Leukemia
A disease of the body's own defenses
White blood cells are the body's foot soldiers in its everyday battle against infections and diseases. Even when we are feeling well, they are working together in a carefully orchestrated manner to target and destroy dangerous substances in our body. Any disease that prevents the white blood cells from doing their job puts us at great risk for infection and illness.
Leukemia is that kind of disease. It happens when our body's system for making white blood cells malfunctions, resulting in the uncontrolled production of abnormal white blood cells that cannot protect us against disease. If left untreated, leukemia can cause death in a matter of months.
Fortunately, advances in medical science have led to a better understanding of leukemia and to improved treatment. People with leukemia are now able to live healthier, happier lives.
Pronunciation
loo-KEE-mee-yuh
Synonyms & Abbreviations
- Acute lymphocytic leukemia (ALL)
- Acute myeloid leukemia (AML)
- Chronic lymphocytic leukemia (CLL)
- Chronic myeloid leukemia (CML)
- Acute nonlymphoblastic leukemia (ANLL)
- Acute monocytoid leukemia
- Monoblastic leukemia
- Acute monoblastic leukemia
- Acute granulocytic leukemia
- Acute myelocytic leukemia
- Leukemic reticuloendotheliosis
Detailed Description
To understand leukemia, it is helpful to know the normal composition of blood. Here are the kinds of blood cells normally produced within the bone marrow:
- White blood cells: There are several types of white blood cells, each of which has a unique and necessary function in the overall effectiveness of the immune system. Their role in defending the body against foreign organisms is critical.
- Red blood cells: These are the oxygen-carrying blood cells. Leukemia inhibits their growth, usually causing anemia (a shortage of red blood cells). Anemia results in weakness, pallor, and fatigue.
- Platelets: These make up the blood-clotting portion of the blood. Their decreased numbers in leukemia sufferers can result in easy bruising, nose bleeding, and other more harmful bleeding disorders.
Simply put, leukemia is a cancer of the blood cells. It usually involves the white blood cells, but in rare cases involves the red blood cells and platelets as well. The disease originates in the bone marrow. Like all cancers, it is characterized by the uncontrolled growth of abnormal cells. When these defective cells accumulate in the bone marrow where they are produced, it inhibits the production of blood cells of every kind.
All blood cells pass through many stages on their way to complete maturity, beginning within the bone marrow as immature cells called blasts. Leukemia can occur at any of these stages of development, affecting one of the two major categories of white blood cells: lymphoid cells or myeloid cells. Lymphoid leukemia and myeloid leukemia have different treatments as well as different symptoms.
Besides being categorized by the type of cell it affects, leukemia is further classified by the course and duration of the disease. Leukemia is said to be either acute or chronic. Acute leukemia has a sudden onset and involves immature cells that cannot perform their regular function. These immature cells multiply quickly, causing the disease to rapidly worsen. The symptoms of acute leukemia are more severe. People who have acute leukemia usually learn they have the disease after they go to the doctor for their symptoms.
Chronic leukemia progresses more slowly. Typically it involves more mature cells that can partially carry out their function. It is often discovered at a routine visit to the doctor's office before symptoms even arise.
About sixteen specific types of leukemia have been identified. The four broad types of leukemia are based on the categories discussed above. They are as follows:
- Acute lymphocytic leukemia (ALL): This is the most common type of leukemia in children, but it also affects older adults.
- Acute myeloid leukemia (AML): This occurs in both adults and children. This type of leukemia is sometimes called acute nonlymphocytic leukemia (ANLL).
- Chronic lymphocytic leukemia (CLL): This leukemia most often affects adults over the age of 55. Sometimes it affects young adults, but seldom affects children. It is the most common type.
- Chronic myeloid leukemia (CML): This affects mostly adults. A small number of children also develop this disease.
People with leukemia are especially susceptible to infection since their white blood cells aren't functioning properly. Secondary infections are the most common cause of death in all types of leukemia.
Characteristics of Leukemia
Leukemia's primary feature is "marrow failure." This term describes the failure of the bone marrow to produce enough healthy red blood cells, white blood cells, and platelets to carry on regular bodily functions. Basically, the abnormal cells crowd out the normal cells so good cells can't be made in enough quantity. Generally, marrow failure is characterized by increasing vulnerability to infection and illness, fatigue, fever, bone pain, and bleeding/bruising.
