Leukemia- Diagnosis, Treatment and Risk Factors

Jun 03, 2019

Leukaemia Risk Factors

Although the doctors are not very clear about the causes of leukaemia, several factors have come to notice that may increase the risk of leukaemia. Some of the risk factors are-

smoking (increases the risk of developing AML, Acute myeloid leukaemia)
genetic disorders like Down's syndrome
a family history of leukaemia
blood disorders like myelodysplastic syndrome
exposure to high levels of radiation
exposure to chemicals like benzene
treatment for cancer previously with chemotherapy or radiation

However, most of the people with the risk factors do not get leukaemia, and many with leukaemia have no risk factors.

Diagnosing Leukemia

Chronic leukaemia may come to notice during a normal blood test, much before the symptoms begin. If this happens or one has signs that suggest the onset of leukaemia, the doctor would begin with a complete history and physical examination. However, since leukaemia diagnosis is not possible only with a physical examination, the doctor would suggest a few tests, biopsies and imaging test to make a diagnosis.

Tests

For the diagnosis of leukaemia, there are a number of different tests that the doctor may advise. The doctor may conduct a physical exam... The physical exam is an essential part of visiting the doctor, where the doctor would conduct various tests. A complete blood test determines the number of Red Blood Cells, platelets, and White Blood Cells present in the blood. Another option is viewing the patient's blood under a microscope to determine any abnormal appearance. For a biopsy, the tissue may be taken from the lymph nodes or bone marrow to look for signs of leukaemia. These small samples would identify the details regarding the types of leukaemia and growth rate. To understand if cancer has spread to other organs, the doctor may advise a biopsy of those as well.

How is Leukemia Staged?

Once the doctor carries out the diagnosis, he will determine how far has the cancer spread, i.e., what stage is cancer in. Staging helps the doctor to understand the course of treatment. The various types of cancers receive stages in accordance with different parameters.

Acute myeloid leukaemia and Acute lymphoblastic leukaemia have stages on the basis of how cancer cells look under the microscope and what type of cells are involved.
Acute lymphoblastic leukaemia and Chronic lymphocytic leukaemia have stages on the basic of WBC count during the time of diagnosis.
Chronic myelogenous leukaemia and Acute myeloid leukaemia have stages on the presence of immature white blood cells, myeloblasts in the blood and bone marrow.

Assessing the Progression

Besides the above, the doctor may suggest a variety of different tests to understand the progression of cancer. The tests include-

Liver function tests tell whether leukaemia cells are invading the liver.
Lumbar puncture allows the doctor to collect spinal fluid and determine if cancer has spread further to the central nervous system. The doctor inserts a thin needle between the vertebrae of the lower back to collect the fluid.
Flow cytometry to examine the DNA of cancer cells and determine the growth rate.
Other imaging tests like CT scans, ultrasounds, X-rays to help doctors understand any damage to other organs due to leukaemia.

Treatment Leukemia

The treatment options will depend on the type of leukaemia, age and overall health of the patient.

With medicine progressing and continuous research, the treatment of leukaemia can aim for complete respite where cancer does not come back for at least five years after treatment.

Over the years, the figure for the percentage of people recovering from the disease has considerably seen a rise. However, it also depends on the stage and time of diagnosis. An early diagnosis and treatment schedule has a higher chance of remission.

Some of the common treatment options to fight leukaemia are-

Chemotherapy

One of the major forms of treatment for leukaemia, it uses chemicals to kill leukaemia cells. After the doctor has understood the type of leukaemia the patient is suffering from, he may prescribe a single drug or a combination of drugs. They may be in the form of a pill or injection.

Biological Therapy

Biological therapy works by guiding the immune system to identify the cancer cells and attacking them.

Targeted Therapy

Targeted therapy uses drugs to attack specific cancer cells. While chemotherapy targets the whole body, targeted therapy focuses on stopping the action of specific compounds for better and more personalised treatment.

Radiation Therapy

Radiation therapy involves the use of X-rays and other radiation forms to damage and stop the growth of leukaemia cells. During radiation therapy, the patient must lie on a table as a large machine moves around, directing radiation to the affected areas.

To prepare the patient for a stem cell transplant, radiation therapy is the first step.

Stem Cell Transplant

A stem cell transplant is a procedure that replaces the damaged bone marrow with a healthy one. Before the stem cell transplant, the doctor may give a high dosage of chemotherapy and radiation therapy to destroy the diseased bone marrow. Then, blood-forming stem cells are inserted to help rebuild the bone marrow. It is quite similar to a bone marrow transplant.

Sometimes, chronic leukaemia may not require treatment in the early stages. However, monitoring is vital.

The bone marrow transplant is different from the stem cell transplant. Here is how-

When stem cells are collected from bone marrow and transplanted into a patient, the procedure is known as a bone marrow transplant. If the transplanted stem cells came from the bloodstream, the procedure is called a peripheral blood stem cell transplant AKA “stem cell transplant.”