Basic Information On Blood Cancer

Leukemia is a term that originally was applied to a few cases in which the blood appeared milky at necropsy. Since such condition can arise only when the leukocyte count almost equals that of the red cells, it means that the leukocyte count must be about 1,000,000 per cubic millimeter and the anemia profound. Only one disease can produce it, the one we still call leukemia or cancer of the blood.

However, in the great majority of cases of this disease the blood is red, since the leukocyte count seldom rises above 500,000 per cubic millimeter.

Several varieties of leukemia or blood cancer are recognized. They all are characterized by the presence of immature leukocytes of one type or another in the peripheral blood and by extensive hyperplasia or overgrowth of the tissue producing that particular cell. The most common are granulocytic, lymphocytic, and monocytic leukemia. These terms referring in each case to the cell type that is involved.

The clinical course of leukemia may be fulminating, progressing to a fatal termination usually within a period of a few weeks or months.

Whether acute or chronic, every leukemia process is a manifestation of malignant neoplasia or the uncontrolled, destructive proliferation of a blood cell that has acquired through some genetic alteration of a biologic advantage over other cells. Thus, this condition enabled the other cells to outgrow them, even in their native tissues, their optimal environments, and freeing it from the physiologic restraints that usually prevent overgrowth.

Acute Leukemia

Cancer of the blood on its acute stage may occur at any age. However, acute leukemia is encountered most frequently in children and young adults.

Regardless of the cell type, like whether one is dealing with an acute lymphoblastic, myeloblastic, monoblastic or stem cell leukemia, these patients exhibit many characteristics in common.

The onset of acute blood cancer is typically very sudden, manifested by an acute tonsillitis, furunculosis or the appearance of an abscess in the mouth or the skin. The total course may be limited to a few days or weeks and is marked by a high fever.

Hemorrhagic features appear early and may include bleeding from the gums, the nose, the stomach, and the rectum, as well as hemorrhages into the skin and into the fundus of the eyes.

Swelling and gangrenous ulceration of the gums, the cheeks, the jaw, and the tonsils likewise are common. Bone pain may become a prominent symptom and neurologic manifestation may appear. Enlargement of lymph nodes, liver, and spleen may occur, but these findings are less common and less prominent than in chronic leukemia.

Acute leukemia is an important disease to keep in mind, since it may be mistaken for an acute infection, acute rheumatic fever, idiopathic thrombocytipenic purpura or some specific type of anemia.

The diagnosis usually, but not invariably, can be made from an examination of the peripheral blood, with findings of primitive leukocytes in the smear, anemia, and thrombocytopenia. The most important diagnostic criterion, however, is the presence of numerous blast cells in the patient's bone marrow. The prediction in all cases is poor. Without treatment, the illness lasts an average of 3 to 4 months, but with treatment, adults with acute leukemia survive about a year, on the average, and children, somewhat longer.

Chronic Leukemia

This is a condition characterized by white cell counts ranging from 100,000 to 1,000,000 per cubic millimeter, where a high percentage of these leukocytes are immature cells. The condition is associated with a great enlargement of the spleen and the liver but little swelling of the lymph nodes.

This type of blood cancer may appear at any period of life, most often between the ages of 25 and 40. The onset of the disease is usually gradual and insidious.

Survey of the Patient's Problems

From the above discussion, one sees that the patient with leukemia or blood cancer has complex problems due to pathologic disturbances in major organ systems. His fatigue, anorexia, bleeding tendencies, neurologic involvement, dyspnea, and fever all require specific therapy and nursing support.

Given all that, the major goal of therapy and nursing management is to help that patient live as normal a life as possible by maintaining him in a state of remission for as long as possible.