GROUP FIVE

1. FARIDAH NDUKU -D/OT/21001/064

2. STANLEY KIEMA -D/OT/21001/063

3. SHARON KEMBOI -D/OT/21001/061

4. SHEILAH CHEPKIRUI- D/OT/20001/182

5. VAUS MUKAMI - D/OT/20001/183

6. LIZ NYAMBURA -D/OT/21001/066

 7. LEUKAMIA

Leukemia is a cancer of the blood cells. There are several broad categories of blood cells,
including red blood cells (RBCs), white blood cells (WBCs), and platelets. Generally, leukemia
refers to cancers of the WBCs. Leukemia usually involves the white blood cells. Your white
blood cells are potent infection fighters — they normally grow and divide in an orderly way, as
your body needs them. But in people with leukemia, the bone marrow produces an excessive
amount of abnormal white blood cells, which don't function properly.
. Once formed, WBCs travel through your bloodstream and lymphatic vessels to fight infection
in the body’s tissues. WBCs are a vital part of your immune system. They protect your body
from invasion by:
 bacteria
 fungi
 abnormal cells
 foreign substances
WBCs are mostly produced in the bone marrow, but certain types of WBCs are also made in the:

 lymph nodes
 spleen
 thymus gland

How leukemia forms

In general, leukemia is thought to occur when some blood cells acquire changes (mutations) in
their genetic material or DNA. A cell's DNA contains the instructions that tell a cell what to do.
Normally, the DNA tells the cell to grow at a set rate and to die at a set time. In leukemia, the
mutations tell the blood cells to continue growing and dividing.
When this happens, blood cell production becomes out of control. Over time, these abnormal
cells can crowd out healthy blood cells in the bone marrow, leading to fewer healthy white blood
cells, red blood cells and platelets, causing the signs and symptoms of leukemia.
CAUSES
Scientists have not yet understood the exact cause of leukemia but it is thought to develop from
combination of genetic and environmental factors.
Mutations of leukemia cells in their DNA makes them grow abnormally and lose their typical
functions of White Blood Cells.
Environmental factors such as cigarette smoking, certain chemicals or radiation lead to leukemia.
RISK FACTORS
  Exposure to high energy radiation from an atomic bomb or nuclear power plant which
increases the risk of developing AML (Acute Myeloid Leukemia) CML (Chronic
Myeloid Leukemia) or ALL (Acute Lymphocytic Leukemia).
 Blood disorders known as Myelodysplastic syndromes confer an increased risk of
developing Acute Myeloid Leukemia.
 Some types of viruses can cause tumors such as Hepatitis B virus and HIV virus.

 Previous cancer treatment. People who've had certain types of chemotherapy and
radiation therapy for other cancers have an increased risk of developing certain types of
leukemia.
 Genetic disorders. Genetic abnormalities seem to play a role in the development of
leukemia. Certain genetic disorders, such as Down syndrome, are associated with an
increased risk of leukemia.
 Exposure to certain chemicals. Exposure to certain chemicals, such as benzene — which
is found in gasoline and is used by the chemical industry — is linked to an increased risk
of some kinds of leukemia.
 Smoking. Smoking cigarettes increases the risk of acute myelogenous leukemia.
 Family history of leukemia. If members of your family have been diagnosed with
leukemia, your risk of the disease may be increased.

SYMPTOMS

Leukemia symptoms vary, depending on the type of leukemia. Common leukemia signs and symptoms
include:

• Fever or chills

• Persistent fatigue, weakness

• Frequent or severe infections

• Losing weight without trying

• Swollen lymph nodes, enlarged liver or spleen

• Easy bleeding or bruising

• Recurrent nosebleeds

• Tiny red spots in your skin (petechiae)

• Excessive sweating, especially at night

• Bone pain or tenderness

Leukemia can also cause symptoms in organs that have been infiltrated or affected by the cancer cells.
For example, if the cancer spreads to the central nervous system, it can cause:

 headaches
 nausea and vomiting
 confusion
 loss of muscle control
 seizures

How the cancer spreads depends on the type of leukemia and how aggressive it is.

