risk for leukemia.

PREVIOUS TREATMENT

  • Previous cancer treatment: Certain types of chemotherapy and radiation therapy for other cancers are considered leukemia risk factors.

Leukemia stages

Leukemia stages vary based on disease type. And, some of the leukemias may be broken out into subtypes during the staging process.

The acute types of leukemia (AML and ALL), are sometimes staged based on the type of cell involved and how the cells look under a microscope. This is called the French-American-British (FAB) classification system.

Lymphocytic leukemias (CLL and ALL) occur in a type of white blood cell called lymphocytes. The white blood cell count at the time of diagnosis may be used to help stage the leukemia. Likewise, staging for myeloid leukemias (CML and AML) is based on the number of myeloblasts (immature white blood cells) found in the blood or bone marrow.

Factors affecting leukemia staging and prognosis

  • White blood cell or platelet count
  • Age (advanced age may negatively affect prognosis)
  • History of prior blood disorders
  • Chromosome mutations or abnormalities
  • Bone damage
  • Enlarged liver or spleen

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