Leukemia is a group of malignant blood tumors that originate from hematopoietic stem cells. Leukemia is classified as acute or chronic depending on the stage of development of the diseased cells and the urgency of onset. The leukemia can be divided into lymphocyte-derived and myeloid-derived depending on the cellular origin.
Acute leukemia
Acute leukemia has a more rapid onset, usually within 3 months of onset, with significant discomfort that prompts the patient to seek care. The early symptoms are mainly related to the suppression of normal hematopoietic function and are not very specific, mainly:
- Fever: Most of them are due to the decrease of normal neutrophil count, which leads to the occurrence of infections. The common sites of infection are respiratory tract, gastrointestinal tract and urinary tract infections, etc. Because the body is in the tumor state, the immunity is low, and the strain of infection may be different from the common pathogenic bacteria, so the infection progresses rapidly, and the conventional anti-inflammatory treatment is slow to work or ineffective. Some patients also have tumor fever due to the proliferation of tumor cells producing a large number of cytokines, resulting in an increase in endogenous pyrogenic factors and ineffective anti-inflammatory treatment.
- Hemorrhage: Mostly due to a sudden decrease in the number and quality of platelets and the invasion of blood vessels by leukemia cells, resulting in impaired vasoconstriction, etc. It manifests as bleeding spots on the skin, bleeding gums, excessive menstruation, and in severe cases, bleeding from the fundus or intracranial area.
- Anemia: is caused by a decrease in red blood cell synthesis by the bone marrow and a large loss of red blood cells after bleeding, mostly progressively. It manifests as pallor, weakness, dizziness and even dyspnea. Anemic heart disease can be induced in the elderly and frail.
As the disease progresses, leukemia cells proliferate heavily and rapidly and infiltrate multiple organ tissues outside of the bone marrow, and most patients will develop some specific manifestations.
The lower and middle sternum, located in the anterior thorax, is markedly distended and painful due to the small volume of the cavity, which is more pronounced when pressed, and other areas of the bones and joints can be painful to varying degrees.
Lymphocytic leukemia is often associated with enlarged lymph nodes and hepatosplenomegaly.
Leukemia cells of myeloid origin form limited infiltrative masses in the subperiosteum or soft tissues that are pale green in color (pale green pigment in the protoplasmic bone of the tumor cells) and are called green tumors, also known as granulocytic sarcomas, commonly in the orbit, causing protrusion of the eye, double vision, and blindness.
Some leukemia cells tend to infiltrate soft tissues such as gums and skin, resulting in swollen gum hyperplasia and a blue-gray skin rash.
At the onset of leukemia, the blood-brain barrier opens and leukemia cells enter the skull, which can cause headache, nausea, vomiting, convulsions, and coma. Staying in the spinal cord can lead to paralysis, and infiltrating nerve roots can produce various symptoms of limb paralysis, mostly in some affected children and patients with high white blood cells.
There are also very rare large intra-thoracic leukemic cell masses compressing large blood vessels and trachea that can cause superior vena cava compression syndrome, and invasion of the testes producing painless enlargement, mostly unilateral.
Chronic myeloid leukemia
Chronic myeloid leukemia has a slow onset and is often asymptomatic in its early stages, and is often diagnosed by further testing when elevated peripheral blood leukocytes or splenomegaly are found by chance or during routine testing. The general symptoms lack specificity and commonly include fatigue, easy fatigue, low fever, abdominal distention and discomfort.
Any abnormal manifestations such as unexplained fever, weakness, bone pain, rapid progressive enlargement of the spleen, and the presence of significant anemia and bleeding tendencies suggest an accelerated or acute phase, so regular physical examination is the primary means of detecting the disease.
Chronic lymphocytic leukemia
Chronic lymphocytic leukemia is a degenerative disease of the elderly that starts more slowly and has no conscious symptoms in the early stages, and is often diagnosed by abnormal blood tests or physical examinations that reveal increased lymphocytes in the blood and enlarged lymph nodes or liver and spleen.
Early patients may present with fatigue, weakness, and susceptibility to infection. Because the disease is mostly of elderly onset, it has little impact on the organism’s quality of life and survival, and treatment may instead aggravate the patient’s impaired immune function, so the principle of watchful waiting is generally adopted.
With the progression of the disease may appear wasting, fever, night sweats and other manifestations, once the rapid increase of leukemia cells, severe anemia and thrombocytopenia, severe enlargement of lymph nodes or liver and spleen with symptoms of compression, only then consider aggressive chemotherapy.
In conclusion, the early manifestations of leukemia are insidious, and good self-management of body and life, attention to and timely diagnosis and treatment of abnormal symptoms, and regular medical checkups are the keys to early prevention and treatment of leukemia.