According to the Cancer Book from the American Cancer Society, Leukemia is acancer of the blood.
It was first identified as a new disease in around 1830 inGermany. The scientific term, “leukemia,” comes from the Greek wordsthat mean “white blood. ” The disease is described as a cancerousdisorder not just of the blood itself, but also of the organs that produce theblood cells in the body. The organs are mainly the bone marrow and the lymphsystem, where normal red and white cells, lymph cells, and platelets grow beforeentering the bloodstream.
Normal cells usually go through the same process butwith differences in rate, number, and function ability. With the disease, thebone marrow will not be able to produce the sufficient levels of red blood cellsand platelets, while the white blood cells will produce so rapidly that thecells will not become mature enough to fight off infections. As the diseaseprogresses, the whole blood system will become useless due to the vast amount ofimmature cells produced. If a person with the disease is not treated, there willbe excessive bleeding and infections until the body reaches the point where itbecomes defenseless.
The body will make minor injury or infection very serious. Leukemia itself does not always kill people. Instead, people die from infectionssuch as small virus or bacteria because there are not enough normal white bloodcells in the body. Also, people could die form internal bleeding, which couldhave been prevented by the platelets.
Leukemia appears more commonly in adultsthen children. A survey in 1989 stated that approximately 25,000 new cases ofthe disease are diagnosed annually in the United States, 22,500 of them areadults and only 2,500 are children. It also shows that men are affected byleukemia 30 percent more frequently than women. Ten years ago, about 17,000people die from the disease each year. Many of the advanced industrial nationshave increased the study of leukemia since the 1930s. In the Personal HealthReport, the information stated that there are two major types are leukemia:”Lymphocytic leukemia which involves lymphoid committed cells which formand mature in the lymphatic system, and granulocytic leukemia which affectsmyeloid committed cells which form and mature in the bone marrow” (355).
Each of the two types can occur in either acute or chronic form. Acute formusually affects young cells that are still in the process of growing; they candivide very quickly and may speed the progress of the disease. The chronic forminvolves the mature cells that reproduce in a low rate or the ones that havestopped dividing. According to the Home Medical Guide, acute lymphocyticleukemia is most commonly seen in children between the age of two and nine. Inthis type of leukemia, males are affected more frequently than females. Beforetreatment was available, the average survival rate is only 5 to 6 months.
Astreatment developed, more then 95 percent of all children are putted intocomplete remission. Both adult and childhood disease can be cured in around fouryears, and the therapy can be discontinued. Chronic lymphocytic leukemia is themost common form of cancer found in the industrialized countries. Like acutelymphocytic, it occurs more frequently in males then in females.
The patientsthat are affected by chronic lymphocytic leukemia are usually older then anyother patients with different types of leukemia. The cause of this specific typeof disease is still unknown: Strong evidence points to problems of function andcontrol in the immune system diagnosis is very often discovered by accident inthe course of routine blood testing for other medical reasons, since fully 25 to30 percent of newly diagnosed patients have no symptomsthe degree of bonemarrow infiltration by small lymphocytes is a much more accurate sign of degreeof disease. (452) According to the Home Medical Guide, acute granulocyticleukemia usually occur in older ages: “The typical patient is thirty tosixty years old, the frequency of the disease increasing with age. The naturalcourse of untreated this disease leads to an average survival of only two tofive months” (451). With chemotherapy, the survival rate can be lengthenedto about 5 years.
Around 75 percent of the patient can be cured with a completeremission. This type of leukemia can cause heart attacks and strokes by blockingthe arteries: “It is treated by removing large numbers of white cells fromthe patient’s blood and increasing the intensity of the chemotherapy”(453). Over 50 percent of the patients are found with abnormalities in the chromosomes:”Evidence strongly suggests that each patient’s individual chromosomalmakeup has a strong direct bearing on prognosis” (453). Patients that haveabnormal genes in their leukemia cells usually have the disease.
