In movies, we often see characters falling ill with leukemia, which makes us somewhat familiar with this disease. However, leukemia is a serious condition that occurs frequently in Thailand and can affect individuals of all genders and ages. Detecting it early can greatly improve treatment outcomes. Therefore, we aim to provide a better understanding of this disease.

Introduction to Leukemia

Leukemia is a form of blood cancer that results from the abnormal production of large numbers of immature white blood cells in the bone marrow, for unknown reasons. This excess interferes with normal hematopoietic systems, leading to reduced production of red blood cells and platelets. The surplus white blood cells enter the bloodstream and may infiltrate organs such as the liver, spleen, brain, and lymph nodes, causing system malfunction. Leukemia can occur in acute or chronic forms.

White blood cells play a vital role in building a strong immune system to fight germs that enter the body, including bacteria, viruses, and fungi, and prevent the occurrence of abnormal cells. These cells are normally produced in the bone marrow, but during leukemia, some are produced by the lymph nodes, thymus, and spleen. These cancerous cells spread throughout the body via the blood and lymphatic systems.

Classification of Leukemia

Leukemia can be categorized based on its onset into two main types:

·        Acute Leukemia is a rapidly progressing cancer caused by immature blood cells that divide and multiply rapidly. It shows clear symptoms and requires urgent treatment to prevent the bone marrow from producing significantly fewer normal cells. Acute leukemia can be classified into two subtypes based on abnormal cells:

o    Acute Myelogenous Leukemia (AML) is the most common type, particularly among adults. It is commonly diagnosed within the first 4 weeks after birth in pediatric patients.

o    Acute Lymphocytic Leukemia (ALL) is the most common type in children aged 2-5 years but can also occur in adults. The cancer cells grow rapidly in the blood, but proper treatment increases the chances of a cure.

·        Chronic leukemia is characterized by the overproduction of white blood cells, causing patients to have more white blood cells than normal. Patients may have no symptoms at all because the abnormalities occur gradually. It can be detected through a blood test. In the later stages of the disease, it may turn into an acute type, which is often the cause of death. Chronic leukemia can be classified into two subtypes based on abnormal cells:

o   Chronic Myelogenous Leukemia (CML) usually occurs in adults, and there may be little to no symptoms for months or years.

o   Chronic Lymphocytic Leukemia (CLL) is mostly found in the elderly, and the likelihood of its occurrence increases with age. Patients are often asymptomatic, and the disease is frequently discovered incidentally from a blood test.

What are the symptoms of a leukemia patient?

The symptoms experienced by a leukemia patient can vary depending on the type and stage of the disease. Some common general symptoms include feelings of exhaustion, constant tiredness, heart palpitations, dizziness, fever and chills, excessive sweating (especially at night), unexplained weight loss, loss of appetite, bone pain or tenderness, swollen lymph nodes (particularly in the neck or groin, but often without pain), easy bleeding or bruising, visible bruises on the skin, and frequent nosebleeds.  The other groups of symptoms that occur according to the type of disease are as follows:

·       ALL and AML

o   Symptoms caused by abnormal bone marrow function – Bone marrow is responsible for the production of blood cells and platelets. When cancer cells interfere, the production of blood cells and platelets is reduced. When the red blood cells are low, patients will be pale and feel weak and tired, faint, dizzy, and their heart will beat faster. In some cases, breathlessness and heart attack may occur. They may also have green bruises on their body or abnormal bleeding from low levels of platelets. In addition, they may get infected easily due to the low amount of white blood cells.

o   Symptoms caused by leukemia cells accumulating in various organs of the body such as:

§  Lymph nodes – Patients will have enlarged lymph nodes, swollen lump in the neck, armpit, or groin.

§  Brain – Patients will feel headache, nausea, vomiting, photophobia, stiff neck, convulsions, etc.

§  Lungs – Symptoms similar to pneumonia, such as coughing, fever, and breathlessness.

§  Kidneys – Kidneys will increase in size which will affect their performance.

§  Skin – Multiple skin lumps of varying sizes which can be colorless or slightly purple.