How Common Is Leukemia?
Each year, nearly 27,000 adults and more than 2,000 children in the United States learn that they have leukemia. It affects 13.2 per 100,000 men and 7.7 per 100,000 women in the United States. Chronic leukemia comprises 35% to 50% of all cases of leukemia. Seventy percent of leukemia occurs in adults (mostly chronic lymphocytic and acute myeloid leukemias). Thirty percent occurs in children (predominantly acute lymphocytic leukemia).
What You Can Expect
The prognosis for remission and long-term survival of leukemia depends on the age of the patient and the type of leukemia. In general, the outlook for children is somewhat better than for adults. Also, acute leukemia has a much better chance of being cured than chronic leukemia.
It is estimated that by the year 2010 one out of 1,000 young adults in the United States will be a childhood acute lymphocytic leukemia (ALL) survivor. In general, the ALL remission rate is very good for children; about 70% survive for at least five years after diagnosis. In adults, the long-term survival rate is about 20% to 30%.
For acute myeloid leukemia (AML), the disease subsides in 60% to 80% of patients. The long-term survival rate for this disease is 20% to 40%.
Chronic myeloid leukemia (CML) almost always turns into the acute form of the disease within five years. Afterward, the survival rate is poor. The average survival rate is between three and four years. Approximately 60% of adults who undergo a successful bone marrow transplant appear to be cured.
As medical science improves, the outlook for leukemia patients is improving enormously. Each leukemia is different, just as individual responses to treatment are different. It is best to confer with your doctor regarding the chances of recovery. He or she is in the best position to make such a determination. But even then, it is important to recognize that your doctor cannot know exactly what course a disease might take.
Established Causes
Several different entities are suspected of causing leukemia, some of which have been more closely linked to the disease than others. The three major categories of possible and established causes are as follows:
- Genetic factors: A chromosomal abnormality between chromosome 9 and chromosome 22 (called the Philadelphia chromosome) has been linked to leukemia. Acute and chronic leukemias often show abnormalities of many chromosomes.
- Diseases: Myelofibrosis, polycythemia vera, and myelodysplastic diseases have been shown to predispose their sufferers to leukemia. Multiple myeloma and Hodgkin's disease also cause increased risk of developing leukemia, though the risk may be related to the treatments associated with these diseases (radiation therapy, chemotherapy).
- Physical and chemical agents: Some of these are perhaps among the most established causes of leukemia and include long-term exposure to the chemical benzene. Some risk is associated with chemotherapeutic agents such as chloramphenicol and alkylating agents. Viruses have been shown to cause leukemia in lower vertebrates and in cultured human cells, and are suspected of causing leukemias in humans. At least one rare type of leukemia (adult T-cell leukemia) has been positively linked to a specific virus.
Theoretical Causes
The theoretical causes of leukemia are mentioned above.
Risk Factors
The following factors have been linked to the development of leukemia:
- Genetic and chromosomal abnormalities: Down's syndrome sufferers are prone to the development of leukemia. Siblings of a leukemia patient are also at high risk for developing the disease. A defect in a part of the genes called the Philadelphia chromosome predisposes a person to develop chronic myeloid leukemia (CML).
- Radiation exposure: Long-term exposure to high-energy radiation increases the risk of developing leukemia.
- Immunodeficiency states
- Chemical and drug exposure: Benzene is a known leukemic agent.
- Cigarette smoking
Some factors associated with increased occurrence of leukemia include:
- Down's syndrome
- Klinefelter's syndrome
- Bloom's syndrome
- Neurofibromatosis
- Ataxia telangiectasia
- Fanconi's anemia
Risk factors are traits or behaviors that may make you statistically more likely than others in the general population to have a certain condition. They are not necessarily "causes" of the condition.
Symptoms
Depending on whether you have chronic or acute leukemia, symptoms may range from nonexistent to severe. In acute cases, symptoms tend to appear and worsen fast, and the person feels ill enough to see a doctor. In chronic cases, there may be no symptoms for a long time. When they do appear, they worsen slowly. Sometimes, chronic leukemia without symptoms is found during routine exams and blood tests.