Chronicgranulocytic leukemia occurs in people with ages forty to sixty. The diseasestarts out very slowly. Patient will not notice anything wrong until after threeto six months. Many organs such as the liver, spleen and lymph nodes willenlarge in over half of the patients.
The study of chromosomes are important inthis type of leukemia: “The so-called Philadelphia chromosomes, the firstabnormal chromosome found in the leukemias, occurs in over 90 percent ofpatients” (454). Applying therapy may reduce of Philadelphia in the whiteblood cells. In the Cancer Book, the author explained that the basic cause ofleukemia is still unknown. Factors such as exposure to radiation, chemicals, andcertain drugs may cause the disease: “Certain chemicals, such as benzene,have long been known to cause damage to bone marrow calls which form the blood,and it is logical to conclude they can also cause a cancer in those cells”(378).
Also, the genes called oncogenes may be directly involved in thedevelopment of many types of cancers, including leukemia: Oncogenes arecancer-causing genes that are part of many people’s normal genetic makeup. Thesegenes can apparently be activated under circumstances that has not yetidentifiedby identifying and understanding specific oncogenes, people who areconsidered at risk can be identified long before a cancer begins. Although thisis a long way in the futurethe concept of the oncogene has given scientists anew and fundamental approach to the study of cancer that much believe will yieldfruitful result. (379) The book further explained the causes of leukemia, and itsays the hereditary causes of the disease are still far form being fullyunderstood. There are chances that close relatives of leukemia patients have arisk of getting the disease.
The greatest possibility is found in the identicaltwin of a child who has the acute leukemia before the age of eight:”Approximately 20 percent of these individuals will develop the diseasewithin one year of their twin’s diagnosis” (379). This shows that geneticsare playing an important role in the disease. But whether heredity is alsoinvolved in all cases is still an unanswered question. According to the PersonalHealth Report, leukemia may be caused by other types of disease that damage thebone marrow, or anticancer drug used to treat other variety of cancer:”Diseases that cause severe depression of the marrow, such as aplasticanemia, are associated with a high incidence of leukemia. ” (356) Patientsthat take anticancer drugs for treatment of diseases may have a chance ofgetting leukemia because the patients received cancer chemotherapy over a longperiod of time: “Up to 10 percent of patients with Hodgkin’s disease whohave been intensively treated with chemotherapeutic drugs may ultimately displaysigns of an acute granulocytic leukemia” (356). There is antileukemiatherapy for Hodgkin’s disease.
They are far more effective and outweigh thechance of developing leukemia later on. According to The Cambridge World Historyof Human Disease, the early symptoms of leukemia are like many other medicalproblems. Fever, loss of weight and fatigue are the general symptoms ofleukemia: Fever may be the most common symptom. It is usually caused by aninfection of the skin, lung, or urinary tract, but it also may be due directlyto the leukemia itself or to the release of compounds by the abnormal whitecells. Infections are frequently because the leukemic white cells cannot protectagainst invasion by bacteria or other organic causes of disease, and too fewnormal white cells remain to do so.
(846) The book also states that since thesesymptoms are involved with many illnesses, doctors do not always have suspicionof leukemia. Early detection of chronic lymphocytic leukemia is often found inelders that are being examined for other medical problems. On the other hand,acute leukemia can occur very suddenly, especially in children because it seemslike a flu or cold: “Common symptoms of the leukemias do not seem to be adirect result of the increase and spread of leukemia cells. Instead, thefunctioning of the remaining normal elements of the blood and bone marrow isimpaired” (847). Up to one third of the patient with cancer in blood havenormal or low circulation white blood counts. In leukemia, the bone marrow istoo crowded with white blood cells that it cannot move out into the bloodstream.
Bleeding problems are not serious in the early period of the disease, but theycan become serious as it progresses: “Bleeding is usually mild at first,with only small patches of black and blue discoloration under the skin. Later,the suppression of the platelet-forming cells in the bone marrow reduces thenumber of platelets produced” (848). Sometimes, patients may feel pain inthe joints and bones, but it is not a major effect. Also, other organs in thebody such as the liver, heart, kidney, brain and the digestive system willcontinue to function quite normal under the early stage of the disease. According to the Cancer Book, all the patients with leukemia must have a recordfrom all the physical examinations and laboratory investigations. The recordwill provide the physician a base line for treatment and to see if there are anyother kinds of medical problem.
