Diagnosis for Leukaemia

Many leukaemia patients do not show any obvious symptoms early in the disease and hence may be diagnosed incidentally during a physical examiation, routine blood testing or bone marrow test.

1. Physical examination 

 If a person appears to be :

• Pale, 
• Enlarged lymph node,
• Swollen gums,
• Persistent infections,
• Fatigue,
• Pale skin from anemia ,
• Significant bruising,

 These are the several symptoms that cause the doctor to suspect leukaemia.

2. Blood Test

Drawing blood sample , doctor can determine if there are abnormal levels of white blood cells or platelets. 

3. Bone marrow test

This diagnosis method is to confirm the diagnosis and to identify the specific type of leukemia.

A needle biopsy and aspiration of bone marrow from a pelvic bone will be needed for a test for leukemic cells , DNA markers and chromosome changed in the bone marrow.

Treatments

Today, we will be talking about different treatments for leukaemia.

Here are some forms of treatment for Leukaemia :

• Chemotherapy
• Radiotherapy
• Stem cell transplant
• Targeted therapies
• Biological therapies
• Clinical trials

1. Chemotherapy

• Use of drugs to kill cancer, injected into vein/muscle, under skin or taken orally
• Drugs travel by bloodstream to reach cancer cells around body, therefore useful for leukaemia because leukaemia affects blood cells.
• Treatment is given in cycles to allow patients’ body to recover
• Chemo drugs usually do not reach the brain and spinal cord so drugs may have to be injected into cerebrospinal fluid (intrathecal chemo)
• Side effects

                • hair loss

                • loss of appetite

                • mouth sores

2. Radiotherapy

• High energy X-rays are used to kill off cancer cells and shrink cancers(tumours?)
• It is also regarded as local therapy as it only targets cancerous site
• Doctors will mark out the area of your body that is going to undergo radiotherapy. A dosage of radiation will be calculated.
• Radiotherapy is usually given in small doses and is completely painless.
• Side effects experienced are similar to side effects of chemo (nausea, vomiting, hair loss and fatigue)

3. Stem Cell Transplant

• aka Bone Marrow Transplant, is a type of stem cell therapy
• Treatment includes destroying cancerous marrow and then introducing stem cells
• 2 types : allogeneic and autologous
• Allogeneic stem cell transplantation involves the use of donor stem cells along with high intensity chemotherapy to kill all existing ALL (acute lymphocytic leukaemia) cancer cells
• Reduced-Intensity Allogeneic Stem Cell Transplantation used lower doses of chemo compared to a standard allogeneic transplant → does not completely inactivate immune system and thus, treats ALL less aggressively
• A serious risk of allogeneic transplants is Graft-Versus-Host Disease (GVHD). This disease develops if donor’s immune cells attack the patient’s normal tissue. Its effects can range from minor to life threatening.
• Autologous stem cell transplantation involves the use of the patient’s own stem cells. However this procedure is not commonly used as it has a high rate of relapse

4. Targeted Therapy

• Targeted therapy drugs work differently from standard chemotherapy drugs, they target specific parts of cancer cells and have different and less severe side effects
• Some targeted therapy drugs are useful in certain cases of ALL (E.g. leukaemia cells with philadelphia chromosomes)
• Are drugs or substances designed to prevent cancer cells from dividing or directly destroying them
• Goal of targeted therapy is to block spread of disease

5. Biological Therapy

Biological therapy is a treatment that makes use of the body’s immune system to kill cancer cells. It slows/prevents tumour growth and also prevents the spread of cancer. The goal of biological therapy is to induce the body’s immune system to recognize and kill cancer cells.

Biological therapy works 2 ways :

1. Inducing immune system to attack
1. Chemicals that stimulate immune system can be injected into body OR sample of immune system cells can be taken and trained in lab to attack cancer cells before being reintroduced into body
2. Making cancer cells more easily recognizable by body’s immune system
1. Target cancer cells by turning on/off cell signals that help them elude the immune system cells

Tyrosine Kinase Inhibitors (TKIs) are used in biological therapy for Acute Lymphocytic Leukaemia (ALL). They block the action of tyrosine kinases, which cells use to signal each other. These signalling systems cause cells to keep dividing.