See your doctor right right away if you have several of these warning signs, which can be found in both forms of the disease:
- Fever, chills, and flu-like symptoms: caused by the decrease in white blood cells, which makes a person more prone to infections. Upper respiratory infections and flu-like illnesses are common.
- Weakness and fatigue: due to low number of red blood cells (anemia).
- Frequent infections: due to decreased white blood cell count.
- Loss of appetite/weight: this may be related to taste alteration, or chemotherapy or radiation treatment itself.
- Swollen/tender lymph nodes, liver, or spleen: due to accumulation of abnormal white blood cells within these organs. Leukemia also can affect the digestive tract, kidneys, lungs, or other parts of the body.
- Easy bleeding or bruising: due to decreased platelet count or due to disseminated intravascular coagulation (DIC).
- Tiny red spots (called petechiae) under the skin: also due to decreased platelet count and predisposition of small areas to bleed.
- Swollen gums, or gums that bleed easily.
- Bone or joint pain: due to accumulation of abnormal white blood cells within bone marrow.
- Sweating, especially at night.
- Testicular swelling/pain: caused by accumulation of abnormal white blood cells.
- Nervous system disturbances: in the acute leukemias, abnormal white blood cells can collect in the brain and surrounding tissues as well as the spinal cord, which can cause severe headaches, nausea and vomiting, confusion, and seizures.
Conditions That May Be Mistaken for Leukemia
Leukemia may be confused with other conditions that have similar symptoms. They include:
- Virally induced cytopenia
- Immune cytopenia
- Drug-induced cytopenia
- Other marrow failure and infiltrative diseases: aplastic, hypoblastic, and refractory anemias; paroxysmal nocturnal hemoglobinuria; Gaucher's disease
- Severe Vitamin B-12 deficiency
How Leukemia Is Diagnosed
If your doctor suspects leukemia, he or she will do several tests to confirm or rule out the disease:
Physical exam
Your doctor will ask about your medical history, as well as check your overall health. He or she will also feel for swelling in the liver, spleen, and lymph nodes under the arms and in the neck and groin.
Blood testing
- Complete blood cell count (CBC): A sample of your blood will be tested to count the number of various types of cells. People with leukemia usually have a low number of red blood cells and platelets, while the white blood cell count may be low, normal, or high. The appearance of the cells also will be checked under a microscope. An important sign to check for are immature white blood cells called blasts. If they're found under the microscope, they point strongly to leukemia becauses blasts aren't normally seen in the blood.
- Bone marrow aspiration/bone marrow biopsy: A bone marrow aspiration or biopsy is the only way to make a firm diagnosis and to determine the type of leukemia you have. Your doctor will withdraw a sample of bone marrow from a large bone (usually the hip). With aspiration, a needle draws liquid bone marrow from the center of the bone. A biopsy is similar to aspiration, except that the doctor uses a larger needle to remove a small plug of bone and bone marrow.
An oncologist (cancer specialist), hematologist (blood disease specialist), or pathologist (a specialist in how disease affects the body) will then examine the bone marrow under a microscope. Also, pathology tests are done on the bone marrow to look for any abnormality in number, size, shape, or maturity of cells. Special stains are used to determine if cells are myeloid or lymphoid. Usually a very sensitive test called flow cytometry is done. This classifies cells more specifically. The marrow is also checked for chromosomal abnormalities.
Staging Leukemia
With some forms of leukemia, you'll need more tests after diagnosis to uncover the extent of the disease. These "staging" tests are crucial in helping your doctor to plan the best treatment for you and to assess your chances of recovery. Among the staging tests you may have is a cerebrospinal fluid (CSF) analysis: Through a spinal tap or lumbar puncture, your doctor can check whether leukemic cells have spread to the fluid that surrounds the brain and the spinal cord.
Your doctor may also order chest X-rays to find signs of disease in the chest. To check for the effects of leukemia on bone tissue, you may need computed tomography (CT), popularly referred to as a CAT scan, or magnetic resonance imaging (MRI). Some types of leukemia tend to drill tiny holes into the bone. CT scanning shows radiologists the relative densities of bone tissues and helps to indicate where leukemia is affecting bone.
