What is leukemia?
Leukemia is a malignant cancer that begins in the bone marrow, where blood cells are produced. Leukocytes (white blood cells) are the affected cells, which causes them to reproduce uncontrollably, generating symptoms and signs of the disease.
Leukemia falls into two categories: myeloid and lymphoid. The first mentioned is derived from the myeloid stem cell and can be granulocyte, basophil, monocyte, eosinophil or erythrocyte. In the case of the lymphoid, the lymphocyte is the diseased cell.
There is also a classification according to the speed of division of these cells. When the division is rapid, it is known as acute leukemia; when the division is slow, it is known as chronic leukemia. Chronic leukemia develops slowly and the cells involved are similar to the normal cell, allowing patients, even if sick, to maintain some normal functions in the body. Acute leukemia, in turn, has rapid progression and affects young cells that have not yet been fully formed (blasts), compromising their functions and the body’s defense capacity.
INCA, the National Cancer Institute, guaranteed that 10,070 people will be affected in 2016, 4,530 women and 5,540 men.
There are 4 types of classification for leukemia, in addition to 4 subtypes:
Acute myeloid leukemia (AML)
This type of leukemia can occur in anyone, but those who suffer the most are those over 65 years of age. The reason for the onset of this disease has not yet been discovered.
The main feature is the production of blasts that immature cells, white blood cells that are responsible for fighting infections. These cells are produced involuntarily and their function to fight infections, viruses and bacteria becomes null.
When there is a large amount of blasts in the bone marrow, the formations of the other blood components are blocked (platelets and red blood cells). Because of the characteristic of acute leukemia to have rapid development, it is important that treatment is done at the beginning.
Chronic myeloid leukemia (CML)
Chronic myeloid leukemia is a type of non-hereditary cancer that occurs in the bone marrow and, mainly, in patients with an average age of 50 years. The reason for the disease to happen is not yet known, but it is known that the disease is acquired throughout life.
This type of leukemia differs from others because of a genetic abnormality that occurs in white blood cells, known as the Ph + chromosome. Humans have 22 pairs of chromosomes added to the 2 sex chromosomes, totaling 46 chromosomes, and when the disease arises, a translocation occurs in two chromosomes (fusion of part of one chromosome into another). The pairs of chromosomes in which this occurs are 9 and 22, characterizing the disease.
It is believed that 7 out of 10 patients can get rid of the disease completely.
Acute lymphoid leukemia (ALL)
This type of cancer is the most common among children. The disease is not hereditary, but its cause is not yet known. It is known that 9 out of 10 children are able to cure acute lymphoid leukemia.
The disease occurs when the stem cells responsible for the origin of blood components undergo changes. These blood components are responsible for fighting infections, preventing bleeding and also oxygenating the body.
The cells stop functioning and reproduce very quickly, because the disease is acute. This type of leukemia affects cells that are still being formed, compromising blood cells. The disease progresses quickly, so it is very important that the diagnosis is made quickly.
Although the disease is found most often in children, adults can also suffer from this type of leukemia. In these cases, half of the patients are able to cure the problem.
Chronic lymphoid leukemia (LLC)
This type of leukemia usually affects people over 50 and there is no record of children with chronic lymphoid leukemia. The disease is not inherited, but acquired during life.
This is a different type of leukemia, as some cases do not require treatment. The problem arises when white blood cells develop unrestrained and their functions are lost. In addition, the disease is characterized as chronic due to an alteration that causes the growth of mature B lymphocytes but the production of normal cells may not be affected. At the same time that the production of cells with problems occurs, the manufacturing process and the maturity of “good” cells also grows.
Granular T or NK lymphocytic leukemia:
Affects T or NK lymphocytes (Natural Killer). It is rare, slightly aggressive and painless.
Aggressive leukemia NK cells:
It is a lymphoma of the NK lymphocytes (rare), which can be induced by the Esptein-Barr virus. More common in adolescents and young adults, it causes a very rapid decline, requiring rapid initiation of chemotherapy.
Adult T cell leukemia:
It is caused by the human T cell lymphotropic virus (HTLV), an HIV- like retrovirus , which also affects CD4 + T lymphocytes, but immortalizes the cell to produce more HTLV.
Hair cell leukemia:
A subtype of chronic lymphocytic leukemia, with lymphocytes that appear hairless when viewed under a microscope. About 80% of affected people are male adults, and no cases in children have been reported.
All types of leukemia mentioned above occur due to a genetic alteration that is not inherited but acquired during life. The cells undergo a genetic alteration causing a cell division to occur that deactivates the tumor suppressor genes. There is also the unbridled multiplication of the same cell leading to the appearance of cancer.