Leukemia can also spread to other parts of your body, including the:

 lungs
 gastrointestinal tract
 heart
 kidneys
 testicles

CLASSIFICATION OF LEUKAMIA

 The first type of classification is by how fast the leukemia progresses:

•Acute leukemia. In acute leukemia, the abnormal blood cells are immature blood cells (blasts). They
can't carry out their normal functions, and they multiply rapidly, so the disease worsens quickly. Acute
leukemia requires aggressive, timely treatment.

•Chronic leukemia. There are many types of chronic leukemia. Some produce too many cells and some
cause too few cells to be produced. Chronic leukemia involves more-mature blood cells. These blood
cells replicate or accumulate more slowly and can function normally for a period of time. Some forms of
chronic leukemia initially produce no early symptoms and can go unnoticed or undiagnosed for years.

 The second type of classification is by type of white blood cell affected:

•Lymphocytic leukemia. This type of leukemia affects the lymphoid cells (lymphocytes), which form
lymphoid or lymphatic tissue. Lymphatic tissue makes up your immune system.

•Myelogenous (my-uh-LOHJ-uh-nus) leukemia. This type of leukemia affects the myeloid cells. Myeloid
cells give rise to red blood cells, white blood cells and platelet-producing cells.
THE TYPES OF LEUKAMIA

The onset of leukemia can be acute (sudden onset) or chronic (slow onset). In acute leukemia, cancer
cells multiply quickly. In chronic leukemia, the disease progresses slowly and early symptoms may be
very mild. Leukemia is also classified according to the type of cell that’s affected.

Leukemia involving myeloid cells is called myeloid or myelogenous leukemia. Myeloid cells are immature
blood cells that would normally become granulocytes or monocytes.

Leukemia involving lymphocytes is called lymphocytic leukemia.

There are four main types of leukemia:

 Acute myeloid leukemia (AML)

Acute myeloid leukemia (AML) can occur in children and adults. According to the Surveillance,
Epidemiology, and End Results Program of the National Cancer Institute (NCI) Trusted Source, about
20,000 new cases of AML are diagnosed each year in the United States. This is the most common form
of leukemia. The 5-year survival rate for AML is 29.5 percent.

 Acute lymphocytic leukemia (ALL)

Acute lymphocytic leukemia (ALL) occurs mostly in children. The NCI Trusted Source estimates about
6,000 new cases of ALL are diagnosed annually. The 5-year survival rate for ALL is 69.9 percent.

 Chronic myeloid leukemia (CML)

Chronic myeloid leukemia (CML) affects mostly adults. About 9,000 new cases of CML are diagnosed
annually, according to the NCI Trusted Source. The 5-year survival rate for CML is 70.6 percent.

 Chronic lymphocytic leukemia (CLL)

Chronic lymphocytic leukemia (CLL) is most likely to affect people over age 55. It’s very rarely seen in
children. According to the NCI Trusted Source, about 21,000 new cases of CLL are diagnosed annually.
The 5-year survival rate for CLL is 87.2 percent.

Hairy cell leukemia is a very rare subtype of CLL. Its name comes from the appearance of the cancerous
lymphocytes under a microscope.
Leukemia diagnosis
Diagnosis of leukemia involves a number of steps. Your doctor will conduct a physical exam, order blood
tests and bone marrow biopsy. The doctor will ask about any symptoms you are experiencing and check
for swollen lymph nodes. The diagnosis often begins with a complete blood count {CBC} and peripheral
blood smear, blood marrow aspiration and biopsy.

•PHYSICAL EXAM AND HISTORY - These are the starting points of the diagnosis of leukemia. It will
review signs of possible leukemia such as lymph node swelling, pale skin.

•BLOOD TESTS AND PERIPHERAL BLOOD SMEAR - Provides an estimate of your blood concentration
of each of the major types of blood cells made by the bone marrow. Can also identify whether
you’re your red blood cells are large or small. The peripheral blood smear can provide details about the
type of white blood cells in the blood.