Imatinib (Gleevec) is a TKI drug often used to treat Chronic Lymphocytic Leukaemia (CML) and also philadelphia chromosome positive ALL. Studies have shown that chances of going into remission have been increased when Imatinib is used as part of the first phase of treatment (remission induction therapy).

6. Clinical Trials

A clinical trial is a research study that helps to determine whether a new drug or treatment is safe and/or effective. There are several phases of clinical trials and these include :

• Phase 1: Clinical trials that are usually conducted on a small number of healthy volunteers with close safety monitoring. The objective is to determine whether the drug is safe for use in humans and how the drug behaves in the human body. 
• Phase 2: Clinical trials that are conducted in a small number of patients with the illness being researched upon. The objective is to explore the therapeutic efficacy of the drug and to further evaluate its safety. A key objective of this phase is to determine the dose for phase III trial. 
• Phase 3: Clinical trials that are conducted in a larger population of patients. These clinical trials help to demonstrate or confirm the therapeutic efficacy of the drug and to collect more information that will allow the drug to be used safely. These studies are intended to provide an adequate basis for submission to regulatory authorities for product registration.
• Phase 4: Clinical trials that are conducted to gather additional information about a drug's safety, efficacy, and optimal use. They are also sometimes known as post-marketing studies.
^ source gathered from:  http://www.hsa.gov.sg/content/hsa/en/Health_Products_Regulation/Clinical_Trials/Overview/Introduction_to_Clinical_Trials.html

Clinical trials also do come with certain risks and such risks depends on the individual's health and also the type of treatment being studied. For some patients, there may be unpleasant side effects. Most of these side effects are only temporary and ends when treatment is ceased.

Factors that increases the risk of Leukaemia

Previously, we covered food that can help fight leukaemia. Today, we are going to cover the few factors that increase the risk of developing leukaemia.

These are the few factors: 

1) Previous cancer treatment

• Certain type of chemotherapies and radiotherapies can cause damage to cells in the bone marrow hence increasing the risk of leukaemia 

For instance, breast cancer patients first undergo a surgery then both radiation therapy and chemotherapy can be given after the surgery to lower the risk of cancer coming back which is also known as recurrence. In a study, they recorded the different types of treatment , also known as adjuvant treatments, and the number of breast cancer patients who undergo it after surgery. Of  the women in the study, 50 of them actually developed leukaemia in the 10 years after radiation therapy, chemotherapy or both treatments.

2) Genetics

• Genetic disorder: This refers to a genetic problem caused by one or more abnormalities in the genome, especially a condition that is present from birth. Not all of the genetic disorders will increase the risk of leukaemia but certain genetic disorders will. An example will be down syndrome.
• Family history: Most leukaemia have no familial link. However first-degree relatives of CLL patients , or having an identical twin who has or had AML or ALL may increase the risk of developing the disease.

3) Exposure to certain chemicals

• Workers exposed to high levels of benzene in the workplace such as benzene and formaldehyde which are commonly used by the chemical industry may be at greater risk of leukaemia.

4) Chemotherapy

• Cancer patients who are consuming drugs that are known as cancer-fighting drugs may develop leukaemia after.
• An example is a drug , alkylating agents

5) General

• Gender: Men are more likely to develop certain  type of leukaemia than women
• Age: Risk of most type of leukaemia except ALL generally increases with age

Food that fight Leukemia

Although there are no specific foods that are linked to fighting leukaemia, there are vitamins that can be taken in order to help improve one’s condition. Some cancer survivors have seen improvements after taking supplements. Some foods that are known to fight cancer are onions and garlic. Carrots have also been proven to fight cancer. Carrots contain β-carotene and polyacetylenes which help to induce apoptosis. Experimentation was conducted by introducing carrot juice extracts to leukaemia and non-tumour control cell lines. Leukaemia cell lines that were treated with carrot juice extracts resulted in apoptosis and inhibition of cell growth. One real-life example would be the case of Earnie Powell

Diet can be a crucial weapon to fight against leukaemia and an especially diet filled with antioxidants such as dark chocolate, cranberries, elderberries, etc.  These food keep the body strong and thus able to fight against leukaemia. There are several recommendations that we can arm ourselves with to fight leukaemia. Here are some recommendations from Sandquist:

1) Aim for 10 fruits and vegetable a day

Reason: They are high in vitamins, minerals, antioxidants and phytochemicals which are all effective to fight cancer cells.

