leukemia cancer Leukemia (cancer of the blood)

Leukemia (cancer of the blood)



 of blood) is a relatively rare disease compared to other types of cancer, such as breast cancer, prostate cancer or colon cancer. Current treatments allow to cure leukemia in most cases.

Leukemia is a carcinogenic disease of the blood-producing system. This pathology usually has the following symptoms:

    Fatigue
    Pallor
    Propensity to infections
    Propensity to hemorrhages

Leukemia is characterized by an excessive increase in white blood cells (leukocytes) in the bone marrow. These are, however, immature and dysfunctional. This situation disturbs the normal formation of blood and leads to a lack of mature and healthy leukocytes, red blood cells (erythrocytes) and platelets (thrombocytes). The doctor determines the diagnosis through a blood test, and to accurately classify the variant of leukemia present, it is usually necessary to extract a sample of bone marrow (biopsy of the bone marrow). There are four types of leukemia (blood cancer):

    Acute lymphoblastic leukemia (ALL): occurs mainly in children. ALL also appears in the brain and brain membranes and, therefore, neurological symptoms such as paralysis can occur. As a treatment, chemotherapy is appropriate in some cases combined with radiotherapy. 80% of all cases are usually resolved completely.
    Acute myeloid leukemia (AML): This type of leukemia arises from immature myeloid cells. Myeloid cells are stem cells of white blood cells. AML can also arise from degenerated red blood cells (erythrocytes). With the rapid growth of abnormal "cancerous" cells in the bone marrow, it interferes with the proliferation of normal red cells (erythrocytes). AML occurs mainly in adults.
    Chronic myelogenous leukemia (CML): granulocytes, a cellular sub-type of white blood cells, multiply enormously in CML. If the CML reaches the acute phase, the so-called blast crisis arises. Then many immature and non-functional white cells are released into the blood. As the degenerated cells also have tropism, affinity for the liver or spleen, these organs are often inflamed in the CML. A typical feature of CML is the so-called Philadelphia chromosome, a genetic change that manifests itself in more than 90% of patients with CML.
    Chronic lymphocytic leukemia (CLL): doctors include CLL among the so-called non-Hodgkin's lymphomas. It occurs mainly in elderly people. In the blood and bone marrow, the lymph nodes, the liver and the spleen accumulate the so-called B lymphocytes. Under normal conditions, the white blood cells produce antibodies and, therefore, play an important role in the immune system. In CLL, accumulated cancerous B lymphocytes do not work well. Therefore, the patient's immune system is weakened.

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Blood cancer is treated primarily through chemotherapy and bone marrow transplantation. After the treatment, it is important to carry out a periodic follow-up.
Definition

Leukemia (cancer of the blood) is a disease of the hematopoietic system or producer of blood cells, which multiplies a certain type of white blood cells (leukocytes) uncontrollably. Partially or totally, the immature white blood cells of the bone marrow flood the bloodstream and settle in the different organs of the so-called lymphatic system. The lymphatic system is part of the immune system, and is part of the so-called lymphoid organs, which include, for example, the lymph nodes, the spleen and the tonsils.

Diseased blood cells are not functional. Leukemia cells proliferate in the bone marrow and interfere with the production of stem cells that are responsible for the formation of all normal blood cells (red blood cells, white blood cells and platelets).




Blood cancer, according to its evolution, is divided into acute and chronic leukemias:

    Acute leukemia is characterized by the rapid development of the disease.
    Chronic leukemia has an insidious course. The patient takes months or years to develop serious symptoms

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Another classification is based on the degree of maturity (mature and immature cells) and the offspring of leukocytes multiplied excessively:

    Myeloid leukemia: degenerated leukocytes come from the bone marrow tissue, from which various blood cells develop, including the so-called granulocytes.
    Lymphocytic leukemia: leukemia cells arise from the malignant degeneration of another family of cells, called lymphocytes.

