A Family Doctor's Tale - BLOOD CANCER

DOC I HAVE BLOOD CANCER

One of the more common cancer in children is leukemia a blood cancer. The chances of a cure in 1970 is about 10% but now the chances of success in acute leukemia is almost 90% due to improvement in chemotherapy and marrow transplant. 
One of my patients who was treated for leukemia came to my clinic for weekly injection of steroid and vitamin B12 in 1990 after his chemotherapy and is presently free of cancer and a father of a one year old child.

Blood cancer consists of mainly lymphoma, leukaemia and multiple myeloma. These cancers developed either in the bone marrow or the lymphatic tissues of the body. These three types of blood cancers all involve an uncontrolled growth of abnormal cells within the blood and bone marrow.

The risk of developing blood cancers increases with age.
Adults therefore are more prone to blood cancer than children.
The acute leukemia tends to affect children.
The chronic leukemia is more common in adults.
However children and adults can develop any kind of leukaemia.
In Multiple myeloma, the average onset is at age 60.

Leukaemia
Leukaemia is a cancer that affects the blood-forming system of the body which include  the bone marrow and the lymphatic system.
Leukaemia can be classified as either acute or chronic.
The acute leukemia tends to affect children while the chronic leukemia is more common in adults.
However children and adults can develop any kind of leukaemia.

Acute leukaemia 
In acute leukaemia, immature blood cells reproduce quickly in the bone marrow, slowly killing the normal cells.
These abnormal cells can also spread to other organs, ultimately leading to disruption and distortion of organ functions.

Acute leukaemia can be further divided into two types according to the predominant type of cells affected:
1.Lymphoblasts are immature cells that normally develop into lymphocytes 
2.myeloblasts are immature cells that normally develop into other cells such as neutrophils.

1. Acute lymphoid leukaemia (ALL) -
here the lymphoblasts, which normally mature to form lymphocytes, reproduce without developing into normal blood cells. These immature lymphoblasts block out the healthy blood cells and frequently congregate in the lymph nodes, causing a swelling in that area.

(b) Acute myeloid leukaemia (AML) -
here the myeloblasts reproduce without developing into normal blood cells. The immature blast cells gather in the bone marrow and upset the production of healthy normal cells.
 Anaemia results due to lack of sufficient red blood cells.
 Frequent infections occurs due to the low levels of white blood cells which fight infections. 

Chronic leukaemia 
Chronic leukaemia occurs when there is over-production of blood cells that appear to be mature.
Unfortunately these cells actually lack the normal functions of mature blood cells.
Chronic leukaemia usually has a slower, less dramatic course than acute leukaemia.  Chronic leukaemia can also be broken into two groups:

(a) Chronic lymphoid leukaemia (CLL) -
Here there is production of too many apparently mature lymphocytes in the bone marrow. The abnormal cells appear to be fully developed ymphocytes, but cannot fight infections as well as normal lymphocytes.

(b) Chronic myeloid leukaemia (CML) -
here the over-production of apparently mature but defective myeloid cells, reach a point where almost no healthy cells remain. 

Lymphoma (A Simple Guide to Lymphoma)
Lymphoma is a cancer of the lymphoid tissues which are composed of several types of immune-system cells that work together to fight infections. Lymphoma usually begins in a lymph node as a primary cancer. It can also begin in the stomach, intestines, skin or any other organ that contains lymphoid tissue

Multiple Myeloma (A Simple Guide To Myeloma)
Multiple myeloma is cancer of the bone marrow which occurs from the uncontrolled growth of plasma cells, a form of immune-protective white blood cells.Normally plasma cells make antibodies to fight infections.
In multiple myeloma, there is a malignant proliferation of plasma cells.

All  three blood cancers have similar symptoms.
Among the common warning signs are:
1.weight loss,
2.constant infections such as flu and diarrhoea,
3.bleeding of gums or nose and slow healing cuts or frequent bruises
In addition to the above,
4.severe kidney problems,
5.pain in the bones 
6.general numbness of the skin
may indicate the existence of multiple myeloma and leukemia as the disease progresses.
The pain can radiate to the back, ribs and arms of the victims.
The pain is a result of an increase in the number of myeloma cells where the bone marrow is being destroyed.
7.swelling of lymph nodes in the neck, the armpits or in the groin may indicate more likely a diagnosis of lymphoma
8.Persistent fever
9.loss of appetite
10.generalised weakness and pallour

Cause may be related to:
1.Exposure to excessive radiation

2.hazardous chemicals like benzene, asbestos, herbicides and pesticides are known to be the primary causes of blood cancer.
Avoid these harmful materials as much as possible.

3.certain genetic abnormalities, such as Down Syndrome and the inheritance of a particular chromosome called the Philadelphia chromosome, have also been linked to the development of specific forms of leukaemia. This is still controversial.

Besides a medical history and full examination especially for signs of:
anaemia,
enlarged liver and spleen,
bleeding tendencies in the skin such as petechie and ecchymoses
enlarged lymph nodes
a full blood test should be done to examine the blood cells under the microscope for cancer cells as well as to assess the patient's kidney, liver  functions and the severity of anaemia.
A bone marrow aspirate using a syringe and needle can be examined for further evidence of blood and bone marrow cell abnormailties.
The presence of the Philadelphia chromosome may suggest evidence of Blood Cancer.

Before any cancer treatment is done, because of the patient's anaemia and bleeding tendency, blood transfusions are usually given to improve the general health and resistance of the patient.

Chemotherapy and radiation therapy have always been used to treat blood cancer effectively. Besides these treatments, stem cells infusion and bone-marrow transplants also give patients and their families another source for a cure.

Unlike chemotherapy and radiation therapy that are used to treat all the three kinds of blood cancer, bone-marrow transplants are more frequently used to cure lymphoma and leukaemia only .
It is also more successful for younger patients and when the disease is in the early stage.

Patients should know that dangers and side effects of bone-marrow transplants exist.  In extreme cases when the transplant fail, death may occur.

When exposed to dangerous chemicals and radiation, take extra precautions by wearing protective and appropriate clothing.
The threat of contracting lymphoma can be reduced by avoiding the risk of HIV. Patients infected with HIV are known to have a higher rate of lymphoma because of their low immune-system cells to fight infections.

Any family member of a leukemia patient should go for genetic testing and regular check-ups to spot the symptoms early.