Leukemia

Each year, nearly 32,000 adults and more than 2,000 children in the United States learn that they have leukemia, a cancer of the blood cells.

ANATOMY There are three different types of blood cells: red blood cells (RBC or erythrocytes), white blood cells (WBC, or leukocytes), and platelets (thrombocytes). Red blood cells contain hemoglobin and use it to carry oxygen from the lungs to the tissues. White blood cells do not carry oxygen but are part of the body's immune system. White blood cells are either lymphocytes (spend much of their time in the lymphatic system) or myeloid cells (spend much of their time in the bone marrow or general circulation). Platelets are not complete cells but are fragments of certain kinds of leukocytes, and they are involved in blood clotting.

Leukemia affects white blood cells only and can arise in either lym-phoid cells (lymphocytic leukemia) or myeloid cells (myelogenous leukemia). The disease has two forms: acute and chronic leukemia. Acute leukemia is a devastating disease that progresses very quickly, destroying the patient's immune system. Chronic leukemia progresses much more slowly, and even though the leukocytes are transforming, they retain some of their normal functions, so the immune system is not destroyed so quickly, or so completely.

RISK FACTORS The patient's age is the primary risk factor. Acute lymphocytic leukemia is the most common type of leukemia in young children and in adults who are 65 and older. Acute myeloid leukemia (also called acute nonlymphocytic leukemia) occurs in both adults and children. Chronic lymphocytic leukemia most often affects adults over the age of 55. It sometimes occurs in younger adults, but rarely affects children. Chronic myeloid leukemia occurs mainly in adults. Very few children ever develop this form of leukemia.

SYMPTOMS Some symptoms of leukemia are fever, chills, and other flulike symptoms; weakness and fatigue; frequent infections; loss of appetite and/or weight; swollen or tender lymph nodes, liver, or spleen; easy bleeding or bruising; tiny red spots under the skin; swollen or bleeding gums; sweating, especially at night; and/or bone or joint pain. Leukemia metastasizing to the brain may cause headaches, vomiting, confusion, loss of muscle control, and seizures. Leukemia cells can also colonize the testicles, where they cause pain and swelling; the skin and eyes, where they produce sores; and many other organs and tissues of the body.

DIAGNOSIS The patient is examined for swelling in the liver, the spleen, and the lymph nodes under the arms, in the groin, and in the neck. A blood sample is examined under the microscope to check for abnormal white blood cells. The most definitive test is the microscopic examination of a bone marrow biopsy, which is obtained by inserting a needle into the hip and removing a small amount of bone marrow. If

The lungs are part of the respiratory system and fill most of the thoracic cavity. The trachea divides into two bronchial tubes, each of which branch out like a tree inside the lung. The branches are called bronchioles and terminate in grapelike clusters of alveoli, where gas exchange occurs between the air and the blood.

The lungs are part of the respiratory system and fill most of the thoracic cavity. The trachea divides into two bronchial tubes, each of which branch out like a tree inside the lung. The branches are called bronchioles and terminate in grapelike clusters of alveoli, where gas exchange occurs between the air and the blood.

cancer cells are found, X-rays are obtained to evaluate the spread of the disease.

STAGING Staging is difficult to determine with this form of cancer, since the leukocytes normally travel throughout the body. Consequently, transformation and metastasis may occur simultaneously.

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