Blood Cell Cancers

Cancer that starts in blood-forming tissue such as bone marrow and causes large numbers of blood cells to be produced and enter the bloodstream

Leukemia

Where does leukemia originate from and what cells does it involve?

Originates in the bone marrow and involve either myeloid or lymphoid cells

Cancer that originates in the bone marrow, but it involves a very particular cell called a plasma cell, which comes from a B-cell, a lymphoid cell.

Myeloma

Cancer that originates in the lymphatic tissues, particularly lymph nodes; involve B or T cells. Is a solid tumor

Lymphomas

Do lymphomas circulate in the blood or are they are solid tumor?

Solid tumors

Leukemia circulates in the blood. True or false?

True

A slowly progressing cancer that starts in blood-forming tissues such as the bone marrow, and causes large numbers of WBCs to be produced and enter the bloodstream

Chronic leukemia

A rapidly progressing cancer that starts in blood-forming tissues such as bone marrow, and causes large numbers of WBCs to be produced and enter the bloodstream

Acute leukemia

Pathophysiology of leukemia

• In leukemia, bone marrow makes abnormal WBCs; abnormal cells are leukemia cells

• Unlike normal blood cells, leukemia cells don’t die when they should; they crowd out normal blood cells (WBCs, RBCs, platelets) , making it hard for normal cells to do their work

• Pancytopenia

Myeloid stem cell matures into a myeloid blast, which can form into a

RBC, platelet, or one of several types of WBCs

A lymphoid cell matures into a lymphoid blast which can form →

Several types of WBCs, such as B or T cells

How are types of leukemia grouped?

• Based on type of WBC affected

• Leukemia can start in lymphoid cells or myeloid cells

• Leukemia that affects lymphoid cells is called lymphoid, lymphocytic, or lymphoblastic leukemia

• Leukemia that affects myeloid cells is called myeloid, myelogenous, or myeloblastic leukemia

Leukemia that affects lymphoid cells are called

Lymphoid, lymphocytic, or lymphoblastic leukemia

Leukemia that affects myeloid cells is called

Myeloid, myelogenous, or myeloblastic leukemia

Leukemia that affects lymphoid cells and usually grows slowly. Accounts for more than 15,000 new cases of leukemia each year. Most often people diagnosed with disease over age 55; almost never affects children.

Chronic lymphocytic leukemia (CLL)

Leukemia where most often people diagnosed with disease over age 55; almost never affects children.

CLL

Leukemia that affects myeloid slowly and usually grows slowly at first. Accounts for nearly 5,000 new cases of leukemia each year; mainly affects adults

Chronic myeloid leukemia (CML)

Leukemia that accounts for 5,000 new cases each year, and mainly affects adults

CML

Leukemia that affects lymphoid cells and grows quickly. It accounts for more than 5,000 new cases of leukemia each year. Is the most common type of leukemia in young children. It also affects adults

Acute lymphocytic leukemia (ALL)

Leukemia that is the most common type of leukemia in young children. It also affects adults

ALL

Leukemia that affects myeloid cells and grows quickly. Accounts for more than 13,000 new cases of leukemia each year. Occurs in both adults and children.

Acute myeloid leukemia (AML)

What age groups does AML affect?

Occurs in both adults and children.

5-year survival rate of AML

24.2%

5-year survival rate of ALL

66.4%

5-year survival rate of CML

54.6%

5-year survival rate of CLL

79.7%

Rare form of chronic leukemia

Hairy cell leukemia

Leukemia that account for fewer than 6,000 new cases of leukemia each year

Rare leukemias (e.g. hairy cell leukemia).

Risk factors for leukemia

• Radiation (atomic bomb explosions, radiation therapy)

• Smoking

• Benzene

• Chemotherapy

• Down syndrome

• Myelodysplastic syndrome

• Human T-cell leukemia virus type I (HTLV-I)

• Family hx

People who have been exposed to very high levels of radiation are more likely than others to develop which types of leukemia?

AML, CML, ALL

Who are at increased risk of leukemia from an atomic bomb explosion?

