Leukaemias are cancers of the white blood cells, which begin in the bone marrow. This information refers to three types of leukaemia; chronic lymphocytic leukaemia, all myeloid cancers and acute myeloid leukaemia.
There are several types, which are grouped in two ways: the type of white blood cell affected – lymphoid or myeloid; and how quickly the disease develops and gets worse – acute leukaemia appears suddenly and grows quickly while chronic leukaemia appears gradually and develops slowly over months to years.
Incidence and mortality
There are more than 4800 new cases a year in Australia, making leukaemia the eighth most common cancer overall. About 40% of cases are acute leukaemia. The risk of being diagnosed by age 85 for chronic lymphocytic leukaemia is 1 in 176 for all persons. For acute leukaemia it is 1 in every 207 persons. The highest risk exists for all myeloid cancers at 1 in every 55 persons by age 85 being diagnosed with the condition.
In 2007, there were 2489 deaths from leukaemia.
Screening
There is no routine screening test for leukaemia.
Symptoms and diagnosis
Many people with leukaemia have no symptoms. Symptoms tend to be mild at first and worsen slowly.
The main symptoms include:
- tiredness and/or anaemia (pale complexion, weakness and breathlessness)
- repeated infections (mouth sores, sore throat, fevers, sweats, coughing, frequent passing of urine with irritation, infected cuts and scratches, and boils)
- increased bruising and bleeding.
Other less common symptoms include:
- bone pain
- swollen tender gums
- skin rashes
- headaches
- vision problems
- vomiting
- enlarged lymph glands
- enlarged spleen that may cause pain or discomfort
- chest pains.
An initial blood test will show if blast cells are present. A bone marrow biopsy, chest x-ray and lumbar puncture are done to confirm diagnosis and the type of leukaemia.
Staging
Chest x-ray, CT scan and lumbar puncture determine if the leukaemia has spread. Cytogenetic analysis also may be used, to look for chromosomal changes.
For acute myeloid leukaemia and acute lymphoblastic leukaemia there is no standard staging system; the disease is described as untreated, in remission, or recurrent.
Staging of chronic myelogenous leukaemia is described in three phases:
- chronic – a few blast cells are found in the blood and bone marrow
- accelerated – after a few years the leukaemia may suddenly change and grow quicker
- blast – the number of blast cells increases, causing symptoms to worsen. Blast cells often spread to other organs
Chronic myelogenous leukaemia is described as stage 0 to IV, determined by the lymphocytes in the blood, size of lymph nodes and organs such as liver and spleen (larger = higher stage) and impact on red blood cells and platelets (fewer = higher stage).
Causes
The cause of acute leukaemia is unknown, but factors that put some people at higher risk are:
- exposure to intense radiation
- exposure to certain chemicals, such as benzene
- viruses like the Human T-Cell leukaemia virus.
Most people diagnosed with chronic myeloid leukaemia have an abnormal chromosone called the Philadelphia chromosone. It has also been linked to exposure to high levels of radiation.
Prevention
There are no proven measures to prevent lymphoma.
Treatment
Treatment depends on the type of leukaemia. Acute leukaemias develop quickly and need to be treated urgently, typically within 24 hours of diagnosis.
Common treatment options are:
- Acute lymphoblastic leukaemia
- chemotherapy
- peripheral blood stem cell and bone marrow transplantation
- radiotherapy to the head
- steroid therapy.
Acute myeloid leukaemia
- chemotherapy
- peripheral blood stem cell and bone marrow transplantation
- radiotherapy to the head.
Chronic lymphoblastic leukaemia
- watchful waiting
- radiation therapy
- chemotherapy (chemotherapy with stem cell transplant is being tested in clinical trials)
- surgery (removal of spleen)
- monoclonal antibody therapy.
Chronic myeloid leukaemia
- tyrosine kinase inhibitory therapy
- chemotherapy
- biologic therapy
- high-dose chemotherapy with stem cell transplant
- donor lymphocyte infusion
- surgery (removal of spleen).
Prognosis
An individual’s prognosis depends on the type and stage of cancer as well as their age and general health at the time of diagnosis. For most children and many adults who achieve remission, the leukaemia may be cured with peripheral blood stem cell or bone marrow transplantation and chemotherapy.
For more information, contact Cancer Council Helpline on 13 11 20 (cost of a local call).