You may also need more lab tests. For instance, the creatinine/blood urea nitrogen (BUN) test measures kidney function.
Not all leukemias are staged. In childhood acute lymphocytic leukemia, for instance, the type of treatment depends not on staging, but on whether or not the youngster has been treated for leukemia before. A child being treated for the first time will most likely receive chemotherapy, while a child being treated for recurring leukemia may have chemotherapy or a bone marrow transplant.
Goals of Treatment
Is the condition curable?
Leukemia is a complicated disease. Treatment will vary from person to person, depending on the type and extent of the disease, as well as someone's age, overall health, and symptoms.
Can leukemia be cured? The answer depends on many factors, including whether you have acute or chronic leukemia. Acute leukemia must be treated immediately. In many cases, treatment brings about remission, which means no signs of the disease can be found. Then you'll need occasional treatments to prevent leukemia from coming back. Often, acute anemia can be cured, especially among children ages 2 to 10. With proper treatment, 70% are still alive five years after diagnosis. Unfortunately, older children and adults with acute leukemia don't fare as well; only 20% to 30% are still alive five years later.
In contrast, certain chronic leukemias can seldom be cured, although in some cases, a bone marrow transplantation may cure the disease. Even when full recovery isn't possible, treatment can slow the disease and relieve symptoms. A person with chronic leukemia may not need treatment until symptoms appear, but he or she still should be under a doctor's care to monitor whether the disease is getting worse.
While many people with leukemia enjoy a remission, the disease can come back. The longer a leukemia stays in remission, and the fewer medications it requires to keep that leukemia in remission, the better the chances are for cure. If leukemia relapses, your physicians will likely suggest a more aggressive approach to treatment, perhaps a bone marrow transplant.
The effectiveness of therapy depends on the type of leukemia being treated, the stage at which it is discovered, and its severity. Main treatments include chemotherapy, radiation therapy, bone marrow transplantation, and biological therapy.
As your doctor treats your disease, he or she will strive to rid your body of leukemic cells, help manage the adverse effects of treatment, and prevent the cancer from returning. If your leukemia has gone into remission, your doctor may also provide maintenance treatment, relatively low-dose chemotherapy given over the course of several years to sustain remission. Your doctor will continue to monitor your overall health for several years after diagnosis, to watch out for signs of recurrence, and to treat any side effects that may occur in the months or years after your treatment.
Treatment Considerations
If possible, try to seek care through a medical center in which doctors are experienced in treating leukemia. Usually, an oncologist (a doctor with specialized training in cancer treatment) will be in charge of your treatment, including coordinating care with other doctors who may be involved in your case. If a child is being treated for leukemia, the doctor may be a pediatric oncologist, someone who specializes in treating children with cancer. Throughout their careers, oncologists keep up with new advances through continuing medical education, and most are associated with medical centers specially equipped for the treatment of leukemia.
If you can't go to such a medical center, your doctor may be able to consult a leukemia specialist at one of these centers about your treatment plan.
Deciding which therapies are appropriate for you is a complex process that you and your doctor will undertake together. The main treatments are as follows:
Chemotherapy
Leukemia is most often treated with chemotherapy, in which potent drugs destroy cancer cells. Usually, a combination of drugs is used, but in some cases, a single drug might be used. Some chemotherapy drugs can be taken by mouth, but most are given by intravenous (IV) injection into a vein. To avoid repeated injections that can injure the skin, you may have a catheter, a narrow, flexible tube, inserted into a large vein in your chest. The catheter remains in place, and the drugs are injected into it.
Chemotherapy is a systemic treatment, meaning that it circulates throughout your body via the bloodstream to destroy cancer cells. Many chemotherapy drugs taken in pill or IV injection form can't reach the brain and spinal cord, because of a protective mechanism called the blood-brain barrier, although there are expections such as methotrexate. To destroy cancer cells in the brain and spinal cord, doctors inject drugs into the lower spine or through a special catheter placed under the scalp. Through these routes, the drugs can enter the cerebrospinal fluid, which surrounds the brain and spinal cord. This procedure is called intrathecal chemotherapy.