Classification

In leukemia (cancer of the blood) you can distinguish four ways:

    Acute lymphoblastic leukemia (ALL)
    Acute myeloid leukemia (AML)
    Chronic myeloid leukemia (CML)
    Chronic lymphatic leukemia (CLL)

Acute lymphoblastic leukemia (ALL)

Acute lymphoblastic leukemia (ALL, also called acute lymphoid or lymphatic leukemia) occurs mainly in children. In the course of the disease can infect other organs such as the brain or meninges. This form of blood cancer is mainly treated with chemotherapy. The drugs available for this treatment are cytostatic drugs. These medications are administered to the patient intravenously. However, cytostatics do not usually reach the brain and spinal cord in large quantities, where the malignant leukemic cells are. Therefore, affected children are given medications directly into the cerebrospinal fluid (CSF), which flows around the brain and spinal cord. Often, chemotherapy is complemented by a cranial irradiation.
Acute myeloid leukemia (AML)

Acute myeloid leukemia (AML) arises from the proliferation of immature myeloid cells, a certain subtype of white blood cells. AML can also occur in the form called erythroid leukemia, in which red blood cells (red blood cells or erythrocytes) degenerate. Normally, AML manifests only in adults.
Chronic myeloid leukemia (CML)

In chronic myeloid leukemia (CML), granulocytes, a specific form of leukocytes, multiply excessively.

In contrast to the acute forms of cancer in the blood, these cells, however, are primarily dysfunctional, they are immature cells.

Only when the myeloid leukemia becomes acute after years immature leukocytes massively reach the blood (crisis). The doctors call this moment blast crisis. In CML, leukemia cells are found in the bone marrow and blood but also in multiple organs. In the LMC, the liver and spleen are usually affected.

For the diagnosis of this type of leukemia it is important to determine the presence of the Philadelphia chromosome, which is present in more than 90% of patients with CML. The Philadelphia chromosome is located on chromosome 22 of the human genetic material, which lacks a gene on the contrary that in healthy people. The relationship between the Philadelphia chromosome and the LMC was discovered in 1960 in research institutions in Philadelphia (United States) and, therefore, bears the name of the city. CML usually occurs between the ages of 50 and 60 years.
Chronic lymphocytic leukemia (CLL)

Chronic lymphocytic leukemia (CLL) belongs to the so-called non-Hodgkin lymphomas and appears mostly at advanced ages.

In CLL certain leukocytes, mainly non-functional, B lymphocytes (B cells) increase in the blood, bone marrow, lymph nodes, liver and spleen.



The intact B cells are important cells of the immune system and are responsible for the formation of antibodies. They are found in the blood and lymphatic organs.

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When the uncontrolled growth of this type of malignant cells increases, the lymph nodes, the liver and the spleen also increase. Skin problems such as pruritus, eczema, herpes zoster (shingles) and skin haemorrhages are typical.

In CLL 97% of the cells are sick and can no longer perform the function of forming antibodies correctly. The result is the disease called antibody deficiency syndrome. This means that the patient's immune system is altered and bacterial infections are increasingly frequent.
Incidence

The Spanish registry of Leukemia (REL) figures the incidence of this disease in our country in 12 men and 8.6 women per 100,000 inhabitants / year. On average, leukemia patients are 68 years old in women and 69 years old in men. Although there are chronic forms of leukemia in adults, acute lymphoblastic leukemia (ALL) is mainly formed in children and young people. ALL is the most common cancer in children, and about 80% of all cases in children are curable.
Causes

The causes of leukemia (cancer of the blood) are not completely clear and defined. However, there are proven risk factors. These are the following:

    Radioactive radiation and X-rays
    Chemical products such as solvents (benzene, for example) or pesticides
    Certain medications (for example, cytostatic agents that suppress the immune system)
    Defects in the immune system

Among the leukemias associated with genetic causes we find chronic myeloid leukemia, related to the Philadelphia chromosome, located on chromosome 22 of the human genome, which is frequently found in patients with chronic myeloid leukemia (CLL), defined as chromosome 22 of the human genome. , which is altered and defective.

