Leukemia can be hard to diagnose early because the symptoms are similar to those of many other conditions. But you should tell your doctor about any bruising that won’t go away or is getting worse, even if it happens rarely.
Some people are at higher risk than others, including those with genetic conditions like Klinefelter syndrome and Down syndrome and those who’ve had radiation or chemotherapy for another cancer.
Diagnosis
If someone has leukemia, the bone marrow produces abnormal white blood cells that build up in the blood and interfere with the production of normal red blood cells and platelets. These can cause problems like swollen lymph nodes, enlarged liver and spleen, bleeding and infections. Some types of leukemia are fast-growing and acute, while others grow more slowly and are chronic. Sometimes a doctor diagnoses leukemia from symptoms, but most often the disease is discovered during blood tests done for other reasons.
A blood smear and a complete blood count (CBC) are usually the first tests used to check for leukemia. The CBC and the smear show how many different blood cell types are in the body. Abnormal numbers of certain types of blood cells and the way these cells look under a microscope can indicate that there’s something wrong.
Bone marrow biopsy is another test that can help confirm the diagnosis of leukemia. For this test, the doctor gives you numbing medicine and then uses a needle to remove some of the soft spongy tissue inside your bones (bone marrow). The bone marrow is tested in a lab to see if there are any abnormal cells. If the results aren’t clear, other tests may be needed.
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Other laboratory tests that can be used to diagnose leukemia include fluorescence in situ hybridization and polymerase chain reaction (PCR). FISH is a molecular technique that uses special DNA probes labelled with fluorescent dyes to find chromosomal changes within the leukemia cells, also called blasts. PCR is used to find the specific genes that are changed in a particular type of leukemia.
X-rays, CT scans and magnetic resonance imaging (MRI) can help determine if the leukemia has spread to other bones, organs or tissues in the body. These tests can also help doctors plan treatment by identifying the type of leukemia and how far it has spread.
People who have a type of leukemia that starts in the bone marrow and then moves to the bloodstream are more likely to develop a type that affects the spleen, liver or stomach. These kinds of leukemia are often harder to treat and tend to be more serious. Some people are at greater risk of developing leukemia because of their age or family history, being exposed to certain chemicals, smoking or having a previous cancer.
Treatment
During treatment, you may have many tests and procedures to find the best medicine for you. These can include a bone marrow biopsy and a central venous catheter placement for blood transfusions and chemotherapy. You also may need a chest X-ray, a blood count and an EKG to see if you have heart problems. These tests help doctors know how well treatment is working.
The main treatment for leukemia is chemotherapy. It is used with other therapies such as radiation and immunotherapy to help increase the chances of a cure. It is important to talk with your doctor about the different treatment options, including what they will mean for you, the expected outcomes and possible side effects.
Most people with leukemia get a combination of drugs called induction therapy. This treatment destroys your leukemia cells and the normal bone marrow cells that make new blood cells. It takes about a week for the bone marrow to recover from induction therapy, and the blood counts can be very low during this time.
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A few days after induction therapy, doctors check your blood levels and do another bone marrow biopsy to see if the leukemia cells are gone. You will have to stay in the hospital while these tests are done. If the biopsy shows few or no leukemia cells, you are in remission. A few weeks after that, the doctor may give you more chemo to kill any remaining leukemia cells. This is called post-remission therapy or consolidation therapy. It may be the same chemo you had during induction or a different one.
If your leukemia has certain genetic changes, you might be given a targeted drug such as gemtuzumab ozogamicin (Mylotarg). These medicines target a protein on the surface of the cancer cells. They can decrease the chance that your leukemia will come back or spread to the brain and spinal cord (central nervous system CNS).
You might be able to get an autologous stem cell transplant, which uses healthy bone marrow cells to replace the ones damaged by chemo. This type of treatment might be an option if a close family member is a match or if you’re young enough for a bone marrow transplant to be beneficial.
Symptoms
Leukemia occurs when the bone marrow (the spongy tissue inside bones) makes too many abnormal white blood cells. These cancerous cells don’t die at a normal time, and they interfere with the production of healthy blood cells. The result is an overabundance of abnormal white blood cells and fewer healthy red blood cells and platelets. This results in a shortage of cells needed to fight infections, carry oxygen and help the body clot. The types of leukemia vary according to where the abnormal cells start, how fast they grow and how they crowd out and suppress the growth of normal blood and bone marrow cells.
Leukemia can be either acute or chronic. Acute leukemia progresses rapidly and needs to be treated right away. Chronic leukemia progresses more slowly and may not cause symptoms for months or even years. Acute leukemia includes lymphocytic leukemia and myelogenous leukemia.
Lymphocytic leukemia is most common in children and teens, while myelogenous leukemia most often affects adults over 65.
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There are many different signs and symptoms of leukemia. These depend on the type of leukemia you have and how it is responding to treatment. The first symptom is usually fever. Some people develop swollen glands, especially in the neck, underarm or groin, enlarged spleen and liver, or a feeling that their stomach is full (abdominal pain). Others experience bleeding problems, like nosebleeds, bleeding gums, frequent bruising, bleeding from the intestines or bladder, or blood in the urine or stools. Other symptoms include achy joints, a sore throat or mouth, difficulty breathing or swallowing, coughing and chills, and fatigue.
Signs and symptoms of leukemia can also look like other conditions, such as the flu or a viral infection. Because of this, it is important to talk with your doctor if you have any concerns.
There are things you can do to lower your risk of getting leukemia. Talk to your healthcare provider about whether a family history of certain types of leukemia might increase your risk. You can also ask about genetic testing for leukemia risk. This isn’t always available, but it can be helpful for some people.
Prevention
Scientists don’t know exactly what causes most types of leukemia. It seems to develop from a combination of genetic and environmental factors. Some people are at a higher risk of developing the disease than others. They may have a family history of the illness or a genetic condition that makes them more likely to get it. They also might have had other cancer treatments in the past that raise their chance of getting leukemia. Exposure to certain chemicals, such as benzene, formaldehyde and tobacco smoke, can raise the risk too.
The four main types of leukemia are acute myelogenous leukemia (AML), chronic lymphocytic leukemia (CLL), acute leukemia and juvenile leukemia. Each type affects different blood cells. These include white blood cells that fight infection, red blood cells that carry oxygen and platelets that help the blood clot. They also affect other blood cells that help the body function normally.
AML starts when abnormal white blood cells develop in the bone marrow and overcrowd healthy blood cells. These mutated cells do not die at the usual time, and they continue to grow and multiply. They also don’t develop into mature cells as they should. The new cancerous cells crowd out other blood cells that need to grow and mature. They may prevent blood cells from making enough oxygen to supply the body’s tissues, or they may block the way that blood carries nutrients and other vital substances throughout the body.
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Children with leukemia may have a fever, bruises and problems clotting blood. They may also have a swollen lymph node or spleen, and they may have difficulty breathing. People who have these symptoms should see their doctor immediately. They may need to have a complete blood count (CBC), which shows the number and kinds of cells in the blood. The test can find whether there are too many immature blood cells, too few healthy red and white blood cells or not enough platelets to clot the blood properly.
People who are at a higher risk of getting leukemia may need regular screenings to watch for signs and symptoms. They should tell their health care provider if they have a family history of the illness or other symptoms, such as bruising easily, a low appetite or feeling tired all the time. They should also talk to their health care provider if they have gotten any radiation treatments in the past.