Chemotherapy is administered in alternating cycles of treatment and recovery periods. In acute leukemia, there is first an intensive treatment period when very potent drugs are used to bring about remission, which is defined as normal lab results and absence of symptoms. While you're undergoing chemotherapy, you may need red blood cell transfusions to prevent anemia and platelet transfusions to prevent bleeding. Because chemotherapy can suppress your body's natural response to infection, you may also need antibiotics to prevent infection.
Remission is not the same thing as cure, and leukemia may return if left untreated. To prevent a relapse, repeated cycles of intensive chemotherapy are given, perhaps along with radiation therapy and/or bone marrow transplant.
Because of extensive research, the list of chemotherapy drugs used to treat leukemia is evolving rapidly. Here are some of the more common ones:
Adrenocorticoids: help diminish the number of white blood cells in the body.
- Orasone (prednisone)
Alkylating agents: interfere with the production of white blood cells.
- BCNU (carmustine)
- Cytoxan (cyclophosphamide)
- Leukeran (chlorambucil)
- Myleran (busulfan)
Antibiotic antineoplastic drugs: help block the division of leukemic cells.
- Cerubidine (daunorubicin hydrochloride)
- Idamycin (idarubicin)
- Mithracin (plicamycin)
- Rubex, others (doxorubicin)
Antimetabolite drugs: interfere with leukemic cell growth.
- Ara-C (cytarabine)
- Cytosar-U (cytosine arabinoside)
- Hydrea (hydroxyurea)
- Lanvis (thioguanine)
- Purinethol (mercaptopurine)
- Rheumatrex (methotrexate)
Miscellaneous antineoplastic drugs: help to stop abnormal cell growth in acute leukemia.
- Elspar (asparaginase)
- Novantrone (Mitoxantrone)
- Oncovin (vincristine sulfate)
Radiation therapy (radiotherapy)
For certain types of leukemia, radiation therapy may be combined with chemotherapy. A large machine delivers high-energy X-rays to damage leukemia cells and prevent them from dividing. Radiation can be beamed to just one part of the body that has leukemia cells, such as the testicles or spleen. Or the whole body may receive radiation before a bone marrow transplantation.
Bone Marrow Transplantation
Some people with leukemia choose to have a bone marrow transplantation (BMT). In BMT, high doses of chemotherapy or radiation, or both, destroy all the bone marrow, which is producing leukemia cells. Then healthy bone marrow is injected into the veins. The marrow finds its way into the bones and begins making its own blood cells in about two to four weeks.
Bone marrow transplants can save lives, but they are expensive, technically complex, and potentially life-threatening. Be sure you thoroughly understand the pros and cons of the procedure, as well as alternative treatments, before you proceed.
Your own bone marrow, or that of a donor, may be used in BMT. An identical twin is a perfect donor because he or she has the same genetic makeup. But obviously, few people have this option. If you receive marrow from another person who is not an identical twin, it's better if the donor's marrow closely matches yours. That's because graft-versus-host disease (GVHD) is one possible complication of BMT. With GVHD, the donated marrow can have mild to severe reactions against your tissues, such as those in the liver, skin, and digestive tract. Drugs can prevent or treat GVHD.
There are three types of bone marrow donors:
- Autologous transplant: This method involves the use of your own bone marrow. Before the transplant and when you are in remission, your doctor will remove some of your bone marrow, possibly treat it with drugs to kill cancer cells, then freeze the marrow. After chemotherapy and/or radiation destroy all the leukemia-producing bone marrow in your body, the frozen marrow is thawed and injected back into your veins. By using your own marrow, autologous transplant avoids the problem of graft-versus-host disease (GVHD). The drawback is that leukemia is more likely to recur than in cases in which donor marrow is used.
- Syngeneic transplant: This involves donated marrow from an identical twin. It also prevents GVHD since the cells being transplanted are of identical genetic make-up.
- Allogeneic transplant: The donor is usually a parent or sibling whose marrow type closely matches the yours, but may also be an unrelated donor with a close bone marrow type match. Close matching reduces the possibility of GVHD, which occurs in 30% to 50% of bone marrow transplants.
After transplantation, you will receive antibiotics to prevent infection. You may be placed in a sterile room with a filtered air supply to prevent infection as well. For up to three or four weeks after the procedure, you may also require red blood cell transfusions to treat anemia, as well as platelet transfusions to prevent bleeding.
