Leukaemia

Leukaemia is a term used to describe a group of cancers that generally affect white blood cells and bone marrow.

Most blood cells are made in the bone marrow, which is the spongy centre of your bones. Some others are made in your spleen (in the abdomen), lymph nodes (small glands throughout the body) and thymus gland (in front of the heart).

White blood cells are an essential part of the immune system and help fight infection and disease. However, in people with leukaemia, the bone marrow produces abnormal white blood cells (called blasts) that cannot fight infection effectively. This increases the risk of getting sick. In addition, abnormal cells may not leave enough room in the bone marrow for the production of healthy blood cells. This often leads to symptoms of bruising and bleeding (from low platelet cells), infection (from low levels of healthy white blood cells) and lethargy, dizziness and breathlessness (from anaemia, or low red blood cell counts).

Leukaemia may develop over several months or years (chronic leukaemia) or suddenly over days or weeks (acute leukaemia).

There are four types of leukaemia:

• Acute myeloid leukaemia (AML) This type of cancer usually occurs in older adults and is rare in children. The average age of people first diagnosed with AML is 68¹. AML affects the myeloid blood cells found in the bone marrow, causing an overproduction of immature myeloid cells, called blasts. Increased blasts in the bone marrow can cause a reduction in healthy blood cell production due to overcrowding. These blasts can also cause increased blood viscosity (thickness) which can cause reduced blood flow to your organs, and symptoms of blurred vision, headache, and breathlessness
• Acute lymphocytic leukaemia (ALL) This type of leukaemia mainly affects children and is rare in adults. ALL is caused by an overproduction of abnormal lymphocytes (called lymphoblasts) which displace healthy blood cells in the bone marrow, and causes similar initial symptoms to AML
  
• Chronic myeloid leukaemia (CML) This cancer occurs only in adults. Like AML, it affects the myeloid cells in the bone marrow but develops more slowly. Patients often present to their doctors with raised white cell count, enlarged spleen and symptoms of lethargy and weight loss. CML is triggered by a specific mutation in chromosomes 9 and 22 in white blood cells, leading to the production of an abnormal intracellular protein called BCR-ABL1. This mutation can be targeted by highly effective tablets called tyrosine kinase inhibitors, which can induce rapid remission of symptoms.
• Chronic lymphocytic leukaemia (CLL) This is a generally slow-growing cancer of the lymphocytes which occurs in older adults. It commonly causes raised lymphocytes in the blood and bone marrow, which can slowly displace healthy blood cells in the bone marrow and cause a reduction in normal blood counts. The abnormal lymphocytes can also cause lymph node swelling and enlarged spleen. Unlike the acute leukaemias, it does not need to be treated unless it causes specific symptoms (including pressure or pain from enlarged lymph nodes or spleen, reduced healthy blood counts, and immune-mediated red blood cell destruction). In the absence of symptoms, patients are usually managed with watchful observation by their doctor

Leukaemia symptoms differ according to the type of leukaemia a person has and its stage. For example, the symptoms of acute leukaemia may come on suddenly, but those of chronic leukaemia may develop slowly over several months or even years.

• Symptoms might include:
• weakness and fatigue that doesn’t improve with rest
• sweating, particularly at night
• unexplained weight loss
• anaemia (low number of red blood cells) that causes breathlessness and tiredness
• bruising for no obvious reason
• bleeding easily, particularly from gums and nose
• swollen lymph glands (often noticeable in the armpits, neck, and groin)
• abdominal pain or discomfort due to an enlarged spleen
• red skin spots called petechiae that usually appear on arms, legs, stomach, and buttocks
• frequent infections and high temperatures

Having any of these symptoms doesn’t mean you have leukaemia, but you should see your doctor for a check-up.

