Let's learn exactly about leukemia. What is it really, and is it something to be afraid of?

You may have been a little scared when you heard the word " leukemia ." That's normal, because we often get scared when we hear words like this. But when you learn exactly what it is, why it occurs, what are the symptoms, and whether there is a treatment, that fear is greatly reduced. So today, we're going to talk about this blood cancer condition called leukemia in a very simple way that you can understand. Just like a friend or family member would tell you about it.

What is Leukemia?

Simply put, leukemia is a cancer that starts in the blood . The bone marrow is the main place where blood is made in our body. It is like a factory. Inside this bone marrow, blood cells, especially immature white blood cells , start to grow rapidly and abnormally. The word "leukemia" comes from the Greek words "leukos" (white) and "haima" (blood).

Unlike other types of cancer , leukemia does not usually develop a tumor that can be seen on an X-ray or CT scan .

There are several types of leukemia. Some types are more common in young children, while others are more common in adults. Treatment options depend on many factors, including the type of leukemia, your age, and your overall health.

How does leukemia develop?

Leukemia starts in the bone marrow , the soft, spongy part of our bones. This is where the blood cells our bodies need are made. These blood cells don't just form all at once, they go through several stages before they become fully mature. There are three types of healthy, mature blood cells:

• Red blood cells : These are what carry oxygen and other important things throughout our bodies.
• White blood cells : Their job is to fight infections.
• Platelets : These help blood clot.

All these blood cells start from special cells called hematopoietic stem cells. These stem cells then divide into two types: myeloid cells and lymphoid cells. If these develop normally, the mature cells that form are:

• Myeloid cells give rise to red blood cells, platelets, and some types of white blood cells (basophils, eosinophils , and neutrophils).
• Lymphoid cells give rise to other types of white blood cells (lymphocytes) and natural killer cells.

But, in a person with leukemia, one of these growing blood cells starts to divide rapidly and uncontrollably . We call these abnormal cells "leukemia cells." These leukemia cells take up space in the bone marrow, crowding out the space for healthy red cells, white cells, and platelets.

How does leukemia affect your body?

Imagine what happens when there are too many leukemia cells and too few healthy cells. This raises several questions:

• Leukemia cells do nothing to keep your body healthy.
• Because leukemia cells fill the bone marrow, healthy blood cells do not have room to develop and grow properly .
• Therefore, the body does not produce enough red blood cells, healthy white blood cells, and platelets to be able to accumulate in the blood.
• As a result, your organs and tissues don't get enough oxygen. Your body can't fight infections or clot blood if you bleed.

What are the main types of leukemia?

There are four main types of leukemia and several subtypes. Doctors classify leukemia based on how quickly the disease spreads and whether the leukemia cells originate from myeloid or lymphoid cells.

By speed of disease progression

• Acute leukemia : In this type of leukemia, the cells divide very quickly, and the disease progresses quickly. If you have acute leukemia, you will start to feel sick within a few weeks. This can be life-threatening, so treatment should be started immediately . Acute leukemia is the most common type of cancer in young children.
• Chronic leukemia : In this type, leukemia cells sometimes behave like immature cells and sometimes like mature cells. Some cells grow to a certain extent and do their job to some extent – ​​but not as well as healthy cells. The disease progresses more slowly than in acute leukemia. If you have chronic leukemia, you may not have any major symptoms for years. It is more common in adults than in children.

By cell type

• Myelogenous or Myeloid leukemia : This develops from myeloid cells. Normal myeloid cells produce red blood cells, white blood cells, and platelets.
• Lymphocytic leukemia : This develops from lymphoid cells. White blood cells that develop from normal lymphoid cells are a very important part of our body's immune system.

Four main types of leukemia

Combining these two classifications, four main types of leukemia have been identified:

1. Acute Lymphocytic Leukemia (ALL) : This is the most common type of leukemia seen in children and young adults (up to 39 years of age). However, it can occur in adults of any age.

2. Acute Myelogenous Leukemia (AML) : This is the most common type of acute leukemia in adults. It is especially common in people over the age of 65. It can also occur in young children.

