Exploring the Frontiers of Blood Cancer: Leukemia
- Evergreen Chapter
- Aug 10, 2023
- 7 min read
Tanish Patel
What is Leukemia and How Prevalent is it?
Leukemia is an umbrella term for cancers of blood cells. There are many types of leukemia, which are grouped based on the type of blood cell that becomes cancerous and how rapidly the cancer develops or worsens. According to the National Cancer Institute, leukemia is most prevalent in adults over the age of 55 but is also the most common cancer in children under 15 years of age. According to the Cleveland Clinic, leukemia is also the 10th most common type of cancer in the United States and is responsible for an estimated 3.2% of new cancer cases.
A Few Types of Leukemia
Acute Lymphoblastic Leukemia (ALL)
ALL is a form of leukemia that causes bone marrow, a spongy substance found in the center of bones, to produce an excess amount of immature white blood cells known as lymphoblasts. These cells proceed to crowd out expelling healthy red and white blood cells and platelets, causing the body to have problems fighting infections and diseases as white blood cells help the body fight disease. ALL is a form of leukemia that progresses rapidly and severely, hence the term acute in the name. It spreads to the lymph nodes, liver, spine, spleen, brain, and testicles, eventually becoming fatal if left alone.
While most leukemias are prevalent in adults over 55 years of age, acute lymphoblastic leukemia is more commonly found in children under the age of 15. According to the Leukemia Research Foundation (LRF), over half the ALL cases are in children and teenagers below the age of 20, and like most leukemias, ALL is most prevalent before 15 years old and after 50. When diagnosed in children, ALL is usually curable, but in rarer cases, ALL is found in adults, it is more difficult to cure. In some cases, ALL in adults can be cured with proper treatments such as chemotherapy.
ALL is believed by researchers to be caused by genetic mutations that affect blood cell production. While the exact causes are still unknown, some speculations exist. Symptoms of the cancer include: easy bruising, excessive bleeding, pale skin, lumps (in the neck, underarm, groin, or stomach), shortness of breath, weakness/fatigue, petechiae, fever, and infections. According to the World Health Organization (WHO), lymphoblastic leukemia is classified into two groups: B-cell lymphoblastic leukemia and T-cell lymphoblastic leukemia. B-cell, the more common type, is when the cancer starts in immature blood cells and develops into B-cell lymphocytes. T-cell lymphoblastic leukemia also starts in immature blood cells but develops into T-cell lymphocytes. There are many ways to diagnose ALL, such as blood tests, imaging, and bone marrow biopsy and aspiration.Treatments include chemotherapy, stem cell transplant, immunotherapy, and radiation or targeted therapy.
Chronic Lymphocytic Leukemia (CLL)
CLL is similar to ALL in the sense that they both occur as bone marrow creates an excess of lymphoblasts or immature white blood cells. The lymphoblasts fail to develop, crowd out healthy red and white blood cells and platelets, and spread to regions such as the lymph nodes, liver, and spleen. Furthermore, CLL can lead to the development of diffuse large B-cell lymphoma, which is a form of lymphoma that grows rapidly but responds to treatment well.
Although CLL is similar to ALL in how it arises, it differs from its acute counterpart in the sense that it is more common among adults and in men, particularly white men, being most frequently diagnosed among patients between the ages of 65 and 74 (according to the LRF). Also unlike ALL, CLL is a type of lymphocytic leukemia that develops slowly, hence the term chronic in its name. According to the LRF, doctors recommend a “‘watch and wait’” approach also known as “watchful waiting or active monitoring,” as treating the cancer in its early stages is not beneficial. Treatment is usually not necessary unless symptoms are developed, as long as patients undergo regular tests and visits to a medical professional.
CLL is also caused by genetic mutations like ALL, in genes that dictate the development of bone marrow cells and can be diagnosed by things like gene testing, imaging, lymph node biopsy, blood tests, bone marrow biopsy, and more. Symptoms of CLL encompass enlargement in the lymph nodes in the groin, neck, stomach, or underarms, fatigue, infections, fever, weight loss, night sweats, and pain due to an enlarged spleen. CLL also has two different types. B-cell chronic lymphocytic leukemia impacts B-cells and is more common. T-cell prolymphocytic leukemia affects the T-cells and is rarer. Treatments for CLL, as mentioned earlier, should only be undergone when the cancer reaches its advanced stages when red blood cells and platelet counts are low and enlargement in the spleen, liver, or lymph nodes is present. Therapy includes things like chemotherapy, targeted therapy, stem cell transplant, clinical trials, and immunotherapy, among others.
Acute Myeloid Leukemia (AML)
When an individual has AML, their bone marrow creates abnormal white blood cells and crowds the bone marrow, taking up space in the marrow and leaving none for healthy blood cells. Myeloid cells, a type of white blood cell, develop into healthy blood cells in the bone marrow including white blood cells, red blood cells, and platelets. These aid in transporting oxygen, fighting infection, and clotting blood. Since the abnormal cells crowd out healthy blood cells, AML often results in easy bleeding, infections, and anemia due to a lack of red blood cells and reduced oxygen in the body.