·       CML – Symptoms can be divided into 3 phases:

o   Chronic phase – This is the phase in which patients have a large accumulation of leukemia cells mixed with normal white blood cells. The bone marrow will still function almost normally. Patients often come to the doctor with a fever, night sweats or feeling unusually tired. Patients will stay in this phase for 3-5 years depending on the response to treatment.

o   Accelerated phase – At this phase, patients will begin to experience more severe symptoms. This can occur acutely or gradually show symptoms. Cancer cells begin to change from the size of normal white blood cells to be similar to embryonic cells causing a condition of low white blood cells, red blood cells and blood platelets. Patients will be in this phase for 1-1.5 years depending on the response to treatment.

o   Blastic phase – At this phase, most of the cancer cells become embryonic cells causing patients to have symptoms similar to AML which are anemia, low platelets, and many embryonic leukocytes both in the blood and in the bone marrow. And when there is more to the point that it clogs blood vessels in other organ tissues, it will cause those tissues or organs to lose their function. Patients usually die within 3 to 6 months, even with treatment.

Diagnosis of leukemia

Leukemia screening can be done in 4 ways:

·       Blood test – Blood sample is collected to check whether the white blood cells, red blood cells, and platelet levels are normal.

·       Bone marrow test – The doctor will inject an anesthetic and take a sample of bone marrow from the hip for testing in a lab to look for cancer cells. If found, further examination will be performed to identify the type of disease in order to find the most appropriate treatment.

·       X-rays – To look at abnormalities in the lymph nodes and internal organs affected by the cancer, and also to assess the phase of the disease.

·       CSF puncture and sampling – To check for cancer cells that have spread into the membranes or areas surrounding the brain and spinal cord.

4 ways to treat leukemia

·       Chemotherapy – The use of drugs to kill leukemia cells, which can be administered orally or through injection. The doctor may recommend either or both of them together. Side effects that may occur are hair loss, nausea, loss of appetite, fatigue, bruising, and ovarian or testicular damage leading to infertility.

·       Immunotherapy – This involves injecting certain substances into the body to stimulate the body's immune system to recognize cancer cells as foreign and destroy them. Side effects of this method are swelling or rash, headache, fever, muscle pain, feeling tired, etc.

·       Radiation therapy – X-rays or other high-energy beams are used to destroy and stop the growth of leukemia cells.

·       Stem Cell Transplantation – This is the transplantation of healthy bone marrow in place of marrow that contains malignant cells. The doctor will use chemotherapy or radiation therapy to destroy the bone marrow that contains cancer cells. Then, blood stem cells are given to help regenerate new bone marrow.

Preventive measures for leukemia

While there is no guaranteed way to prevent leukemia, there are steps you can take to minimize your risk. These include avoiding exposure to toxic substances such as benzene, formaldehyde, and radiation, as well as avoiding smoking and secondhand smoke. Additionally, you can reduce your consumption of heavily processed foods and increase your intake of fruits and vegetables. If you experience any symptoms that are indicative of leukemia, seek medical attention promptly to receive a proper diagnosis and advice.

While leukemia may be frequently depicted in media, it is a serious disease that can greatly impact one's health or the health of loved ones. Therefore, taking care of oneself is crucial. It's recommended to promptly seek medical attention if any abnormal symptoms arise to maintain good health. For those who are Krungthai-AXA Life Insurance customers and interested in healthcare, additional health articles can be accessed at: https://www.krungthai-axa.co.th/th/health-advisories

References

·       Faculty of Medicine, Siriraj Hospital, Mahidol University
https://www.si.mahidol.ac.th/th/healthdetail.asp?aid=323

·       Bumrungrad Hospital
https://www.bumrungrad.com/th/conditions/leukemia

·       MedPark Hospital
https://www.medparkhospital.com/content/leukemia

·       Sikarin Hospital
http://bit.ly/3leYCNa

·       Pobpad website
http://bit.ly/3I2kkx7

·       MedThai website
http://bit.ly/3DJLDtz

·       Rajavithi Hospital
https://www.rajavithi.go.th/rj/?p=4013

·       Synphaet Hospital
http://bit.ly/3lbXTwq