Examples of how we can include more fruits and vegetables into our daily diet: 

-Adding berries peaches into frozen yogurt or ice cream.

-Replace tidbits such as potato chips with vegetables and fruits

2) Steam your vegetables

Reason: To retain most of its nutrients

Example: Steamed sweet peas

3) Go for whole grain

Reason: They are more nutritious and thus taking 100% whole-wheat bread, brown rice is the best option.

Example: Replace white rice with brown rice

4) Make protein a priority

Reason: After doing chemotherapy, there will be side effects such as nausea and vomiting which causes one to lose appetite. Hence by taking in more protein, it actually allows one to remain strong. For vegetarian, food with a good source of the protein includes nuts and seeds, tofu, soy milk, etc.

Example to make food more appealing while including protein: Chicken or fish in the soup instead of a piece of fish or chicken with not much seasoning.

5) Soothe your stomach

Reason: Losing appetite after chemotherapy may be hard for patients to consume solid foods. It is also wise to avoid spicy foods and caffeine.

Example of food that can be consumed: Crackers and sipping ginger ale

6) Fill up on healthy bacteria

Reason: Healthy bacteria present in stomach aid body to handle the food. Thus consuming food that is high in healthy bacteria such as probiotics is recommended

Example of food that contains probiotics: Yogurt with live active culture and drinking kefir.

7) Eat every two to four hours

Reason : Leukaemia patients tend to lose weight caused by the losing of appetite thus it is hard to consume a big meal at one goal. Therefore eating small snacks or meals every two to four hours can be helpful.

Mechanism and types of Leukaemia

Leukaemia is the cancer of the bone marrow, which is where blood cells are produced. The normal bone marrow contains immature blood cells, which then mature into red blood cells, white blood cells and platelets. However, when the immature blood cells does not mature properly, they grow and multiply uncontrollably forming leukaemia cells. This interferes with normal blood cell production as resources used to produce new, functioning blood cells are wasted. At the end of their life spans, normal white blood cells are replaced by newer ones, but abnormal white blood cells can live for a long time. Leukaemia patients may suffer from low red blood cell and platelet counts, and therefore, need transfusions to provide enough  blood cells for their body to function. A leukaemia patient may die due to several reasons like loss of blood as they are unable to form blood clots, or an infection due to low haemoglobin levels. One common complication that leukaemia patients suffer from is Pneumonia, which is an infection caused by aspiration. Did you know that infection alone, or, in combination was the most common cause (75%) of leukaemia patients’ deaths, followed by haemorrhage (24%) and organ failure (9%)?

white blood cell

 There are actually 4 types of Leukaemia :

1)      Acute Lymphocytic Leukemia (ALL) – This is the most common type of leukaemia amongst young children. Symptoms include fever and higher risk of infection. Some symptoms of infections that they might suffer from include difficulty breathing, chest pain, coughing, vomiting and changes in bowel or bladder habits.

2)      Chronic Lymphocytic Leukemia (CLL) – This type of leukaemia is more common among adults over 55, and men in general. Experts claim that this form of leukaemia is fatal. The leukemia cells accumulate slowly over time, allowing normal blood cell production to take place. Symptoms do not show up until years later. The leukemia cells may also spread to other parts of the body like the liver, spleen and lymph nodes.

3)      Acute Myelogenous Leukemia (AML) – Like CLL, this is also more common among adults than children. This disease advances fast, and immature, useless cells accumulate quickly in the bone marrow and blood. Leukaemia cells crowd out useful cells more quickly than in chronic leukaemia.

4) Chronic Myelogenous Leukemia (CML) - The majority of CML sufferers are adults. Chronic myelogenous leukaemia cells are slow growing leukemia but as time passes, it can become a fast-growing leukaemia that is difficult to treat.