Leukemia

Your Questions, Answered

Leukemia is a diagnosis that nearly everyone has heard of before. However, it’s not necessarily a widely understood diagnosis. There are many different types, and in some cases, it doesn’t manifest itself in obvious ways, making it more difficult to detect. Here, we aim to shed some light on leukemia by answering some of the most common questions about the disease. 

By Anna Hill

Leukemia is cancer of the blood and blood-forming tissues, which include bone marrow and the lymphatic system. Perhaps one of the biggest misconceptions about leukemia is that there’s only one universal type of it. “There are four kinds of leukemia, all with unique features, and therefore unique management techniques,” Hannah Tunks, a physician assistant with Erlanger Oncology and Hematology, explains. It can be broken down into two different types – acute and chronic – and each of those types can be further broken down into lymphocytic or myeloid. 

With acute leukemia, the abnormal blood cells are immature blood cells that cannot function normally and multiply rapidly, which can cause symptoms to appear more quickly. With chronic leukemia, which involves more mature cells, the cells fail to produce or replicate normally, but are much slower, and function normally for a longer period of time, which can lead to relatively symptomless cases that can go undiagnosed for quite some time – even years. 

While acute versus chronic indicates how the leukemia progresses, the other classifications indicate where. Lymphocytic leukemia affects the lymphoid cells, which form lymphatic tissue and make up your immune system. Myeloid leukemia affects the myeloid cells, which make up red and white blood cells as well as platelet-producing cells.

Who is at risk for leukemia?

Unlike some other cancers, such as lung cancer, leukemia doesn’t have many clear-cut risk factors. “One of the biggest risk factors for leukemia is that it can be caused by chemotherapy or radiation treatments for other cancers,” Dr. Will Donnellan, an oncologist and hematologist with Tennessee Oncology, explains. For some types, such as chronic myeloid leukemia (CML), there aren’t any identifiable risk factors. For others, being in a certain age group might present an elevated risk: Acute lymphocytic leukemia (ALL) is most often diagnosed in children, and people over the age of 65 are at an increased risk for acute myeloid leukemia (AML) and chronic lymphocytic leukemia (CLL). Some data suggests that exposure to certain chemicals or radiation might elevate risk of leukemia, and having several first-degree relatives who have had it might increase the risk as well. 

What kind of symptoms can it cause? 

As alluded to earlier, cases of chronic leukemia might not present any symptoms at all for a number of years. In fact, chronic leukemia is often only discovered during routine medical visits or a visit for a different medical issue, and it’s discovered in abnormal bloodwork results. Acute leukemia develops more rapidly, and some symptoms might occur. “Fatigue, weakness, easy bruising or bleeding, fevers and chills, and enlarged lymph nodes or abdominal pain might persist as a result of acute leukemia types,” says Tunks. These usually prompt someone to consult with their healthcare provider, which leads to the diagnosis. 

Is there any way to prevent leukemia?

According to Dr. Eric Turner, an oncologist with the Peeples Cancer Institute at Hamilton Medical Center, “Other than avoidance of potential environmental risk factors, there are not really any definitive or proven ways of preventing leukemia.” However, early detection can be beneficial. “It’s important to have a primary care provider that checks bloodwork periodically, and to have regular routine exams,” says Donnellan. “Maintaining a healthy lifestyle will be beneficial if you do end up being treated.” As leukemia can develop as a result of treatment for other cancers, simply caring for your health in general, such as avoiding smoking or secondhand smoke, can help. 

How is it diagnosed and treated?

Abnormal bloodwork results are usually the first indication that something is amiss. “This may prompt a physician to pursue further laboratory testing,” Tunks explains. “If white blood cells, hemoglobin, or platelets appear at abnormal levels, the patient will be referred to a hematologist.” Following this, a bone marrow biopsy is the standard test for a formal diagnosis. If the results of the biopsy show that the bone marrow cells are made up of more than a certain percentage of blast cells (immature myeloid or lymphoid cells), a diagnosis of leukemia is confirmed. 

Thankfully, all subtypes of leukemia are treatable, but treatment can vary widely, depending on which diagnosis someone receives. For chronic subtypes of leukemia, if blast cells stay below a certain count and are carefully monitored, no aggressive treatment may be necessary. However, if it advances, some oral medications are available as treatment, as well as chemotherapy or immunotherapy if needed. According to Donnellan, “acute leukemia requires more immediate and aggressive treatment: strong chemotherapy, which will often put a patient in the hospital for considerable amounts of time.”

What are the side effects or complications from treatment?

For acute subtypes, the common side effects of chemotherapy apply here, and they can include nausea, vomiting, diarrhea, hair loss or skin and nail changes, weight loss, and mouth sores, though there are medications that can be prescribed to treat these side effects. According to Turner, “Some of the long-term effects of treatment can include organ damage, bone loss due to steroid treatments, and abnormalities with joints.” Following chemotherapy, one of the biggest decisions if the cancer persists is whether or not the patient will undergo a stem cell transplant, which is a major procedure that comes with a host of its own complications. A stem cell transplant will take place at a transplant center and often involves a hospitalization of at least a month, with patients returning to normal activities after about one year. 

What does life look like after treatment?

After treatment, patients will go in for follow-up visits with their oncologist or hematologist for months and even years in order to monitor any lingering side effects from treatment as well as cell counts in case of relapse. “Patients will typically be followed very closely in-clinic with frequent blood work and repeat bone marrow biopsy testing designed to detect residual or recurrent leukemia,” explains Turner. Luckily, when it comes to chronic leukemia, patients will still undergo monitoring and check-ins, but most go on to lead long, full lives.

Leukemia can be a frightening word to hear. However, as there are many kinds of leukemia, there are also many ways to treat it, and early detection is important. Be sure to stick with your routine exams and doctor visits, as regular bloodwork can be a lifesaver. HS