It’s not known exactly what causes leukaemia. However, some factors appear to increase the risk of getting leukaemia. These include:

• a family history of leukaemia
• advanced age
• exposure to high levels of radiation from previous cancer treatment, but not from X-rays or CT scans
• smoking, as the benzene in cigarettes is thought to increase the risk of leukaemia
• exposure to benzene at work
• genetic disorders such as Down syndrome
• blood disorders

Your GP will probably refer you to a specialist if they are concerned about your symptoms and risk factors for leukaemia. Although your doctors will perform a complete physical examination, they may also order tests to help them make a diagnosis. These tests may include:

• Blood tests These can give doctors lots of information about your health, and they can also show whether your blood cells look abnormal under a microscope
• Bone marrow biopsy A small amount of bone marrow is extracted from the pelvic bone to examine under a microscope
• Lymph node biopsy A small amount of tissue is taken from a swollen lymph node for examination under a microscope
• Lumbar puncture Some fluid is removed with a needle from a space between the bones in the back for testing at a lab

If the tests show you have leukaemia, your doctor may ask you to have more tests, such as MRIs, ultrasounds or CT scans to establish if there is damage to your organs.

If you are found to have leukaemia, your doctor will explain what stage your cancer is and how far it has progressed. 

Treatment for leukaemia depends on several factors, including what type of leukaemia you have, whether it has spread to other parts of your body, your age and overall health. Your doctor (haematologist) will discuss treatment options with you. These may include:

• chemotherapy
• immunotherapy
• leukapheresis
• radiation therapy
• stem cell or bone marrow transplant
• targeted therapy

We understand that a cancer diagnosis can be emotional and life changing. It’s natural to feel disbelief, anxiety, sadness, anger and loneliness. At GenesisCare, we strive to strengthen your confidence, settle your emotions and create care experiences that give you the best possible outcomes.

Our care team will know your name and get to know who you are as a person. We don’t want you to feel alone when you’re at GenesisCare. Your nursing team and oncology team are here to support you before, during and after your cancer treatment. We are here to guide you to get you the support you need from experts such as psychologists, exercise physiologists, physiotherapists and dietitians.

Please contact your local GenesisCare centre for more details on the services available. View a list of our centres here.

Whether you experience side effects and how severe they are depends on the type and dose of treatment you are given and your reaction from one treatment cycle to the next. Most side effects are short term and can be managed. These may include:

• fatigue
• nausea or vomiting
• constipation or diarrhoea
• hair loss
• easily bruising or bleeding
• weight changes
• skin changes
• mood changes
• sores and pain around the mouth

These symptoms tend to improve gradually once treatment stops and the normal, healthy cells recover. Reach out to your doctor or nurse if you feel upset or anxious about how long treatment is taking or the impact of side effects.

• Get as much rest as possible
• Aim for a wholefood, varied diet, but we also encourage you to eat foods that interest you rather than what you think you should eat
• Appetite changes are common, and you may experience taste changes or nausea. Help manage this by eating small, frequent snacks and avoiding smells that make you nauseous
• Drink lots of water
• Reach out to support groups and others who have had chemotherapy
• Ask your team about topical treatments for your skin if you are getting irritation or pain
• Stay out of the sun as much as possible throughout your treatment
• Record your side effects in a diary or journal
• Take some gentle exercise, such as walking, if you feel up to it. Light to moderate exercise can reduce treatment-related fatigue and improve your mood. Plan your exercise for times in the day when you know you have more energy
• It is important to acknowledge when you are fatigued and rest when you need to
• Ask for and accept help from family, friends and neighbours
• Be open with employers about your treatment and discuss flexible working options if you need them

These may include:

• fever or chills
• bowel issues
• headaches
• nausea or vomiting
• weight loss
• itching or localised rashes

The leukapheresis procedure isn’t painful, but it can cause your calcium levels to drop. This can cause side effects including:

• numbness and tingling
• muscle spasms

General side effects include:

• soreness and swelling around the treatment area
• tiredness and lethargy for a few weeks after you finish

Specific side effects (depending on the area being treated):

• digestive issues – reduced appetite, pain, discomfort or bloating
• change in bowel habits
• nausea or vomiting.

Most of these side effects will ease soon after treatment is finished. Your team will discuss any long-term considerations with you depending on the tumour type.

Side effects from a bone marrow transplant can also include the side effects of chemotherapy or radiation therapy that may be performed before the transplant. These may include:

• nausea and vomiting
• bleeding
• infection
• lung issues
• weight loss
• fatigue

The side effects may vary depending on the type of targeted therapy you have and how your body reacts. These may include:

• diarrhoea
• fatigue
• high blood pressure
• dry skin
• liver problems