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Leukaemia

Clinical Oncology

Blood cancer, also known as leukaemia, is a cancer of white blood cells. Leukaemia can be classified into two main types: chronic and acute, and further categorized as lymphocytic or myeloid. Leukemia is one of the top ten deadliest cancers in Hong Kong, with approximately a thousand new cases reported each year. Unlike most other cancers, both children and young adults are at risk of developing this disease.

Leukaemia is not a death sentence and has one of the highest cure rates among cancers. Different types of leukaemia require different treatment approaches, and the proper treatment can significantly improve a patient's chances of recovery. Even if diagnosed with leukaemia, understanding the treatment options and learning about care and recovery during and after treatment can help expedite the healing process and prevent relapse.

Symptoms

Early stages of chronic leukaemia may not exhibit obvious symptoms and progress slowly, making it easy for patients to overlook its presence. However, individuals with chronic leukaemia might experience symptoms such as fatigue, night sweats, weight loss, enlarged spleen, and swollen lymph nodes.

In contrast, the symptoms of acute leukaemia are relatively more pronounced. These may include pallor due to a shortage of red blood cells, leading to anaemia, resulting in fatigue and shortness of breath. Additionally, a deficiency of white blood cells may cause mouth sores and can lead to recurrent symptoms such as a sore throat, fever, cough, and a burning sensation during urination.

The exact causes of leukaemia are still under research. Still, one possibility explored by the medical community is that genetic mutations may lead to the overproduction of immature lymphocytes in the bone marrow, affecting the body's ability to fight infections. Furthermore, changes in the ordering of individual chromosomes within a patient's body can also lead to genetic mutations, causing uncontrolled growth of white blood cells, resulting in leukaemia and potentially damaging the bone marrow.

Factors

In summary, the following factors can increase the risk of developing leukaemia:

Genetic mutations (such as Down syndrome)
Exposure to environments with radiation pollution or contact with excessive radiation (such as X-rays)
Long-term exposure to certain chemicals
Viral infections (such as the HTLV-I virus, found in Japan)

Diagnosis

Preliminary Examination Methods:

Bone Marrow Biopsy	Applicable to both chronic and acute leukaemia. A doctor will use a thin tube to extract a small piece of bone marrow from the patient's hip bone to determine whether there are leukaemia cells or other abnormal chromosomes in the body.
Chest X-ray	Used for acute leukaemia, it involves taking X-rays to determine if the malignant cells of the lymph nodes have spread to the chest area.

After conducting the preliminary examinations mentioned above, a doctor may request further in-depth tests:

Chromosomal or DNA Analysis	Applicable to acute leukaemia, this test helps determine whether leukaemia cells have spread to the chest area.
Lymph Node Biopsy	Used for chronic leukaemia, the patient undergoes local or general anaesthesia, and the doctor removes a small piece of the swollen lymph node from the body.
CT Scan	Mainly used for chronic leukaemia, it involves taking X-ray scans of the patient's body to capture images, observing whether there are abnormalities in the lymph nodes and whether the spleen is enlarged.
Lumbar Puncture	Applicable to acute leukaemia. After the patient takes pain relievers, the doctor inserts a thin needle into the lower back's spinal area to extract fluid for examination to check for the presence of malignant cells.

Doctors stage lymphocytic, chronic leukaemia in approximately three stages for assessment:

Stage	Extent
A	Elevated white blood cell count, with lymph node enlargement in 1-2 areas.
B	Elevated white blood cell count, with lymph node enlargement in at least 3 areas.
C	Low red blood cell or platelet count, with lymph node enlargement in at least 3 areas.

As for chronic myeloid leukaemia, it can also be divided into three stages:

Stage	Extent
Chronic Phase	A small number of immature cells are present in the blood and bone marrow, lasting for several years.
Accelerated Phase	The cancer progresses beyond the chronic phase and suddenly accelerates, leading to symptoms such as spleen enlargement, increased white blood cells, and high fever.
Blast Phase	An increase in immature cells, even spreading to other body parts.

Treatment

Once the doctor has staged the patient's condition, they choose an appropriate treatment plan. For chronic lymphocytic leukaemia (CLL), which has no complete cure, patients are usually managed through close monitoring and various treatments to control the disease and maintain an everyday life. In the case of chronic myeloid leukaemia (CML), treatments primarily include bone marrow transplantation, chemotherapy, or the use of a drug called imatinib. Acute leukaemia, on the other hand, is typically treated with chemotherapy or radiation therapy.

Chemotherapy
- Induction chemotherapy: This intensive treatment lasts for 4 to 6 weeks and aims to clear blood and bone marrow of cancer cells.
- Consolidation chemotherapy: The purpose is to kill any remaining cells that the induction chemotherapy might have missed. This phase of chemotherapy is relatively gentler, with fewer side effects.
- Maintenance chemotherapy: Less intense than consolidation chemotherapy, patients require regular follow-up to determine the effectiveness of the treatment.
Bone Marrow Transplantation
As chemotherapy can damage the bone marrow's stem cells, peripheral stem cells or bone marrow can be transplanted to help restore blood cell counts to a healthy level. These stem cells can come from the patient's own blood or bone marrow or a donor.
Radiation Therapy
In this treatment, a machine generates radioactive substances, such as X-rays or gamma rays, targeted at cancer cells to inhibit their reproduction.
Imatinib
It is a drug used to treat chronic myeloid leukaemia. Most CML patients have an abnormal chromosome, and imatinib targets the protein produced by this chromosome, suppressing its growth.