Leukemia is a cancer of the blood cells. Get the statistics on survival rates, find out the most common symptoms, diagnostic options, and treatments.
What is leukemia?
Leukemia is a cancer that starts in Blood Stem Cells. Stem cells are basic cells that develop into different types of cells that have different jobs.
Blood stem cells develop into either lymphoid stem cells or myeloid stem cells.
Lymphoid stem cells develop into lymphocytes, a type of white blood cell. Lymphocytes help fight infection and destroy abnormal cells. The 3 types of lymphocytes are B cells, T cells and natural killer (NK) cells.
Myeloid stem cells develop into red blood cells, granulocytes, monocytes or platelets. Red blood cells carry oxygen to all tissues of the body. Granulocytes and monocytes are types of white blood cells that destroy bacteria and help fight infection. Platelets form clots in damaged blood vessels to stop bleeding.
As the stem cells of the blood develop, they become blast cells (blasts), which are immature blood cells. In leukemia, there is an overproduction of blast cells. These blast cells develop abnormally and don’t develop into mature blood cells. Over time, the blast cells crowd out normal blood cells so that they can’t do their jobs. When leukemia is diagnosed, these blast cells may be called leukemia cells.
There are many different types of leukemia. They are grouped based on the type of blood stem cell they developed from. Lymphocytic leukemias (also known as lymphoblastic leukemias) develop from abnormal lymphoid stem cells. Myelogenous leukemias develop from abnormal myeloid stem cells.
The types of leukemia are further grouped based on how quickly the leukemia develops and grows. Acute leukemias start suddenly, developing within days or weeks. Chronic leukemias develop slowly over months or years.
The 4 main types of leukemia are:
- Acute lymphocytic leukemia (ALL)
- Acute myelogenous leukemia (AML)
- Chronic lymphocytic leukemia (CLL)
- Chronic myelogenous leukemia (CML).
In adults, CLL and AML are the most common leukemias. There are many different subtypes of leukemia.
Risk factors for leukemia
A risk factor is something that increases the risk of developing cancer. It could be a behaviour, substance or condition. Most cancers are the result of many risk factors. But sometimes leukemia develops in people who don’t have any of the risk factors described below.
Men are more likely than women to develop leukemia. The risk for developing most types of leukemia increases with age.
Different types of leukemia have different risk factors. One risk factor may not increase the risk for all types of leukemia. Not all risk factors for the different types of leukemia are listed below.
Risk factors are generally listed in order from most to least important. But in most cases, it is impossible to rank them with absolute certainty.
Risk factors
- Radiation
- Radiation therapy and chemotherapy
- Smoking
- Benzene
- Formaldehyde
- Family cancer syndromes
There is convincing evidence that the following factors increase your risk for leukemia.
- High levels of Radiation: Coming into contact with high levels of radiation – for example, radiation from nuclear reactor accidents – is a risk factor for leukemia.
- Previous Radiation Therapy and Chemotherapy: Radiation therapy given in the past to treat cancer or other health conditions increases the risk of leukemia. Chemotherapy given in the past to treat cancer also increases the risk. Having had both radiation therapy and chemotherapy to treat cancer increases the risk more than having had the individual treatments alone.
- Smoking: Smoking tobacco increases the risk of some types of leukemia, and it may increase the risk for other types.
- Breathing in benzene: Benzene is found in unleaded gasoline and is used by the chemical industry. People may breathe in benzene at work or in the general environment or by using certain products. Benzene increases the risk of leukemia.
- Breathing in formaldehyde: Some studies have shown that breathing in formaldehyde increases the risk of leukemia. Factory workers, chemical workers, embalmers and other people may come into contact with formaldehyde at work. Embalmers are at a higher risk of leukemia because they tend to have contact for a longer time and use more formaldehyde in their work.
- Family cancer syndromes: Some conditions are linked to an increased risk of cancer, including leukemia, because of an inherited gene mutation (a change in the gene). These conditions are called family cancer syndromes or inherited (hereditary) cancer syndromes. Most family cancer syndromes are rare. Family cancer syndromes can lead to leukemia in both children and adults.
- Possible risk factors: Overweight and obesity are possible risk factors for leukemia. This means that they have been linked with leukemia, but there is not enough evidence to show for sure that they are risk factors.
Symptoms of leukemia
The signs or symptoms of leukemia may vary depending on whether you have an acute or chronic type of leukemia.
- Acute leukemia may cause signs and symptoms that are similar to the flu. They come on suddenly within days or weeks.
