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Leukemia

  

What Is It? A type of malignant cancer of the white blood cells leading to excessive sweating especially at night, fatigue and weakness that do not resolve upon resting, bone pain and tenderness all over the body, fever or chills, lymphadenopathy (swollen non tender lymph nodes, especially in the neck and under the arms), weight loss, spleen and liver enlargement, petechiae (red rash), easy bruising, numerous infections

Incidence: The prevalence (number living with leukemia) in the US is 334,000 (one out of every thousand people).  The incidence is 60,000 new cases per year in the US. The overall incidence is about 15 out of 100,000 people each year in the US. Depends on the type: Acute Myelogenous Leukemia (AML) affects the granulocytes- ie. eosinophils and neutrophil types of white blood cells.  21,000 new cases are seen each year in both adults and children.

Acute Lymphocytic Leukemia (ALL) only occurs in children and affects the lymphocytes that are produced bone marrow.  Approximately 6,000 new cases are diagnosed each year. 

Chronic Myelogenous Leukemia (CML) is a slower onset disease affecting the neutrophil and eosinophil white cells , mainly in adults, with 7,000 new cases annually diagnosed.

Chronic Lymphocytic Leukemia (CLL) is a slower onset disease affecting people over 55, with 15,000 new cases seen each year.

Location:  Originates in leucocytes  (white blood cells).  The difference between leukemia and lymphoma is that in leukemia the cancer is primarily confined to the bone marrow whereas in lymphoma, the cancer is in the lymph nodes and other tissues (that may also include the bone marrow)

Anatomy: The lymphocytes are a type of white blood cell arising from the liver and spleen whereas the granulocytes are composed of the neutrophils and eosinophils made in the bone marrow.

Onset: Weeks to months

Character: Deep aching bone pain

Intensity: Moderate

Worsens: Night time

Relieved by: -

Causes: All are genetic mutations induced or "switched on" by environmental factors or endogenously mutated.  The mechanisms of how all the genetic mutations occur is unknown.  There are associations with other conditions as listed below

Diagnosis: CBC and liver function tests, lymph node biopsy, bone scan, flow cytometry, and biopsy of tissues for staging.

Outcome: Survival from leukemia depends on the stage of the leukemia, type of leukemia, age of the patient, and specific treatment protocol employed. These are constantly changing protocols.  Childhood 5 year survival rates overall: ALL 85%, AML 70%, CML 80%.  Adult plus children combined 5 year survival rates overall: ALL 70.1% overall, AML 26% overall, CML 62%, CLL 85%.  

Associated with: Family history of leukemia, smoking (AML), Down's syndrome, preleukemia (myelodysplastic disorders), benzene exposure, high radiation exposure, prior treatment of cancer with ionizing radiation or chemotherapy

Treatment: Chemotherapy, radiation, bone marrow transplantation, stem cells all depending on the staging of the leukemia

Differential Diagnosis: Lymphoma, other types of leukemia

Complications: Metastasize (spread) to the lungs, kidneys, heart, gastrointestinal tract, and testes.