3. Chronic Lymphocytic Leukemia (CLL) : This is the most common type of chronic leukemia among adults (especially those over 65 years of age). In CLL, symptoms may take several years to appear.

4. Chronic Myelogenous Leukemia (CML) : This is also more common in older people (especially those over 65), but it can affect adults of any age. It is very rare in young children. In CML, symptoms may take several years to appear.

How common is leukemia?

According to statistics in some countries around the world, leukemia is considered the tenth most common cancer. Although it can develop in anyone, some groups have been found to be at a slightly higher risk:

• People between the ages of 65 and 74.
• Men.
• Among some ethnic groups (e.g. Caucasians/whites - these are foreign data).

Many people think of leukemia as a disease that only affects young children. However, some types of leukemia are more common in adults. Although leukemia is rare in children, it is the most common type of cancer in children and young adults.

What are the symptoms of leukemia?

Symptoms depend on the type of leukemia. For example, if you have chronic leukemia, you may not have any major symptoms in the early stages.

Here are some of the common symptoms of leukemia:

• Sudden fatigue , easily tired.
• Having a fever or sweating at night .
• Frequent infections .
• Difficulty breathing .
• Pale skin .
• Weight loss without reason.
• Bone/joint pain or tenderness.
• Pain or a feeling of fullness under the ribs on the left side.
• Swollen lymph nodes in the neck, armpits, groin, or abdomen, enlarged spleen or liver.
• Easy bruising and bleeding . Nosebleeds, bleeding gums, a rash that looks like small red spots on the skin (petechiae) or purple/black spots on the skin.

If you have one or more of these symptoms, it does not necessarily mean that you have leukemia. However, if you have these symptoms, it is very important to see a doctor for advice.

What are the causes of leukemia?

Leukemia starts with a change (mutation) in the DNA of a single cell in your bone marrow. DNA is like a "set of instructions." This DNA tells a cell when to grow, how to form, and when to die.

Because of this mutation, leukemia cells start to divide continuously. Every cell that develops from the original mutated cell has this mutated DNA.

Scientists still don't know exactly why these cells mutate, but they have identified some common mutations that are seen in people with different types of leukemia.

Who is at higher risk of developing leukemia?

Anyone can develop leukemia. However, studies have found that certain factors may increase the risk. Some of these factors include:

• Having received previous cancer treatment : If you have received cancer treatments such as radiation therapy or chemotherapy, you are more likely to develop some types of leukemia.
• Smoking : If you are a smoker or are exposed to second-hand smoke, you are at increased risk of developing acute myelogenous leukemia (AML).
• Exposure to industrial chemicals : Benzene and formaldehyde are carcinogenic chemicals. They can be found in building materials and household chemicals (plastics, rubber, dyes, pesticides, medicines, detergents, soaps, shampoos, cleaners).
• Certain genetic conditions : Genetic conditions such as neurofibromatosis, Klinefelter syndrome, Schwachman-Diamond syndrome, and Down syndrome may increase the risk.
• Family history of leukemia : Research suggests that some types of leukemia may run in families. However, in most cases, just because someone in your family has leukemia doesn't mean you or someone else in your family will develop leukemia. Tell your doctor if you or someone in your family has a genetic condition. They may recommend genetic testing to assess your risk.

How is leukemia diagnosed?

The results of a routine blood test may give your doctor a clue that you may have acute or chronic leukemia, and that further testing is needed. Or, if you have symptoms of leukemia, your doctor may recommend a series of tests.

