Chronic Lymphocytic Leukemia
Leukemia is cancer of the white blood cells. White blood cells help your body fight infection. Your blood cells form in your bone marrow. In leukemia, however, the bone marrow produces abnormal white blood cells. These cells crowd out the healthy blood cells, making it hard for blood to do its work. In chronic lymphocytic leukemia (CLL), there are too many of a specific type of white blood cell called a lymphocyte. CLL is the second most common form of leukemia in adults. If you have symptoms, they may include: - Painless swelling of the lymph nodes in the neck, underarm, stomach or groin. - Feeling very tired. - Pain or a feeling of fullness below the ribs. - Fever and infection. - Weight loss. Tests that examine the blood, bone marrow and lymph nodes diagnose CLL. Your health care provider may choose to just monitor you until you have symptoms. Treatments include radiation therapy, chemotherapy, surgery to remove the spleen and targeted immune therapy.
Introduction
Leukemia is cancer of the white blood cells. The increase in number of these cells leads to overcrowding of healthy blood cells. As a result, the healthy cells are not able to function properly. In chronic lymphocytic leukemia, or CLL, there are too many of a specific type of white blood cell called a lymphocyte. CLL is the second most common form of leukemia in adults. This program explains chronic lymphocytic leukemia. It covers its causes, symptoms, diagnosis and treatment options.
The Blood
Normal blood is made of a fluid called plasma and 3 types of cells:
- White blood cells.
- Red blood cells.
- Platelets.
White blood cells, also called WBCs, or leukocytes, help the body fight infection and disease. Red blood cells, also called RBCs, or erythrocytes, carry oxygen from the lungs to the body’s tissues. They also take carbon dioxide from the tissues back to the lungs. The red blood cells give blood its red color. Platelets, also called thrombocytes, help blood to clot when a person is injured. By clotting, bleeding is controlled and the injured person does not lose excessive amounts of blood. Blood cells are formed in the soft, spongy center of bones called bone marrow. New, undeveloped blood cells are called blasts. Some blasts stay in the marrow to mature, while some travel to other parts of the body to mature.
Chronic Lymphocytic Leukemia
Normally, blood cells are produced in a controlled way, as the body needs them. This process helps keep us healthy. When leukemia develops, the body produces large numbers of abnormal blood cells. The leukemia cells usually look different from normal white blood cells. They also do not function properly. There are several different types of leukemia. Leukemia is commonly labeled by how quickly it develops and gets worse. In acute leukemia, the disease gets worse quickly. In chronic leukemia, the disease gets worse gradually. Leukemia can also be labeled based on the type of white blood cells it affects. Chronic lymphocytic leukemia, or CLL, affects a specific type of white blood cell called a lymphocyte. Chronic lymphocytic leukemia is the second most common form of leukemia in adults. It often develops during or after middle age. Rarely, it can also develop in children.
Risk Factors
It is usually impossible to specify the cause of CLL in an individual patient. Health care providers know about factors that can increase the chances of getting cancer. These are known as “risk factors.” There are very few known risk factors for CLL. Exposure to certain chemicals, such as herbicides or insecticides, is a risk factor for CLL. For example, exposure to Agent Orange, which was used during the Vietnam War, increases the chances of getting CLL. Being middle-aged or older, male or white are all risk factors for CLL. A family history of CLL or cancer of the lymph system also increases the chances of getting CLL. Not everybody who has risk factors for chronic lymphocytic leukemia develops it. Some people who have no risk factors for CLL will still develop the cancer.
Symptoms
Leukemia cells are abnormal cells that cannot do what normal white blood cells do. They cannot help the body fight infections. For this reason, people with leukemia often get infections and have fevers. As leukemia cells increase in number, the healthy red blood cells and platelets decrease due to overcrowding. As a result, the body does not receive enough oxygen. Without enough red blood cells, a person develops a condition called anemia. Anemia causes a person to look pale and feel weak and tired. Without enough platelets, patients bleed and bruise easily. Some of the common symptoms of leukemia include:
- Fever or chills.
- Weakness and fatigue.
- Frequent infections.
- Unintended weight loss.
- Swollen or tender lymph nodes.
- Easy bruising or bleeding.
Other symptoms of leukemia include:
- Tiny red spots under the skin, called petechiae, caused by abnormal bleeding.
- Swollen or bleeding gums.
- Sweating, especially at night.
- Bone or joint pain.
- Painless lumps in the neck, underarm, stomach or groin.
Like all blood cells, leukemia cells travel through the body. Depending on where these cells accumulate, patients with leukemia may have a number of symptoms. If leukemia cells collect in the brain or spinal cord, the result may be:
- Headaches.
- Vomiting.
- Confusion.
- Loss of muscle control.
- Seizures.
