Understanding your diagnosis
Your test results provide a lot of information about your leukaemia.
This will include:
- the type of blood cell the leukaemia started in
- whether it is growing quickly (acute) or more slowly (chronic)
- whether there are abnormal chromosomal or other genetic changes in the blood cells.
Your specialist uses this information to explain how the leukaemia could affect you in the future (your prognosis), and what your possible treatment options are.
Your specialist may arrange further tests if more information is required.
What you need to know
Blood cells are formed through a process called haematopoiesis. This usually occurs in the bone marrow, which is a sponge-like tissue found inside many bones in the body. It may also occur in other tissues, like the spleen, liver, thymus (a gland behind the breastbone), and lymph nodes.
During this process, immature cells called haematopoietic stem cells develop into different types of blood cells.
The three main types of blood cells are:
- red blood cells
- white blood cells
Blood cancers start when a part of haematopoiesis goes wrong, and one or more cells become abnormal and start growing and dividing rapidly.
These immature abnormal blood cells crowd out normal blood cells in the bone marrow. They can also enter into the blood or lymphatic circulation and travel around the body.
The main types of blood cancer are:
In leukaemia abnormal blood cells divide uncontrollably. They have no useful function and crowd out the bone morrow preventing the development of normal blood cells. Sometimes, there are so many in the bone marrow that they also spill out into the blood circulation
The main types of leukaemia and their major characteristics are:
- acute leukaemias
- develop quickly and progress rapidly (over weeks)
- involve mainly large numbers of immature cells (blasts)
- need prompt treatment.
- chronic leukaemias
- develop and progress more slowly (over months)
- involve more mature but still abnormal blood cells
- may not need treatment when diagnosed.
Chronic leukaemia usually develops slowly over months to years. There are 2 main types of chronic leukaemia.
Chronic lymphocytic leukaemia (CLL)
This is a cancer of white blood cells called lymphocytes.
There are several different ways to stage CLL. One system commonly used in Australia is the ABC or Binet staging system. This divides CLL into 3 stages based on the person’s clinical features and blood test results:
- stage A – early disease with a high number of white blood cells but minimal enlargement of lymph nodes.
- stage B – intermediate disease with a high number of white blood cells and enlarged lymph nodes in 3 or more areas.
- stage C – late disease with a high number of white blood cells, enlarged lymph nodes, and a low number of platelets and red blood cells. The liver and/or spleen may also be enlarged.
Chronic myeloid leukaemia (CML)
This type of leukaemia starts in white blood cells known as granulocytes.
CML has 3 phases:
- chronic – early disease where white blood cell counts are relatively stable - this phase can last for years
- accelerated – when the white blood cell counts start to rise and other abnormalities may develop
- blast phase – rapidly progressive disease with a high number of blasts in the blood that can cause many symptoms. This phase of CML behaves like acute leukaemia.
What to ask or talk about
Talking about prognosis
Prognosis means what is likely to happen to you in the future because of your cancer. You may find it hard to talk about prognosis but it can help you make decisions about the treatment and care you want.
Everyone’s cancer is different, and everyone responds differently to treatment. Because of this, doctors can’t tell you exactly what will happen to you. Instead, they can give you the best information they have about what to expect.
Doctors work out prognosis based on statistics. These show what happens in large groups of people with cancer. They cannot predict what will happen to you or any other individual person.
Your specialist will share information about you and your cancer with a multidisciplinary team (MDT) to decide the best treatment options for you.
You may need more than one type of treatment or have a choice of treatments. You may also need to see other specialists during treatment planning.
Dealing with your diagnosis
Getting a cancer diagnosis is very distressing for the person with cancer, and their carers, family and friends. Different people react in different ways. They can be upset and angry or just in shock. Many people find it difficult to take in all the information and understand what it will mean for them.
The situation can be especially difficult for people who get a diagnosis of advanced cancer.
If you need to speak to someone about your diagnosis, you can call the Cancer Council on 13 11 20.