In this article
- Diffuse large B-cell lymphoma which affects 5,500 people a year.
- Chronic lymphocytic leukaemia, or CLL, which affects 4,700 people a year.
- Myeloma which affects 4,500 people a year.
- Chronic myeloproliferative neoplasms (MPNs) which affect 3,900 people a year.
- Marginal zone lymphoma which affects 2,700 people a year.
- Acute myeloid leukaemia, or AML, which affects 2,700 people a year.
Leukaemia is the most common type of cancer in children; over 30% of all cancers in the under 14s are leukaemia. Over 650 children and young adults are diagnosed with leukaemia every year in the UK. Leukaemia in children has an overall survival rate of 88%; within this, acute lymphoblastic leukaemia (ALL), the most common form, has a survival rate of 90% and acute myeloid leukaemia (AML) has a 65% survival rate.
What is leukaemia?
Leukaemia is a type of blood cancer that affects blood cells in your bone marrow, usually the white blood cells. Your bone marrow is a spongy tissue found inside some of your bones, and it is where the body makes blood cells. All blood cells begin as stem cells, which mature in the bone marrow. They then develop into the three types of blood cells: red blood cells, white blood cells, or platelets. In a healthy person, the system of blood cell production is finely controlled in a process called haematopoiesis.
When the stem cell divides, it can either produce more stem cells or other immature blast cells that develop into mature blood cells over time. In this process of specialisation, immature blast cells become either lymphoid or myeloid cells.
Lymphoid cells are a type of white blood cell. They help fight infection, and they include B lymphocytes and T lymphocytes. Myeloid cells go on to form red blood cells, platelets and other types of white blood cells such as monocytes and granulocytes.
In leukaemia, blood cells are not produced the way they should be and you may have too many, too few, or blood cells that don’t work properly. The leukaemia cells behave and function differently from normal blood cells. In leukaemia, a high number of abnormal white blood cells are not able to fight infection, and they may also impair the ability of the bone marrow to produce red blood cells and platelets.
What causes leukaemia?
In most cases of leukaemia there is no obvious cause.
However, it is important to understand that:
- Leukaemia is not a condition which can be caught from someone else (contagious).
- Leukaemia is not passed on from a parent to a child (inherited).
There are, however, a number of different things that can increase the risk of developing the condition:
- Age – Most forms of leukaemia are more common in older people. The main exception to this is acute lymphocytic leukaemia (ALL) in which peak incidence is in children.
- Gender – Leukaemia is generally more common in males.
- Chemical exposure – Being exposed to some chemicals such as Benzene, which is found in petrol and is also found in cigarette smoke. People who smoke have an increased risk of developing acute myeloid leukaemia (AML).
- Radiation exposure – High levels of radiation may increase the chance of developing leukaemia. These factors account for only a very small proportion of all cases. Treatment with radiotherapy and certain chemotherapy medicines for an earlier, unrelated cancer can increase your risk of developing acute myeloid leukaemia (AML) many years later.
- Pre-existing forms of blood cancer – Some forms of leukaemia are seen more commonly in people who have other bone marrow disorders. The most common bone marrow disorders which behave in this way are myelodysplastic syndromes (MDS) and myeloproliferative neoplasms (MPN).
- Genetic disorders – People with certain genetic conditions, including Down’s syndrome and Fanconi’s anaemia, have an increased risk of developing leukaemia.
Despite a wealth of research, much uncertainty remains over what causes cancers such as leukaemia in children. Many different factors have been linked with the development of childhood cancer with varying degrees of certainty; the main causes cited are radiation and chemical exposure.
The types of leukaemia
The different types of leukaemia are named according to:
- The type of blood cell which is affected.
- Whether the leukaemia is acute (faster growing) or chronic (slower growing).
There are four main types of leukaemia:
- Acute lymphocytic leukaemia (ALL) is a type of cancer that affects white blood cells. It progresses quickly and aggressively and requires immediate treatment. Both adults and children can be affected.
- Acute myeloid leukaemia (AML) is an aggressive cancer of the monocyte or granulocyte cells. Both adults and children can be affected.
- Chronic lymphocytic leukaemia (CLL).
- Chronic myelogenous leukaemia (CML).
The three most common types of childhood leukaemia are:
- Acute lymphoblastic leukaemia.
- Acute myeloid leukaemia.
- Chronic myeloid leukaemia.
Acute lymphoblastic leukaemia (ALL) is an overproduction of immature lymphoid cells, called lymphoblasts. ALL is the only form of leukaemia that is more common in children than in adults.
Acute myeloid leukaemia (AML) is an overproduction of immature myeloid cells, called myeloblasts. Around 76 new cases of childhood AML are diagnosed every year in the UK, which accounts for 15% of children’s leukaemia cancer cases.
What are the signs and symptoms of leukaemia?
Leukaemia is often difficult to spot as its symptoms aren’t specific and aren’t well known.
The most common signs and symptoms of leukaemia in both adults and children include:
- Fatigue – This is characterised by persistent or extreme tiredness that disrupts a person’s daily activities. It often doesn’t go away after a good night’s sleep.
