Leukaemia

Last week, we discussed the challenges of treating cancer in Nigeria. This week, we will look at one of the most common cancers that is not considered a solid cancer: leukaemia. This is a cancer of the blood or bone marrow, and it occurs when some damage has occurred to the DNA of developing blood cells, mainly of the white blood cell variety.

This development causes the blood cells to grow without control or with poor control and also to divide uncontrollably. The hallmark of controlled cellular division in the body is the ability of the native cells in each organ to reproduce and divide in a controlled and predictable manner.

This is governed by intricate communication between and among the various cells in the body. When this control goes out of sync, cancer results. With regard to blood, healthy cells usually die after a while, and new cells develop in the bone marrow to replace those that die.

So, in leukaemia, the blood cells grow too fast, do not function effectively in doing their assigned tasks, and do not die at the natural point in their life cycle. After a while, they simply increase in number and mass to occupy more space.

When this has gone on for long enough, the increasing number of cancer cells crowd out the normal blood cells and prevent the white blood cells from effectively doing their tasks.

Over time, this also affects the red blood cells and platelets, and the cancerous cells ultimately outnumber the normal cells in the blood. Then the patient becomes ill. Leukaemia is often seen in adults over the age of 55 and in children under the age of 15. It is the most common cancer in children, and they are classified based on the following criteria;

1. Whether they have occurred in a child or an adult
2. The type of blood cell they grow from
3. Whether they are acute (if they grow quickly over a short period of time) as against if they are chronic (when they grow slowly over a period).

Therefore, in acute leukaemia, the developing blood cells multiply and gather in the bone marrow and blood. A blood test will be able to show that more than one-fifth of these blood cells are not functional and are immature because they have left the bone marrow too soon and entered the blood circulation. In chronic leukaemia, more mature blood cells are produced, with less than 20 per cent of them being immature.

The symptoms of leukaemia vary according to the kind of origin. Such people may bleed easily due to frequent bruises sustained during the conduct of normal activities. This results from the inability of the blood to clot because of the negative effects on the platelets.

These wounds are likely to occur frequently, may be small in size and heal slowly. They may also have dark blotches under the skin from bumps against furniture and other objects in the home. They can also have nosebleeds and bleeding from the gums. Infections are also common because the white blood cells are affected by uncontrolled blood cell growth, leading to a poor ability to attack invading organisms within the body.

As fewer normal red blood cells become available for the person’s use, anaemia may develop, leading to weakness, rapid breathing, shortness of breath especially when climbing a staircase or walking fast, a rapid heart rate and feeling faint. Such people may also have dizzy spells and look obviously pale, as demonstrated by white fingernails, pale tongue, and white palms. Weight loss, bone, and body aches will often become part of the complaints as time progresses.

Who are those most prone to this type of cancer? They are people who have been exposed to benzene found in petrol; those who live in the same house with smoking parents; those with a history of previous exposure to X-Rays and other types of radiation, including previous radiotherapy; those with a history of previous viral infection such as the Epstein-Barr virus. Besides, the person’s gender is important, as this disease is more common in males, as well as exposure to pesticides and inherited genetic conditions like Down Syndrome, which we discussed on this page about 11 years ago.

When this condition is suspected, the person should be taken to a hospital where doctors will examine them and check for specific signs of anaemia. They will obtain some blood samples to determine the full blood count, examine the blood film under a microscope, and, if the features are suspected in the blood test, arrange for a bone marrow aspiration.

This test is carried out with a long, fine needle either from the centre of a long bone or the hip, and the result obtained is often accurate in helping to diagnose which type of leukaemia the patient has. That determination is absolutely important for the design of a treatment plan for the patient.

The treatment of this disease depends on the type. Chronic myeloid leukaemia and Hairy cell leukaemia are both rare, slow-growing tumours that can be closely observed over a period, without the need for treatment. Usually, a cancer team can meet over the diagnosis and determine how to proceed with the patient’s treatment. Chemotherapy is often the initial modality of treatment.

This is often followed by radiotherapy, depending on the stage of the disease at diagnosis. More recently, targeted therapy using smart drugs, immunotherapy and bone marrow transplantation have all been deployed in the management of these patients. These latter methods of treatment are available only in specialised centres outside Nigeria, and the cost is often prohibitive.

In addition, stem cell transplant with chemotherapy has also been tried in even more experimental cancer treatment centres in advanced countries. Due mainly to the reasons put forward in last week’s essay, most of these more recent treatment options are not available to the average Nigerian. The reasons are not far to seek; they are simply not available due to cost. Such treatment is beyond the financial capacity of most people.