AML is an acute form of leukemia, meaning that it spreads rapidly to organs such as the lymph nodes, brain, and spine. Also due to its acute and fatal nature, if AML is left untreated it can be life-threatening. Although being one of the most dangerous, AML is also one of the rarest of leukemias. It accounts for a minor 1% of all new cancer cases although about 50% of AML patients experience a relapse according to LRF. Like the types of leukemias discussed in this article, AML is suspected to be caused by genetic mutations and may possibly be inheritable as well. AML also occurs more often in men and older adults, and conditions such as blood disorders, chemotherapy drugs, smoking, and genetic disorders may increase the risk of developing AML.
AML is widely considered the most fatal leukemia, and its symptoms are bruising, infections, weakness/fatigue, weight loss, and excessive bleeding including bleeding from the nose and in the gums. Acute myeloid leukemia also has several different subtypes, such as myeloid sarcoma, AML with genetic abnormalities, AML related to previous chemotherapy or radiation, and more. Diagnosis for AML can happen through several mediums including blood tests, bone marrow aspiration/biopsy, and lumbar puncture, among others. AML can also be treated through things like stem cell or targeted therapy, clinical trials, or supportive therapies.
Chronic Myeloid Leukemia (CML)
Similar to AML, CML is a rarer form of leukemia, but unlike AML, it is a more slowly progressing cancer in the bone marrow. CML can also lead to anemia due to the scarcity of red blood cells and bleeding. However, due to advances in medicine and technology, CML is especially treatable. CML also impacts immature blood stem cells in the bone marrow which, instead of transforming into healthy blood cells and platelets, become abnormal CML white blood cells. These abnormal cells proceed to overpopulate normal blood cells and crowd out healthy cells. Like AML, this can lead to anemia, bleeding, and an increase in infections. If not treated, CML can progress into an advanced stage in which it is more difficult to treat, and the unusual cells spread to the bloodstream and other body parts. CML is also more prevalent in adults, responsible for about 15% of all leukemia in adults (according to LRF). Although not hereditary, CML is known to be caused by a rare genetic mutation known as the Philadelphia chromosome, which leads to the development of abnormal white blood cells and cancer.
CML’s symptoms comprise excessive bleeding, infection, weakness, fever, pain due to an enlarged spleen, unanticipated weight loss, and night sweats. Diagnoses of cancer can also be done through imaging, blood tests, genetic testing, and other methods. Treatments include therapies such as chemotherapy, targeted therapy, immunotherapy, bone marrow transplant, and more.
Mental Health Outcomes of Leukemia & Coping Methods
As with other cancers and disorders, when individuals are diagnosed with such conditions, they often experience immense emotional stress and anxiety, and may sometimes develop mental health disorders as well. The emotional burden of being diagnosed with blood cancer is nearly as significant as the cancer itself, as the physical symptoms are only a part of the effects of leukemia. Individuals with leukemia may be overwhelmed with anxiety, as they may feel helpless and without control of their future. In order to overcome these emotional obstacles, it is recommended that individuals with leukemia talk to close relatives or friends about their emotions or with a medical professional as information can help ease uncertainty and fear of the unknown. Discussing leukemia with other patients or their family members who have undergone similar experiences may also be beneficial.
Anxiety as a result of a leukemia diagnosis can also lead to feelings of depression and develop into more malicious conditions. Talking to counselors, doctors, nurses, or loved ones about mental and physical symptoms can aid in identifying coping strategies and other solutions. In some more severe cases, therapies such as drug therapies and antidepressant drugs can prove to be helpful. Feelings of fatigue and tiredness after treatments for leukemia may build on feelings of depression or anxiety as well, so maintaining a daily routine or daily/periodic goals for the future are good habits that can alleviate harmful emotions.
References
“Leukaemia: Causes, Symptoms & Treatments.” Cancer Council, www.cancer.org.au/cancer-information/types-of-cancer/leukaemia. Accessed 6 Aug. 2023.
“Leukemia - Leukemia Research Foundation.” Leukemia Research Foundation - A World without Leukemia, 23 Mar. 2023, leukemiarf.org/leukemia/?gad=1&gclid=Cj0KCQjwoK2mBhDzARIsADGbjepL7vUx6p6-EQUQ-NWY8jPCWtLbf9o98GGY92YOuf933pEGJZ1QsXYaAigjEALw_wcB.
“Leukemia-Patient Version.” National Cancer Institute, www.cancer.gov/types/leukemia#:~:text=Overview,in%20children%20younger%20than%2015. Accessed 6 Aug. 2023.
“Mental Health.” Leukaemia Foundation, 2 Mar. 2023, www.leukaemia.org.au/blood-cancer/journey/living-well-with-blood-cancer/emotional-health/mental-health/#:~:text=A%20diagnosis%20of%20a%20blood,trust%20or%20feel%20comfortable%20with.
professional, Cleveland Clinic Medical. “Leukemia: Symptoms, Signs, Causes, Types & Treatment.” Cleveland Clinic, my.clevelandclinic.org/health/diseases/4365-leukemia#:~:text=Leukemia%20is%20the%2010th%20most,Ages%2065%20to%2074. Accessed 6 Aug. 2023.
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