Chronic Lymphocytic Leukemia

Learn a brief background of leukemia and it's effects on the population.

Understanding Cancer

Cancer is a malignant growth or tumor resulting from the division of abnormal cells. 7.6 million people died of Cancer in the year 2007, which accounted for about 13% of the deaths the occurred that year around the world. 70% of these deaths are reported among families of lower income tax brackets and third world countries. 1/4th of all cancers are brought on by diseases such as HIV and IDS. Certain cancers such as cervical or breast cancer can be treated and cured early on.  There are more than 100 known types of cancer, one of the most common being Leukemia.

Leukemia

Leukemia is a cancer of the early blood-forming cells. Chronic Lymphocytic Leukemia (CLL) in particular is a blood and bone marrow disease that usually gets worse slowly. Most often, leukemia is a cancer of the white blood cells. White blood cells are involved in protecting the body against both infectious disease and foreign invaders. The bone marrow produces abnormal white blood cells, which don't function properly.

Leukemia is the most chronic cancer in children and teens and these children have an increased chance of getting it by a genetic disease, such as Down syndrome, klinefelter syndrome, or Li-Fraumeni syndrome.

My main reason for choosing this cancer type in particular is because I'm having a check up at the pediatrician this week, and thought it would be great to ask my doctor if he knew a little about this disease.

Chances of Survival

There are many factors that determine the survival rate among patients with Leukemia. Most patients who been diagnosed live after five years of being told.

  • For white women, it is about 26%
  • For white men, it is about 22%
  • For black women, it is about 26%
  • For black men, it is about 24%
  • For children 90%

However there are also many individual factors that effect your chances of surviving that long. The subtype of your AML is a very important factor in determining a prognosis(a forecast of the likely course of a disease or ailment.) , as some subtypes of AML have a much better outlook than others. Here is a list of other conditions and characteristics that affect your prognosis.

Your prognosis may be better if you have any of these traits:

  • Your leukemia cells have translocations between chromosomes 8 and 21 or between 15 and 17.
  • Your leukemia cells have an inversion of chromosome 16.
  • Your leukemia cells have changes in certain genes, such as mutations in the NPM1 gene.
  • You are younger than 60.

Your prognosis may be worse if you have any of these traits:

  • Part of chromosomes 5 or 7 is missing in your leukemia cells.
  • Your leukemia cells have complex changes involving many chromosomes.
  • Your leukemia cells have certain gene changes, such as mutations in the FLT3 gene.
  • You're older than 60.
  • Your white blood cell count is over 100,000 at the time of your diagnosis.
  • Your leukemia does not respond well to the initial treatment.
  • You have had a preleukemic condition or your AML developed after being treated for another cancer.
  • You have an active blood infection.
  • The leukemia has reached the area around your brain and spinal cord.

Groups more likely to survive:


Men are more likely to develop the disease than women, and whites are more likely to develop leukemia than people of other racial or ethnic groups.

Carcinogens

A carcinogen is any substance or radiation that is an agent directly involved in causing cancer. There are many carcinogens that contribute to the development of cancer including:

  • Lifestyle factors (nutrition, tobacco use, physical activity, etc.)
  • Naturally occurring exposures (ultraviolet light, radon gas, infectious agents, etc.)
  • Medical treatments (radiation and medicines including chemotherapy, hormone drugs, and drugs that suppress the immune system, etc.)
  • Workplace exposures
  • Household exposures
  • Pollution

Benzene is the most common carcinogen and it is mainly linked leukemia. Benzene is a colorless but flammable liquid that can form from natural occurrences like volcanoes but is mostly liked to human activity. Benzene is commonly used as a starting material to make chemicals such as plastic, lubricant, rubbers and dyes.

Most patients are exposed to benzene by breathing it through air. People working in factories that manufacture or use benzene are at a higher risk of cancer as benzene is closely linked to leukemia and other cancers of the blood cells.

Treatment

Leukemia in children is usually treated using chemotherapy. Chemotherapy is a type of cancer treatment that uses drugs to destroy cancer cells. Side effects of chemotherapy could include:

  • Temporary hair loss
  • Mouth sores
  • Anemia (decreased numbers of red blood cells; may cause fatigue, dizziness, and shortness of breath)
  • Leukopenia (decreased numbers of white blood cells; may lower resistance to infection)
  • Thrombocytopenia (decreased numbers of platelets; may lead to easy bleeding or bruising)
  • Gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea)

However this is just one of a few ways leukemia can be treated and doctors will make the decision on what method to use depending on each person. Doctors may choose to use:

Induction Therapy: Kills leukemia cells in the blood and bone marrow to induce remission.

Consolidation Therapy: kills any leukemia cells that may be present even though they don't show up in tests.

Maintenance Therapy: Prevents any remaining leukemia cells from growing. This may be done using lower doses of chemotherapy than those used during induction or consolidation.

