Five-year-old Tushar doesn’t know what it is like to play in the garden with boys his age. He hasn’t done so is the last 3 years for fear of infection. His only trips in the outside world are those when he visits the cancer hospital for his chemotherapy. His parents’ lives revolve around him, his appointments at the hospital. Even after all this, they aren’t sure if he’ll grow to be a healthy adult with his leukaemia.
White blood cells are like soldiers of our body. They fight infections and help maintain our immunity against disease. However, when there is uncontrolled and/or abnormal growth of these cells, it results in a type of cancer called leukaemia or commonly called ‘blood cancer’.
The so-called ‘acute’ leukaemias are aggressive cancers which affect children and older people over 65 years or age whereas ‘chronic’ leukaemias affect adults and take months or even years to develop.
Depending on the kind of cells that are affected, they are again classified into ‘myeloid’ and ‘lymphoblastic’.
Read more about causes, symptoms, diagnosis and treatment of blood cancer.
Thus, leukaemias are classified into Acute Lymphoblastic (ALL), Acute Myeloid (AML), Chronic Lymphoblastic (CLL) and Chronic Myeloid (CML).
Cancer is complex and involves many interactions that occur inside your body. Anything from your genes, diet, hormones, exposure to high levels of radiation or chemicals such as benzene, chemotherapy drugs (to treat another cancer), pre-existing blood disorders and smoking could act as risk factors. Children with chromosomal abnormalities (Down’s syndrome, Fanconi’s anaemia) have also been reported to be at a higher risk of developing leukaemia.
So, what happens in leukaemia? How can someone who is otherwise healthy develop such a deadly disease? To figure this out, we need to understand some basics.
Inside each of your bones, the various cells of blood are produced – red blood cells (which carry oxygen), white blood cells (which fight infection) and platelets (which stop bleeding). In a healthy human being, these cells grow to a certain size, live for a particular amount of time, perform their duty and die. In a person with what is called ‘acute leukaemia’, the young white blood cells do not mature properly but multiply in number very fast. Hence, there are a large number of immature white cells which cannot fight infections, like they are supposed to. In ‘chronic leukaemia’, even though the white blood cells mature, they are abnormal and are hence unable to fight infections. The abnormal white blood cells take over the bone marrow thus reducing its capacity to produce red blood cells and platelets. This leads to anaemia (due to reduced red blood cells) and bleeding (due to reduced platelets). The increased number of white blood cells also spill over into the blood stream and are carried to various other organs of the body ultimately resulting in reducing their function too.
Leukaemia usually does not present with any symptoms at first and may be found by chance during a blood test. Even if the symptoms appear, they may be indefinite and non-specific. Most of the symptoms are caused by the decreased healthy blood cells and show up slowly. But as the immature white blood cells increase in the blood the symptoms quickly get severe. Some of the symptoms are:
- repeated infections
- flu-like symptoms
- breathlessness and tiredness
- excessive sweating
- swollen lymph nodes (glands), swollen testicles in men
- weight loss
- bleeding gums or nose bleeds
- high temperature (fever)
- easily bruised skin
- swollen liver, spleen
- bone and joint pain
- headaches, dizziness, seizures (fits)
- vomiting
- blurred vision
A person may either visit a doctor after he notices any of the above symptoms or it may be diagnosed during routine blood tests. The doctor will perform a physical exam to check for any swollen lymph nodes, liver or spleen. Blood tests show abnormal type and number of white blood cells and reduced red blood cells and platelets. Lymph node biopsy in acute leukaemia establishes how far the leukaemia has spread. A lumbar puncture is performed to test a sample of cerebrospinal fluid (fluid that surrounds spine) to determine whether leukaemia has reached the nervous system. To find out if the leukaemia has spread to other parts of the body, various scans like CT, MRI or ultrasound may be done.
Once diagnosed, acute leukaemia cases need quick and aggressive treatment. Patients go into ‘remission’ or periods of no symptoms with treatment.
The chronic lymphocytic type may need treatment only when symptoms appear whereas the myeloid type may require treatment as soon as it is diagnosed.
The most effective method of treating leukaemia is chemotherapy. High percentage of remissions can be achieved in a patient with leukaemia through anti-cancer drugs, either used singly or in combinations of two or more drugs. Side effects such as nausea and vomiting, anaemia, decreased blood-clotting, diarrhoea, hair loss, susceptibility to infections, mouth sores, etc. may occur with varying degrees in different individuals. Side effects disappear when treatment is stopped.
In cases of acute leukaemia, since the blood will not have enough healthy blood cells regular blood transfusions may be needed. It is important to keep the patient in a sterile environment because he/she will be vulnerable to infection. Antibiotics may also be prescribed to prevent infections.
Radiotherapy is usually used in acute leukaemia to treat advanced cases that have spread to the nervous system and/or brain and to prepare the body for a bone marrow transplant. Nausea, fatigue, skin sensitivity and hair loss are some of the side effects of radiotherapy which pass once the course has been completed. Children treated with radiotherapy may have restricted physical growth during puberty.
If the leukaemia does not respond to chemotherapy, an alternative treatment option for some patients is bone marrow or stem cell transplants. An aggressive, high-dose chemotherapy and radiotherapy is given to destroy any cancerous cells in the body prior to the transplant.
Since all the treatment options for leukaemia are very aggressive, the immune system is weakened making the patient more vulnerable to developing an infection. Regular doses of antibiotics need to be taken to prevent infections. Low levels of platelets (clot-forming cells) cause easy and excessive bleeding and bruising. Chemotherapy and radiotherapy can cause temporary, and in some cases permanent, infertility.
Even after all the advances in treatment options for leukaemia, depending on the type of leukaemia, what stage it was first diagnosed, how well it responds to chemotherapy and overall health of the patient, prognosis and survival from leukaemia varies in each case.
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