- Losing weight without trying – This can include being unable to attribute weight loss to diet or exercise, as well as losing weight quickly over a short period of time.
- Swollen glands / lymph nodes in your neck, armpit or groin – These are enlarged lumps that can be seen or felt underneath the skin and may be sore when you touch them. Often, they can be the result of an everyday infection or allergy. However, they might be a sign of leukaemia, particularly if they are painless, last longer than two weeks, are hard or unmovable, or grow in size.
- Swollen and/or painful stomach – This can include a sharp pain or swelling in the stomach and constantly feeling full. Leukaemia cells can build up in your spleen or liver, causing swelling or an enlarged spleen and creating general discomfort and sometimes pain around the stomach area or under your ribs on the left.
- High temperature, and feeling hot or shivery (fever) – This may include night sweats that are regular, drench you in sweat, or occur in cool environments.
- Bone and joint pain – This can be a sharp pain or a constant dull ache in one or more bones. Bone pain caused by leukaemia is usually felt in the arms and legs, or in the ribs and sternum of the rib cage. Joint pain in ankles or wrists and swelling of large joints like the hips and shoulders can also be experienced.
- Breathlessness – This may come on suddenly or during activities that would normally be effortless for the person, breathlessness lasting longer than a month, breathlessness that worsens over time and coughing lasting three weeks or more.
- Easily bruised skin – Leukaemia bruising is often unexplained, appears in unusual places and takes longer than usual to go away. Also, the appearance of flat red or purple spots on the skin or skin looking pale or washed out.
- Anaemia – Leukaemia can cause anaemia. Anaemia means having a low level of red blood cells in your blood. Symptoms of anaemia are:
– Dizziness or feeling faint.
– Chest pain.
– Pale skin.
- Bleeding – Unexplained nose bleeds can also be a symptom of leukaemia. Blood in your stool or black, tarry stools, or stools that are streaked with red because of bleeding in your gut.
- Blood clots – These may include a painful or swollen leg due to blood clots in the leg or tummy area, chest pain and difficulty breathing due to blood clots in the lungs, or headache, vomiting or problems with vision due to blood clots in the brain.
- Frequent infections – Factors such as the duration and frequency of infections can help determine if they are a sign of leukaemia. Specific signs include a cough, fever or chest infection that is recurring or long lasting, and small cuts to your skin becoming infected more frequently.
Leukaemia symptoms are also common in other illnesses, so if you experience any or a combination of the symptoms above, contact your GP who will arrange for tests.
Diagnosis of leukaemia
There are a range of tests that your GP may carry out to help diagnose whether or not you have leukaemia. Having these tests does not necessarily mean you have blood cancer. Many of these tests are used to diagnose a range of health conditions.
First, they will check for physical signs of the condition and arrange for a blood test. Most blood tests are carried out at your GP surgery or local hospital. Blood will be taken from your vein using a thin needle and syringe. It might hurt a bit as the needle goes in, but it is usually over quite quickly. Your blood will then be sent to a laboratory to be tested. Your doctor should tell you when you will get the results.
Your blood will generally be tested for:
- Full blood count (FBC) – This measures the number of each type of cells in your blood, that is red blood cells, white blood cells and platelets.
- Liver function tests – Blood tests called liver function tests (LFTs) can check how well your liver is working.
- A peripheral blood film – This looks at your red blood cells, white blood cells and platelets to see whether they are the right size and shape, and whether they look healthy.
To confirm a diagnosis, you may also have a bone marrow biopsy. A bone marrow biopsy involves removing a sample of bone marrow to look at under the microscope. This can show whether your body is making normal, healthy blood cells or not.
The bone marrow sample will normally be taken from your hip bone. The doctor or nurse will give you a local anaesthetic to numb the area. If you are having sedation, you will need someone with you to take you home and stay with you overnight. To take the sample, the doctor will use a large needle (aspirate) to suck out a sample of bone marrow from your hip bone. A piece of bone may also be taken using an instrument called a trephine.
A bone marrow biopsy is a common procedure and any risks are small, such as slight damage to the area near where the biopsy is being done. Removing the bone marrow sample only takes a few minutes, and this can be done as an inpatient or as an outpatient at the hospital.
Your appointment will normally take about 30 minutes, and it can feel uncomfortable when the sample is being taken, you may also have bruising and discomfort for a few days afterwards. You can usually go home the same day if you are feeling well enough.
You won’t get the results of a bone marrow biopsy straight away. It can take one or two weeks to get them, and you will usually have a follow-up appointment.
You may be referred for a lymph node biopsy. This is when all or part of a lymph node is removed during a short operation and looked at under a microscope to find out whether there are any abnormal blood cells present. Lymph nodes are glands that are part of your lymphatic system.
You usually have a lymph node biopsy as an outpatient, which means you don’t have to stay in hospital overnight. You will either have a local anaesthetic to numb the area or a general anaesthetic to sedate you, depending on where the lymph node is.
