Doris Obinna
Caroline Adams, at a time, found herself frequently visiting her doctor for multiple new health issues. For over seven months, her doctors could not work out what was wrong with her. She ended up in the emergency room, admitted and was finally diagnosed with AML.
Narrating her ordeal, she said: “After multitude of tests, they finally diagnosed me with acute myeloid leukemia (AML).
“I was usually in good health but I started to suffer from severe pain in the bones in my forearms, continual swelling of my glands, problems with my fingers and stomach swelling. My blood tests continued to come back showing nothing.
“I was admitted to hospital at a point and two days later it all started happening and I was having chemotherapy.
“I was also diagnosed with budd-chiari syndrome, a very rare condition which was causing the ongoing stomach swelling due to a liver enlargement.”
With the added complication of the budd-chiari syndrome diagnosis and her unique genetic cell makeup, she knew her treatment and recovery might not be the same as others.
“I never wanted to read too much into all the information I was given as I knew it might be different for me. I just told my haematologist to do what was needed to be done.”
Caroline went through three rounds of chemotherapy and spent a month in hospital. “My body reacted well to the chemotherapy and I was lucky to not experience any sickness or harsh side effects. I was to also undergo a stem cell transplant, which I had to make an advanced care plan and that was the hardest part of the journey so far. With only a 40 per cent chance of survival I knew I had to do it.”
Despite the many side effects and complications she was told she might encounter after the transplant, her body once again responded well and she was at home recovering within three weeks. It was three months after the transplant when she was meant to be getting better that she began to deal with complications.
She said: “I started to feel really sick and tired all the time and I had never felt like that before. I wondered if it was my body rejecting the donor cells from the transplant.”
Her doctor diagnosed the sudden sickness as a leg condition called polyradiculoneuropathy – an autoimmune neurological impairment. According to her, she became so sick very quickly and was admitted at a neurology ward and suddenly lost all feeling in her legs, leaving her in a wheelchair.
“Going through chemotherapy and the transplant process was not too difficult for me but being bound to a wheelchair and losing all my independence was definitely the lowest part of my journey,” says Caroline.
Caroline spent two months in the wheelchair while working with a physiotherapist to get the movement back in her legs. She then slowly moved to using a walker for a few months, then to crutches before being able to walk properly again seven months later.
“I still have a bit of trouble with balance and I don’t have the full capabilities of walking but I don’t need any equipment to help me anymore and I got my independence back,” she said.
Caroline suffered leukemia, cancer of the body’s blood-forming tissues, including the bone marrow and the lymphatic system. This condition occurs in children and adults.
Leukemia usually involves the white blood cells, the potent infection fighters they normally grow and divide in an orderly way, as the body needs them. In people with leukemia, the bone marrow produces abnormal white blood cells, which don’t function properly. These abnormal cells usually can’t carry out the normal functions of white blood cells. They crowd the bone marrow and spill into the blood and may then spread into organs, such as the lymph nodes, spleen, liver, the brain, spinal cord, lungs, kidneys and testicles, where they can keep other cells in the body from doing their jobs.
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.
According to Executive Secretary, Committee Encouraging Corporate Philanthropy (CECP Nigeria), Dr. Abia Nzelu, leukemia has a 94 per cent rate in Nigeria, meaning that only one out of every 20 Nigerians with leukemia survives.
Leukemia is one of the four most deadly cancers in Nigeria. The other common cancers with a death rate of over 90 per cent in Nigeria are liver, pancreatic and stomach cancers.
According to Nzelu, “the Nigerian leukemia situation is unfortunate because, it is now curable. For instances, the Tata Cancer Centre in India has a 99 per cent survival rate for leukemia, in sharp contrast to the current situation in Nigeria.”
Causes and classification
One of the causes of leukemia is family history as usually it runs in the blood. The other cause is smoking, which increases the risk of developing AML genetic disorders, such as Down syndrome. Also chemotherapy or other medicines that weaken the immune system could cause leukemia.
