Cancer is a progressive disease that worsens or spreads within the patient’s body over time. As such, doctors diagnose cancer at a particular stage of development and make an accurate prognosis of the condition from the diagnosis. In most cancers, this is achieved by measuring the tumor’s footprint. However, diagnosing and staging leukemia is a bit different. For one, leukemia does not form tumors. Two, the type of leukemia determines the disease’s progression and the symptoms and treatments associated with every stage.
This article explains terminal leukemia symptoms. At this stage of the disease, the chances of full recovery are slim unless aggressive treatment measures are taken. Most patients will have stopped responding to conventional medications at this point and may be relying on salvage treatments or palliative care.
The Occurrence and Types of Leukemia
Before getting to the symptoms of end-stage leukemia, it’s important to have some basic knowledge of how leukemia occurs and the different forms it takes.
Leukemia begins in stem cells found in the red bone marrow. Stem cells are infant cells that can differentiate and becomes cells of various organs and tissues. The red bone marrow synthesizes blood cells through a process known as hematopoiesis. These new cells replenish the blood by replacing damaged, dysfunctional, or dying older cells.
During this process, hematopoietic stem cells differentiate into either myeloblasts or lymphoblasts that further develop into different types of blood cells. Myeloblasts divide into erythrocytes (red blood cells), megakaryocytes (platelets), granulocytes, and monocytes. Meanwhile, lymphoblasts go on to become various types of immune cells — NK cells, B-lymphocytes, and T-lymphocytes.
Leukemia occurs during hematopoiesis when one or more genes responsible for controlling the regulation and growth of the resulting cells become translocated, inverted, or deleted. When that happens, the affected blast cell stops differentiating and instead proliferates. With time, less differentiated or immature cells accumulate in the bone marrow at the expense of healthy cells. Some eventually find their way into the bloodstream, lymphatic tissues, and various organs throughout the body.
There are two main types of leukemia: myeloid leukemia, which affects myeloblasts, and lymphoid leukemia, which affects lymphoblasts. In some cases, the gene mutation occurs on both types of blast cells, resulting in Bi-phenotypic leukemia. The disease is described as “acute” if the gene abnormality occurs early in hematopoiesis and “chronic” if it occurs later in nearly mature cells. That explains the four different types of leukemia:
- Acute myeloid leukemia (AML)
- Chronic myeloid leukemia (CML)
- Acute lymphoid leukemia (ALL)
- Chronic lymphoid leukemia (CLL)
As far as staging is concerned, the only difference between acute and chronic leukemia is the rate of progression. Acute leukemia is characterized by an abrupt onset of symptoms, while the signs of chronic leukemia are more subtle and manifest relatively slowly.
Leukemia Staging and Symptoms
The staging of myeloid leukemia differs from that of lymphoid leukemia. But the early stages in both cases are generally asymptomatic, while the terminal stages share mostly the same symptoms.
The terminal stage of myeloid leukemia is called the Blast Phase. It comes after two other phases, the Chronic Phase and the Accelerated Phase, which are often asymptomatic. However, patients in the Accelerated Phase may experience abnormal itching on the skin and discomfort from having an enlarged liver and/or spleen. The liver and spleen swell to supplement hematopoiesis as more and more malignant blast cells build up in the red bone marrow. This response is known as extramedullary hematopoiesis.
On the other hand, lymphoid leukemia has five stages, labeled “Stage 0” through “Stage 4.” Here is a quick overview of how the disease progresses through the first four stages:
- Stage 0 – Elevated lymphocyte count (lymphocytosis)
- Stage 1 – Enlarged lymph nodes
- Stage 2 – Enlarged liver and/or spleen
- Stage 3 – Anemic stage (hemoglobin level below 10 gram/100 ml of blood)
Terminal Leukemia Symptoms
Most leukemia patients are diagnosed in the early stages of the disease, usually by accident during random blood tests. With early detection, treatment can start before the patient reaches the terminal phase. So, many leukemia patients only experience mild symptoms, if any at all. Nevertheless, here’s a list of end-stage symptoms for both myeloid leukemia and lymphoid leukemia:
- Platelet levels drop to less than 100,000 cells per microliter of blood. This causes spontaneous or abnormal bruising and bleeding. In some patients, the risk of bleeding out, even from small cuts, is very high.
- The enlarged spleen condition (splenomegaly) may cause early satiety and pain in the left upper part of the abdomen. Early satiety often leads to loss of appetite and weight.
- The patient may feel tenderness or blunt pain over the lower sternum, and other bones around the body as the red marrow inside them expands due to the buildup of blast cells.
- Signs of severe anemia, including constant fatigue, pale skin, dizziness, irregular heartbeat, and shortness of breath, become increasingly apparent. The anemia results from malignant lymphocytes attacking healthy red blood cells or the body failing to produce enough red blood cells.
- Frequent and reoccurring infections, particularly viral infections such as flu, pneumonia, and shingles. The patient’s immunity gets compromised by a deficiency of healthy immune agents in the bloodstream and lymphatic systems.
- Swollen lymph nodes (lymphadenopathy), mainly in lymphocytic leukemia cases.
- Painless swellings or lumps under the skin (leukemia cutis). These appear in some patients when leukemic cells infiltrate the skin.
- Excessive sweating is often accompanied by chills and fevers, mostly at night.
- Some patients may develop neurological symptoms such as headaches, behavioral changes, sensory processing disorders, seizures, and stroke. This happens when cancer starts to interfere with the nervous system.
Can a Patient Recover from End-Stage Leukemia?
The simple answer is yes, although cancer never really goes away. But a patient can recover, in some sense of the word, from end-stage leukemia through a combination of aggressive chemotherapy, remission induction therapy, medications, and, in some cases, bone marrow transplantation. But as with other cancers, the treatment response depends on the patient in question. The most recent figures from the National Cancer Institute put the overall odds of surviving the first five years after a positive leukemia diagnosis at 65.7%. Generally, the more progressed cancer, the lower the chance of recovery.
There is so much more to learn about leukemia than can be condensed into one short article. But the information that really matters comes from medical professionals who see and work with cancer patients every day. For instance, many cancer clinics provide little-known alternative treatments that can truly help leukemia patients lead a more comfortable life. Get in touch with an expert today to learn more about new ways to fight leukemia and other cancers.