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Leukemia

Leukemia: Introduction

What is cancer?

Cancer starts when cells in the body change (mutate) and grow out of control. Your body is made up of tiny building blocks called cells. Normal cells grow when your body needs them. They die when your body doesn’t need them anymore. Cancer is made up of abnormal cells that grow even though your body doesn’t need them. In most types of cancers, the abnormal cells grow to form a lump or mass called a tumor.

Leukemia is different from most other cancers. Leukemia cells don’t always form a tumor. This cancer starts in the bone marrow. The bone marrow is the thick, spongy liquid inside your bones. It’s where new blood cells are made.

Leukemia starts in early forms of blood cells, often white blood cells, which help fight infections. When you have leukemia, your body makes too many “bad” blood cells that don’t work like they should. Instead of forming tumors, leukemia cells travel in the blood and go all over the body. This means they can reach almost any organ. Leukemia can cause problems and be found in many different ways, depending on which organs are affected.

Anatomy of a bone, showing blood cells

What are normal blood cells?

Blood is made up of liquid, called plasma, and 3 main kinds of cells. Each kind of cell has a special task:

  1. White blood cells. These help the body fight infection and disease.

  2. Red blood cells. These carry oxygen from the lungs to the body’s tissues and carry carbon dioxide from the tissues to the lungs.

  3. Platelets. These help form blood clots and control bleeding.

Blood cells are made in the soft center of the bones called the bone marrow. In adults, active bone marrow is found mostly in the hip bones, ribs, spine, and skull. Normal cells in the bone marrow develop from very immature cells into mature, working cells ready to go out in the blood. Early, less mature, non-working forms of new blood cells are called blasts.

As cells mature in the bone marrow, they become smaller and more compact. They’re better able to do their special jobs. Some new blood cells stay in the bone marrow to grow, while others move to other parts of the body to grow. More blood cells are made when the body needs them, such as when a person has an infection or low numbers of red blood cells (anemia). This process keeps the body healthy.

What are leukemia cells?

When a person has leukemia, the body makes too many nonworking blood cells of one type. These abnormal cells, most often white blood cells, don’t mature and look different from normal blood cells. They don’t work as they should. They also crowd the bone marrow so it can’t make other blood cells, often red blood cells and platelets.

Types of leukemia

Two types of abnormal white blood cells can turn into leukemia: lymphoid cells and myeloid cells.

  • When leukemia involves the lymphoid cells, it’s called lymphocytic or lymphoblastic leukemia.

  • When it starts in the myeloid cells, it’s called myelogenous or myeloid leukemia.

Leukemias are also grouped based on how fast they grow:

  • Acute leukemias. These grow fast and get worse very quickly.

  • Chronic leukemias. These tend to be slow growing, but may get worse over time.

In acute leukemia, the abnormal blood cells are often young cells (immature blasts) that don’t work the way they should. These cells grow quickly. Acute leukemia often needs to be treated right away.

In chronic leukemia, young blood cells are present. But mature, functional cells are also made. In chronic leukemia, blasts grow slowly. It takes longer for the disease to get worse. In some cases, treatment can be delayed until it gets worse or starts causing problems.

These categories result in 4 combinations, which make up the main types of leukemia:

  • Acute lymphoblastic (lymphocytic) leukemia (ALL). ALL is the most common type of leukemia in children. But it can occur in adults.

  • Acute myeloid (myelogenous) leukemia (AML). AML is the most common type of acute leukemia in adults. It can also occur in children.

  • Chronic lymphocytic leukemia (CLL). CLL is more common in older adults. It may be seen in younger adults, but almost never in children.

  • Chronic myelogenous (myeloid) leukemia (CML). CML is seen mostly in adults. Very few children develop this type of leukemia. 

Leukemia: Risk Factors

Woman smoking a cigarette.

What is a risk factor?

A risk factor is anything that may increase your chance of having a disease. Risk factors for a certain type of cancer might include smoking, diet, family history, or many other things. The exact cause of someone’s cancer is often not known. But risk factors can make it more likely for a person to have cancer.

Things you should know about risk factors for cancer:

  • Risk factors can increase a person’s risk, but they don’t always cause the disease.

  • Some people with one or more risk factors never get cancer. Other people get cancer and have no risk factors.

  • Some risk factors are very well known. But there’s ongoing research about risk factors for many types of cancer.

Some risk factors, such as family history or gender, may not be in your control. But others may be things you can change. Knowing about risk factors can help you make choices that might help lower your risk. For instance, if smoking is a risk factor, you may choose to quit smoking.

Who is at risk for leukemia?

Anyone can get leukemia. Most people with leukemia don’t know what caused it. Many have no risk factors. But here are some known risk factors for leukemia:

Smoking

People who smoke are more likely to get acute myeloid leukemia (AML) than people who do not smoke.

Exposure to certain chemicals

Being exposed to certain chemicals has been linked with some types of leukemia. For example, exposure to benzene is a risk factor for AML. It may also be a risk factor for acute lymphocytic leukemia (ALL). Exposure to Agent Orange, an herbicide used in the Vietnam War, has been linked to an increased risk for chronic lymphocytic leukemia (CLL).

Chemotherapy in the past

People who get certain chemotherapy drugs to treat other cancers are more likely to get AML or ALL later on. A person’s risk for leukemia is higher for a number of years after the first cancer is treated. But this small increased risk of getting leukemia later on does not outweigh the need to use these medicines to treat the cancer.

Radiation exposure

High doses of radiation raise a person’s risk for AML, ALL, and chronic myeloid leukemia (CML). This exposure could be from an atomic bomb blast or a nuclear reactor accident. It could also be from radiation therapy used to treat another type of cancer.

Rare congenital diseases

A small number of people are at greater risk for AML and ALL because they have certain rare diseases from the time they are born. For example, people with Down syndrome, ataxia-telangiectasia, and Bloom syndrome have an increased risk of getting acute leukemias.

Certain blood disorders

People who have certain blood diseases are more likely to get AML. These diseases include myelodysplastic syndromes. 

Family history

Most people who get leukemia don’t have a family history of it. But people with relatives who have AML or CLL may be at increased risk.

Age

Most types of leukemia, especially chronic leukemias, become more common as people get older. But ALL is more common in children than in adults.

Gender

Most types of leukemia are slightly more common in males than in females. Doctors don’t know why.  

What are your risk factors?

Talk with your healthcare provider about your risk factors for leukemia and what you can do about them. 

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