Leukemia: Frequently Asked Questions
Listed below are some frequently asked questions about leukemia.
Q: What is leukemia?
A: Leukemia is cancer of the bone marrow, which is where new blood cells
are made. When a person has leukemia, the bone marrow makes too many blood
cells, and they aren't normal. Most often the abnormal cells are white
blood cells. Two types of white blood cells can turn into leukemia. They
are the lymphoid cells and the myeloid cells. When leukemia is in the
lymphoid cells, it is called lymphocytic (or lymphoblastic) leukemia.
When it is in the myeloid cells, it is called myeloid (or myelogenous)
leukemia. Leukemia cells can travel with the blood all over the body.
That means they can reach almost any organ. Therefore, leukemia can be
present in many different ways, depending on which organs are involved.
Q: What are normal blood cells, and what do they do?
A: Blood has several parts.
The liquid part is called plasma. Blood cells are made in the soft center
of bones, which is called bone marrow. There are three kinds of cells
in blood. They are white blood cells, red blood cells, and platelets.
Each kind of cell has a special task. Less mature forms of new blood cells
are called blasts. As cells mature in the bone marrow, they become smaller
and more compact. They are better able to perform their special job. Some
new blood cells stay in the bone marrow to grow. Some move to other parts
of the body to grow. Your body produces blood cells at a faster rate when
your body needs them. This process helps you stay healthy. It helps to
understand the role of each kind of blood cell:
White blood cells. These help the body fight infection. If you have a bacterial
infection, your body produces larger numbers of white blood cells to help
fight the infection. But if your white blood cell count is too low, your
risk for infection increases.
Red blood cells. These give your blood its color. They carry oxygen from
your lungs to your tissues. They also take carbon dioxide from your tissues
to your lungs. When you don't have enough red blood cells (known as
anemia), other cells may not get enough oxygen. This can cause fatigue,
dizziness, weakness, headaches, and irritability.
Platelets. These help form blood clots and control bleeding. If your number
of platelets is abnormally low, it may lead to easy bruising or excessive
bleeding from wounds or in mucous membranes.
Q: Can leukemia be prevented?
A: For many types of cancer, certain things make you more likely to get
it. These are known as risk factors. So changing your lifestyle to avoid
those risks can decrease your chance of getting the disease. But most
people with leukemia have no known risk factors. There is no absolute
way to prevent leukemia. Smoking has been associated with an increased
risk of developing acute myeloid leukemia (AML). So stopping smoking may
lower your risk of developing leukemia. Quitting smoking also decreases
the risks of getting lung, head, neck, esophagus, stomach, bladder, and
some other cancers.
Q: What are the symptoms of leukemia?
A: People with leukemia do not have enough healthy blood cells, which can
lead to symptoms. However, some people with chronic types of leukemia
may not have any symptoms.
These are some common symptoms of leukemia:
Fever with chills and sweating
Infections that don't go away
Weakness, fatigue, or pale skin, which can be signs of anemia
Tiny red spots and bruises under the skin
Sore or bleeding gums
Swollen lymph nodes, liver, or spleen
Pain in the bones or joints
Cough, shortness of breath, and pains in the chest
Loss of appetite and weight loss
See a health care provider if these symptoms persist. These symptoms are
not specific to leukemia. Many of them are more likely to be caused by
less serious conditions. Special tests of your blood and bone marrow are
needed to confirm a diagnosis of leukemia.
Q: What's the difference between chronic and acute leukemia?
A: Leukemia is grouped in two ways. It may be acute or chronic, depending
on how fast the cells grow and progress to more advanced phases of the
disease and how much the leukemia cells resemble normal cells. The disease
is also lymphoid or myeloid, depending on the type of blood cell that
has turned into cancer. Here is more information about acute and chronic
types of leukemia:
Acute leukemia. The cancer cells are immature blood cells, called blasts,
which cannot do their job. The number of these cells increases fast. The
disease will quickly get worse unless it is treated.
Chronic leukemia. Some young blood cells are present, but the body also
makes more mature, functional cells. The number of blasts grows slowly.
It takes a longer time for the disease to get worse. Sometimes the disease
remains stable for many months or even years, even without treatment.
Q: What are the different types of leukemia?
