LEUKEMIA

CANCER OF BLOOD

Subject: Pathology
Submitted to: Ma’am Rabia Asghar
Submitted by: Hafsa Malik
Roll number: BPD02183251
Section: 5 th -A
 LEUKEMIA
What is leukemia?
Leukemia is a malignant progressive disease in which the bone marrow and
other blood-forming organs produce increased numbers of immature or
abnormal leucocytes. These suppress the production of normal blood cells,
leading to anaemia and other symptoms
OR
It is a cancer of blood or bone marrow characterized by an abnormal increase of
white blood cells called “blasts.”

It covers a spectrum of diseases that affect blood, bone marrow and lymphoid
system which are all known as hematological neoplasms.
While the exact cause(s) of leukemia is not known, risk factors have been
identified, including radiation exposure, certain chemotherapy for cancer,
smoking, family history of leukemia, and exposure to certain chemicals.
 ETIOLOGY OF LEUKEMIA
Scientists don't understand the exact causes of leukemia. It seems to
develop from a combination of genetic and environmental factors.
In general, leukemia is thought to occur when some blood cells acquire
mutations in their DNA — the instructions inside each cell that guide
its action. There may be other changes in the cells that have yet to be
fully understood that could contribute to leukemia.
Certain abnormalities cause the cell to grow and divide more rapidly
and to continue living when normal cells would die. 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.
 MECHANISM OF LEUKEMIA
◦ The lack of control causes normal bone marrow to be replaced by
immature and undiffrentiated leukocytes or blast cells. These abnormal
leukocytes then circulate in blood and infilterate the blood forming
organs (liver, spleen, lymph nodes) and to other sites of the body.
◦ Leukemia cells are known to have an overactive level of a protein
called β-catenin, which can drive cancer development. Once this
protein moves into the nucleus of cells, where DNA is stored, it can
assist the activation of genes important for leukemia development.
 SYMPTOMS OF LEUKEMIA
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
 CLINICAL FEATURES
The clinical features include:
1. Acute onset
2. Symptoms related to depression of normal marrow function
 Fatigue: Due to anemia
 Fever: Due to infection resulting from absence of mature leukocytes
Bleeding: Secondary to thrombocytopenia
3. Bone pain and tenderness
4. CNS manifestations: Headache, vomitting, nerve palsies
 PATHOPHYSIOLOGY
◦ As with many malignancies, the
precise aetiology of childhood
leukaemia remains unknown.
It is clearly a multi-factorial condition,
with infection, genetic predisposition
and numerous environmental
exposures all playing a potential role
in its development.
◦ Disruptions in the regulation and proliferation of lymphoid
precursor cells in the bone marrow leads to excessive
production of immature
“blast” cells and a subsequent drop in numbers
of functional red blood cells, white blood cells
and platelets.
 RISK FACTORS
Factors that may increase your risk of developing some types of leukemia include:
◦ 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.
 CLASSIFICATION OF LEUKEMIA
(Based on speed of progression)
Leukemia is classified in two different ways. First, there are two main
types of leukemia, classified as acute or chronic, based on its speed of
progression
◦ Acute leukemia: With acute leukemias, immature blood cells (blasts)
do not function properly and multiply at a very rapid pace. 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: Chronic leukemias involve mature blood cells
functioning normally for a period of time before becoming cancerous
and replicating themselves at a slightly accelerated pace. 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.
 CLASSIFICATION OF LEUKEMIA
(Based on type of cells affected)
The second way in which the condition is classified is by the type of cells affected:

1. Lymphocytic leukemia:
It means that the cancer affects the lymphoid cells (lymphocytes), which form the lymphatic tissue that makes
up the body’s immune system.
Lymphocytic leukemias develop from cells that give rise to T lymphocytes (T cells), B lymphocytes (B cells),
or natural killer (NK) cells. Each of these cell types has a specialized role in the immune system; some
produce antibodies, whereas others directly fight or direct other immune cells to fight infections.
2. MYELOGENOUS LEUKEMIA:
Myeloid leukemias develop from cells that give rise to white
blood cells called granulocytes and monocytes.
It means the leukemia affects the myeloid cells, which
make up the blood-forming tissue that produces red blood
cells, white blood cells and platelet-producing cells
 TYPES OF LEUKEMIA
There are four main types of leukemia, based on whether they are acute or chronic, and myeloid or
lymphocytic. These are:
◦ Acute lymphocytic leukemia - The most common form of leukemia in children.
◦ Acute myeloid leukemia - The most common form of leukemia overall, affecting both adults and
children.
◦ Chronic lymphocytic leukemia - The most prevalent form of chronic leukemia in adults.
◦ Chronic myeloid leukemia - Mainly affects adults and may produce few or no symptoms for months or
even years.