Causes CLL

It is not known yet what exactly causes CLL but doctors do know that something happens to cause a mutation in DNA. This mutation causes the blood cells to produce abnormal, ineffective lymphocytes.

Risk Factors

There are a few known risk factors that may be linked to CLL

  • Your age. Most people diagnosed with chronic lymphocytic leukemia are older than 60.
  • Your sex. Men are more likely than are women to develop chronic lymphocytic leukemia.
  • Your race. Whites are more likely to develop chronic lymphocytic leukemia than are people of other races.
  • Family history of blood and bone marrow cancers. A family history of chronic lymphocytic leukemia or other blood and bone marrow cancers may increase your risk.
  • Exposure to chemicals. Certain herbicides and insecticides, including Agent Orange used during the Vietnam War, have been linked to an increased risk of chronic lymphocytic

There are no true risk factors that are directly related to this disease so avoiding it would be pretty difficult.

The Diagnosis

There are a few ways scientist may be able to detect Chronic lymphocytic leukemia earlier on.

Physical exam: Your doctor will look for physical signs of leukemia

Blood tests: Looking at a sample of your blood, your doctor can determine if you have abnormal levels of white blood cells or platelets

Bone marrow test: Your doctor may recommend a procedure to remove a sample of bone marrow from your hipbone. The bone marrow is removed using a long, thin needle.


What are Your chances of developing this condition?

Lifetime Percentage

Men           Risk of Developing:  %           1in    Risk of Dying: %          1in

                                               1.70        59                          1.03       97

Women                                   1.19         84                          .72         139

Percentage of people that will develop this cancer out of all cancer:

26%

A short interview with Mrs. Cathy Daniels, a breast cancer patient.

Here I have a brief interview with a. old daycare teacher of mine who had just been diagnosed with Breast cancer. A couple years ago she had to move to to Raleigh NC from Wilson so that she and her family could be closer to Duke Medical Center.

Sidra: Can you describe your journey with breast cancer?

Mrs. Daniels : People keep talking about this mythical journey with breast cancer, but since my first treatment I've only moved from my old home in Wilson to here! :) My treatment has been long and rough. Initially, I had a mastectomy and then did six rounds of chemotherapy (taxotere and carboplatin). I had some problem with the taxotere and neuropathy, so I switched to taxol, and I did weekly herceptin for a full year. Once the year was up, I felt very free — I was done. I was a Survivor. I had already decided that I was not going to worry about cancer returning. I was going to believe that I got my life back and live in that way.

Unfortunately, only a few months later in May of 2011, a scan showed a spot in my liver and a biopsy confirmed that it was metastatic cancer. It was found relatively quickly. I’d been having some back pain, and my doctor did a bone scan — which found nothing. The next time I saw him, he asked me about the pain, and I said it was still there. I figured by then it was my bed or my chair at work, but he took it seriously. He did an abdominal CT which found the spots in the liver. Oddly enough, it had nothing to do with the back pain, which I still have. Since I no longer work, it must be the bed! I was Stage IV and the cancer was terminal. My oncologist is very forward-thinking, and because it was only in my liver, he referred me to Duke Medical Center, where I was given a liver resection. They took all of the left lobe of the liver out and ablated a spot of cancer in the right lobe

Sidra: Who has been your biggest support through this emotional journey?

Mrs. Daniels: Obviously, my husband and children have been the greatest support. My husband has had to take on the day-to-day things that I’m just too tired to do, like cleaning and taking my son to competitions. My sister was supportive when I had surgery — she came all the down from Lansdale, Pennsylvania to see me in the hospital, watched my younger son, and cleaned the house (which needed it!).  She has carpentry and construction skills, and gave me this fabulous retreat — it’s really amazing. I had to give up my job in a few months after I was diagnosed, but the people I worked with are still supporting me, with thoughts, poetry, and gifts. This week, somebody gave me a lovely blown glass candle-holder and a teacher-friend brought me a meal It’s just amazing how supportive people can be at a time like this.

Sidra: Are there any other assumptions or misconceptions about breast cancer that you would like to shed some light on?

Mrs. Daniels: The myth that early detection leads to a cure is a big one. By now, I know hundreds of woman with late stage cancer. Nearly all of them were diagnosed early stage, and their cancer came back. That is not to say a woman shouldn't get her mammogram or ignore her health, but there is an assumption in the Pink World that if you catch it early, you’ll be okay. And, sadly, that is not the case. Something like 25% of early stage women end up like me, with metastatic disease.

And then, I think that you might be surprised to know I have metastatic cancer if you met me. I might be standing in line at the grocery store, and I am dying of a disease, but you don’t know it. I have hair most of the time — I look relatively normal. My main issue is being tired. So, be nice to people and be thankful for all the blessings God has given you, because you really don’t know what they are facing or living with and He will always make a way.

Sidra: Thank you for asking just a few questions for me Mrs. Daniels.

Mrs. Daniels: You're welcome anytime you need.

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