Frequently Asked Questions About Leukemia

Leukemia is a form of cancer affecting blood cells that can be either acute or chronic. Here are some frequently asked questions about leukemia.

What is leukemia?

New blood cells are made in a substance within our bones called marrow. When a person has leukemia, his or her body makes too many blood cells, and the blood cells aren’t normal. Most often, the abnormal cells are white blood cells, either lymphoid cells (lymphocytic leukemia) or myeloid cells (myeloid or myelogenous leukemia).

Because the abnormal cells travel throughout your body in in your blood, they can affect almost any organ. That means leukemia can be present in many different ways, depending on which organs are involved.

YOU MIGHT ALSO LIKE: Types of Leukemia

What are normal blood cells, and what do they do?

Blood has several parts. The liquid part is called plasma. Blood cells are made in the soft center of bones, which is called bone marrow.

There are three kinds of cells in blood: white blood cells, red blood cells, and platelets. Each kind of cell has a special task.

Less mature forms of new blood cells are called blasts. As cells mature in bone marrow, they become smaller and more compact. That helps them do their jobs better.

Some new blood cells stay in bone marrow to grow. Some move to other parts of your body to grow. Your body produces blood cells at a faster rate when your body needs them. The process helps you stay healthy.

It helps to understand the role of each kind of blood cell:

• White blood cells. These help your body fight infection. If you have a bacterial infection, your body produces larger numbers of white blood cells to help fight the infection. If your white blood cell count is too low, your risk for infection increases.
• Red blood cells. These give your blood its color. They carry oxygen from your lungs to the rest of your body. They also take carbon dioxide from your body to your lungs. When you don’t have enough red blood cells, other cells may not get enough oxygen. This can cause fatigue, dizziness, weakness, headaches, and irritability.
• Platelets. These cells help form blood clots and control bleeding. If your number of platelets is abnormally low, it may lead to easy bruising or excessive bleeding from wounds or in mucous membranes.

Can leukemia be prevented?

Quitting smoking may lower your risk of acute myeloid leukemia (AML), as well as cancers of the lung, head, neck, esophagus, stomach, bladder, and some other cancers.

What are the symptoms of leukemia?

People with leukemia do not have enough healthy blood cells.

• They may not have enough red blood cells to carry oxygen throughout their body. This may cause them to look pale and feel weak and tired.
• People who do not have a lot of platelets may bruise and bleed very easily.
  
• A lack of healthy white blood cells may lead to infections that don’t go away.
• They may develop petechiae, called “leukemia spots.”
• Some people with chronic types of leukemia may not have any symptoms.

Other common symptoms of leukemia include:

• Frequent flu-like symptoms
• Persistent bruises
• Lethargy and weakness
• Dizziness
• Frequent infections
• Severe nosebleeds
• Headaches
• Feeling unusually cold
• Lack of appetite and weight loss
• Bone or joint pain
• Abdominal swelling

See a healthcare provider if such symptoms persist. They are not specific to leukemia. Many are more likely due to less serious conditions. Special tests of your blood and bone marrow can confirm a diagnosis of leukemia or another health problem.

What do leukemia spots look like?

They are reddish, purplish, or brown dots about the size of the head of a pin, occurring when capillaries break open and bleed underneath your skin. Normally, healthy blood would clot and stop the bleeding.

The dots come in clusters and are most noticeable in people with light skin. They most often show up on your arms, hands, legs, and feet but may appear on eyelids or inside your mouth.

The spots do not mean you have leukemia. They can occur if you vomit for a long time or if you have strep throat, mononucleosis, or another illness. See a doctor if you develop these spots and do not know the cause.  

What’s the difference between chronic and acute leukemia?

Leukemia is grouped in two ways. It may be acute or chronic, depending on how fast the cells grow and progress to more advanced phases of the disease, and on how much the leukemia cells resemble normal cells.

The disease is also lymphoid or myeloid, depending on the type of blood cell that has turned into cancer.

During acute leukemia, cancer cells are immature blood cells, called blasts, that cannot do their job. The number of these cells increases fast. The disease will quickly get worse unless it is treated.

In chronic leukemia, some young blood cells are present, but your body also makes more mature, functional cells. The number of blasts grows slowly. It takes a longer time for the disease to get worse. Sometimes the disease remains stable for many months or even years, even without treatment.

What are the different types of leukemia?

Leukemia is labeled as either acute or chronic. It grows in either the myeloid cells or the lymphoid cells. The four main types of leukemia are:

• Acute lymphocytic leukemia (ALL). This is the most common kind of leukemia in children. It can also occur in adults with increasing incidence as age increases.
• Acute myeloid leukemia (AML). This type affects adults and, less often, children. It is also called acute nonlymphocytic leukemia (ANLL).
• Chronic lymphocytic leukemia (CLL). This type is mostly seen in adults older than age 55. It is sometimes seen in younger adults but rarely occurs in children.
• Chronic myeloid leukemia (CML).  This type is seen mostly in adults. Very few children get this type.

Who is most at risk for developing leukemia?