A: Leukemia is labeled as either acute or chronic. And it grows in either
the myeloid cells or the lymphoid cells. This gives four combinations,
which are the main types of leukemia:
Acute lymphocytic leukemia (ALL). This is the most common kind of leukemia
in children. It can also occur in adults with increasing incidence as
Acute myeloid leukemia (AML). This type affects adults and, less often,
children. It is also called acute nonlymphocytic leukemia (ANLL).
Chronic lymphocytic leukemia (CLL). This type is mostly seen in older adults.
It is sometimes seen in younger adults but almost never in children.
Chronic myeloid leukemia (CML). This type is seen mostly in adults. Very
few children get this type.
Q: How is leukemia treated?
A: Chemotherapy is the most common treatment for most types of leukemia.
Other types of treatment for leukemia are radiation therapy, targeted
therapy, stem cell transplant, biologic therapy, and surgery. Each is
Chemotherapy. Most people with leukemia (especially acute leukemia) are
treated with chemotherapy. This treatment uses medicine to kill cancer
cells. People may take two or more medicines. Some of the medicines are
taken as a pill, but most are given intravenously (IV). This treatment
is considered systemic, meaning it destroys cancer cells throughout the
Radiation therapy. The goal of radiation is to kill cancer cells using
X-rays. This treatment is sometimes used in combination with chemotherapy
or with a stem cell transplant. You can receive radiation over the whole
body, called total-body irradiation (TBI). Or you may receive radiation
to just one part where more leukemia cells have gathered. Sometimes radiation
is used to treat leukemia in the brain or to prevent it from spreading there.
Targeted therapy. This is a newer type of treatment. It uses medicine to
attack specific factors that make cancer cells different from normal cells.
This treatment affects mainly leukemia cells, not normal cells. That means
it may cause fewer side effects than other treatments. It is usually the
first treatment used for CML, although targeted medicine can also be used
to treat some other types of leukemia.
Stem cell transplant. The goal of this treatment is to kill as many of
the cancer cells as possible by treating the body with very high doses
of chemotherapy and radiation. Normally, the body would not be able to
handle such high doses because it would kill the stem cells in the bone
marrow. Therefore, after a person is treated with these high doses, the
blood needs to be rescued with healthy, new stem cells. The new stem cells
can come from the blood or bone marrow of a donor. Then it's called
an allogeneic transplant. Less often, the stem cells can come from the
person's own blood or bone marrow, called an autologous transplant.
In the case of autologous transplants, the stem cells are collected and
stored before the treatment with high-dose chemotherapy. Stem cell transplants
are done in centers that specialize in this form of treatment.
Biologic therapy. The goal of this treatment is to help your immune system
fight the leukemia.
Surgery. This is used less often for leukemia. In some cases, your doctor
will do surgery to remove a swollen spleen.
Q: Should everyone get a second opinion for leukemia?
A: Many people with cancer get a second opinion from another doctor. There
are many reasons to do this. Here are some:
A person is not comfortable with the treatment decision.
The cancer is a rare type.
There is more than one way to treat the cancer.
A person is not able to see a cancer expert.
Q: How can someone get a second opinion for leukemia?
A: Here are ways to find someone for a second opinion:
The person's primary doctor may be able to recommend a specialist,
such as a hematologist, medical oncologist, or radiation oncologist. Sometimes
these doctors work together at cancer centers or programs.
The Cancer Information Service at 800-4-CANCER (800-422-6237) tells callers
about treatment facilities, including cancer centers and other programs
supported by the National Cancer Institute.
People can get names of doctors from their local medical society, a nearby
hospital, a medical school, or local cancer advocacy groups, as well as
from other people who have had that type of cancer.
Contact other support organizations, such as the American Cancer Society,
the Leukemia and Lymphoma Society, or the National Comprehensive Cancer Network.
Q: Should I consider a clinical trial for leukemia?
A: Clinical trials are people-based studies. Among other things, they help
show which types of treatment work best and which don't. Deciding
whether to participate is not easy. It's a personal decision. No one
can tell you whether a clinical trial is right for you. But it will help
to discuss the risks and benefits of clinical trials with your doctor.
Being open to a trial, for example, may give you access to treatment that
would otherwise not be available. On the other hand, the new treatment
can have unknown risks and side effects that are difficult to manage.
The main thing to determine is whether the potential benefits outweigh
the risks for you. This might be true if the leukemia doesn't respond
to the standard types of treatment. If you decide to participate in a
clinical trial, be sure to get all your questions answered first.