- Chronic leukemia often causes only a few symptoms or none at all. Signs and symptoms usually develop gradually. People with a chronic leukemia often complain that they just do not feel well. The disease is often found during a routine blood test.
Other health conditions can cause the same symptoms as leukemia.
See your doctor if you have:
- Fatigue
- A general feeling of discomfort or illness (called malaise)
- Loss of appetite
- Weight loss
- Fever
- Shortness of breath
- Paleness
- Rapid heartbeat (called palpitations)
- Weakness
- Dizziness
- Easy bruising
- Frequent or severe nose bleeds
- Bleeding gums
- Bleeding in the middle of a menstrual cycle or heavy menstrual flow
- Tiny, flat, red spots caused by bleeding just under the surface of the skin (called petechiae)
- Frequent infections in the lungs, urinary tract or gums or around the anus
- Frequent cold sores
- Vomiting
- Headache
- Sore throat
- Night sweats
- Bone or joint pain
- Enlarged lymph nodes in the neck, underarm, groin or above the collarbone
- Abdominal discomfort or feeling of fullness
- Vision problems
- Sores in the eyes
- Swelling of the testicles
- Chloroma – a collection of leukemia cells, or blasts, under the skin or in other parts of the body
- Leukemia cutis – appears as sores or as patches of any size that are usually pink or tan in colour
- Leukocytoclastic vasculitis – a condition that looks like an allergic reaction on the skin and usually causes sores on the hands and feet
- Sweet’s syndrome, or acute febrile neutrophilic dermatosis – causes fever and painful sores that may appear anywhere on the body
Diagnosis of leukemia
Diagnosing leukemia usually begins with a visit to your family doctor or when a routine test suggests a problem with the blood. Your doctor will ask you about any symptoms you have and may do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for leukemia or other health problems.
The process of diagnosis may seem long and frustrating. It’s normal to worry, but try to remember that other health conditions can cause similar symptoms as leukemia. It’s important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of leukemia.
When symptoms are severe, acute leukemia diagnosis may proceed rapidly, with the person admitted to hospital to quickly start treatments.
The following tests are commonly used to rule out or diagnose leukemia. Many of the same tests used to diagnose cancer are used to find out the stage, which is how far the cancer has progressed. Your doctor may also order other tests to check your general health and to help plan your treatment.
Health history and physical exam
Your health history is a record of your symptoms, risk factors and all the medical events and problems you have had in the past. In taking a health history, your doctor will ask questions about a personal history of:
- Symptoms that suggest leukemia
- Exposure to high doses of radiation
- Genetic syndromes, such as Down syndrome, Fanconi anemia, ataxia-telangiectasia or Bloom syndrome
- Exposure to benzene
- Previous chemotherapy or radiation therapy
- Blood disorders
- Viral infections
Your doctor may also ask about a family history of leukemia.
A physical exam allows your doctor to look for any signs of leukemia. During a physical exam, your doctor may:
- Check your vital signs to see if you have a fever, shortness of breath and rapid heartbeat
- Check your skin for bruising and paleness
- Feel areas of the neck, underarm (axillary) and groin (inguinal) for any swollen, or enlarged, lymph nodes
- Check your mouth for infection, bleeding or swollen gums
- Feel your abdomen for enlarged organs
- Examine your skeleton for tenderness or pain
Complete blood count (CBC)
A CBC measures the number and quality of white blood cells, red blood cells and platelets. Leukemia and other conditions can cause abnormal blood cell counts.
Immature blood cells (called leukemia cells, or blasts) are not normally seen in the blood, so doctors will suspect leukemia if there are blasts or blood cells do not look normal.
Blood chemistry tests
Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are functioning and can help find abnormalities. They help doctors find problems with the liver or kidney that are caused by the spread of leukemia cells. They can also help doctors stage leukemia.
Levels of the following chemicals may be higher than normal with leukemia:
- Blood urea nitrogen (BUN)
- Creatinine
- Phosphate
- Lactate dehydrogenase (LDH)
- Alanine aminotransferase (ALT)
- Aspartate aminotransferase (AST)
- Uric acid
Bleeding and clotting factors
Tests measure blood clotting factors to see how well the body can clot blood. Abnormal levels of blood clotting factors may occur with leukemia. They are measured using the following tests:
- Fibrinogen level
- Prothrombin time (PT)
- Partial thromboplastin time (PTT)
- International normalized ratio (INR)
Cytochemistry
Cytochemistry uses stains, or dyes, to identify tissue structures and components in blood or bone marrow cells. Certain stains are attracted to certain substances found in some types of leukemia cells, or blasts. The staining results can be seen under a microscope. Cytochemistry helps doctors determine the type of cells that are present.
