Leukaemia
Leukaemia is a cancer of the blood which affects thousands in the UK. It is caused when a surplus of white blood cells, produced to fight infection, do not perform and function in the same manner as a regular white blood cell. These abnormal white blood cells divide and reproduce rapidly leading to major difficulty in fighting infections and transporting oxygen. Leukaemia is different from other types of cancer because it develops in organs eg. Lungs and then spread to the bone marrow.
There are many different types of Leukaemia. For example, Leukaemia can be chronic or acute. This depends on the blood cells, whether they are mature (like normal white blood cells) or are immature (like stem cells). Chronic Leukaemia is when the cells cannot mature as they should, they do not die as normal white blood cells do and therefore build up and can crowd out the normal cells in the bone marrow. The chronic cells can live in a person for years and not cause any issues however, the chronic cells are often more difficult to treat than acute. Acute Leukaemia on the other hand, means that the leukaemia is more aggressive and will progress a lot more rapidly and will often require immediate treatment.
Another difference is that Leukaemia can also be lymphocytic or myeloid. This all depends on the type of bone marrow cancer begins in. if it begins in cells that become lymphocytes it will be lymphocytic and if it begins in early myeloid cells it will be myeloid leukaemia.
The main types of Leukaemia are:
• Acute myeloid leukaemia (AML)
• Chronic myeloid leukaemia (CML)
• Acute lymphocytic leukaemia (ALL)
• Chronic lymphocytic leukaemia (CLL)
Acute Myeloid Leukaemia
The focus of this assignment is on Acute myeloid leukaemia. The reason I have chosen to focus on this type of leukaemia is because a family member has been affected by it. This caused me to look into and research Acute myeloid leukaemia and is something I am passionate about.
Acute myeloid leukaemia is caused by a DNA mutation in the stem cells of a person’s bone marrow which produced red blood cells. There are many possible causes for this mutation. These include: Translocation; which is when part of a chromosome breaks off and attaches to another chromosome affecting nearby genes, Addition/duplication; which is when too many copies of a particular gene are produced in one cell, Deletions; which is when a part of a chromosome is lost, Inversions; which is when a chromosome is inverted causing the chromosome to be lost and is no longer readable by the cell.
Classification
Leukaemia unlike other cancers is not classified in stages instead they are classified by two main systems which are the new World Health Organisation Classification (WHO) and the French-American-British (FAB) classification. The reason Acute myeloid leukaemia cannot be classified in stages is because the cancer does not form tumours which is what the stage classification system is based on. The WHO and FAB classifications are based on other information such as patients age and other lab test results
Risk Factors
Risk factors are extremely important as they give information to patients but also healthy people on what lifestyle choices and environments to avoid. Acute myeloid leukaemia has many risk factors. Smoking is the only proven lifestyle related risk factor for not only acute myeloid leukaemia but also many other types of cancers such as cancer of the lungs and mouth. In addition to this some chemical exposures such as high levels of benzene. Also factors such as old age and family history cause a person to be more at risk. Sometimes a person may not be exposed to any of the risk factors associated with acute myeloid leukaemia but still have it.
Treatment
Throughout the years many different types of treatments have been trialled for acute myeloid leukaemia and luckily a good number of these trials have been proven to work. The different types of treatment depend on the type of leukaemia a patient may have. Treatment for Acute myeloid leukaemia should begin straight away as the cancer can spread rapidly.
Chemotherapy is the is usually the primary type of treatment for a patient suffering with acute myeloid leukaemia which is accompanied by a a targeted therapy drug and a stem cell transplant. Chemotherapy is split into two phases:
• Remission induction
• Consolidation
The aim for remission induction is to kill as many leukaemia cells as you can. There are different intensities of chemotherapy available depending on the patient’s age and health. For patients under 60 two types of drugs are given to the patient, cytarabine and anthracycline drug which is usually given to the patient in hospital. The problem that comes with chemotherapy and the remission induction stage is that the most of the normal bone marrow is destroyed as well as the leukaemia cells causing the patient to become quite ill. At this point the patient would require antibiotics, blood transfusions and drugs may also be used to boost the immune system by raising the white blood cell count. Eventually the blood marrow will regulate and return back to normal and will make new blood cells.
Consolidation is the next stage after induction is successful and remission is achieved. During this stage, the doctor usually decides what type of treatment to give the patient. The main objective of the consolidation stage is to destroy any remaining leukaemia cells and to prevent a relapse. The doctor has to take into account a many factors such as: tissue types, age of patient, wishes of the patient and the amount of chemotherapy courses that were taken by the patient. The treatments at this stage include: several cycles of high dose cytarabine which stops the cancer cells from making and repairing DNA that they need to grow and multiply. Alternatively, the patient could have an autologous stem cells transplant which is when your own stem cells are used to save the bone marrow from the harsh treatment. This method however is risky and could lead to more complications, usually doctors use this treatment as a backup in case the leukaemia returns after the regular treatment.
Symptoms
Symptoms are features which indicate a condition of disease. Symptoms allow doctors to come up with a prognosis. The symptoms for acute myeloid leukaemia include: tiredness, pale skin, weight loss, frequent infections, easily bruised skin, bone pain, joint paint, high temperature and breathlessness. The symptoms usually develop over time and can become worse as the patients’ health weakens.
Diagnosis
A number of steps need to be taken when diagnosis acute myeloid leukaemia. Firstly, the doctor will look for simple physical signs of leukaemia such as swollen gums, pale skin or significant bruising. A blood test should then be arranged for the patient. The blood tests are extremely important as they show the blood count, if the blood count is very low or alternatively very high, it can indicate a presence of leukaemia. In addition to this a sample of bone marrow must be taken and examined to see if there are any cancerous cells and should be checked for cancerous cells. If there are cancerous cells present, you can identify the genetic makeup of the leukaemia cell. There are many different variations of acute myeloid leukaemia so this helps the doctor pin point which type it is and make a decision on a treatment plan that suits the patient. Scans such as CT-scans and X-rays are also often used just to check the general health of the patient, the result of these test will also be used to help the doctor decide on the treatment plan. Lumbar punctures may also be used as a precaution to check if the leukaemia has spread to the nervous system. If this is the case the patient will require injections of chemotherapy medication directly into the patient’s cerebrospinal fluid.
Side effects
The drugs used when treating acute myeloid leukaemia have many side effects which are extremely likely to affect the patient. Each drug has different side effects so depending on the drug the side effects can vary. The side effects also depend on different factors such as: the dosage of drug, the way the drug is administered. The most common side effects are: hair loss, nausea, fatigue, high risk of infection and easy bruising. Many are short term side effects however some can be long term such as Infertility.
Conclusion
Leukaemia is the 11th most common cause of cancer in the UK (2014) and with 15% of the cases being preventable. As research continues treatment are significantly improving and mortality rates are decreasing, leukaemia mortality rates have decreased by around 4% which is significant.