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Blood Disorders : Leukemia

Leukemia is a cancer beginning in the bone marrow, the soft inner portion of some of your bones. In a patient affected by leukemia, the body makes too many immature or abnormal blood cells, which crowd out normal blood cells. Leukemia can spread from the bone marrow to other parts of your body, including the lymph nodes, brain, liver and spleen. 
Kinds of Leukemia

There can be four main kinds of leukemia - acute or chronic leukemia that is either lymphocytic or myelogenous. In acute leukemia, the bone marrow cells remain immature. In chronic leukemia, the cells mature but are abnormal. Whether acute or chronic leukemia is lymphocytic or myelogenous depends on which bone marrow cells are affected. When the disease starts in the lymphocytes, the leukemia is lymphocytic. It is myelogenous if the granulocyte or monocyte cells of the bone marrow are affected.

Causes and Prevention

Not smoking is the most important thing you can do to help prevent leukemia. Scientists estimate that about 20 percent of adult acute leukemia cases are related to smoking. A small percentage of leukemia cases are linked to exposure to high doses of radiation (from an atomic bomb or a nuclear reactor accident, for instance) or long-term exposure to high levels of solvents such as benzene in the workplace.

Some types of leukemia are more likely to develop in people with other cancers who are treated with certain chemotherapy drugs. Combining those drugs with radiation therapy heightens the risk.

But many people with one or more of these risk factors never develop leukemia. And most of the people who do develop the disease have no risk factors at all. The cause of most leukemia is still unknown. Scientists do know that most leukemias are associated with specific gene mutations. 

Symptoms and Diagnosis

Acute leukemia may cause many non-specific symptoms, including: 
Frequent minor infections or poor healing of minor cuts 
Swollen lymph nodes, stomach, head, arms, and gums 
Tiny red spots in the skin Fever, headache 
Loss of weight and/or appetite 
Bone or joint pain 
Difficulty in maintaining balance 
Blurred vision 
Easy bruising and/or bleeding 
An enlarged, painless testicle 
Weakness and fatigue 
Coughing, shortness of breath 
Seizures, vomiting 
Eighty percent of patients with chronic leukemia may suffer from one of the following: weakness, fatigue, weight loss, fever, bone pain, or a feeling of fullness or pain in the abdomen, especially after eating a small meal. The remaining 20 percent have no symptoms. Their cancer is discovered by blood tests taken for other reasons or during a regular checkup. 

Specific blood tests need to be carried out to determine if leukemia is the cause of symptoms. These blood tests will show changes in your blood cells. But even if these findings indicate leukemia, an accurate diagnosis usually depends on testing a sample of your bone marrow cells.  

The blood and bone marrow samples are then examined under a microscope in a laboratory. These laboratory tests determine the type and subtype of leukemia to help doctors decide which treatments might work best for you.

Leukemia: Treatment

More effective ways of treating leukemia are being discovered every year. People with the disease can live for months or years, and many are now cured.

Surgery is not a cure for leukemia. Radiation therapy is sometimes used for leukemia in the central nervous system or testicles and for pain caused by bone destruction. But radiation therapy is not the primary treatment. The standard treatments for adult leukemia are chemotherapy, immunotherapy, and bone marrow transplantation.

Bone Marrow Transplantation

A bone marrow transplant, which offers some leukemia patients the best chance for a cure, is usually performed when your leukemia is in remission or when you relapse during or after treatment. The transplant enables you to receive greater amounts of chemotherapy drugs than your body could tolerate otherwise. High doses of these drugs effectively destroy cancer cells, but they also kill the normal infection-fighting cells of the bone marrow. To compensate for this destruction, high doses of anticancer drugs and of radiation therapy (to destroy any remaining cancer cells) are followed by an infusion of healthy bone marrow cells. The procedure is called an autologous transplant if these new healthy cells the body's own. If they are donated by a donor, it is known as an allogeneic transplant.

In allogeneic bone marrow transplantation, the donor's bone marrow must "match" the body's own to ensure the body is to accept the donated marrow. Relatives (usually siblings) are the people best considered as possible donors.

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