Leukaemia - a general overview

About leukaemia

Blood cells, which include red cells, white cells and platelets, are made in your bone marrow. White blood cells play a vital role in your immune system and help to defend your body from infection. But if you have leukaemia, some of your white blood cells grow in an uncontrolled way. These abnormal cells can affect how well your body fights infections. They can also cause and bleeding problems.

In India, around people are diagnosed with leukaemia each year. It’s the most common type of cancer in children.

Types of leukaemia

There are four main types of leukaemia. They’re named according to the speed at which the leukaemia develops (chronic or acute) and the type of white blood cell involved (myeloid or lymphoid). Acute leukaemia develops quickly over weeks, while chronic leukaemia develops slowly over months and years.

The four main types of leukaemia include:

• Acute lymphoblastic leukaemia (ALL). This is the most common type of leukaemia in children. It usually affects children under six and is one of the most curable cancers in children. Adults can also develop ALL, but this is far less common. 
• Chronic lymphocytic leukaemia (CLL). This is the most common type of leukaemia in older adults. It usually develops slowly and you might have few or no symptoms when it’s diagnosed. 
• Acute myeloid leukaemia (AML). This type of leukaemia is rarer and it tends to develop more quickly. It is possible to develop AML at any age, but it’s more common in older adults.
• Chronic myeloid leukaemia (CML). This is a rare type of leukaemia that usually develops very slowly. It mostly affects adults and is rare in children. 

There are also other, less common types of leukaemia – for example, hairy cell leukaemia. Ask your doctor for more information on the different types of leukaemia.

Symptoms of leukaemia

Leukaemia symptoms can vary depending on which type you have, and how advanced it is. Symptoms can differ between children and adults. It’s also possible to have no symptoms at all. 

Symptoms of leukaemia in childern

In children, symptoms of leukaemia can vary depending on how old your child is and how developed the cancer is. Symptoms can sometimes be vague and general. So if your child has any of the following symptoms, make an appointment to see your Doctor.

Symptoms of leukaemia in children may include:

• feeling very tired with little energy
• long periods of fever or repeated fevers
• being irritable and crying for long periods
• lots of infections or severe infections
• not growing as well as they should
• bruising easily, nose bleeds and bleeding gums
• being sick (vomiting) and feeling sick (nausea)
• being short of breath or having a cough that lasts for a long time
• headache or dizziness
• joint pain, especially in the legs

Symptoms of leukaemia in adults

The symptoms of leukaemia in adults can come on very slowly, so you may not be aware of them. The most common type of cancer in adults is chronic lymphocytic leukaemia (CLL) and most people have no symptoms from it. It’s often diagnosed after a blood test for something else.

Symptoms of leukaemia in adults may include:

• feeling tired and short of breath
• swollen lymph nodes, often on both sides of your body – these are glands your neck, groin and armpits that are part of your immune system
• getting lots of infections such as shingles, cold sores and [MH1]
• pale skin
• bleeding or bruising easily, which can show as tiny red or brown spots under your skin
• a swollen or tender tummy (abdomen)
• discomfort or pain on the left side of your tummy
• a fever and night sweats
• losing weight
• pain in your bones and joints

These symptoms aren't always caused by leukaemia, but if you have them, contact your doctor.

Diagnosis of leukaemia

Your doctor will ask you about your symptoms and examine you. They’ll ask about your medical history too.

You will be asked to have blood tests to see if there’s anything unusual. If your doctor notices anything abnormal, they’ll refer you to see a specialist. If your child has symptoms of leukaemia, they’re likely to have urgent investigations and be referred to a specialist straightaway. 

You might need to have some more tests, including a bone marrow aspiration or biopsy. This means taking a small sample of bone marrow and looking at it under a microscope. This is usually taken from your hip bone or, occasionally, from your breastbone.

Blood tests and bone marrow tests can help to show whether you have certain genes linked to leukaemia. They can also help to identify which type of leukaemia you have and how developed the cancer is. 

Treatment of leukaemia

The main treatment for leukaemia will depend on the type of leukaemia you have, and how far your condition has progressed. Ask your doctor to talk you through your options. They may include the following.

• Watching and waiting. If you have chronic lymphocytic leukaemia (CLL) without symptoms and it’s in the early stages, your doctor may suggest you don’t have treatment straightaway. Instead, you’ll be closely monitored and treatment will start if the cancer develops. Some people are monitored this way for years before they need treatment. 
• Chemotherapy. This is medicine that destroys cancer cells. Chemotherapy can cure some types of leukaemia and can also put some types of leukaemia [MH2] . How you have this treatment, and for how long, will depend on the type of leukaemia you have.
• Targeted cancer drugs. These are medicines that interfere with how cancer cells grow. They can stimulate your body to control the growth of cancer cells or destroy them. These medicines are sometimes used alongside chemotherapy.
• A stem cell transplant. You’ll usually have other treatments such as chemotherapy before you have a transplant.

As well as medicines, you may need to have supportive care. This may include fluids, antibiotics and blood and platelet transfusions.

Side-effects of leukaemia treatment

Like all medicines, the ones used to treat leukaemia can have side-effects. Side-effects are the unwanted effects of taking a medicine. The side-effects of leukaemia treatment will be different for each person and depend on the medicine being taken, but some of the main ones can include:

• being more likely to get infections or have bleeding
• losing your hair
• wounds taking longer to heal or not healing properly
• feeling sick (nausea) and being sick (vomiting)
• feeling extremely tired (fatigue)
• mouth ulcers
• changes in your appetite
• problems with fertility
• problems with your digestive system such as diarrhoea, constipation, indigestion or heartburn

If you have side-effects, it’s important to talk to your doctor who prescribed your medicine before you stop taking it. There are sometimes ways to reduce or ease side-effects. 

Causes of leukaemia

Doctors don’t yet know the exact reasons why people develop leukaemia. But some things make you more likely to develop some types of leukaemia. These include the following.

• Your age. Acute lymphoblastic leukaemia (ALL) is more likely to develop in children under six. You’re more likely to develop the other main types of leukaemia as you get older.
• Being male – you’re more likely to get leukaemia if you’re a man.
• Being exposed to radiation or chemicals such as benzene.
• Genetic conditions such as Down’s syndrome and conditions that affect your bone marrow.
• Having had chemotherapy in the past.
• Family history. Your risk of getting some types of leukaemia may be higher if you have a brother, sister or parent with the condition.

Living with leukaemia

Everyone reacts in a different way to a diagnosis of cancer and it’s likely to bring with it lots of different feelings for you and your family. It’s natural to feel anxious and overwhelmed about it and it takes time to sort out how you’re feeling. People cope with it in different ways and there is no right or wrong.

You may find it helpful to talk to someone about how you're feeling, maybe a friend or family member. Or you might find it helps to contact a support group to talk to people who are going through a similar experience.

During and after treatment it’s important to take care of yourself. That means [SS1]  and being active when you can. You may also feel very tired and lacking in energy even months ends and these feelings can be severe. Tiredness like this can affect every part of your life including your work, relationships, and home life. Talk to your nurse or doctor for advice about how to manage these symptoms.