Are you aware of the leukemia symptoms in adults?
Leukemia is a white blood cell disease that plays a vital role in our immune system. White blood cells or lymphocytes strengthen the body’s immune system by engulfing bacteria and other foreign substances, thus protecting them from infection.
In leukemia, abnormal white blood cells show unlimited multiplication, crowding the normal blood cells. This abnormal cell growth occurs due to mutational changes in the bone marrow, where different blood cells like RBC, WBC, and platelets are produced.
Early symptoms of leukemia in adults can often mimic the symptoms of common illnesses. The most common symptoms of leukemia in adults include :
- Unexplained weight loss: When you notice sudden weight loss without effort, this might be a sign of leukemia. Here more abnormal WBCs are produced, which take up the energy normally stored as fat.
- Night sweats: Due to the abnormal build-up of leukemia cells in the body, the temperature goes higher than normal, which is fever followed by excessive sweating at night. This is the body’s natural mechanism to fight against abnormal infection-causing cells.
- Easy bruising and bleeding: Platelets play an essential role in the blood clotting mechanism. Due to leukemia, the number of platelets is remarkably reduced, resulting in bleeding gums, nosebleeds, heavy menstrual bleeding, and small purple spots under the skin.
- Aching in bones and joints: In leukemia, the abnormal cells accumulate in the space around the bone and joints, creating pressure, and resulting in aching pain.
- Shortness of breath: Since leukemic patients develop anemia due to low RBC count due to overcrowding of WBC, the red blood cell cannot function properly. This hampers the ability to carry oxygen to the tissues and the cells, causing shortness of breath.
- Other additional symptoms of leukemia include lightheadedness, weakness, feeling tired, loss of appetite, swollen lymph nodes, enlarged liver or spleen, nausea or vomiting, and numbness
Types of leukemia
There are 2 types of leukemia
The first type of leukemia can be classified based on how fast leukemia spreads or the rate of the disease.
Chronic leukemia :
In chronic leukemia, mature blood cells replicate over time slowly and can function normally for a longer period. Some symptoms include enlarged but painless lymph nodes, weight loss, and fatigue.
Acute leukemia :
In acute leukemia, the cells of the bone and the bone marrow are affected, which in turn affects the white blood cells to multiply abnormally, causing cancer. In this type of leukemia, immature blood cells multiply rapidly and fail to carry out their normal function causing the disease to worsen quickly.
Symptoms of this disease include enlarged lymph nodes, bleeding gums, fever, and bone pain.
The second type of leukemia can be classified based on the type of white blood cells affected.
- Lymphocytic leukemia, chronic or acute lymphocytic leukemia, mostly affects older adults. It affects the lymphoid tissue. Symptoms include swollen lymph nodes, pain in the upper left portion of the abdomen, and fatigue.
- Myelogenous leukemiaThis type of leukemia affects the myeloid cells that produce red blood cells, white blood cells, and platelets.
Types of leukemia in adults
The types of leukemia which occur in adults are:
#1. Chronic lymphocytic leukemia (CLL)
CLL or chronic lymphocytic leukemia usually occurs in older adults above 65. It rarely affects children and is a prolonged process. Here the cells usually function for years, and survival is possible without needing treatment. This is caused due to changes in the DNA of the cells to produce abnormal, ineffective lymphocytes.
Apart from being ineffective, these abnormal cells multiply even after the normal cells die. This causes crowding and interferes with the blood cell production in the bone marrow. Having a first-degree relative or anyone in family history having leukemia puts people at increased risk.
Symptoms of CLL include:
- Painless enlarged lymph nodes
- Fever, Frequent infections.
- Shortness of breath
- Unexplained weight loss
- Loss of appetite
- Enlarged spleen and lymph nodes2. Chronic myeloid leukemia (CML)Chronic myelogenous leukemia or CML is a type of leukemia that affects the myeloid cells, similar to CLL. symptoms include shortness of breath
2. Chronic myeloid leukemia (CML)
Chronic myelogenous leukemia or CML is a type of leukemia that affects the myeloid cells similar to CLL. symptoms include shortness of breath
3. Acute myeloid leukemia (AML) is fast-growing leukemia that usually affects immature white blood cells. Still, sometimes it can also affect the red blood cells blood tests for AML reveal more WBC. Myleoblasts are typically found and are not present normally among healthy blood cells.