In addition, smoking is considered as an additional risk factor. Nicotine is also a risk factor in special viral infections, the human T cell leukemia virus, can alter decades later and cause the rare human T cell leukemia.
symptom

Each case is particular but, normally, leukemia (cancer of the blood) usually has the following symptoms:

    Fatigue
    Decay
    Fever
    Night sweats
    Weightloss
    Loss of appetite
    Propensity to infections

Leukemia originates in the marrow because that is where the production of normal blood cells (red blood cells, white blood cells and platelets) is generated. The disease decreases the number of these vital cells. This situation causes anemia, fatigue, paleness, dizziness and difficulty breathing due to the lack of red blood cells (erythrocytes). The susceptibility to infections, especially with bacteria and fungi, is due to the lack of activity of white blood cells (leukocytes). Due to the lack of platelets (thrombocytes), the blood coagulation is reduced and there is a greater tendency to hemorrhages in patients with leukemia. Common signs are nosebleeds, bleeding spots on the skin and bruising after harmless injuries.

The physical examination involves the palpation of the lymph nodes, the spleen and liver, which can increase in size in the case of leukemia. If meningitis develops in the course of blood cancer, neurological symptoms such as headache or paralysis develop.


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In acute leukemia, symptoms develop rapidly. A chronic leukemia, however, evolves hidden without typical signs and often is not discovered for a long time.
Diagnosis

In leukemia (cancer of the blood) the diagnosis is made through a blood test. This blood test includes the so-called differential blood count, which examines the different components of the cell, among others, under the microscope and counts the different blood cells. In the differential blood count can be determined the components of the different cells that are visualized under the microscope red blood cells, white and platelets. If the number of red, white and platelet cells is normal, it is very unlikely that the patient will suffer.

The analytical alterations and the symptoms described by the patient direct the suspicion of leukemia. Confirmation of the diagnosis is achieved with a bone marrow biopsy. This test involves taking a sample of bone marrow from the hip bone or sternum under local anesthesia. In leukemia, many immature blood cells are found in the sample. Through the use of imaging techniques, such as x-rays, computerized tomography (CT) or ultrasound, the doctor can track the lymph nodes invaded by cancer.
Treatment

In a leukemia (cancer of the blood), treatment depends, above all, on the form of leukemia suffered by the patient.
Chemotherapy

Chemotherapy is the treatment of choice in most cases of leukemia (cancer of the blood). The drugs that are used are called cytostatic drugs. Cytotoxins inhibit the growth and proliferation of cancer cells. The cytostatics mainly attack the cells that divide since the cancer cells divide quickly in an uncontrolled way, the cytostatics act on them. However, in the body there are also healthy cells that divide rapidly (for example, mucous cells). Chemotherapy, therefore, can temporarily affect other organs or healthy tissues of the body.

In general, cytotoxic agents are administered in a single dose or in combination. Chemotherapy is carried out at regular intervals (cycles). During the treatment, the doctor regularly performs a blood test.

Chemotherapy temporarily damages the bone marrow, damaging the formation of new blood cells and cells of the immune system. As a result, anemia and immunosuppression ensue, which increases the risk of hemorrhage and infection.

Other side effects of chemotherapy may be the following:

    Sickness
    Vomiting
    General discomfort
    Mucosal inflammation (mucositis)
    Hair loss

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Cytostatic drugs may increase the risk of cancer (carcinogens). Physicians must first weigh the usefulness and risks of a treatment. In leukemia, chemotherapy is often the only possibility to fight against the disease.

The intensity, form and degree of chemotherapy depend, among other things, on the type of leukemia that the patient suffers from.
Radiotherapy

Side effects of radiation therapy may include the following symptoms:

Radiotherapy, along with chemotherapy, may be useful in the treatment of certain leukemias. Thus, irradiating specific regions of the body, such as the skull, can prevent certain malignant cells from passing into the central nervous system in certain leukemias. X-rays at certain doses damage both healthy and diseased cells. Healthy cells can recover at a faster rate because they have better repair mechanisms. The tumor cells are more sensitive and die.