Usually leukemia can be suspected by thephysician based on the patient’s history and other symptom: “The definitivediagnosis must be made by examination of the cells in the bone marrow”(382). Observation of blood samples can confirm the doctor with the suspect ofthe disease. Also, inserting a thin needle into the marrow-rich cavity, in thebackbone or the breastbone can do a bone marrow test. The test take about 15 to20 minutes and it can be performed in local clinics or doctor’s offices.
Thetest may seem frightened to many patients, but it only involves a littlediscomfort in the back of the body. The Cancer Book further states that ifleukemia is confirmed, different types of study will be performed: “Immunologictissue typing, blood typing, coagulation and transfusion studies will be done. This information is most valuable if acquired before transfusions have made itdifficult to test the properties of the patient’s own blood” (382). Bonetransplantation is dependent on the tissue typing.
Brothers and sisters of thesick patient are strongly suggested to tissue typing because they will have agreater chance of success in the bone marrow transplantation. In the CancerBook, the information shows that the first treatment for all types of leukemiais chemotherapy. The purpose of this treatment is to destroy the lurkemic cellsin the bone marrow. But at the same time, the normal cells are being destroyed. It is hoping that the destruction of the leukemic cells will let the bodydevelop the bone marrow with new and healthy cells. Patients will receivecombination of chemotherapeutic drugs.
It depends on the types of leukemia thepatients carry; a completed remission is possible in 50 to 90 percent ofpatients. The chemotherapy protocol is divided into three stages-induction,consolidation, and maintenance: “During the induction stage, the patientreceives intensive chemotherapy in an attempt to induce a complete remission. The largest number of leukemic cells are destroyed at this time” (384). When the first remission is completed, the consolidation stage will take place:”The purpose of this stage is to eliminate any remaining leukemic eliminateany remaining leukemic cells” (384). The consolidation stage primarily usesthe same drugs as in the induction stage.
Both of the stages last about 2 to 3months, depending on the patient’s response to the treatment. If the remissionis succeed, the patient will enter the maintenance stage: “It is designedto keep the patient in remission by preventing leukemic cells from returning tothe bone marrow” (384). This stage will provide treatment to the patientswhile they can maintain a near-normal life style. From the Mayo Clinic FamilyHealth Book, there is an article that talks about other treatments besidechemotherapy: “A bone marrow transplant is another treatment option forpatients with acute leukemia” (357).
The procedure is still underinvestigation, and it is only performed at selected medical centers. This methodis usually not being considered unless the chemotherapy is not effective. Beforethe transplantation, the patient will require to take ultrahigh doses ofradiation and chemotherapy to destroy all blood-forming cells. The success ratefor bone marrow transplants vary. The average survival rate is 10 to 15 percent.
In further discussion, it is found that problems can occur after injection ofthe donor marrow: “The recipient’s immune system can reject the marrowtransplant or the donor’s marrow, in its immunologically foreign environment,can reject the host” (358). For this reason, the closer the genetic makeupbetween the donor and host, the better the transplant will succeed. Somepatients will try to match themselves with a donor from their family or closedrelatives because it will give them a better chance of the transplant’s process. In the transplantation, the following steps will be done: “The donor’scells are injected into the recipient’s bloodstream to re-seed the marrow withhealthy cells.
The leukemia patient is kept in isolation to diminish the chanceof infection and is given transfusions and antibiotics as needed” (387). Inthe bone marrow transplantation, the donor’s cell is to develop into new healthycells in the sick patient’s body. According to the Cancer Book, great progresshas been make over the last thirty years in treating the disease. An increasingnumber of patients are cured.
Although the process of treatment is long andproduces painful illnesses, but rate of success in remission and other methodsare worthwhile for most patients.Health Care