4. Acute lymphocytic leukemia (ALL)
It is common in children and is also fast-growing leukemia affecting lymphoid cells. Symptoms of acute lymphoblastic leukemia include night sweats, easy bruising and bleeding, shortness of breath, and pinpoint scars under the skin.
5. Hairy cell leukemia is a rare form of leukemia where the bone marrow produces too many lymphocytes.
How does chronic leukemia differ from Acute?
In acute leukemia, the cells divide rapidly, and the disease progresses quickly. The body shows signs and symptoms of leukemia within weeks of leukemia cells forming. Acute myeloid leukemia is most common in children and is called pediatric cancer. Chronic leukemia is slow and progresses slowly with older age.
Often they have features of both mature and immature cells. People suffering from chronic myeloid and lymphocytic leukemia may not show the obvious signs and symptoms for years.
Here the blood cells function almost like the healthy blood cells but not to the extent that the normal ones do.
Who is at a higher risk of getting leukemia?
Leukemia is a non-communicable disease that cannot catch this disease by someone else. White males over 65 are more susceptible to acquiring leukemia, but it can affect children too. Here are a few possible risk factors which are the most common :
- Genetic disorders: Genetic disorders like down syndrome, Klinefelter’s syndrome, or neurofibromatosis are at risk of leukemia cell formation.
- Age: Mostly, leukemia develops in older males because they are slow-growing cancerous cells that develop slowly, affecting the healthy white blood cells
- Demographics: According to statistics, white males are more prone to develop leukemia. Males, in general, are more susceptible than females as the mutation in the gene is seen to occur in the X chromosome, and males only possess one, so it is dominant.
- Chemotherapy: Exposure to radiation and previous cancer treatment can effectively increase the risk for the same.
- Environmental Factors: People working in industrial areas expose themselves to smoke, which contains harmful cancer-causing chemicals like formaldehyde and benzene. The history of smoking also causes potential risks.
Is Leukemia a genetic disorder?
Leukemia is not a hereditary disease, and it does not pass in families; however, a person can attain some genetic abnormalities that can lead to the disease. An abnormal chromosome called the Philadelphia chromosome is formed when chromosomes 9 and 22 exchange positions.
When found in bone marrow, this chromosome is the obvious proof of myelogenous leukemia. Philadelphia chromosomes act as a marker and help doctors identify the cancer cells.
This chromosome produces an abnormal enzyme called tyrosine kinase, which causes the cancer cells to grow uncontrollably.
Tests that diagnose Leukemia
The physical exam checks for general symptoms like swollen lymph nodes in the armpit and the neck region. Bleeding gums and tiny bruises under the skin are called petechiae.
These are the signs of an enlarged spleen. Early-stage chronic leukemia patients may or may not have any obvious symptoms. Early leukemia symptoms may be similar to common illnesses like fever, flu and cold, and feeling tired.
The examiner may check for the sensations and reflexes in different body areas along with a physical test that involves checking body balance.
Laboratory tests :
Complete blood cell count:
This test measures the ratio of red blood cells, white blood cells, and platelets in the blood smear. Generally, amount the of red blood cells and platelet count is lesser than that of white blood cells because in chronic leukemias WBC count is abnormally large. The developing leukemia cells are usually immature and may be found in this blood test.
Other blood tests may include examining the substances released from tissues and organs. These help in determining chromosomal abnormalities that lead to leukemia.
Bone Marrow aspiration /Bone Marrow biopsy
A long needle is inserted into your hip bone to extract the fluid from the bone marrow during this procedure. If leukemia cells are present, the percentage of abnormal cells in the bone marrow will confirm leukemia.
CT scan/MRI or chest x-ray are used to determine if there is a complication. Lumbar puncture is done to see if cancer has spread to the surrounding fluid brain and spinal cord.
- Chemotherapy: These are medications administered to a patient’s body through subcutaneous shots under the skin or an Intravenous injection, or in the form of a pill. The treatment consists of chemicals that kill leukemia cells or stop them from further multiplication. Here the treatment is followed by a few days of rest for the patient’s body to recover.
- Radiation therapy: This treatment kills the leukemia cells by imparting strong energy beams to the position where the collection of cancer cells is present.
- Targeted therapy: Targeted therapy uses drugs to kill the ability of leukemia cells to multiply and divide by cutting off the blood supply to the cells or killing them directly. This is less likely to harm the normal cells.
