Leukemia (Mild and Chronic Lymphocytic and Myelogenous Leukemias)
Leukemia, a term used to describe several types of blood cancer, comes from the Greek words for "white blood". The name refers to the whitish or pale-pink blood leukemia patients have because of high numbers of abnormal white cells. Although leukemia affects all types of blood cells, as well as bone marrow and other blood-producing structures, the white cells, or lymphocytes, are involved the most.
The types of leukemia are broadly classified as follows:
Acute lymphocytic or lymphoblastic causes a rapid increase in abnormal lymph cells, or lymphocytes. It occurs most commonly in children.
Chronic lymphocytic entails a slow increase in abnormal lymphocytes and generally affects older people.
Acute myelogenous progresses rapidly and involves increased numbers of abnormal myelocytes, or granulocytes, the white cells that fight bacteria. It is rare in children and becomes increasingly common with advancing age-Chronic myelogenous progresses slowly at first and most frequently strikes middle-aged people.
Leukemia is further classified according to cell size, rate of proliferation, and such characteristics as the appearance and immunologic features of the proliferating cells. Acute leukemias are the most serious, they appear abruptly and worsen rapidly.
Common symptoms of leukemia include easy bruising and bleeding, fatigue, pallor, weakness, fever, shortness of breath, joint pain, and abdominal swelling and tenderness. Chronic leukemia may be present for years without producing noticeable symptoms. As the disease worsens, however, it may cause a low-grade fever, night sweats, loss of appetite and weight, and fatigue that comes on quite easily. Unless diagnosed and treated, the disease eventually enters an acute stage, producing more pronounced symptoms and a rapid decline.
Leukemia is the most prevalent childhood cancer, with about 2,500 new cases and 600 deaths a year. The incidence is even higher among adults, however, with some 26,000 new cases and 20,000 deaths a year. Radiation exposure greatly increases the risk of leukemia, as does contact with benzene and the use of anti-cancer and some other drugs. Several genetic disorders, including Down's syndrome, also seem to increase its risk.
Diagnostic Studies and Procedures
Abnormal cells, found in a microscopic examination of blood, raises the suspicion of leukemia, which is confirmed by a bone marrow biopsy. (This study entails removing a sample of bone marrow with a hollow needle inserted into the breastbone or hip.) The specific type of leukemia can also be established this way. Additional blood studies and bone marrow biopsies will be performed during treatment to monitor its effectiveness and adverse side effects.
Acute leukemias are usually treated with intensive chemotherapy, using various combinations of anti-cancer drugs. Radiation treatment is often used also. It is sometimes directed at the brain to eliminate any leukemia cells that may elude anti-cancer drugs, which ordinarily do not cross the protective blood-brain barrier. Even after a remission has been achieved, chemotherapy, using lower doses of anticancer drugs, is continued to help prevent a recurrence.
Transfusions of red cells, platelets, and sometimes white blood cells may be part of the treatment. Because leukemia makes infections difficult to control, patients may be placed in a special germ-free room, especially during certain phases of treatment. Visitors must wear gowns and masks.
Relapses are common in all types of acute leukemia, so frequent follow-up is necessary. If a relapse occurs, the patient will begin a new course of chemotherapy, perhaps using a different combination of drugs.
For a growing number of patients, doctors are recommending bone marrow transplants, preferably after the first or second remission. This procedure involves destroying the patient's diseased marrow with drugs or intensive radiation and then replacing it with healthy marrow from a donor. Usually the donor must be a close relative to achieve a good genetic match and reduce the risk of rejection.
An alternative approach calls for removing bone marrow from the patient during a remission, treating it with drugs to kill any cancer cells, and then freezing it for possible future use if a relapse occurs. This is referred to as an autologous marrow transplant.
The treatment for chronic leukemia is different from that of acute forms of the disease. Often, treatment is not even advised during the early, asymptomatic stages. Instead, the patient is closely monitored with periodic blood tests and marrow biopsies. If these tests indicate that the disease may be getting worse, chemotherapy is started. A bone marrow transplant may also be tried, especially in patients under 40 who have chronic myelogenous leukemia.
Any alternative therapy should be employed as an adjunct to, rather than a substitute for, medical treatment. Imagery, visualization, hypnosis, and meditation and other relaxation techniques are examples of safe alternative therapies that enhance feelings of well-being and may promote healing by strengthening the immune system. Other alternative therapies include:
Acupressure. Practitioners recommend pressing a poini on the underside of the wrist to counter nausea. Alternatively, you can wear an acupressure bracelet, such as that promoted for preventing motion sickness.
Herbal Medicine. Madagascar periwinkle is the source of vinblastine and vincristine, potent anti-cancer drugs that are often used to treat leukemia. Western herbalists may advocate taking periwinkle extract, but doctors discourage this practice, as the herb can interact with the chemicals of chemotherapy, increasing the risk of side effects.
However, other herbs, such as ginger, ginseng, sarsaparilla, and wild Oregon grape, can reduce nausea. Garlic pills may be recommended to bolster the body's immune system.
Nutrition Therapy. Sound nutrition is especially important during chemotherapy, which often causes nausea and loss of appetite. Patients are encouraged to eat their largest meals when they feel best, which is usually in the morning. The emphasis should be on bland, high-calorie foods that are easy to swallow and digest. Scrambled eggs, cream soups, and enriched milk shakes will be better tolerated than spicy or fried foods. Any supplements need the approval of an oncologist; high doses of some vitamins can cause digestive problems that could be serious in a leukemia patient.
A word of caution: In the past, laetrile, a toxic substance that is obtained from apricot pits and other seeds, was promoted as a cure for leukemia and other cancers. Numerous studies have failed to prove that it is of any benefit; in fact, it may do considerable harm. One reason is that laetrile contains cyanide and can cause cyanide poisoning when taken in high doses, especially if it is combined with vitamin C. Other strategies that should be avoided are fasting and strict macrobiotic diets, which can exacerbate weight loss.
Because even a cold can be a serious threat to anyone undergoing intensive chemotherapy, leukemia patients should try to avoid contact with anyone who has an infectious disease. It's best to stay away from crowds as much as possible, especially during the flu and cold season, wash hands often to decrease the chances of contracting an infection, and try not to become chilled.
Leukemia and its treatment accelerate dental and oral problems. Consult a dentist before beginning treatment, and schedule dental checkups at least every three months. For mouth ulcers, rinse often with a solution of 1 tablespoon of salt in 8 ounces of warm water. Use a soft toothbrush; if this still provokes bleeding gums, clean your teeth with a soft cloth dipped in 3-percent hydrogren peroxide. Do not take aspirin because it increases bleeding.
Other Causes of Leukemia Symptoms
Anemia, mononucleosis, bleeding disorders, and chronic infections such as tuberculosis can produce a constellation of symptoms that can be confused with those of leukemia.