Leukaemia in adults

Leukaemia is a type of blood cancer and the name comes from a Greek word meaning ‘white blood’. Although there are different blood cells (white cells, platelets, red blood cells), leukaemia generally refers to cancers that affect the white blood cells. It is very important to know what type of leukaemia you have as this affects both the type of treatment that is needed and your long-term outlook.

White blood cells are essential to fight infections and build up your immune system. When the white cells don’t function as well, our immune defences become weakened, and we are more susceptible to getting infections in the first place and becoming more unwell from them.

Leukaemia is fairly common among adults, with around 27 new cases each day in the UK. Age is a big factor, with those over 75 accounting for more than 4 in 10 cases. While not many children get cancer, leukaemia is one that frequently affects them – it behaves quite differently for them, so we’ll address that elsewhere.

There are 4 main types of leukaemia;

1. Acute lymphoblastic leukaemia (ALL). (Disease that progresses quickly)
2. Chronic lymphoblastic leukaemia (CLL). (Persistent or ongoing disease)
3. Acute myeloid leukaemia (AML). (That derives from a myeloid stem cell quickly)
4. Chronic myeloid leukaemia (CML). (Ongoing illness from a myeloid stem cell)

How do I know if I have leukaemia?

Leukaemia can cause several symptoms. The main ones to be aware of include night sweats or increased sweating, tiredness and fatigue, and weight loss. You can also experience symptoms like mild fever, frequent infections, bleeding and unexplained easy bruising, bone pain and an enlarged liver or spleen.

When leukaemia spreads to affect other organs it can cause symptoms such as seizures, headaches, confusion, nausea and vomiting.

Certain factors increase your risk of getting leukaemia. Age is a significant risk factor, with the chance increasing as you get older. Cigarettes contain many toxic chemicals – benzene is one that specifically increases your risk – and previous treatment with chemotherapy or radiotherapy for other types of cancers can also increase your risk of leukaemia. If you have suffered other blood cancer disorders you are at higher risk, and certain genetic disorders such as Down syndrome are also linked.

A doctor will take a detailed history of your symptoms, any particular risk factors and anything that runs in your family. They will examine your abdomen, heart and lungs, and anything else of note such as easy bruising. If they are concerned, they will organise an urgent referral to the haematology team, which looks after blood conditions.

They will arrange blood tests and imaging. They may arrange to take samples (biopsies) of your bone marrow, which is the active tissue inside your bones that makes white blood cells.

Once leukaemia is diagnosed, the cells are reviewed under a microscope to see how the cancer cells look, and specifically, whether there are immature cells present. You will have further tests to check if there has been spread to other organs.

Treatment depends on the type of cancer and how advanced it is. Your treating team will also take into account you, your life and your health in general, and discuss with you the best treatment, tailored to you.

The team may pick one treatment option or a combination of chemotherapy, where drugs are used to kill the cancerous cells, radiotherapy, where high energy radiation damages the cancerous cells to stop them growing, and stem cell transplantation.

White blood cells are made by stem cells in the bone marrow, and leukaemia originates there. Stem cell transplantation is a bone marrow transplant, used in the hope of replacing damaged bone marrow with healthy stem cells to grow into new healthy white blood cells.

There are other types of therapy called biological, targeted or immune therapy. These are newer to the treatment armoury, aimed at boosting your immune system to fight the abnormal cells or targeting vulnerable cancer cells and breaking them down.

With any discussion of a cancer diagnosis, most people want to know whether it will affect their chance of survival. Modern treatments now mean that if treated you have a much better chance of survival with leukaemia than before, with more than 6 out of 10 people alive 5 years after diagnosis and 4 out of 10 at the 10-year mark.