What Type of Cancer is Leukemia?

cancer leukemia via peacemedicaltourism.com

Hi my name is dr. Tim Cole I'm one of the hematologists here at Mayo Clinic Rochester Minnesota and I just wanted to spend the next few minutes describing a little bit about the disease chronic lymphocytic leukemia

 which I specialize in along with several of my colleagues here the this is a disease that if you've been given this diagnosis or have someone who has had this diagnosis the word

leukemia or as I call it the l word is one of that's quite shocking but we'll talk a little bit about

it and hopefully we can remove some of the the fear that goes along with it the most CLL

chronic lymphocytic leukemia kadam can also be called small and pathetic lymphoma one of

the diseases that has two names the World Health Organization classifies Chronicle beside

leukemia and small office Oklahoma as the same disease but that will it will sometimes create

confusion unless you're aware of that this is the most common what we lymphoid malignancy

 in the North in North America and it is one that we see on a regular basis now the average age of for the median age of diagnosis is in the mid 6 min to late 60s there's a slight

predominance of males versus females but both sexes can be affected the one thing that needs

 to be mentioned about Chronicles of leukemia is it it's often an incidental or as I call it a

surprise diagnosis because most patients at diagnosis have no symptoms it comes up as kind of

oh by the way there's a problem in your blood test so for example if you you may have gone

in for a hypertension check a gallbladder surgery a preoperative exam and the blood was found to be abnormal with an elevated white blood count that then generates a series of tests the

 tests that's used most commonly to confirm the diagnosis is what's called a flow cytometry so

 the diagnosis can be established with a simple blood test process in a pathology lab which can

 identify that in fact this is chronic lymphocytic leukemia once the diagnosis is made then the

question is where do we go next the what happens really what should happen next is

evaluation by a specialist in hematology oncology who knows about chronic lymphocytic

leukemia and we generally will start with a fairly simple staging evaluation this can include in patients who are without symptoms some additional blood tests physical examination the

physical examination will focus on whether they're in large lymph nodes whether there's an

enlarged spleen the blood tests will focus on several things there are a couple blood chemistry's that can be helpful one is called an LDH one is called a beta 2 microglobulin elevations in

these may both be important in predicting time from diagnosis to potential need for

treatment going into a few more advanced tests going into the molecular area we have a test

called a fish test which looks at chromosomal mutations and can be very helpful in separating

out who may need treatment sooner versus later there are also molecular tests called zap-70

cd38 and several other complex names and another test called an immunoglobulin mutation

status which really looks at the gene level regarding the propensity for progression now the main thing to remember in CLL is that not everyone with CLL needs treatment well it's a

 disease that can look the same under the microscope but can have a great variability of need for treatment so some patients need treatment at diagnosis in which case more tests would

 need to be done such as a bone marrow biopsy cat scans and then moving towards treatment other patients have no symptoms the blood tests findings are fairly mild or minor although

 still significant and one can move on to a period of what we like to call active monitoring in

the past this has commonly been called watch and wait that's kind of an anxiety provoking

turn we like active monitoring so we're watching with active monitoring patients may be able

to be watched very safely for 1 5 10 and in one case I have a gentleman who was watched for

 50 years before he needed treatment many patients will not need treatment or during the rest

 of their natural adult life yet on the other hand about half of individuals at least with CLL will need treatment at some point in those individuals focused series of periodic tests physical

 examination and monitoring is appropriate in that in the group of people who then become

symptomatic there are criteria for treatments such as development of anemia low platelets symptoms such as weight loss night sweats progressively enlarging lymph nodes progressively

 large explained then the observation is then stopped and we move to treatment the

unfortunate thing with CLL is that we don't have a disease treatment we don't have a

treatment that clearly will cure this we don't have anything that clearly will make it go away

never come back again yet there are many treatments and when we treat the goal is remission

 and hopefully the most complete and long remission possible so when treatment is started we

go through a series of treatments currently we tend to use in patients who are an otherwise

good health what is called chemo immunotherapy a combination of chemotherapy drugs with

a drug called rituximab with that we're seeing very high response rates and very good remission rates many of these are long lasting once treatments over we go back to careful observation

and monitoring if treatment fails then there are no possibility of what we call Salvage

 treatments and even progressing up to bone marrow transplantation with CLL there are

several things to know during this journey there are complications that can occur there is an increased risk of infection increased risk of the infection increasing risk of infections and

these infections can be viral reactivation jingles pneumonias and several others there's also an

increased risk of complications called autoimmune complications a couple of these diagnoses

are hemolytic anemia where there can be antibodies breaking down red blood cells or immune thrombocytopenia where there is break down into platelets these are treated with slightly

different measures and but frequently usually will go and remission B finally there is an

increased risk of skin cancers so sun protection is important it's a complex diagnosis and one

that needs active monitoring and support throughout here at Mayo we have a team of

physicians who specialize in CLO along with a nurse practitioner we have about 250 to 300

new referrals per year and we have an active database of over 3,000 patients that we study and

 try to learn more from the disease and we have active ongoing research in CLL causation of CLL and familial CLL thank you. Related Type of eye cancer

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