•Example;

DISEASE CBC RESULTS BLOOD SMEAR

RESULTS

Acute myelogenous Lower than normal Many immature

leukemia amount of RBCs and WBCs and sometimes
Platelets presence of Auer rods

•BONE MARROW ASPIRATION AND BIOPSY – Since blood tests are not enough to conclusively diagnose
the disease, bone marrow aspiration and biopsy are done. During a bone marroaspiration , a long, thin
needle is inserted into the bone marrow in the hip or breast bone. After a sample of the bone marrow
is aspirated, a biopsy sample is also taken.

•CYTOCHEMISTRY – Look at how the cells in the cells in the bone marrow take up certain stains. Tests
can include;

 Flow cytometry – bone marrow cells are coated with antibiotics to look for the presence
of proteins found on the surface of the cells.
 Immunohistochemistry – examination of the cells using a microscope.

•GENE STUDIES – Looking for chromosomal changes and changes in specific genes.

 Cytogenetics
 Fluorescent in situ Hybridization{FISH}
 Polymerase chain reactions{PCR}
 OTHER PROCEDURES

• Imaging
• X- rays
• CT scan
• MRI
STAGING – After diagnosis, the cancer is staged based on factors such as symptoms, the subtypes of
leukemia, and the number of abnormal cells in the blood or bone marrow.

Example;

• Chronic lymphocytic leukemia {CLL} –Based on the presence of several findings.

 Number of lymphocytes
 Enlarged lymph nodes
 An enlarged liver or spleen

Based on the stages, the cancer are then separated into low, intermediate, and high risk categories.

Leukemia are separated into only three stages;

STAGE A: Less than 3 lymph node regions.

STAGE B: Greater than 3 affected lymph node regions.

STAGE C: Any number of lymph nodes but combined with either anemia or a low level of platelets.

{Reference: w.w.w.verywellhealth.com}

TREATMENT OF LEUKEMIA

•Chemotherapy – Chemotherapy are chemicals {medications } given in pill form, administered through
an IV into a vein or a central line or given in shots under the skin { subcutaneously }.The chemicals kill
leukemia cells or stop them from dividing. This is the most common form of leukemia treatment.

•Radiation therapy – Uses strong beams of energy to kill leukemia cells and stop them from growing.

•Immunotherapy {biologic therapy} – Uses certain drugs to boost body self-defense system and fight
leukemia. Immunotherapies include interferon, interleukins and CAR-T cell therapy.

•Targeted therapy – It uses drugs that are focused on a specific features of leukemia cells. They work by
blocking the ability of leukemia cells to multiply and divide. It is also less likely to harm normal cells.
Examples of targeted therapy include monoclonal antibodies such as inotuzumab, ofatumumab and
tyrosine kinase inhibitors.

•Hematopoietic cell transplant {stem cell or bone marrow transplant} – This procedure replaces the
cancerous blood forming cells that have been killed by chemotherapy and radiation therapy with new
healthy hematopoietic cells.

{Reference: my.clevelandclinic.org,}
There are four main types of leukemia:

 Acute myeloid leukemia (AML)

 Acute myeloid leukemia (AML) can occur in children and adults. According to the Surveillance,
Epidemiology, and End Results Program of the National Cancer Institute (NCI)Trusted Source,
about 20,000 new cases of AML are diagnosed each year in the United States. This is the most
common form of leukemia. The 5-year survival rate for AML is 29.5 percent.
 Acute lymphocytic leukemia (ALL)

 Acute lymphocytic leukemia (ALL) occurs mostly in children. The NCITrusted Source estimates
about 6,000 new cases of ALL are diagnosed annually. The 5-year survival rate for ALL is 69.9
percent.
 Chronic myeloid leukemia (CML)

 Chronic myeloid leukemia (CML) affects mostly adults. About 9,000 new cases of CML are
diagnosed annually, according to the NCITrusted Source. The 5-year survival rate for CML is 70.6
percent.
 Chronic lymphocytic leukemia (CLL)

 Chronic lymphocytic leukemia (CLL) is most likely to affect people over age 55. It’s very rarely
seen in children. According to the NCITrusted Source, about 21,000 new cases of CLL are
diagnosed annually. The 5-year survival rate for CLL is 87.2 percent.

 Hairy cell leukemia is a very rare subtype of CLL. Its name comes from the appearance of the
cancerous lymphocytes under a microscope.