The doctor will make a small cut in the skin and remove all or part of your lymph node. The procedure may take up to half an hour and the small wound left will need stitching which may leave a small scar. You may feel sore and bruised around the area for a few days after the biopsy. You will usually get the results of a lymph node biopsy within two weeks.
Scans can also be used to help diagnose leukaemia. They look at organs and bones inside the body.
They may include:
- CT scan – This uses X-rays and computers to create a detailed picture of the inside of your body.
- MRI scan – This uses magnetic fields and radio waves to produce detailed images of the inside of the body.
- PET scan – This is similar to an MRI scan. It uses low-dose radiation to check the activity of cells in different parts of the body. It may be used to give more detailed information about cancer or abnormal areas seen on other scans.
- X-rays – This is a test that uses small doses of radiation to take pictures of the inside of your body, especially your bones.
- Ultrasound scan – This is sometimes called a sonogram. It uses high-frequency sound waves to create an image of part of the inside of the body.
Other tests used for detecting and diagnosing leukaemia might include:
- Genetic tests – Using a sample of cancer cells, doctors can look for particular changes in the genes and chromosomes, to help them identify the specific type of blood cancer.
- Lumbar puncture – In rare situations where it is thought there’s a risk that leukaemia has spread to your nervous system, a lumbar puncture may be carried out. In this procedure, a needle is used to extract a sample of the fluid that surrounds and protects your spine (cerebrospinal fluid) so it can be checked for cancerous cells.
What are the treatment types for leukaemia?
Treatments for leukaemia may be one particular type of treatment or a combination of more than one. Immediate treatment may not be recommended for some people, particularly those with a slow-growing or chronic form of leukaemia.
The treatment or treatments recommended for leukaemia will depend on several factors including:
- Type of leukaemia.
- Age of the person diagnosed.
- General health of the person diagnosed.
- How fast the cancer is progressing.
- The wishes of the patient.
Some people diagnosed with leukaemia, particularly a slow-growing form, may not need treatment straight away, and some may never need treatment. The doctor may recommend “watch and wait”, usually considered when the symptoms are not troublesome, and the doctor believes there is no benefit to starting treatment straight away.
Watch and wait is a safe option that avoids the side effects caused by many types of cancer treatment; treatment may be recommended at a future date, if or when needed. If watch and wait is recommended, regular appointments with the doctor will be necessary to check general health and symptoms, specifically to monitor whether the leukaemia remains stable or starts to progress.
Chemotherapy is the use of potent drugs or chemicals, often in combinations and given at regular time intervals, to kill or damage the cancer cells in the body. The chemotherapy drugs must be toxic enough to kill the cancer cells. It is therefore a harsh treatment option.
All chemotherapy drugs interfere with cancer cells’ ability to grow or multiply. However, the drugs’ toxicity can harm the healthy cells as well which results in unpleasant side effects.
The ultimate goal of chemotherapy treatment is to damage or kill the cancer cells so there’s either no sign of illness (remission) or the disease’s progress is slowed. Chemotherapy can produce long-term remission or outright cure for many people, depending on the leukaemia type and the severity of the disease.
Radiotherapy involves using high doses of controlled radiation to kill cancerous cells. It is used to prepare the body for a bone marrow or stem cell transplant or to treat advanced cases that have spread to the nervous system or brain, although this is uncommon.
If the treatment is not working or there is a high chance of the leukaemia coming back, a bone marrow or stem cell transplant (SCT) may be offered. This is a procedure in which a patient receives healthy stem cells to replace faulty stem cells. Before transplantation can take place, the person receiving the transplant will need intensive high-dose chemotherapy, and possibly radiotherapy, to destroy the cells in their bone marrow. This is called “conditioning treatment”.
The main types of SCT are:
- Autologous transplantation uses the patient’s own stem cells. These cells are removed, treated and returned to the patient’s own body after a conditioning regimen.
- Allogeneic transplantation uses stem cells from a donor. A donor may be a family member or someone who is not related to the patient.
You may be offered targeted medicines if you have certain types of leukaemia. Targeted medicines affect the way cancer cells grow.
Rarely, you may need to have an operation to remove your spleen if you have chronic lymphocytic leukaemia. The spleen is a small organ that filters your blood. It is part of your immune system, but you can live without it.
As well as medicines, you may need to have supportive care. This may include fluids, antibiotics and blood and platelet transfusions. It is important to talk to your GP or your healthcare professional about treatment options, possible side effects and prognosis as every patient’s diagnosis and experience is individual.
Anyone who has received or is waiting for a leukaemia diagnosis or who is going through treatment for leukaemia may benefit from talking to somebody outside friends and family about their condition.
Sources of advice and support include:
- Leukaemia Care – Freephone Helpline 08088 010 444 email@example.com.
- Leukaemia UK.
- Blood Cancer UK 0808 2080 888.
- If you have a child diagnosed with leukaemia, you can visit the Children’s Cancer and Leukaemia Group who have resources on looking after your child with leukaemia, as well as for siblings and grandparents.
- Young Lives vs Cancer have a specific section for parents as well as resources for young people themselves.
- Solving Kids’ Cancer UK – Family Support Team 0207 284 0800 or email firstname.lastname@example.org.