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what type of cell they develop from what kinds of leukaemia there are and what kinds of lymphoma there are who gets them the most common symptoms they cause how they are diagnosed how they are treated how they are followed up.
We have included a list of useful organisations that provide more detailed information on leukaemia and lymphoma and support for people with these conditions at the end of the article.
What is leukaemia?
Leukaemias are a group of cancers of the blood-forming cells. They start in the bone marrow, which is spongy tissue that is found in the middle of some of our bigger bones. The abnormal cells spread from there into the bloodstream and to other parts of the body. The leukaemia is described as lymphoid or myeloid, depending on which type of blood-forming cell in the bone marrow the abnormal leukaemia cells develop from.
What is lymphoma?
Lymphomas are cancers of the lymphatic system. The lymphatic system is a complex network of tubes (lymphatic vessels), glands (lymph nodes) and other organs including the spleen and thymus gland. Lymph nodes are found in the neck, armpits, groin, chest, abdomen and pelvis. The vessels and nodes contain a fluid called lymph and special types of cells called lymphocytes, which help us fight infections. A lymphoma develops when some of your
Leukaemia and lymphoma whats the difference?
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lymphocytes are out of control. These abnormal cells can build up in lymph nodes, in the bone marrow or in the spleen and sometimes in other places in the body.
Types of lymphoma
There are many different types of lymphoma but the two main kinds are:
Hodgkin lymphoma (HL) non-Hodgkin lymphoma (NHL) these are then further subdivided into two main types of NHL, depending on how quickly they are growing, high-grade (or aggressive) NHLs and low-grade (or indolent) NHLs.
ALL can occur at any age but it is more common in childhood, especially between the ages of 2 years and 5 years. The risk also increases again in people aged over 45. AML is the most common type of acute leukaemia in adults. It becomes more common the older people get but children and adults can be affected at any age. CLL mainly affects people aged over 50. CML mainly affects adults.
Hodgkin lymphoma is more common in young people aged between 20 and 25 years. It becomes more common again in later life, with another peak at about 7580 years. NHL becomes more common with increasing age; around 70% of people with NHL are aged over 60 when they are diagnosed.
A lack of red blood cells (anaemia) causes tiredness, reduced ability to exercise and breathlessness on exertion. A lack of the white blood cells that normally help us combat infections with bacteria (neutropenia) leads to an increased risk of developing these infections. A lack of platelets, which are cell fragments that normally help with blood clotting, leads to bruising and bleeding, especially from the gums, nose and gut. This shortage of platelets is called thrombocytopenia.
Other symptoms of leukaemia include fever, night sweats, abdominal discomfort or a feeling of fullness when eating (due to an enlarged spleen) and enlarged lymph nodes.
enlarged lymph nodes fever excessive sweating, especially at night unexplained weight loss unusual tiredness abdominal discomfort and fullness when eating, due to an enlarged spleen.
This involves injecting local anaesthetic into the skin at the back of the hip and taking a small sample of the bone marrow from the hipbone using a special needle. This test will be done in hospital and takes about 20 minutes. Although it is an uncomfortable test to have done, most people only need a paracetamol painkiller for some dull pain around the hip afterwards. The bone marrow sample provides a lot of very useful information, which will help your medical team to decide on the very best treatment for you. The initial results of the test are normally available within 24 hours, with more detailed results being sent from the lab over the next couple of weeks.
Diagnosis of lymphoma
Lymphoma is diagnosed by obtaining a biopsy of the affected tissue. A biopsy means taking a sample from an enlarged lymph node under a local or a general anaesthetic and looking at it under a microscope. Where possible, the whole lymph node will be removed. X-rays are often used to help the medical team take the sample from the suspicious gland. The blood count is less useful in lymphoma than it is in leukaemia. It can be entirely normal or it can show a low red blood cell count (anaemia); the white cell count and platelet count can be high, normal or low in lymphoma. Most people will also need a scan to see if there are enlarged lymph nodes in the chest, abdomen or pelvis, and a bone marrow biopsy is often done to see if there are lymphoma cells in the bone marrow. This allows the doctors to determine the stage of the disease. It can often take up to 2 weeks for all these results to come back.
what kind of leukaemia or lymphoma you have your age your general health before becoming unwell.
People who develop leukaemia and lymphoma might be given the option of entering a clinical trial. It is considered advisable (in fact, best practice) for patients to be treated in the context of a clinical trial, but for a variety of reasons this is not always possible.You will be given plenty of opportunity to discuss this.
you have and your age. Your doctors might discuss the possibility of a bone marrow transplant with you, although this is not always the best treatment for everyone with acute leukaemia. Most people with chronic myeloid leukaemia can be treated as an outpatient and will be given a drug called imatinib (Glivec), which is given in tablet form on a long-term basis. Some people with chronic lymphocytic leukaemia will not need any treatment when they are first diagnosed if the leukaemia is not causing any symptoms and their blood counts are satisfactory. A few people will never require treatment. Most patients, however, will require treatment with chemotherapy tablets at some time. The chemotherapy that is usually given is either chlorambucil or a combination of fludarabine plus cyclophosphamide. Many patients now also receive rituximab, which is a type of drug called a monoclonal antibody. This is given as an infusion into the veins.
Follow-up
How are people with leukaemia followed up?
Once intensive treatment is finished patients with acute leukaemia usually continue to attend the outpatient clinic indefinitely, although the frequency of visits usually decreases with time. People with CLL will usually attend the hospital outpatient clinic, although some patients with very early CLL might have their blood checked periodically by their GP. People with CML are usually on continuous treatment and attend the outpatient clinic on a regular basis.
Acknowledgements
The Lymphoma Association would like to thank Dr Pam McKay, consultant haematologist, and Sister Nan Ramsay, both of the Beatson West of Scotland Cancer Centre, Glasgow, for writing and reviewing this article.
More information
The Lymphoma Association produces a wide range of booklets and information sheets on all aspects of lymphoma and its treatment (including information on CLL). Visit our website at www.lymphomas.org.uk or telephone our freephone helpline on 0808 808 5555 if you would like to receive any of this information or if you would like to talk to someone about your lymphoma.
Useful organisations
Leukaemia Care provides care and support to all those whose lives have been affected by leukaemia, lymphoma, myeloma and allied blood disorders. Their work extends to the welfare of families and carers, as well as that of patients themselves. One Birch Court Blackpole East Worcester WR3 8SG 08088 010 444 (24-hour CARE line) care@leukaemiacare.org.uk www.leukaemiacare.org.uk
Leukaemia & Lymphoma Research is dedicated exclusively to researching blood cancers, including leukaemia, lymphoma and myeloma. 3940 Eagle Street London WC1R 4TH 020 7504 2200 (MonFri, 9am5pm) info@beatingbloodcancers.org.uk www.leukaemialymphomaresearch.org.uk Macmillan Cancer Support exists to improve the lives of those affected by cancer by providing practical, medical, emotional and financial help, as well as pushing for better cancer care. 89 Albert Embankment London SE1 7UQ 0808 808 0000 via website www.macmillan.org.uk
This publication should not be used for medical diagnosis or treatment and is for information only. Although the Lymphoma Association has taken great care in researching and putting such information together, we cannot give any warranties as to its accuracy. Please consult a medical professional if you have concerns about your health or treatment. See www.lymphomas.org.uk for our full disclaimer. Lymphoma Association PO Box 386, Aylesbury, Bucks, HP20 2GA Produced 21.06.2011 Due for revision 2014