Signs and symptoms
Signs and symptoms of leukaemia (and blood cancers generally are notoriously vague and non-specific). There are no specific signs or symptoms of any type of leukaemia which would allow a doctor to make a diagnosis without laboratory tests.
In all types of leukaemia, symptoms are more commonly caused by lack of normal blood cells than by the presence of abnormal white cells. As the bone marrow becomes full of leukaemia cells, it is unable to produce the large numbers of normal blood cells which the body needs. This leads to:
Anaemia – due to lack of red blood cells
Weakness, tiredness, shortness of breath, light-headedness, palpitations
Infections – due to lack of normal white blood cells
Infections are more frequent, more severe and last longer
Fever, malaise (general feeling of illness) and sweats
Purpura (small bruises in skin), heavy periods, nosebleeds, bleeding gums
Bleeding and bruising – due to lack of platelets
There are some symptoms that are only seen in certain patients or forms of leukaemia. For example, young children with ALL may complain of pain in bones or joints and, in some types of AML, the gums may be swollen by leukaemia cells in the tissues.
In lymphoid malignancies, lymph nodes (glands) may be swollen. In some forms of the leukaemia the liver may be enlarged (hepatomegaly) or the spleen (an organ of the immune system found just under the ribs on the left hand side) may be enlarged (splenomegaly).
Although a doctor may suspect a patient has leukaemia based on signs and symptoms, it can only be diagnosed by laboratory tests. The results of a simple blood count will usually indicate leukaemia although, rarely, a blood count may be normal. Most patients with leukaemia will have a bone marrow sample taken to confirm the diagnosis and to help to determine exactly what type of leukaemia a patient has. More specialised tests are often done at the same time.
Usually, a chest x-ray will be taken as well as scans, to look for swollen lymph nodes, or other affected sites. Blood samples will be taken to test for any problems with the liver, kidneys or other organs. In some, but not all, types of leukaemia a sample is taken of the fluid which surrounds the brain and spinal cord – cerebrospinal fluid (CSF). This is because some kinds of leukaemia cells can get into the nervous system, which protects them from most kinds of treatment. Some blood tests and scans will be repeated to check for the response to treatment and any complications. Other tests are usually only done at diagnosis.
Treatment of leukaemia
Some patients who have leukaemia do not start treatment straight away. If patients are not being treated they have regular check-ups. This is known as “watch and wait” or “active monitoring”. This is mainly relevant for patients with CLL. Almost all patients with CML or with acute leukaemia will start treatment soon after diagnosis. Some patients with CLL will never need to receive treatment for their leukaemia.
Although patients on watch and wait do not have to deal with side effects of treatment, it can be an incredibly anxious time. If this applies to you it is important to let your healthcare team know, as they can offer support and reassurance.
Acute leukaemia is often curable with standard treatments. Chronic leukaemia is usually not curable, but treatable. Although most patients with chronic leukaemia have a good initial response to treatment the condition will sometimes come back, this is known as a relapse and it can usually be treated again, using similar treatments as were used the first time.
The main ways in which leukaemia is treated are:
Chemotherapy - cell-killing drugs. Steroids are normally used along with chemotherapy for lymphoid leukaemia
Radiation therapy - usually only for stem cell transplant or local disease e.g. in spleen
Targeted therapy - drugs which specifically recognise and kill leukaemia cells
Biological therapy - treatments which use the immune system to destroy leukaemia cells. Often these use antibodies against markers on the leukaemia – these are known as monoclonal antibodies.
Stem cell transplant - Younger/fitter patients may be given a stem cell transplant (bone marrow transplant). This may be done using your own healthy stem cells or stem cells from a donor. This is most commonly done for acute leukaemia if chemotherapy does not cure the disease.
Chemotherapy is the use of cell-killing drugs. These kill the cancer cells and/or stop them from dividing. Chemotherapy is usually given in blocks or ‘cycles’ of treatment. One cycle of treatment will consist of a series of doses of chemotherapy followed by a break for the healthy cells to recover.
Chemotherapy is normally given as a combination of drugs, which, for lymphoid leukaemia, will usually include steroids. Steroids used to treat lymphoid leukaemia are a laboratory-made version of chemicals naturally made by the body. They are very different from the type of steroids sometimes misused by body builders or sportsmen.
The details of the treatment will vary depending on the features of the leukaemia and the patient’s general fitness. Patients will be given a chance to discuss treatment options and detailed information on the treatment plan before it starts. The side effects of treatment vary between different types of treatment and different patients. Patients will be given detailed information about any likely side effects before treatment starts.
Questions to ask your doctor about leukaemia
We understand going through a blood cancer through journey can be difficult. It may help to talk to a close friend or relative about how you are feeling. Here are some questions that may be useful to ask your doctor.
-How would I know if I had leukaemia?
-What tests will I need to have?
-What will the tests show?
-How long will the results take?
-How rare is leukaemia?
-What sort of treatment will I need?
-How long will my treatment last?
-What will the side effects be?
-Is there anything I should or shouldn’t eat?
-Will I be able to go back to work?Where can I get help with claiming benefits and grants?
-Where can I get help dealing with my feelings?