Foreign treatment inevitably means obtaining visas, securing hospital treatment spots using foreign exchange, and payment for airline tickets. In addition, hotel accommodation must be arranged if relatives who can provide accommodation outside the country are not available to assist.

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In the end, many patients make do with ancient chemotherapy drugs long discarded by advanced countries but kept in production for nations whose citizens have little purchasing power.

Herein lies some of the significant frustrations of our current healthcare system. Until we move beyond a narrow pharmaceutical manufacturing base that produces paracetamol, ampicillin, cough syrup and magnesium trisilicate, not much can be achieved.

Questions and answers

Sunday Doctor. I have pain in my knees, wrists, and ankles. I don’t know the cause or what to do about it. What is your recommendation, please?   0813*******

Pain alone in those joints tells only part of the story. If there is associated swelling, or the swelling moves between the joints, the cause would be different, thereby demanding different kinds of treatment. You should first see a doctor for a proper examination, confirm your age and gender, and they would then do several tests, including X-rays, before a specific cause is clear. Then, you can get treated.

Sunday Doctor, my daughter is two years old and finicky about food. She refuses to eat fruits or vegetables which I mix for her. Yesterday, I observed some blood in her stool while changing her diaper, and she has also been crying while pushing it out. What do we do now?                        0708*******

Children her age will almost certainly refuse to take mixed fruit and vegetables. There are high-residue cereals which she can eat, like Cococops, but if she doesn’t like that either, you may have to get Lactulose syrup and give it at a pharmacist’s direction.

Sunday Doctor, as a diabetic woman on insulin injection, can I also use tablets? If so, which one?                0706*******

What I perceive here is that you are just injecting yourself without the necessary follow-up with a physician. That is dangerous. Otherwise, you would have known that using insulin together with oral medications to control diabetes will ultimately reduce your insulin dose and potentially reduce your complications from the use of Insulin.

Sunday Doctor. I am a 43-year-old mother of three. My periods have ceased for the past three months. Which drug can I use to bring it back?   0816*******

Well, it is important to understand what is going on with you first. At your age, menopause is a bit premature, but it can happen. So, first, you should get an abdominal ultrasound scan done, which will demonstrate whether there is any reason to worry about what might be going on in your abdomen.

Sunday Doctor, thank you for the essay you published 2 weeks ago on fake products and the harm they are causing the populace. A well-placed friend once told me that the current DG of NAFDAC once requested more staff through the Civil Service Commission to enhance the effectiveness of the agency, but that officials at the Commission asked her to give them money before her request could be granted. Look at the effects now!                                           0909******

This is beyond serious! Thank you very much for your comments and contribution. There is no doubt that the antics of civil servants often sabotage the wider aims of government.

Sunday Doctor, for a couple of months now, I have been experiencing electric shocks running down my right arm. It is very unpleasant, almost as if I touched a naked wire. I don’t know the cause. I have been to see two different doctors, but the prescriptions I was given were ineffective. In addition, whenever I sit down for a long time, I suffer to get up because of the kind of pain I feel on the left side of my buttocks. The pain is terrible, and it does not allow me to walk properly for the first few minutes after getting up. My blood pressure is normal, and I am not sick. Please advise me on what tests to do and what medications to take.  I am very worried about this acute problem.         0803*******

The advice you will get here will be somewhat limited because you neither disclosed your age nor gender. A problem that has gone on for a couple of months is no longer acute; it is now a chronic problem. As it affects just one arm, the cause is less clear than if both arms were involved. However, in either case, you will need to use a good analgesic and a second medication that can provide some nerve supplementation. However, a proper examination and certain basic tests are necessary before you are given a prescription. Physiotherapy may also be required.

Sunday Doctor. I have an 11-year-old son with ugly, weeping rashes over the back and sides of his feet for more than a month now. I have bought him different kinds of antibiotics to use, but there is no change. I will send you the pictures by WhatsApp, so that you can advise me. Thank you.                   0803*******

Well, there is little wonder that your various antibiotics failed to work, even though you did not disclose which specific ones you used and how they were used. These lesions look like a bad fungal infection, complicated by bacterial infection. The only way to solve this problem is to have a doctor examine those feet and take culture swabs from the fluids being secreted. When that is done, treatment will work, but there must also be use of an antifungal medication, either as a cream or a tablet or both, for these lesions to be effectively treated.