A brief guide to understanding leukemia

While a diagnosis of leukemia is certainly frightening, many forms of this disease can be held in check for years with minimal treatment and appropriate follow-up. Here's are some facts about leukemia:

Leukemia is a cancer of the body’s infection-fighting white blood cells. Unlike most cancers, in which solid tumours form in specific organs, the malignant cells in leukemia often appear in your bone marrow, where all blood cells are made, and then spread throughout your body.

• No one is sure what causes leukemia, although pesticides, industrial chemicals, radiation, high-voltage power lines, a virus called HTLV-1 and previous treatments for cancer have in some cases been linked to an increased risk for developing it.
• Some people may also possess genetic factors that increase their susceptibility to certain forms of the disease. The broad categories of leukemia are grouped according to the types of cells affected and how fast the disease progresses.
• Acute forms develop rapidly, whereas chronic forms may remain stable for many years.
• There are four major types of leukemia: acute lymphocytic leukemia (ALL), chronic lymphocytic leukemia (CLL), acute myelogenous leukemia (AML) and chronic myelogenous leukemia (CML), as well as many subcategories.
• One of the rarer forms of the disease is a chronic variation called hairy cell leukemia, because the malignant cells look as though they have projecting hairs when they're examined under a microscope.
• In all forms of leukemia, white blood cells proliferate or grow out of control. Your symptoms will depend on the type of leukemia you have. In acute leukemia (ALL or AML), you produce lots of white blood cells, but they are immature and can't perform their normal infection-fighting duties. That’s why symptoms similar to the flu (respiratory or throat infections, fever, fatigue) often arise suddenly and recur. By contrast, chronic leukemia (CML or CLL) often causes no symptoms at all; it’s commonly discovered during a routine blood test. Over time chronic leukemia sometimes develops into a more acute form. By monitoring symptoms and body changes, you can provide information so your doctor can choose the best treatment for you.

• Imaging techniques (X-rays, ultrasound, bone scans) may be done to check the chest, kidneys, liver, spleen, bones or other areas.
• A spinal tap may be needed to see if leukemia has spread.
• For acute leukemia, chemo­therapy and a bone marrow transplant may be indicated.
• For chronic leukemia, a wait-and-watch approach may suffice.
• New drugs like Gleevec may be an option for some.

Work with your doctor to find a leukemia specialist: an oncologist specializes in cancer care, a hematologist in diseases of the blood and a hematology-oncologist specializes in leukemia and other blood-related cancers.

• See your doctor for regular follow-up visits. It’s important that you report any new symptoms so that your doctor can gauge treatment success and disease remissions.
• Try relaxation therapies. Coping with leukemia can be emotionally exhausting. Relaxation therapies (guided imagery, meditation, biofeedback, massage) may all improve your ability to deal with daily stresses.
• Start a healthy eating program to bolster your strength and reserve. Leukemia treatment is hard on the body. A nutritionist can help you design an optimal diet.
• Avoid exposure to known toxins such as benzene, which may increase your leukemia risk. Pesticides used in farming have been linked to the disease.

Many people with leukemia enter clinical trials. Contact the National Cancer Institute of Canada (613-533-6430 or www.ctg.queensu.ca).Considering a bone marrow transplant? The Vancouver-based Canadian Blood and Marrow Transplant Group is a good place to start (604-874-4944 or www.cbmtg.org).

Although it can be terrifying, there are many options out there for people diagnosed with leukemia, especially if it is caught early. Talk to your doctor about the best way to approach your treatment.