Diagnostic tests may include:

• Physical exam : The doctor will ask you about your symptoms and feel your body for swollen lymph nodes, an enlarged spleen, or liver. They will also check for bleeding or swelling of the gums. They may also look for a skin rash, which can be red, purple, or brown, and is associated with leukemia.
• Complete Blood Count (CBC) : This blood test can tell your doctor if your red blood cell, white blood cell, and platelet counts are abnormal. If you have leukemia, your white blood cell count will likely be much higher than normal.
• Blood cell tests : Your doctor may also order additional blood tests to look for signs of leukemia cells or a specific type of leukemia. Flow cytometry and peripheral blood smear are other tests your doctor may order.
• Bone marrow biopsy (or bone marrow aspiration) : Your doctor may do this test if you have an abnormality in your white blood cell count. In this test, a long needle is inserted into your bone marrow (usually in your hip bone) to remove a sample of fluid. The sample is then tested in a lab to see if there are leukemia cells. A bone marrow biopsy can determine the exact percentage of abnormal cells in your bone marrow, which can help confirm a diagnosis of leukemia.
• Imaging and other tests : If your symptoms suggest that leukemia has affected your bones, organs, or tissues, your doctor may order a chest X-ray, CT scan, or MRI scan. However, these imaging tests cannot see leukemia cells.
• Lumbar puncture (or spinal tap) : The doctor may test a sample of spinal fluid to see if leukemia has spread to the fluid surrounding the brain and spinal cord (spinal fluid).

How is leukemia treated?

Treatment for leukemia depends on the type of leukemia you have, your age and overall health, and whether the leukemia has spread to other organs or tissues.

Common treatments may include one or more of the following:

• Chemotherapy : This is the most common treatment for leukemia. It uses chemicals (drugs) to kill leukemia cells or stop them from dividing. During treatment, you may receive these chemicals as pills, as an injection into a vein, or as an injection under the skin. Chemotherapy is usually given in combination with several drugs.
• Immunotherapy (or biologic therapy) : This treatment uses special drugs to boost your body's defense system—the immune system—to fight leukemia. Immunotherapy helps your immune system recognize cancer cells and produce more immune cells to fight them.
• Targeted therapy : This treatment uses drugs designed to attack specific parts of a leukemia cell (such as a protein or gene). These parts are what cause the leukemia cells to outnumber normal blood cells. Targeted therapy can stop leukemia cells from dividing, cut off the cells' blood supply, or kill them outright. Targeted therapy causes less damage to normal cells. Examples of these drugs include monoclonal antibodies and tyrosine kinase inhibitors.
• Radiation therapy : This treatment uses high-energy beams or X-rays to kill leukemia cells or stop them from growing. During treatment, a machine can either direct the radiation to the exact location of the cancer cells or distribute it throughout the body. Whole-body radiation may be given before a hematopoietic cell transplant.
• Hematopoietic cell transplant (or `stem cell` or `bone marrow transplant`) : In this treatment, cancerous blood-forming cells that have been destroyed by chemotherapy and/or radiation therapy are replaced with new, healthy blood stem cells. Your doctor may take these healthy cells from you before chemotherapy and radiation therapy, or they may come from a donor. These new healthy cells divide and make new bone marrow and blood cells (the red blood cells, white blood cells, and platelets that your body needs).
• Chimeric Antigen Receptor (CAR) T-cell therapy : This is a new type of treatment. It involves taking your body's own infection-fighting T-cells (a type of immune cell called a T-cell or T-lymphocyte), re-engineering them to fight leukemia cells, and then reintroducing them back into your body.

You may also have the opportunity to participate in clinical trials that test new cancer treatments. Talk to your doctor about the pros and cons of participating in such a trial.

What are the stages of leukemia treatment?

Depending on your treatment plan, you may receive leukemia treatment continuously for a long time, or you may receive treatment in several stages. Typically, staged treatment consists of three parts. Each stage has a specific goal.

1. Induction therapy : The goal of this is to kill as many leukemia cells as possible in your blood and bone marrow and put you in remission. In remission, your blood cell counts return to normal, your leukemia cells are no longer detectable in your blood, and all signs and symptoms of the disease disappear. Induction therapy usually lasts about four to six weeks.

2. Consolidation therapy (also called ``(Intensification)``) : The goal of this is to destroy any remaining, undetectable leukemia cells. This can help prevent the cancer from coming back. This treatment is usually given in several cycles, over a period of four to six months.

3. Maintenance therapy : The goal of this is to destroy any leukemia cells that may remain after the first two treatment cycles and prevent the cancer from coming back (relapse). This treatment is continued for about two years.

