Leukaemia

What is leukaemia?

Leukaemia affects white blood cells, which are part of the body's defence against infection. It can develop quickly (acute), or more slowly (chronic).

Depending on the type of white blood cell affected, most acute leukaemia is either acute lymphoblastic leukaemia (ALL) or acute myeloid leukaemia (AML). Chronic leukaemia is usually either chronic lymphocytic leukaemia (CLL) or chronic myeloid leukaemia (CML). However there are also several less common types of leukaemia.

In acute leukaemia, immature white blood cells accumulate in the body and can disrupt the function of many tissues and organs. Cells in chronic leukaemia are slightly abnormal and do not function as well as they should.

Symptoms

Often there are no symptoms at first and leukaemia may be a chance finding on a blood test. When symptoms do appear they may be vague and non-specific, similar to a flu-like illness.

Common symptoms include:

* Generalised weakness and fatigue
* Anaemia
* Frequent infections and fever
* Weight loss
* Excessive bruising or bleeding
* Pain in the bones and joints
* Breathlessness
* Enlarged lymph glands, liver and/or spleen
* Abdominal discomfort

Causes and risk factors

Leukaemia is the ninth most common cancer in men in the UK and the eleventh most common cancer in women in the UK. There are about 7,000 new cases in the UK each year and more men are affected than women.

It is the most common form of childhood cancer, but is ten times more common in adults.

The incidence of acute and chronic leukaemia is about equal. Slightly more men than women develop acute leukaemia, and slightly more men than women develop CML.

The risk of developing acute leukaemia is increased by radiation exposure, smoking, previous cancer and treatment for cancer, and blood disorders that damage the bone marrow. Chemical (benzene) exposure increases the risk of AML, while not smoking reduces it.

The risk of developing CML is increased by ageing, radiation exposure, chemical (benzene) exposure.

The risk of developing CLL is increased by ageing, being male and having a member of the family affected by CLL. Avoiding exposure to benzene reduces the risk of AML and CML.

Treatment and recovery

The diagnosis of a leukaemia will be based on a number of different tests including blood and bone marrow tests, scans to see which organs and tissues may be affected and tests to look for particular chromosomal or genetic changes. These will help to pin down the particular type of leukaemia and the treatment that should be recommended.

Not everyone diagnosed with leukaemia will need treatment immediately, and some patients never require treatment (CLL, for example, can progress so slowly in some older people that they are more likely to die from other problems first). However, for those who do, the earlier it begins the more effective it is.

Treatment for acute leukaemia can include chemotherapy (anti-cancer drugs), steroids, radiotherapy, intensive treatments (including bone marrow or stem cell implant) and growth factors (substances that stimulate the bone marrow to make blood cells). Treatment for chronic leukaemia can also include biological therapy, such as interferon alpha.

Prognosis and survival from leukaemia varies enormously, and depends on factors such as the type of leukaemia you have, how advanced it was when first diagnosed, how well it responds to chemotherapy treatment, and how generally fit you are. Each person should discuss this individually with the team in charge of their care.