Patients are usually discharged from the hospital about five to six weeks after the surgery. But even after that, it will take some time for your immune system to heal. Outpatient care continues after the surgery. Patients should plan to return to work in nine months to one year after the procedure.
Biological therapy
Biological therapy uses the injection of substances that stimulate or restore the immune system's ability to fight cancer. One such substance used in leukemia treatment is interferon. Studies have shown that its use alongside chemotherapy drugs may lengthen survival time by slowing the progress of some chronic leukemias.
Leukapheresis
Leukapheresis is a supportive treatment for leukemia if the white blood cell count is very high. In it, a special machine filters the blood to remove extra white blood cells. Then the filtered blood is returned to to the bloodstream.
Appropriate Health Setting
Treatment for acute leukemia requires patients to stay at a hospital. Treatment for chronic leukemia is often on an outpatient basis.
Healthcare Professionals Who May Be Involved
Besides your family doctor/pediatrician, the following specialist physicians may be involved in your care:
- Radiologists
- Hematologists
- General surgeons
- Pathologists
- Medical oncologists (chemotherapists)
- Surgical oncologists
- Radiation oncologists (radiotherapists)
- Immunologists
- Medical geneticists
- Psychiatrists
- Clinical psychologists
Activity & Diet Recommendations
People with leukemia, mostly those with acute cases, may lose their appetite and begin to drop weight. Even though eating becomes hard, it's still important to take in foods high in calories and protein to stay strong and maintain body tissues. If you lose your appetite, try eating smaller meals frequently and throughout the day.
A bitter or metallic taste in the mouth can also occur as a result of leukemia or its treatment. It may help to drink lots of fluids, such as fruit juices, tea, or water. Eating foods that leave their own taste (like hard sugarless candies and fresh fruits) may also help.
Leukemia treatment or anemia can bring on fatigue, so try to plan regular rest periods throughout the day. If you can, sleep at least eight hours a night and takes naps during the day. During treatment, you may need to shorten your work day or stop working altogether for a time.
People with leukemia are at high risk for infections, both during and after treatment. Your doctor may prescribe antibiotics or other drugs to help protect you from infections. To lessen your chances of getting sick, avoid crowds and stay away from people with colds and other illnesses that can spread. Avoid contact with human or pet feces, which means letting someone else clean litter boxes and fish tanks. Any infections may become serious, even to the point of hospitalization. If you get an infection, especially a wound that won't heal, a fever, chills, or other illness, call your doctor right away.
Bleeding and anemia are other problems to watch for. It's wise to avoid activities such as contact sports and carpentry to prevent injuries that can cause bleeding. Be extra careful when gardening or handling pets that might scratch or bite you. Using an electric shaver instead of a razor may prevent cuts. A soft toothbrush will help prevent the gums from bleeding. In fact, good dental care is important. Leukemia and chemotherapy can leave your mouth more sensitive to infections and bleeding. You dentist can show you how to keep your mouth clean and healthy.
Monitoring the Condition
After intensive treatment of leukemia, you'll still need regular follow-up exams with your doctor to monitor your health and to make sure the leukemia has not returned. Checkups may include exams of the blood, bone marrow, and cerebrospinal fluid, as well as a complete physical exam.
Because cancer treatment may cause side effects many years later, it's important for you to promptly tell your doctor about any changes in your health or any new symptoms that appear.
Possible Complications
Leukemia treatment may lead to complications and side effects, such as infections, loss of appetite, and fatigue. Ask your doctor for suggestions on how to cope with these problems through medication, diet changes, and other measures. As a precaution against infections, doctors often prescribe antibiotics during leukemia treatment. If a serious infection such as pneumonia arises, your doctors will treat it with very potent medications.