◦ Other rare types of leukemia include hairy cell leukemia, myelodysplastic syndromes and
myeloproliferative disorders.
1. ACUTE LYMPHOCYTIC (LYMPHOBLASTIC) LEUKEMIA (ALL)
◦ Acute lymphoblastic leukemia (ALL) is a fast-growing cancer of a type of white blood cell called a
lymphoblast.
◦ It occurs when the bone marrow produces a large number of immature lymphoblasts. .
◦ ALL prevents healthy blood cells from being made. Life-threatening
symptoms can occur as normal blood counts drop.
◦ ALL can affect the bone marrow all over the body.
It can also spread to the:
Lymph nodes
Liver
Spleen
2. ACUTE MYELOID LEUKEMIA (AML)
◦ AML is the most common type of acute leukemia in adults.
◦ In AML, myeloid stem cells usually mature into abnormal myeloblasts, or white blood cells. But,
they sometimes become abnormal red blood cells or platelets. As they multiply, they overwhelm the
normal cells in the bone marrow and blood. The cancer cells can also spread to other parts of the
body.
3. CHRONIC LYMPHOCYTIC LEUKEMIA (CLL)
◦ CLL accounts for about a third of leukemia diagnoses. It usually affects
older adults.
◦ One form of CLL progresses slowly. Symptoms may not appear until
years after onset. Another form of CLL grows very quickly.
◦ CLL begins in the B lymphocytes. As the abnormal cells proliferate, they
crowd out the normal cells.
◦ It's a type of cancer that starts in cells that become certain white blood
cells (called lymphocytes) in the bone marrow. The cancer (leukemia)
cells start in the bone marrow but then go into the blood.
◦ In CLL, the leukemia cells often build up slowly. Many people don't have
any symptoms for at least a few years. But over time, the cells grow and
spread to other parts of the body, including the lymph nodes, liver, and
spleen.
4. CHRONIC MYELOID LEUKEMIA (CML)
◦ Chronic myelogenous leukemia (CML), also known as chronic
myeloid leukemia, is a cancer of the white blood cells. It is a form
of leukemia characterized by the increased and unregulated
growth of myeloid cells in the bone marrow and the accumulation
of these cells in the blood.
◦ This type of leukemia is rare. Only 10 percent of leukemias are
CML.
◦ Adults are more likely than children to get CML.
◦ CML occurs when a genetic change turns the myeloid cells into
immature cancer cells. These cells then grow slowly and
overwhelm the healthy cells in the bone marrow and blood.
 DIAGNOSIS OF LEUKEMIA
Doctors may find leukemia in a routine blood test, before symptoms begin. If this
happens, or if you have signs or symptoms that suggest leukemia, you may undergo the
following diagnostic exams:

◦ Physical exam
Your doctor will look for physical signs of leukemia, such as pale skin from anemia,
swelling of your lymph nodes, and enlargement of your liver and spleen.
◦ Blood tests
By looking at a sample of your blood, your doctor can determine if you have abnormal
levels of red or white blood cells or platelets — which may suggest leukemia.
◦ Bone marrow test
Your doctor may recommend a procedure to remove a sample of bone marrow from
your hipbone. The bone marrow is removed using a long, thin needle. The sample is
sent to a laboratory to look for leukemia cells. Specialized tests of your leukemia cells
may reveal certain characteristics that are used to determine your treatment options.
 TREATMENT OF LEUKEMIA
Treatment for your leukemia depends on many factors. Your doctor determines your leukemia treatment options
based on your age and overall health, the type of leukemia you have, and whether it has spread to other parts of your
body, including the central nervous system.
Common treatments used to fight leukemia include:
◦ Chemotherapy
Chemotherapy is the major form of treatment for leukemia. This drug treatment uses chemicals to kill leukemia cells.
Depending on the type of leukemia you have, you may receive a single drug or a combination of drugs. These drugs
may come in a pill form, or they may be injected directly into a vein.
◦ Biological therapy
Biological therapy works by using treatments that help your immune system recognize and attack leukemia cells.
◦ Targeted therapy
Targeted therapy uses drugs that attack specific vulnerabilities within your cancer cells.
◦ Radiation therapy
Radiation therapy uses X-rays or other high-energy beams to damage leukemia cells and stop their growth.
During radiation therapy, you lie on a table while a large machine moves around you, directing the radiation to
precise points on your body. You may receive radiation in one specific area of your body where there is a
collection of leukemia cells, or you may receive radiation over your whole body. Radiation therapy may be used
to prepare for a stem cell transplant.

◦ Stem cell transplant

A stem cell transplant is a procedure to replace your diseased bone marrow with healthy bone marrow. Before a
stem cell transplant, you receive high doses of chemotherapy or radiation therapy to destroy your diseased bone
marrow. Then you receive an infusion of blood-forming stem cells that help to rebuild your bone marrow.
You may receive stem cells from a donor, or in some cases you may be able to use your own stem cells. A stem
cell transplant is very similar to a bone marrow transplant.
 IS LEUKEMIA PREVENTABLE?
Because the cause of leukemia remains unknown, there is no
certain way to prevent it. However, avoiding exposure to
solvents, such as benzene and toluene, and unnecessary exposure
to x-rays is generally good practice. If you think you may be
exhibiting signs of leukemia, being aware of the risk factors and
symptoms and talking with your doctor are critical to early
diagnosis and treatment. It is especially important for people who
have a family history of leukemia to be aware of symptoms and
share their family medical history with their doctors.