Some patients develop sores in the eyes or on the skin. Leukemia also can affect the digestive tract, kidneys, lungs or other parts of the body. In chronic leukemia, symptoms may not appear for a long time. When symptoms do appear, they are generally mild at first and get worse gradually. These symptoms may not be caused by CLL or another type of leukemia. Make sure to see a health care provider to find out what is causing your symptoms.
DiagnosisYour health care provider will ask about your family medical history in addition to your own. A physical exam will be performed. Blood tests also help in diagnosing leukemia. A sample of blood is examined under a microscope to see what the cells look like. This also determines the number of mature cells and blasts. Blood tests also help in diagnosing leukemia but do not diagnose the type. Your health care provider may test bone marrow samples to find out more. CLL always arises from changes that happen in the chromosomes. Special blood or bone marrow tests may be done to look for these changes. Further testing may be done to diagnose one type of leukemia from another. Ask your health care provider about additional testing you may need.
Staging
If you have chronic lymphocytic leukemia, your health care provider will determine the stage of the cancer. Staging is an attempt to find out if the cancer has spread and, if so, to which parts of the body. Stages are usually described using the numbers 0 - 4; a lower number indicates an earlier stage. Staging is helpful in deciding the best course of treatment. Chronic lymphocytic leukemia can spread to other parts of the body through blood vessels and lymph nodes. If leukemia cells are found in a bone marrow sample, the health care provider orders more tests to determine the stage of the disease. Chest x-rays can reveal signs of leukemia in the chest. Other imaging tests, such as a CT scan or MRI, may also be done to look for signs of cancer. Further blood tests may also be done. An antiglobulin test examines a blood sample under a microscope to look for antibodies on the surface of red blood cells or platelets. These antibodies are the result of CLL spreading in the body and may destroy the red blood cells and platelets.
Treatment and Supportive Care
Treatment for leukemia is complex. It is not the same for all patients. Treatment for chronic lymphocytic leukemia depends on:
- The extent of the disease.
- Whether the leukemia has been treated before.
- The patient’s age, symptoms and general health.
The goals of treatment for CLL patients are to:
- Stop the disease, also called remission.
- Prevent it from coming back, which is called relapsing.
Many people with CLL can be cured. Treatment for CLL may involve:
- Radiation therapy.
- Chemotherapy.
- Surgery.
- Targeted therapy.
- Stem cell transplant.
Often some combination of these treatments is used. Radiation therapy uses high-energy rays to kill cancer cells and stop them from growing and spreading. The radiation that treats the cells comes from a machine. To treat CLL, the radiation may be aimed at a specific area of the body where there is a collection of leukemia cells. Radiation therapy may also be given internally. This is done using a radioactive substance sealed in needles, seeds, wires or catheters that are placed into or near the cancer. The way radiation therapy is given depends on the stage of cancer. Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy is usually given in the blood stream through an IV. Sometimes it may be taken by mouth. A special kind of chemotherapy may be done to treat CLL that has spread to the brain or spinal cord. This is called intrathecal chemotherapy. In this type of treatment, anticancer drugs are injected directly into the fluid surrounding the brain and spinal cord. Another treatment option for CLL is surgery. A surgery called a splenectomy may be done to remove the spleen. This procedure usually takes an hour to complete. Most patients recover in a health care facility for 2-4 days following the surgery. Targeted therapy uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Monoclonal antibody therapy is a type of targeted therapy used in the treatment of CLL. Monoclonal antibody therapy uses antibodiesade in the laboratory from a single type of immune system cell. After being injected into the body, they attach to the cancer cells. This can help kill the cancer cells, block their growth or keep them from spreading. Stem cell transplants are another treatment option for CLL. First the patient’s leukemia-producing bone marrow is destroyed by high doses of drugs and radiation. It is then replaced by healthy bone marrow. Stem cells are removed from the blood or bone marrow of a donor. When the cells are taken from bone marrow, the procedure is sometimes called a bone marrow transplant. The donor’s stem cells are given to the patient. These stem cells grow into and restore the patient’s blood cells. There also may be clinical trials available for people with CLL. Clinical trials test new medical approaches and treatments. CLL and its treatment can lead to other health problems. It is important to have supportive care before, during and after cancer treatment. Supportive care is treatment to control symptoms, to relieve the side effects of therapy and to help you cope with emotions. Supportive care also deals with the pain associated with cancer and its treatments. Your health care provider or a pain control specialist can suggest ways to relieve or reduce pain.
Summary
Leukemia is cancer of the white blood cells. The increased growth of these cells leads to overcrowding of healthy blood cells. As a result, the healthy cells are not able to function properly. In chronic lymphocytic leukemia, or CLL, there are too many of a specific type of white blood cell called a lymphocyte. CLL is the second most common form of leukemia in adults. Treatment for CLL may involve:
- Radiation therapy.
- Chemotherapy.
- Surgery.
- Targeted therapy.
Often some combination of these treatments is used. CLL is most treatable in its early stages. Research already has led to advances that have helped people live longer. It continues to find better ways to care for people with chronic lymphocytic leukemia.
