What is leukemia?

Leukemia is cancer of the blood cells. It starts in the bone marrow, the soft tissue inside most bones. Bone marrow is where blood cells are made.

• White blood cells help your body fight infection.
• Red blood cells carry oxygen to all parts of your body.
• Platelets help your blood clot.

When you have leukemia, the bone marrow starts to make a lot of abnormal white blood cells, called leukemia cells. They don't do the work of normal white blood cells. They grow faster than normal cells, and they don't stop growing when they should.

Over time, leukemia cells can crowd out the normal blood cells. This can lead to serious problems such as anemia, bleeding, and infections. Leukemia cells can also spread to the lymph nodes or other organs and cause swelling or pain.

Symptoms of acute leukemia depend on how much the cancer has grown. They may include:

• A new lump or swollen gland in your neck, under your arm, or in your groin.
• Frequent nosebleeds, bleeding from the gums or rectum, more frequent bruising, or very heavy menstrual bleeding.
• Frequent fevers.
• Night sweats.
• Bone pain.
• Unexplained appetite loss or recent weight loss.
• Feeling tired a lot without a known reason.
• Swelling and pain on the left side of the belly.

The chronic forms of leukemia often cause no symptoms until much later in the disease. And when symptoms appear, they usually appear gradually.

Finding the type of leukemia

If your blood work points to possible leukemia, your doctor will want to find out what kind you might have. Your treatment plan will depend on the specific kind of leukemia that you have.

• A blood test is usually enough to find signs of chronic lymphocytic leukemia (CLL).
• Tests that look closely at unusual cells, chromosomes, or proteins on cells can show what type or subtype of leukemia you have. These tests include:
  • A test that looks for certain changes in the cell chromosomes from a sample of blood or bone marrow (cytogenetic analysis).
  • A test that compares cancer cells to normal blood cells to find the specific kind of leukemia (immunophenotyping).
  • A test to look for genes that are "turned on" in several types of leukemia, such as acute myelogenous leukemia (AML). This test is called a reverse transcription-polymerase chain reaction test, or RT-PCR.

These tests can help guide treatment. Sometimes they can help your doctor and you know whether your leukemia is likely to go into remission or come back. In some cases, the tests can predict survival rates.

Your doctor may also order other tests, including:

• Chest X-rays, to find out if leukemia or an infection is the cause of lung problems such as persistent coughing, coughing up blood, chest pain, or trouble breathing.
• CT scan of the head, chest, and belly, to find out if leukemia has spread there.
• Lumbar puncture, to find out if leukemia cells are in your cerebrospinal fluid (CSF).
• MRI of the brain, to look into symptoms such as confusion, paralysis, numbness, vision problems, vertigo, or headaches. Those symptoms could mean that leukemia has spread to the brain.
• A biopsy of a lymph node or other tissues, to look for leukemia cells.

Treatment for leukemia is based on the type of leukemia, whether it has spread, and other things such as your overall health. Treatment options may include:

Chemotherapy and other medicines.

Chemotherapy medicines kill fast-growing cells, including cancer cells and some normal cells.

Other medicines may be given to help chemotherapy work better and prevent infection or bleeding. Examples include steroids and antibiotics.

Radiation therapy.

This uses high-dose X-rays to destroy cancer cells and shrink tumors.

Stem cell transplant.

This replaces damaged cells with healthy stem cells. They help your bone marrow make healthy blood cells.

Targeted therapy.

These medicines target cancer cells. They help keep cancer from growing or spreading.

Immunotherapy.

This treatment helps your immune system fight cancer. It may be given in several ways.

Sometimes a clinical trial may be a good choice.

Your doctor will talk with you about your options and then make a treatment plan.

• Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
• Follow your doctor's instructions to relieve pain. Pain from cancer and surgery can almost always be controlled. Use pain medicine when you first notice pain, before it becomes severe.
• Eat healthy food. If you do not feel like eating, try to eat food that has protein and extra calories to keep up your strength and prevent weight loss.
• Get some physical activity every day, but do not get too tired.
• Get enough sleep, and take time to do things you enjoy. This can help reduce stress.
• Think about joining a support group. Or discuss your concerns with your doctor or a counselor.
• If you are vomiting or have diarrhea:
  • Drink plenty of fluids to prevent dehydration. Choose water and other clear liquids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
  • When you are able to eat, try clear soups, mild foods, and liquids until all symptoms are gone for 12 to 48 hours. Other good choices include dry toast, crackers, cooked cereal, and gelatin dessert, such as Jell-O.
• If you have not already done so, prepare a list of advance directives. Advance directives are instructions to your doctor and family members about what kind of care you want if you become unable to speak or express yourself.