Side effects of radiation therapy may include the following symptoms:

    Fatigue
    Sickness
    Vomiting
    Diarrhea
    Headache
    Irritation of the skin and mucous membranes

Bone marrow transplant

A bone marrow transplant or stem cell transplant offers great potential for cure in leukemia.

Autologous stem cell transplantation

In the transplant of autologous stem cells, the doctor obtains bone marrow from the patient through the puncture of the hip bone (iliac crest). This has a high content of stem cells, cells that have not yet differentiated into a particular cell line (red blood cells, white blood cells or platelets).

Bone marrow stem cells are the precursor of all blood cells (red blood cells, white blood cells and platelets). In order to perform the transplant, it is necessary to completely destroy the diseased bone marrow, which forms the blood of patients with intensive prior chemotherapy treatment. The object of this therapy is to kill all tumor cells with drugs (cytostatic) and then healthy cells (transplant) are introduced into the body with the ability to form new, non-tumorous blood. The patient receives the healthy stem cells by means of a transfusion. The new stem cells thus reach the blood and find their way to the bone marrow by themselves.

Allogeneic stem cell transplantation

In allogeneic stem cell transplantation, the donor and recipient are not identical. The donated cells should, however, be as similar as possible and show many characteristics on cell surfaces. The best chance of finding donor cells with identical characteristics is found among relatives.

First, it is necessary to destroy the bone marrow that forms the blood of patients with leukemia by high doses of chemotherapy. Then the healthy donor stem cells are transferred by transfusion, which are established in the patient's bone marrow. To prevent the immune system from rejecting the donor's cells, the patient also receives drugs that suppress his immune system (called immunosuppressants).

A stem cell transplant also has risks. In the phase in which the bone marrow is destroyed, the patient has no defenses in the body. Therefore, he is threatened with infection with harmless germs and should receive medications such as antibiotics during this period, in order to prevent serious infections.

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In some types of leukemia (blood cancer), new therapeutic lines are beginning to be used, thanks to advances in clinical trials, including interferon alfa.

Imatinib is mainly used with good results in the CML.

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In chronic lymphocytic leukemia (CLL), chemotherapy is supplemented with medications such as Rituximab and Aalemtuzumab.

Both are artificial antibodies, which recognize the small structures that specifically have white blood cells on their cell surface "receptors" and destroy them.
Evolution

Acute leukemias develop rapidly and are accompanied by severe symptoms, while chronic forms develop slowly and gradually.

  

Complications

Because leukemia severely weakens the immune system, complications can arise from the high risk of infections that patients have. Patients with leukemia are very susceptible to infections. This occurs in all forms of leukemia.

In chronic lymphocytic leukemia (CLL) B cells (B lymphocytes) that form the important antibodies for immunity are damaged. The risk of infection increases, because the B lymphocytes are no longer functional. The risk of blood clots (thrombosis) also increases, since from the beginning of the CLL the number of platelets increases (thrombocytes). When platelets end their normal life cycle, the risk of bleeding increases.
Forecast

The prognosis of the leukemia and the chances of recovery depend on the form of the cancer of the blood and the effectiveness of the treatment.

Acute lymphoblastic leukemia (ALL), which is common in children, has a good chance of cure.

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In 80% of cases, children are cured after treatment.
Stage after treatment

After completing treatment, long-term follow-up of blood cancer is very important. It is particularly important to examine the blood on a regular basis by means of blood count and leukocyte formula or differential count. The subsequent treatment stage is aimed at recognizing and treating a recurrence of the leukemia and the possible damages derived from it.
Prevention

So far there is no known measure that can prevent leukemia (cancer of the blood). In addition, there is no possibility of early detection. However, in order to minimize the risk of cancer, care must be taken with chemical contaminants, in particular, benzene and benzene-containing substances. It is advisable to have a good quality of life, taking care of the diet, exercising and avoiding tobacco and alcohol. Ionizing radiation (for example, X-rays) is a risk factor.

In case of prolonged symptoms such as weakness, malaise, fatigue and fever, always consult a doctor to clarify the possible causes. Even if the likelihood of a leukemia is low compared to other diseases, the earlier a disease is detected, the greater the chance of cure.