Many people with leukemia have no known risk factors. Risk factors include:

• Advanced age (65 and older)
• Exposure to radiation
• Chemotherapy
• Genetic blood disorders
• Down syndrome
• Family history of blood cancer
• Tobacco use and exposure to secondhand smoke
• Exposure to certain chemicals, pesticides, or industrial solvents

For the specific kinds of leukemia, risk factors vary. Risk factors for AML include:

• Smoking
• Long-term exposure to high levels of benzene
• Prior exposure to high doses of radiation
• Certain blood disorders (polycythemia vera, essential thrombocythemia)
• Idiopathic myelofibrosis and myelodysplastic syndrome)

Certain genetic syndromes that are risk factors for AML include:

• Down syndrome
  
• Fanconi anemia
• Bloom syndrome
• Ataxia-telangiectasia
• Blackfan-Diamond anemia
• Li-Fraumeni syndrome
• Neurofibromatosis
• Kostmann syndrome

Risk factors for ALL include:

• Long-term exposure to high levels of benzene
• Exposure to high doses of radiation
• Certain viral infections (HTLV-1 and Epstein-Barr)

Some genetic syndrome risk factors for ALL include:

• Down syndrome
  
• Klinefelter syndrome
• Fanconi anemia
• Bloom syndrome
• Ataxia-telangiectasia
• Neurofibromatosis

Risk factors for CLL include exposure to Agent Orange and a family history of CLL

There are no known risk factors for CML.

How is leukemia treated?

Treatment depends on the kind of leukemia.

For some people with chronic leukemia, it is best to delay treatment while your medical team monitors the situation, an approach called “watchful waiting.”

Because leukemia affects bone marrow, surgery is not usually part of the treatment, and radiation is less common than in other cancers.

A person usually has a combination of treatments, such as:

• Chemotherapy. Most people with leukemia (especially acute leukemia) are treated with chemotherapy. This treatment uses drugs to kill cancer cells. People may take two or more drugs. Some of the drugs are taken as a pill, but most are given intravenously (IV). This treatment is considered systemic, meaning it destroys cancer cells throughout your entire body.
• Radiation therapy. The goal of radiation is to kill cancer cells using x-rays. This treatment is sometimes used in combination with chemotherapy or a bone marrow transplant. You can receive radiation over your entire body, called total-body irradiation (or TBI). You may receive radiation to just the part of your body in which more leukemia cells have gathered. Sometimes radiation is used to treat leukemia in the brain or to prevent it from spreading there.
• Targeted therapy. This treatment uses drugs to attack specific factors that make cancer cells different from normal cells. It affects mainly leukemia cells, not normal cells. That means targeted therapy may cause fewer side effects than other treatments. It is usually the first treatment for CML. 
• Stem cell transplant. The goal of this treatment is to kill as many cancer cells as possible, treating your body with very high doses of chemotherapy and radiation. Normally, your body would not be able to handle such high doses because it would kill the stem cells in your bone marrow. Therefore, after this treatment, your blood needs to be rescued with healthy, new stem cells. The new stem cells can come from the blood or bone marrow of a donor (allogeneic transplant). The stem cells can also come from your own blood or bone marrow (autologous transplant). In autologous transplants, stem cells are collected and stored before treatment with high-dose chemotherapy. Stem cell transplants occur in centers that specialize in this treatment.
• Biologic or immunotherapy. The goal of this treatment is to help your immune system fight the leukemia.
• Surgery. This is used less often for leukemia. In some cases, your doctor will do surgery to remove a swollen spleen.

Should everyone get a second opinion for leukemia?

Many people with cancer get a second opinion from another doctor. Reasons include:

• You are not comfortable with treatment recommendations.
• The cancer is a rare type.
• There is more than one way to treat the cancer.
• You are not able to see a cancer expert.

How can someone get a second opinion for leukemia?

Here are ways to find someone for a second opinion:

• Your primary doctor may recommend a specialist, such as a hematologist, medical oncologist, or radiation oncologist. Sometimes these doctors work together at cancer centers or programs.
• The Cancer Information Service at 800-4-CANCER (800-422-6237) tells callers about treatment facilities, including cancer centers and other programs supported by the National Cancer Institute.
• People can get names of doctors from their local medical society, a nearby hospital, a medical school, or local cancer advocacy groups, as well as from other people who have had that type of cancer.
• Contact other support organizations, such as the American Cancer Society, the Leukemia and Lymphoma Society, or the National Comprehensive Cancer Network.

Should I consider a clinical trial for leukemia?

Clinical trials are people-based studies. Among other things, they help show which types of treatment work best and which don’t. Deciding whether to participate is not easy. It’s a personal decision. No one can tell you whether a clinical trial is right for you.

It will help to discuss the risks and benefits of clinical trials with your doctor. Being open to a clinical trial, for example, may give you access to treatment that would otherwise not be available. On the other hand, the new treatment can have unknown risks and side effects that are difficult to manage.

What’s important is to determine whether the potential benefits outweigh the risks for you. That might be true if the leukemia doesn’t respond to the standard types of treatment. If you decide to participate in a clinical trial, be sure to get all your questions answered first.

YOU MIGHT ALSO LIKE: Our Cancer Care section