Immunophenotyping
Immunophenotyping is the study of proteins expressed by cells. It is used to determine the type or subtype of leukemia.
Immunophenotyping uses a very specific antigen-antibody reaction to identify proteins in tissues or cells. It uses monoclonal antibodies marked with a fluorescent label or specific enzyme label that binds only to specific antigens (proteins). The fluorescent or enzyme label allows doctors to see the leukemia cells (also called blasts).
Immunohistochemistry and flow cytometry are the 2 most common methods used in immunophenotyping for leukemia.
Immunohistochemistry
Immunohistochemistry uses a microscope to view the immunoperoxidase labels. It also allows doctors to look at cells and what is around them.
Flow cytometry
Flow cytometry is a technique used to sort and classify cells using fluorescent labels on their surface. The cells are exposed to a laser, which makes them give off a light. The light is measured and analyzed by a computer. Flow cytometry allows doctors to view many antibodies at the same time and collect data rapidly from thousands of cells in a single sample.
Flow cytometry helps to define unique features of leukemia cells, or blasts. These features can help doctors form a prognosis and measure response to treatment using minimal residual disease (MRD). MRD means that there are blasts in the bone marrow that can’t be found using standard lab tests (such as microscopy), but are found using more sensitive tests (such as flow cytometry or polymerase chain reaction).
During a bone marrow aspiration and biopsy, cells are removed from the bone marrow so they can be tested in a lab. The report from the lab will confirm whether or not there are leukemia cells in the sample and, if so, the type of leukemia.
Lumbar puncture
A lumbar puncture, or spinal tap, removes a small amount of cerebrospinal fluid (CSF) from the space around the spine to look at it under a microscope. CSF is the fluid that surrounds the brain and spinal cord.
A lumbar puncture is done to see if cancer has spread to the spinal fluid.
Lymph node biopsy
A lymph node biopsy is a type of surgical biopsy. It is called an excisional biopsy because the lymph node is completely removed. Sometimes the lymph node cannot be completely removed; instead a portion of the lymph node is removed as a core biopsy. Doctors (pathologists) then look at the lymph node under a microscope to find out if there are cancer cells in it, identify the type of cancer and find out how quickly the cancer cells are growing.
Chest x-ray
An x-ray uses small doses of radiation to make an image of the body’s structures on film. It is used to look for:
- Enlarged lymph nodes in the centre of the chest (called mediastinal lymph nodes)
- Enlarged thymus gland
- Buildup of fluid between the lungs and the walls of the chest (called pleural effusion)
- Lung infection (called pneumonia)
CT scan
A computed tomography (CT) scan uses special x-ray equipment to make 3-D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.
A CT scan may be used to look at the spleen and liver to see if they are larger than normal, or enlarged. It can also be used to check if lymph nodes around the heart, near the trachea (windpipe) or in the back of the abdomen are enlarged.
MRI
Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3-D pictures.
MRI is most often used when doctors think that the leukemia has spread to the brain.
Ultrasound
Ultrasound uses high-frequency sound waves to make images of structures in the body. It is used to see if internal organs, such as the kidneys, liver or spleen, have been affected by leukemia.
Treatments for leukemia
If you have leukemia, your healthcare team will create a treatment plan just for you. It will be based on your needs and may include a combination of different treatments. When deciding which treatments to offer for leukemia, your healthcare team will consider:
- The type of leukemia
- Your age
- Chromosomal (genetic) abnormalities
- Your overall health
The following are treatment options for leukemia:
Chemotherapy is the main treatment for many kinds of leukemia.
Stem cell transplant may be an option for some people younger than 55 years of age.
Radiation therapy is most often used to prevent leukemia from spreading to, or treat leukemia that has spread to, the central nervous system (CNS). It is also used to prepare the bone marrow for stem cell transplant.
Targeted therapy is offered for some types of leukemia.
Watchful waiting is a treatment option for some people with chronic lymphocytic leukemia (CLL).
Supportive therapy is given to manage the expected complications of the leukemia and its treatments.
Follow-up care
Follow-up after treatment is an important part of cancer care. You will need to have regular follow-up visits. These visits allow your healthcare team to monitor your progress and recovery from treatment.
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