Among the more common side effects you may find:
Chemotherapy
- Nausea and vomiting
- Hair loss
- Reduced resistance to infection
- Diarrhea, constipation
- Fatigue, weakness, loss of coordination
- Mouth, throat sores
- Irregular menstrual periods, or no periods
- Menopause symptoms (hot flashes, vaginal dryness)
- Infertility
- Developmental problems in children
- Heart problems
Radiation therapy
- Loss of appetite and/or weight
- Nausea and vomiting
- Fatigue
- Hair loss
- Skin irritation
- Reduced resistance to infection
- Changes in sense of taste and smell
- Infertility
- Secondary cancers
- Slowed growth in children
- In children, radiation to the brain can cause problems with learning and coordination
Bone marrow transplantation
- Graft-versus-host disease (GVHD)
- Wound infection
- Bleeding
Quality of Life
Having leukemia is extremely stressful for you and your loved ones. Besides concerns about your health and well-being, you may be worried, too, about treatments, hospital stays, and medical bills, as well as your ability to meet job and family responsibilities. If you are the parent of a child with leukemia, you may be concerned about the effect of treatments on your child's growth and development, as well as the impact of the disease on his schooling and social activities.
You may feel isolated in your concerns, which can making coping even harder. People have different styles when it comes to handling life crises, but many people with leukemia find it helpful to talk with close friends, relatives, a clergy member, or a therapist. Some people prefer to join cancer support groups, where they can find others who can offer emotional support, as well as swap information about treatment. Ask your doctor or hospital to help you locate such groups.
In many cases, a hospital or clinic social worker can also assist you with transportation, home care, financial help, and other practical matters.
Considerations for Fertility
Radiation therapy and chemotherapy can cause women to become infertile. A woman's menstrual cycles can become irregular or stop. Postmenopausal women may have worsened symptoms of menopause, such as hot flashes and vaginal dryness.
In men, radiation and chemotherapy treatments can affect fertility. A man may stop producing sperm temporarily or permanently. If you are a man who wants to have children, consider storing sperm at a sperm bank before radiation or chemotherapy.
Because their sex glands are more resistant to treatment, children who receive chemotherapy or radiation therapy usually have normal fertility when they become adults. However, depending on the drugs used and the dosages given, some boys and girls may not be able to have children when they grow up.
Considerations for Children and Adolescents
Children can cope with just about anything if they know their parents are at their side. It is important to explain as much as possible to your child. For a sick child and his brothers and sisters to feel secure, they must be able to depend on their parents to tell them the truth, whether it is good news or bad.
During the treatment of leukemia, parents are often filled with feelings of sadness, shock, anger, confusion, and even guilt. Though you shouldn't allow these natural responses to overpower you, it is important to recognize them and find healthy ways of expressing them.
It is just as important to remember that children, both siblings and the ill child, are also overcome with strong feelings. But children have fewer emotional skills and may not be able to handle their feelings as well. Be sensitive to this and help your child or children to understand their emotions. It may be helpful for the family to meet with a counselor, clergy member, or other families in which a child has leukemia. Your doctor or hospital may be able to put you in touch with cancer support groups for children and families, as well as therapists, social workers, and other sources of help.
Leukemia is a serious illness that requires the most sophisticated treatments medicine has to offer. However, a few alternative treatments may be helpful to your well-being.
Vitamins, minerals, and other supplements
Most healthcare professionals agree that while certain supplements can be of use in treating cancer, nutrients are best obtained by eating a healthy diet. Look for foods high in beta carotene and vitamins C and E. Good choices are dark green vegetables, yellow and orange fruits, citrus fruits and bell peppers, wheat germ, seafood, legumes, and poultry.
Herbal recommendations
- Madagascar periwinkle (use only under doctor's supervision)
- Ginger (to reduce nausea)
- Ginseng (to reduce nausea)
- Sarsaparilla (to reduce nausea)
- Wild Oregon grape (to reduce nausea)
- Garlic pills (may bolster immune system)
- Royal jelly (preventive substance)
Yoga/Meditation/Relaxation Techniques
The regular practice of stress reduction techniques can do a lot to relieve the anxiety related to leukemia. Studies have shown that reducing stress helps strengthen the immune system.
Group Support
There are many support groups for those with leukemia and parents of children that have leukemia. These support groups can be an invaluable aid in educating you about leukemia as well as providing emotional support through the experience and expertise of others that are going or have gone through leukemia.
Listed below are some organizations that can help you find a leukemia support group in your area. Also, check your local phone book for these organizations.
- The Leukemia Society of America (800) 955-4572