Cancer is the number one cause of death in Korea. [앎으로 이기는 암]is a planned article by Hidak in collaboration with specialists, and provides ‘professional knowledge’ and ‘the latest treatment status’ for various cancers in an easy-to-understand manner.
Treatment of leukemia, which was considered an incurable disease in the past, has achieved remarkable growth with the development of medical technology in the modern era. The 5-year survival rate is close to 90% or more. Now, only for certain leukemias, the stigma of ‘lower evil’ seems to be more appropriate than the ‘worst’ stigma of incurable disease, rather than the ‘lower-evil’ stigma of a chronic disease that requires ‘sufficient’ management.
Despite this good news, acute lymphocytic leukemia in adults remains a nuisance. Leukemia is mainly divided into various types depending on whether it is chronic or acute, myeloid or lymphocytic. In adult acute lymphocytic leukemia, more than half of the patients do not respond to first-line chemotherapy or relapse, and the 5-year survival rate is only 7%. do.
In the case of adult acute lymphocytic leukemia, the average survival time of relapsed patients is only 3.3 months. In particular, the fact that there are many 30-59 years of age, the age at which this disease will have an active social life, makes this disease even more vicious. Hydak Internal Medicine Consultant Shin Kwang-sik (Seoul New Internal Medicine Clinic) explained in detail about lymphocytic leukemia, which can destroy an individual’s life in an instant.
Q. What are the causes and differences between acute lymphocytic leukemia and chronic lymphocytic leukemia?
A: acute lymphocytic leukemiais a blood cancer that results from the overgrowth of lymphocytes in the immature cell stage within the bone marrow. It is known that ‘genetic predisposition’, ‘viral infection’, ‘smoking’, ‘exposure to electromagnetic fields and radiation’, ‘chemical drug’, etc. These include ‘Down Syndrome’, ‘Klinefelter Syndrome’, ‘Patau Syndrome’, ‘Fanconi Syndrome’, ‘Bloom Syndrome’ and ‘vasodilatory ataxia’. The annual incidence is about 3 to 5 cases per 100,000, which is a recent increase, and age is an important treatment factor, and although a disease-free survival rate of about 80% in children has been reported, it is far below this in adults.
chronic lymphocytic leukemiais a blood cancer with a marked increase in mature lymphocytes in the blood. Leukemia cells proliferate and accumulate very slowly in lymph nodes, bone marrow, and spleen. The incidence rate is about 1 to 3 per 100,000 people, and it is very rare in Korea.
Although the cause of chronic lymphocytic leukemia is not clear, factors involved include a family history of leukemia, myelopathy, and lymphoma. If there is a patient with chronic lymphocytic leukemia in the immediate family, the incidence is three times higher than that of the general public, and it can develop at a young age of about 10 years. , it is presumed that there is no relation with human histocompatibility antigen.
Q. Are the symptoms of leukemia and early diagnosis possible?
Most of the patients complain of anemia, bruising, nosebleeds, or bleeding gums as cancer cells grow in the bone marrow and suppress normal hematopoiesis. In addition, systemic symptoms such as fever, weakness, fatigue, and weight loss may be complained of due to decreased immune function. As the disease progresses, white blood cells invade the organs, which can lead to bone pain, enlarged gums, and an enlarged liver and spleen. If the central nervous system is invaded, nausea, vomiting, convulsions, and cranial nerve paralysis may occur.
Since there are no characteristic symptoms, it is difficult to distinguish them from common colds, anemia, and growing pains. Diagnosis is made after the disease has developed throughout the bone marrow within 2 to 3 months from the onset of the disease until symptoms appear, and most often within several months. If leukemia is suspected, blood is collected from peripheral veins through a blood test, and the number of blood cells such as ‘white blood cells’, ‘hemoglobin’, and ‘platelets’ is measured and checked for abnormalities. After that, the shape, number and distribution of blood cells is observed with a blood smear, and if there is an abnormality in the blood test, a bone marrow test is performed to confirm the diagnosis. In addition, the types of leukemia are diagnosed more accurately through ‘immunophenotypic tests’, ‘cytogenetic tests’, and ‘molecular biology tests’.
Chronic lymphocytic leukemia is usually asymptomatic, with few direct symptoms in its early stages due to the proliferation of cells in the bone marrow, lymph nodes, and peripheral blood. Therefore, early diagnosis of the disease is difficult. In most cases, it is detected as an increase in lymphocytes on a blood test at a health checkup, and systemic symptoms appear little by little as the disease progresses.
When leukemia cells continue to proliferate, lymph nodes, spleen, and liver become swollen and enlarged, and in about 80% of cases, enlarged lymph nodes in the neck and upper clavicle are observed. Symptoms such as bleeding tendency due to ‘anemia’ and ‘thrombocytopenia’ appear, and non-specific symptoms such as ‘weight loss’, ‘general malaise’, ‘fever’, ‘sweating’, and ‘decreased exercise capacity’ appear.
Complications include infection symptoms such as fever and pneumonia as resistance to bacteria and viruses is lost due to abnormal lymphocytes and reduced immunity. If an abnormality is found in a blood test, a bone marrow test is performed to confirm the diagnosis, and an immunological test of the cells is performed to check the cell type to check for T-cell leukemia or B-cell leukemia due to the difference in markers on the cell surface. In addition, chromosomal testing of leukemia cells is also performed.
(Continued in part 2)
Help = Dr. Shin Kwang-sik, a consulting doctor at Hidak (Seoul New Internal Medicine Clinic)
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