The exact cause of leukemias is still unknown, but it is known that there are some factors that facilitate the onset of cancer. They are:
- Some blood disorders, such as myelodysplasia and myeloproliferative neoplasms;
- Some genetic diseases, such as fanconi anemia, neurofibromatosis, Down syndrome and others;
- Exposure to chemicals, derived from benzene, which may be present in petrochemical industries and chemical factories;
- Previous treatment with radiotherapy or chemotherapy;
- Exposure to ionizing radiation, as seen in people who survived a nuclear leak and an atomic bomb.
It must be made clear that, no matter how much there is a risk factor, it is not certain that the patient will have the disease.
Hemorrhages, infections and anemias are common symptoms of leukemia, due to the damage caused by the production of platelets, white blood cells and red blood cells, respectively.
The proliferation of cells causes the bone marrow to be occupied, preventing normal cells from reproducing, which can cause different symptoms:
They can appear by decreasing the production of erythrocytes by the bone marrow.
- Little hunger;
- Irritability and weakness;
They can arise from the decrease in platelets, cells that are very important for blood clotting, because they prevent bleeding.
- Gingival bleeding;
- Bruises that may appear after minor trauma or that appear without any trauma;
- Excessive menstruation;
- Petechiae inside the mouth;
- Blood in the stool.
Symptoms can appear due to the decrease in normal leukocytes, mainly neutrophils, which act in the defense of the organism against infections.
- Sore tongue;
- Frequent infections;
- Canker sores;
- Excessive sweating at night;
- Jumped lymph nodes.
In addition to these symptoms, bone pain, enlarged spleen, joint pain, organ problems and pain in the sternum may also arise.
Yes, the disease has a cure. Most cases of cure involve bone marrow transplantation, but it can also occur through chemotherapy and radiation therapy.
The doctors who specialize in diagnosing leukemia are oncologists, or hematologists.
There is no way to detect leukemia early, so paying attention to symptoms and signs is the best way to discover the disease. If there are children in the family with genetic diseases marked by risk factors, this care must be even more intense, as the risks are greater. The same is true for people who work in the chemical industry or who have undergone chemotherapy and / or radiation therapy.
Some tests can be done to make the diagnosis of the disease effective:
CBC and blood smear
This type of test is done with a blood sample and, if there are changes in the count of the different types of cells and in appearance, the doctor may suspect leukemia. Although the blood test indicates, only a sample of the marrow cells can confirm the diagnosis of leukemia.
Biopsy and myelogram
This examination is done by aspirating a part of the bone marrow. After anesthesia, a fine needle is inserted into the bone and a portion of the spinal cord is aspirated. Soon after the biopsy is done, taking small cylindrical samples from the bone and the medulla. These two tests are done at the same time, in most cases, it is usually necessary to do this procedure more than once, the first to give the diagnosis and the second to see the reaction of the disease after treatment.
Blood tests are ordered by doctors so that they can check the functionality of the liver and kidneys and find out if these organs were affected during treatment. In addition, the test is recommended to discover infections due to the fragility of the immune system.
A needle is inserted into the spine after anesthesia, and a sample of cerebrospinal fluid is taken to find out if leukemia cells are present.
Excisional lymph node biopsies
For this test, a ganglion can be removed. In addition, excisional biopsy can be done under local anesthesia if the ganglion is close to the skin, or under general anesthesia if it is not.
When performing the X-ray examination , the enlargement of the thymus or lymph nodes in the chest can be detected more easily.
This type of examination is performed to produce a detailed image of a part of the organism. X-ray images are taken while the machine revolves around the patient. A contrast can be injected into the patient so that body structures are more easily defined. To perform this examination, the patient must remain motionless on a table for about half an hour. The test also helps to find out if the liver and kidneys have been affected by leukemia.
Ultrasound uses sound waves to produce an image of Organs internal organs. With the instrument used to perform the examination, the echo (a reflection of sound that reaches the listener shortly after the direct sound) is captured and converted by the computer into an image.
The MRI is done to check if the disease has reached the nervous system and it usually takes up to an hour. The resonance uses radio waves and those that are analyzed are absorbed and then released in a pattern given by the type of tissue in the body.
A small amount of a radioactive compound is injected into the patient and the substance accumulates in areas of the bones affected by metastases or infections.
This type of technique is used to analyze bone marrow cells, blood and lymph nodes in order to determine the type of leukemia. The cells are treated with special antibodies and receive a laser beam. These antibodies bind only to substances present in some types of leukemic cells. If the sample contains these cells, the antibodies bind to them and the laser causes lights to be emitted, allowing them to be analyzed by the computer.
Cytometry is also used to assess the amount of DNA in leukemic cells.