Children

Could X-rays and CT scans cause leukemia?

Not known; still be studied

What type of leukemia dose smoking increase the risk of?

AML

How is benzene exposure a risk factor for leukemia?

Exposure to benzene in the workplace can cause acute myeloid leukemia. It may also cause chronic myeloid leukemia or acute lymphocytic leukemia. Benzene is used widely in the chemical industry. It's also found in cigarette smoke and gasoline

• TLDR → can cause AML, CML, or ALL

Which types of leukemias can chemo cause?

• AML or ALL

• Caused by alkylating agents or topoisomerase inhibitors → acute leukemia

Down syndrome and other inherited diseases increases r/o developing what type of leukemia?

Acute leukemias

Myelodysplastic syndrome and certain blood disorders is a risk factor for which leukemia?

AML

HTLV-I is risk factor for what type of leukemia?

Rare type of leukemia known as adult T-cell leukemia; virus causes this disease, but is not contagious

Family history of leukemia is often associated with which type of leukemia?

CML

What do symptoms of leukemia depend on?

• Number of leukemia cells

• Where these cells collect in the body

• Chronic leukemia may be symptomatic (diagnosed w/ routine blood test)

S&S leukemia

• Feeling sick

• If brain affected → HA, vomiting, confusion, loss of muscle control, seizures

• Can affect GI tract, kidneys, lungs, heart, or testes

S&S of chronic or acute leukemia

• Swollen lymph nodes that don’t hurt (esp. in neck or armpits)

• Fever or night sweats

• Frequent infections

• Feeling weak or tired

• Bleeding/bruising easily (bleeding gums, purplish patches in skin; purpura, tiny red spots under skin; petechiae)

• Swelling/discomfort in abd (from swollen spleen/liver)

• Unexplained weight loss

• Pain in bones or joints

How is leukemia diagnosed?

• Routine blood test (CBC, # of WBCS, RBCs, platelets)

• Physical exam (swollen lymph nodes, liver, spleen)

• High WBC, low levels of platelets and Hgb found in RBCs

• Tissue/bone marrow biopsy (bone biopsy uses thick, hollow needle)

• Bone marrow is removed from hipbone

• Pathologist using microscope

• Bone marrow aspiration (needle)

• Spinal tap (remove CSF; patients lies flat to prevent HA)

• Chest X-ray → shows swollen lymph nodes

Lab hallmarks of leukemia

• Very high WBC

• Low levels of platelets & Hgb

Diagnostic leukemia test where lab looks at the chromosomes of cells from samples of blood, bone marrow, or lymph nodes. If abnormal chromosomes are found, the test can show what type of leukemia is involved. For example, people with CML have an abnormal chromosome called the Philadelphia chromosome

Cytogenic

People with CML have an abnormal chromosome called

Philadelphia chromosome

Leukemia treatment

• Chemotherapy

• Targeted therapy

• Biological therapy

• Radiation therapy

• Stem cell transplant

• Surgery if spleen is enlarged (splenectomy)

Treatment of leukemia depends on what?

• Type of leukemia (acute/chronic)

• Age

• Whether leukemia cells were found in CSF

Treatment for acute leukemia

• People must be treated right away

• Goal of treatment is to destroy signs of leukemia in body and make symptoms go away → remission

Acute leukemia remission

• More therapy is given to prevent relapse → consolidation therapy/maintenance therapy

• Many people w/ acute leukemia can be cured

A decrease in or disappearance of S&S of cancer. In partial remission, some, but not all, S&S of cancer have disappeared

Remission

All S&S of cancer have disappeared, although cancer still may be in the body.

Complete remission

The return of a disease or S&S of a disease after a period of improvement

Relapse

Treatment that is given to help keep cancer from coming back after it has disappeared following initial therapy

• includes drugs, vaccines, and antibodies that kill cancer cells

• May be given for a long time

Maintenance

Chronic leukemia treatment

• Chronic leukemia without symptoms my not need cancer treatment right away

• Careful monitoring

• Watchful waiting (not getting cancer treatment right away)