If the leukemia comes back, your doctor may restart or change your treatment.

What kind of outcome can I expect after a leukemia diagnosis?

It is difficult to give an exact prognosis for leukemia, as everyone's experience is different. The outcome depends on several factors:

• Genetic abnormalities or mutations (`(Mutations)`) : The mutations within the leukemia cells are the most important indicator of the outcome.
• Type of leukemia : Some types of leukemia have better outcomes than others.
• Blood cell count at diagnosis : The number of leukemia cells present at diagnosis can also affect your results.
• Age : In general, the younger you are when diagnosed, the better the outcome is likely to be.
• Health status : In general, the healthier you are when diagnosed, the better the outcome is likely to be.
• Response to treatment : The time it takes for the cancer to go into remission (`(Remission)`) can give an idea of ​​how successful the treatment is.
• Presence of leukemia cells in the central nervous system : If there are cells in your spinal fluid, it may be difficult to treat them.

Ultimately, your doctor is the best person to understand how your cancer affects you uniquely. Ask them about treatment outcomes.

Can leukemia be completely cured?

There is no such thing as a "complete cure" for leukemia. But that doesn't mean that some people don't go into long-term remission. Being cured of leukemia means that the cancer is gone, it won't come back, and no further treatment is needed. But with leukemia, this is hard to say for sure.

On the other hand, long-term remission means that there are no signs of the cancer, with or without treatment. This remission can last from a few weeks to several years. The leukemia may never come back. If it does come back, your doctor may recommend new treatments to achieve remission.

Your medical team can best answer the question, "Is my leukemia cured?" They will carefully monitor your health and create a treatment plan that is right for you.

What questions should you ask your doctor?

Empower yourself by learning as much as you can about how your cancer diagnosis affects you specifically. It's a good idea to write down things and take a friend with you when you go to see your doctor. Don't be afraid to ask questions.

Some questions you can ask:

• What type of leukemia do I have? What type of cells does it consist of? Is it a fast-growing cancer or a slow-growing one?
• How early was leukemia detected?
• What treatment options do I have?
• What are the benefits and risks of each treatment method?
• What treatment plan is best for me? Why?
• When should treatment start?
• How long does treatment (and each treatment phase) take?
• How long will I have to stay in the hospital?
• What are the side effects of treatment? What can be done to prevent or reduce them?
• What if I want to have children? What are the options to preserve my fertility?
• What is the survival rate for my type of leukemia?
• Should I participate in a clinical trial?

Where can I get more information and support about leukemia?

To learn more about clinical trials for leukemia, you can visit international websites (e.g., Leukemia & Lymphoma Society, National Cancer Institute, American Cancer Society). Also, ask your doctor about local resources and support groups.

Any cancer diagnosis is scary. But a leukemia diagnosis can be even more scary. Without a tumor to remove, it can be hard to know what the treatment experience will be like and what the future holds. Remember, leukemia is not a one-size-fits-all. Your treatment and chances of long-term remission depend on many factors. No one can predict your outcome without understanding your health and leukemia, including the characteristics of the leukemia cells. Talk to your doctor about what a leukemia diagnosis means to you.

Brief points to remember

Okay, so from what we've discussed, I hope you've got a good idea about leukemia. Here are some important things to remember:

• Leukemia is a cancer of the blood , caused by the uncontrolled growth of abnormal cells in the bone marrow.
• There are two main types of this: acute and chronic, and myeloid and lymphoid .
• Symptoms vary, and may include sudden fatigue, frequent infections, and easy bruising .
• Although the exact cause is unknown, genetic changes, certain chemicals, and previous cancer treatments may be risk factors.
• The disease is mainly diagnosed through blood tests and bone marrow biopsy .
• There are many treatment options (such as ``Chemotherapy'', ``Immunotherapy'', ``Targeted therapy''), which depend on the patient and the nature of the disease.
• Rather than talking about a complete cure, we can hope for a long-term remission .
• Don't be afraid to ask questions and get information from your doctor . You are not alone.

We hope this information is useful to you. Stay healthy!

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