The sample cells are spread on a slide and exposed to dyes that react only with some types of leukemic cells. Thus, this test is very useful to differentiate the types of leukemia.
Cytogenic or karyotype examination
The study detects changes that occur in the chromosomes (normal cells contain 46 chromosomes). In some types of leukemia, one chromosome appears attached to another, which is called a translocation and can be seen under a microscope. The identification of these translocations allows the diagnosis of acute myeloid leukemia and acute lymphoid leukemia.
This procedure involves treating the cells obtained from the biopsy with special antibodies. But, instead of using laser and computer in the analysis, the sample is made by changing the color of the cells, which allows discovering the different forms of leukemia.
The detection of chromosomal and molecular changes is done using chain polymerase or hybridization methods. In addition to diagnosing, the prognosis can be made according to the abnormality found in the exam.
Just as leukemia is separated into 4 types, the form of treatment also usually varies according to the cause of the disease and its variations. Generally, treatment of chronic lymphoid leukemia does not need to be done immediately after diagnosis, unlike acute leukemia, which needs immediate treatment with chemotherapy and even bone marrow transplantation.
The main way to treat leukemia is with chemotherapy. The way it is done depends on specific factors of each patient and it will be the doctor who will evaluate the best way to perform it. This type of treatment uses chemicals to fight leukemia cells. Depending on the case, only one medication is used, or a combination of several can be used for the treatment to be carried out.
Radiotherapy is used, in most cases, by patients suffering from chronic lymphoid leukemia, so that the lymph node masses are reduced. In addition, radiotherapy can be used to prepare the patient for bone marrow transplantation. Radiotherapy uses X-rays and other high-intensity beams to damage leukemic cells and inhibit growth.
This type of treatment is done with therapies that help the immune system to attack and recognize leukemic cells.
Stem cell transplantation
The procedure is based on replacing the bone marrow affected by cancer with a healthy one. Before the transplant occurs, chemotherapy and radiotherapy sessions can be done so that the diseased bone marrow is destroyed. The infusion of stem cells is indicated to reconstruct the spinal cord.
The doctor must analyze several factors before deciding on the best way to treat the disease, but, generally, the treatment is done to destroy the leukemia-causing cells, so that the bone marrow returns to producing normal cells. In some specific cases of the disease, bone marrow transplantation is indicated.
Treatment can be done in some stages. The first is to achieve complete remission, that is, the cure that can be obtained through polychemotherapy. This occurs only after months of treatment and when examinations no longer show abnormalities that were previously present.
In the following stages, treatment varies according to the type of leukemia, and may last less than one year in myeloid leukemias and more than two years in lymphoids. In them, three other phases are known:
Intensive treatment with substances not previously used.
Repetition of drugs used in the remission induction phase.
Mild and continuous treatment that can last for several months.
In cases of polychemotherapy, hospitalization of the patient may be necessary due to infections that may occur due to the fall of white blood cells that occur during treatment.
- Androcortil ;
- Betatrint ;
- Dexamethasone ;
- Dipropionato de Betametasona;
- Prednisolone Sodium Phosphate ;
- Prednisone ;
- Duoflam ;
- Diprospan ;
- Predsim .
It is very important to make it clear that self-medication should never be done. If done, symptoms can get worse and complications arise. Do not stop using the medicine without medical advice.
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained on this site is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
At first, the diagnosis of leukemia can become a terror for family members and the patient, but over time people learn to deal with the problem.
It is indicated to study about the disease that you have to be able to debate with the doctor about the treatment, symptoms, diagnosis and also so that he can solve your doubts.
Keeping family members and friends close is essential for the disease to be viewed more lightly. Close relationships make support more and emotional support at that time is critical.
Attending support groups can be comforting for the patient, sharing his doubts, anxieties and fears with people who go through the same situation. This can bring great relief to patients.
To avoid seasickness, nausea and vomiting it is essential that the patient maintain a balanced diet and avoid dehydration. Eating small portions several times a day can be a good option to avoid the problem.
Problems such as lack of sleep, tiredness and pain can be adequately treated at bedtime and getting up. Creating a routine is important for tiredness to be controlled and for sleep to be stabilized.
Nowadays, leukemia is not a death sentence, as it is possible to live with the problem. Thanks to the advancement of technology and science, the cure can occur in the 4 types of leukemia.
The only way to prevent the disease is to avoid the risk factors that increase the likelihood that the disease will arise. But, as already mentioned, the risk factors do not guarantee the disease, they only increase the chances of the disease to appear.
Leukemia is a common type of cancer. Informing yourself about the disease is essential to understand what is going on in a patient’s head and also to be able to help him. Share it with your friends so they can also help others.