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Risk factors for leukaemia
Radiation: People who are exposed to very high levels of radiation are much more likely than others to get acute myeloid leukaemia, chronic myeloid leukaemia, or acute lymphocytic leukaemia.
This was particularly evident in increased incidence in Hiroshima and Nagasaki where an atomic bomb emitting radiations were dropped during the World War II.
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Similarly, the Chernobyl disaster which saw radiation leakage into the environment also led to a lot of children coming down with leukaemia. Another source of exposure to high levels of radiation is medical treatment for cancer and other conditions called radiotherapy. Radiotherapy can increase the risk of developing leukaemia.
Chemicals: Exposure to certain chemicals such as benzene in the workplace is associated with development of acute myeloid leukaemia, chronic myeloid leukaemia or acute lymphocytic leukaemia.
Benzene is used widely in the chemical industry and also found in cigarette smoke and gasoline.
Cancer treatment drugs: Patients with cancer treated with certain types of cancer-fighting drugs sometimes get acute myeloid leukaemia or acute lymphocytic leukaemia later. For example, being treated with drugs known as alkylating agents or topoisomerase inhibitors is linked with a small chance of developing acute leukaemia later.
Genetic abnormalities: Certain genetic abnormalities, such as Down Syndrome, are at an increased risk of developing acute leukaemia. People with certain blood disorders called myelodysplastic disorders are at an increased risk of acute myeloid leukaemia.
Human T-cell leukaemia virus type I (HTLV-I): People with HTLV-I infection are at increased risk of a rare type of leukaemia known as adult T-cell leukaemia.
Family history of leukaemia: Even though this is very rare, sometimes more than one person in a family may have the chronic lymphocytic leukaemia type.
It is worth noting that having one or more risk factors does not mean that a person will get leukaemia. Most people who have risk factors never develop the disease while some without any of these risk factors have developed leukaemia.
Symptoms of leukaemia
Like all blood cells, leukaemic cells travel through the body. The symptoms of leukaemia depend on the number of leukaemia cells and where these cells settle in the body.
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People with chronic leukaemia may not have symptoms. It may be discovered by accident where a routine blood test brings it to the fore.
People with acute leukaemia usually go to their doctor because they feel sick. If the brain is affected, they may have headaches, vomiting, confusion, loss of muscle control, or seizures. Leukaemia can also affect other parts of the body such as the digestive tract, kidneys, lungs, heart or testes.
Common symptoms of leukaemia include
• Painless swollen lymph nodes usually around the neck and armpit
• High temperature that persists for a long time
• Frequently catching one infection after the other
• General feeling of weakness or tiredness
• Bleeding gums and bruising easily
• Swelling or discomfort in the abdomen (from a swollen spleen or liver)
• Weight loss for no known reason
• Pain in the bones or joints
Most often, these symptoms are not due to the cancer but its effect on these organs. In addition, an infection or other health problems may also cause these symptoms. Only a doctor can tell for sure after extensive investigations.
Diagnosis
Doctors sometimes suspect leukaemia after a routine blood test. Symptoms that suggest leukaemia will cause certain laboratory investigations to be done by the clinician. These include:
Blood tests: A full blood count to check the number of white blood cells, red blood cells, and platelets may be suggestive of leukaemia. Leukaemia causes a very high level of white blood cells. It may also cause low levels of platelets and blood levels.
Biopsy: This is removal of some tissue from the bone marrow to look for cancer cells. A biopsy is the only sure way to know whether leukaemia cells are in the bone marrow or not. A pathologist uses a microscope to check the tissue for leukaemic cells.
Other more elaborate laboratory tests include;
Cytogenetics: This test looks at the chromosomes of cells from samples of blood, bone marrow, or lymph nodes. If abnormal chromosomes are found, the test can show the type of leukaemia and also determine how good or bad the prognosis is.
Spinal tap: This involves the removal of cerebrospinal fluid, the fluid that fills the spaces in and around the brain and spinal cord. The lab then checks the fluid for leukaemic cells. It also helps to determine the spread of the disease known as stage of the disease.
An x-ray of the chest can show swollen lymph nodes or other signs of disease. It also helps to exclude certain diseases such as tuberculosis which if present, will be worsened by the medications used to treat leukaemia.
In the same vein, the kidney function test, urine and stool test as well as other relevant tests are done to ensure that the treatment of the leukaemia will not be detrimental to the health of the child.
I will conclude next week with treatment of leukaemia.
The writer is a member of the Paediatric Society of Ghana.
E-mail: astom2@yahoo.com.