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Friday, 17 March, 2000, 16:44 GMT
Leukaemias and lymphomas

Leukaemias and lymphomas are cancers which affect the cells which are part of the fluids circulating around the body.

Cancer: the facts
Leukaemias affect certain blood cells, particularly the white cells, or "leukocytes" which help fight off infections and disease.

And lymphomas are cancers of the lymphatic system, a network of vessels which form part of the body's immune system, and carry other infection-fighting cells called "lymphocytes", as well as draining dead cells away from the tissues.

There are several different types of leukaemia, classed mainly according to the way the cancer develops, and the variety of white blood cells they affect.

There are two principal kinds of lymphoma - Hodgkin's and non-Hodgkin's - the latter is more common, and also slightly harder to treat.

Professor Peter Johnson, an expert in lymphomas from the University of Southampton, who carries out work for the Cancer Research Campaign, is hopeful that new chemotherapy and radiotherapy techniques will help improve survival rates in lymphoma.

He said: "The sorts of treatment we are investigating in the future centre around how we can stir the body's immune system into recognising that the lymphoma is there.

"This we think is a very promising form of new treatment."

Click here to listen to Professor Peter Johnson talk about lymphomas

There are different symptoms for leukaemias and lymphomas

Symptoms of leukaemias include:

  • Anaemia - patient unusually pale, weak and tired
  • Frequent infections, fevers, chills, or flu-like symptoms
  • Easy bruising or bleeding
  • Night sweats
  • Bone or joint pain
  • Weight loss
  • Swollen lymph nodes, tender to the touch

Leukaemia cells can also affect the testicles, causing swelling, or affect the spinal column and cause headaches, seizures and vomiting.

The different types of leukaemia develop in different ways. Acute leukaemias progress rapidly, whereas in chronic leukaemia, symptoms take longer to develop and the decline is far less swift.

Some of the symptoms of lymphomas can be very similar to those of leukaemia.

The main difference is a painless rather than tender swelling of the lymph nodes, particularly in the neck, under the arms or around the groin.

Hodgkin's and non-Hodgkin's patients also often suffer night sweats, unexplained fevers, fatigue and weight loss. There can also be itchy skin or red patches.

Surviving Hodgkin's: click here to hear Sandra Davies' story.

The first thing a doctor will do to investigate suspicions of leukaemia or lymphoma is carry out a physical examination.

The lymph nodes in the neck, under the arms and in the groin will be "palpated", or felt. It can be slightly uncomfortable, but not painful.

A doctor can also feel for unusual swellings in the liver, which can happen if lymphoma spreads to that organ.

Blood tests, known as "full blood counts" will also give a strong clue as to both the presence of disease - and what type it is.

The numbers of various types of cell, mature and immature, are physically counted to make sure there are the right number.

Another key test is the x-ray or CT scan, which can look for swellings in the lymph nodes, liver, lungs and spleen.

In the case of leukaemia, this may take the form of taking a sample of bone marrow, normally from the hip with a needle. Sometimes a sample of bone is taken for analysis.

If this confirms the presence of leukaemia cells, a lumbar puncture, which involves inserting a needle through the back into the lower spine takes more fluid for analysis.

This is usually a relatively painless procedure.

For lymphoma, a biopsy of lymph nodes, normally from the neck and underarm area is taken to check for disease.

All this information will help doctors work out how aggressive the cancer is, and how far it has already spread.

The causes of lymphoma and leukaemia have not yet been established.

However, in Hodgkin's lymphoma, there appears to be a connection with a virus called the Epstein-Barr virus.

This is the virus which causes glandular fever, and Hodgkin's is often found in people in their 20s.

However, the incidence of glandular fever is high among this age group - and the number of Hodgkin's cases is very low.

Doctors try to tailor treatments for both lymphomas and leukaemias to fit the variety of disease found.

When your child has cancer: click here to hear how Corinne Reddington coped.

Although many patients will be given chemotherapy , different combinations of drugs are often used.

The aim is to get the cancer into "remission", which means no evidence of cancer can be found on scans or blood tests.

Often, leukaemia patients are given short, intensive courses of chemotherapy through a tube left linked into the main blood vein in the chest - this is called a "Hickman line".

Sometimes, drugs are injected through a tube directly into the spinal column or brain to reach the cells there.

This may require the patient to stay in hospital for the duration of treatment.

Lymphoma patients are also often given chemotherapy .

This can be a combination of eight different drugs.

However, if the cancer does not appear to have spread far, then radiotherapy may be an option.

Both leukaemia and lymphoma patients sometimes need to have bone marrow transplants, particularly if the first chemotherapy treatment fails and more powerful drugs have to be used.

The bone marrow is found at the centre of the body's larger bones, such as in the spine and upper leg, producing blood cells and helping the body fight infection.

If high-dose chemotherapy is to be used, this may permanently damage the bone marrow, so it has to be replaced afterwards.

The patient can be given drugs to stimulate the production of cells vital to rebuilding the bone marrow, which are then harvested and replaced after the treatment.

Or a donor may have to be found whose bone marrow is an exact match for the patient.

A close relative may be able to provide a match, but this is far from certain.

The Anthony Nolan Bone Marrow Trust keeps a register of 130,000 volunteers who are all prepared to give bone marrow if they prove a match for a patient.

This increases the chances of an unrelated match being found.

To learn more about survival rates for leukaemias and lymphomas compared to other cancers, click here .
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