Intense exposure to radiation, including radiotherapy for another condition can also lead to leukemia. For instance, many of the survivors of the atomic bomb used in World War II developed leukemia due to the fallout of radiation. However, leukemia has not been linked to radiation from x-rays and CT scans.
Doctors classify leukemia based on its speed of progression and the type of cells involved.
On the speed of progress, acute leukemia and chronic leukemia are involved.
Acute leukemia: In acute leukemia, the abnormal blood cells are immature blood cells (blasts). 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: There are many types of chronic leukemia. Some produce too many cells and some cause too few cells to be produced. Chronic leukemia involves more mature blood cells. These blood cells replicate or accumulate more slowly and can function normally for a period of time. Some form of chronic leukemia initially produce no early symptoms and can go unnoticed or undiagnosed for years.
Leukemia by type of white blood cell affected include, Lymphocytic and myelogenous leukemia.
Lymphocytic leukemia: This type of leukemia affects the lymphoid cells (lymphocytes), which form lymphoid or lymphatic tissue. Lymphatic tissue makes up your immune system.
Myelogenous (my-uh-LOHJ-uh-nus) leukemia: This type of leukemia affects the myeloid cells. Myeloid cells give rise to red blood cells, white blood cells and platelet-producing cells.
Types of leukemia
Acute lymphocytic leukemia (ALL): This is the most common type of leukemia in young children. ALL can also occur in adults too.
Acute myelogenous leukemia (AML): AML is a common type of leukemia. It occurs in children and adults. AML is the most common type of acute leukemia in adults.
Chronic lymphocytic leukemia (CLL): With CLL, the most common chronic adult leukemia, you may feel well for years without needing treatment.
Chronic myelogenous leukemia (CML): This type of leukemia mainly affects adults. A person with CML may have a few or no symptoms for months or years before entering a phase in which the leukemia cells grow more quickly.
Symptoms
Common leukemia signs and symptoms include, fever or chills, persistent fatigue, losing weight without trying enlarged liver or spleen and easy bleeding or bruising. Also, recurrent nosebleeds, tiny red spots in your skin (petechiae) and bone pain or tenderness.
Symptoms of leukemia, according to Nzelu, are vague and non-specific. This is partly responsible for the late detection and high mortality in Nigeria.
Nzelu said: “It is therefore important for everyone to be aware of these symptoms and to report promptly to the hospital for evaluation. The symptoms include: paleness, weakness, shortness of breath and tiredness; recurrent infections as well as bleeding and bruising. Other symptoms include: fever, malaise (feeling unwell), swollen lymph glands and excessive sweating.
“In children, there may be pain in bones or joints. There may also be swelling of the belly due to enlargement of the liver of the spleen (an organ of the immune system found just under the ribs on the left hand side).
Treatment
Treatment for leukemia can be complex depending on the type and other factors. However, there are strategies and resources that can help to make your treatment successful. Treatment 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,” says an expert.
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 recognise and attack leukemia cells.
Targeted therapy: Targeted therapy uses drugs that attack specific vulnerabilities within your cancer cells. For example, the drug Imatinib (Gleevec) stops the action of a protein within the leukemia cells of people with chronic myelogenous leukemia. This can help control the disease.
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.
When to see a doctor
Leukemia symptoms are often vague and not specific. You may overlook early leukemia symptoms because they may resemble symptoms of the flu and other common illnesses.
Rarely, leukemia may be discovered during blood tests for some other condition.
It is important to make an appointment with your doctor if you have any persistent signs or symptoms that worry you.
A diagnosis of leukemia may be devastating, especially for the family of a newly diagnosed. With time you will find ways to cope with the distress and uncertainty of cancer. Until then, you may find it helpful to: learn enough about leukemia to make decisions about your care. Ask your doctor about your leukemia, including your treatment options and, if you like, your prognosis. As you learn more about leukemia, you may become more confident in making treatment decisions.
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.
The good new is this: “Most people with known risk factors don’t get leukemia. And many people with leukemia have none of these risk factors,” according to an expert.