- Hematopoietic cell transplant: Before chemotherapy, the normal healthy cells are taken from your bone marrow or a donor and injected into your body and the bloodstream. These hematopoietic cells multiply and grow to produce blood cells and platelets.
- Tyrosine kinase Inhibitors: This is taken orally in the form of pills. It is a targeted therapy that has lesser side effects than chemotherapy. It identifies and attacks the cancer cells directly. This causes less damage to normal cells and effectively treats long-term chronic myeloid leukemia.
- Stem cell transplant: A stem cell transplant is performed to replace the stem cells damaged during chemotherapy or radiation. Stem cells are the only cells that can transform into RBC, WBC, and platelets. A stem cell therapy has 3 stages induction, conditioning, and transplantation. First, the patient’s WBC count is brought to normal by chemotherapy. Any residual leukemia cells are destroyed with the help of a strong dose of chemotherapy. The donor cells are then infused, growing sufficiently into the bone marrow within 2 to 6 weeks. These donor cells then produce healthy new blood cells. Medication is also provided to the patient in case of graft rejection by the immune system.
What are the stages of leukemia treatment?
Induction: This is the first phase which lasts for about 6 weeks. This phase aims to kill as many leukemia cells as possible in the blood and the bone marrow. After this process, no more leukemic cells are found, and limited signs and symptoms are observed. This state is known as remission.
Consolidation: Consolidation therapy is more intense and is given to the patient in cycles over four to six months. This therapy aims to kill any undetected leukemia cells so that cancer does not relapse.
Maintenance Therapy: This usually lasts for two years and is given to kill the cells that may have survived the first two treatments. This prevents cancer from returning.
Sometimes leukemia cells hide in the brain and spinal cord where the chemotherapy cannot reach, which creates an increased risk of developing cancer again. Hence the treatments can also be extended to the central nervous system during these three phases.
Can leukemia be cured permanently?
Cancer researchers don’t guarantee that your body will be free of the disease after getting treated with chemotherapy or stem cell transplant but long-term remission is possible in this case. A remission is a state where the cancer is no longer detected in the body after the diagnosis and treatment.
According to the American cancer society, children under the age of 5 and younger adults are at high risk of leukemia and this slowly declines as they reach their mid 20’s.
According to the Leukemia and lymphoma society, nearly 90 per cent of children and 40 per cent of adults diagnosed with acute lymphocytic leukemia can expect a long-term remission.
What is the difference between leukemia and lymphoma:
Apart from leukemia, multiple myeloma and lymphoma are the types of blood cancer with more than 170,000 cases per year. There are 3 types of blood cancers
Multiple Myeloma: This cancer develops in the bone marrow and affects the plasma cells. These cancerous plasma cells accumulate around the bone and cause pain. Cancerous plasma cells also produce faulty antibodies that hamper the body’s ability to fight against infections.
Lymphoma: Unlike leukemia, lymphoma cells will not appear in the bloodstream. They affect the cells in the lymphatic system and mostly manifest in the lymph nodes and bone marrow.
As the symptoms of leukemia mimic the common illnesses in the early stage, it is difficult to figure out whether the disease is severe. However, the symptoms shouldn’t be ignored if they last for more than two weeks. The symptoms can vary with age. One should consult with their primary health care physician in such a case.
Leukemia can affect a vast age range from 5-year-old children to young adults or adults over 65. Although there are various treatments available to treat leukemia, every person’s body responds differently to them.
This does not mean there are fewer chances of survival, but in older adults, leukemia is often accompanied by other health conditions that worsen cancer. Hence age becomes an important risk factor. Chronic leukemias tend to increase with older age and tend to worsen gradually. One should never lose hope and have faith in treatments.
With the advancement in technology, newer therapy methods such as gene editing and immunotherapy are being developed, which program your immune system so that it is easier to kill the cancer cells.
One should talk to their doctors to choose the treatment plan that is best suited for their condition and whether one can handle chemotherapy or not. It is best to look for cancer support groups such as the leukemia and lymphoma society that provide you exposure to people with similar health issues during the treatments.
Here you can discuss your concerns, questions and how to handle anxieties surrounding cancer. These groups generally meet once a month to have a healthy discussion. These groups make you feel less alone and more connected to the people around you, motivating you for the journey ahead. They also provide mutual support and education to the family members to handle such sensitive issues.