Leukemia (Kanser Darah): Tanda, Jenis, Punca & Rawatan

Leukemia (leukaemia) is a type of blood cancer, or kanser darah, that affects blood cells in the bone marrow, usually white blood cells. Common signs include feeling very tired or weak, looking pale, bruising or bleeding easily, frequent infections, fever, bone pain and swollen glands. There are 4 main types: acute types develop quickly and need treatment straight away, while chronic types develop slowly. In Malaysia, leukemia is the seventh most common cancer and the most common cancer in children. These symptoms are usually caused by something else, but see a doctor if you have them, because finding leukemia early can make treatment more likely to succeed.

What is leukemia (kanser darah)?

According to Blood Cancer UK, leukemia is a type of blood cancer that affects blood cells in your bone marrow, usually white blood cells. The bone marrow is a spongy tissue inside some of your bones, where the body makes blood cells. In leukemia, blood cells are not made the way they should be, and you may have too many, too few, or blood cells that do not work properly.

The US National Cancer Institute explains that leukemia cells cannot fight infection very well, and as they increase in the blood and bone marrow, there is less room for healthy white blood cells, red blood cells and platelets. This may cause infections, anaemia (kurang darah) and easy bleeding.

Kanser darah (blood cancer) is a broader term: leukemia is one type, and lymphoma is another.

Types of leukemia

Leukemia is grouped by how fast it develops (acute or chronic) and by the type of white blood cell affected (myeloid or lymphoid).

The NHS describes all 4 types as rare.

How common is leukemia in Malaysia?

According to the Malaysia National Cancer Registry Report 2017-2021 (Ministry of Health):

• 6,265 leukemia cases were registered in 2017-2021, up from 4,273 in 2012-2016;
• 56.3% were in males and 43.7% in females;
• leukemia was the seventh most common cancer in Malaysia and among men, and the ninth among women;
• the lifetime risk was about 1 in 250 for men and 1 in 333 for women;
• rates were higher in early childhood (0 to 9 years), dropped in young adults, and rose steadily from middle age, peaking from age 70.

Tanda leukemia: what are the symptoms?

According to the NHS, symptoms are not always obvious at first and can be similar to other conditions. In acute leukemia they usually appear quite quickly, over a few weeks. Chronic leukemia may cause no symptoms, especially in the early stages.

Main symptoms listed by the NHS across the types include:

• feeling very tired or weak, even after a good night's sleep;
• looking paler than usual (on brown or black skin, this may be easier to see on the palms or inside the eyelids);
• shortness of breath;
• bleeding or bruising easily or for no reason;
• getting ill a lot or taking longer than usual to recover;
• a high temperature (see our guide to demam);
• pain in the bones or joints;
• swollen glands, usually in the neck, armpits or groin;
• a swollen tummy that may feel painful, uncomfortable or full;
• loss of appetite or losing weight without trying, and night sweats.

Less common symptoms of ALL include headaches, being sick, blurred vision, a cough and fits (sawan).

Call 999 if you or your child suddenly develop a swollen, red face, neck, arms or hands, or swollen veins in the neck or chest (NHS, ALL). For men, CML can rarely cause an erection that does not go down; the NHS advises going to the emergency department if it lasts more than 2 hours.

The NHS stresses that these symptoms are very common and can be caused by many conditions. Having them does not mean you have leukemia, but they should be checked.

Lebam: is bruising a sign of leukemia?

Lebam (bruising) is one of the signs people search for most. According to the NHS:

• bleeding or bruising easily or for no reason is a main symptom of AML, ALL and CML;
• CLL can cause a rash that looks like small bruises or bleeding under the skin, which does not fade when you roll a glass over it;
• if your child is bleeding or bruising easily or for no reason, ask for an urgent doctor's appointment.

What matters is bruising without a reason, especially together with tiredness, paleness, fever or frequent infections. The NHS notes that the CLL rash is similar to the rash of meningitis, so get medical help quickly for any rash that does not fade under a glass. Fever with a rash is also common in demam denggi, which needs its own medical check.

Leukemia in children

Leukemia is the most common childhood cancer in Malaysia. According to the Malaysia National Cancer Registry Report 2017-2021, it made up 41.0% of cancers in boys and 39.8% in girls aged 0 to 14, followed by brain and nervous system tumours and lymphoma.

According to the NHS, acute lymphoblastic leukemia is most common in children aged 4 and under. Take your child to a doctor if they have symptoms such as tiredness, paleness, frequent infections, fever, bone pain or swollen glands, and ask for an urgent appointment if they bruise or bleed easily for no reason.

Punca leukemia: who is more likely to get it?

According to the NHS, it is not always clear what causes leukemia. You may be more likely to get it if:

• you are older: AML risk rises from age 60, CML is more likely from 65, and CLL is very rare under 40;
• you are a young child (for ALL);
• you have a genetic condition such as Down's syndrome (AML, ALL);
• you have had chemotherapy or radiotherapy in the past, especially as a child, or were exposed to a lot of radiation;
• you have been regularly exposed to high levels of benzene, a chemical used in some industries such as oil refineries;
• you smoke (AML);
• you have another blood disorder, an autoimmune condition such as rheumatoid arthritis (AML), or a weakened immune system, for example from HIV (ALL);
• a close family member has had CLL; CLL is also more common in men.

Leukemia is not the same as talasemia, which is an inherited blood disorder, although both can cause tiredness and paleness.

How is leukemia diagnosed?

According to the NHS, a doctor will usually examine you, check for bruises and swollen areas, and arrange an urgent blood test if leukemia is possible. A specialist may then arrange:

• more blood tests;
• a bone marrow biopsy, where a small sample of bone marrow is taken with a needle, usually under local anaesthetic;
• a lumbar puncture (a sample of fluid from the lower spine), scans and other tests to plan treatment.

Blood test results may come within a few days, but other tests can take a few weeks.

How is leukemia treated?

Treatment depends on the type of leukemia, your age and your general health. According to the NHS:

Supportive treatments, such as medicines to prevent infections and blood or platelet transfusions, help manage symptoms and side effects. Blood Cancer UK notes that some people with slow-developing types are carefully monitored and only start treatment when it is needed.

Tell your specialist team about any medicines or supplements you take before and during treatment.

When should you see a doctor?

See a doctor (at a klinik kesihatan or a GP) if you have symptoms such as ongoing tiredness, paleness, frequent infections, fever, bone pain, swollen glands, weight loss or night sweats. According to the NHS, get an urgent appointment if:

• you have symptoms of acute myeloid leukemia, which can develop over a few weeks;
• your child is bleeding or bruising easily or for no reason.

Call 999 for a sudden swollen, red face, neck, arms or hands, or suddenly swollen veins in the neck or chest.

Frequently asked questions (FAQ)

What is leukemia (kanser darah)?

Leukemia is a type of blood cancer that affects blood cells in the bone marrow, usually white blood cells. The bone marrow is the spongy tissue inside some bones where blood cells are made. In leukemia, blood cells are not made the way they should be, so you may have too many, too few, or blood cells that do not work properly.

What are the early signs of leukemia?

According to the NHS, common symptoms include feeling very tired or weak, looking paler than usual, shortness of breath, bleeding or bruising easily or for no reason, getting ill a lot or taking longer to recover, a high temperature, bone or joint pain, swollen glands in the neck, armpits or groin, and a swollen tummy. These symptoms are common and usually caused by other conditions, but they should be checked by a doctor.

Is bruising (lebam) a sign of leukemia?

Bruising easily or for no reason is one of the main symptoms of leukemia listed by the NHS. Some people also get a rash that looks like small bruises or bleeding under the skin and does not fade when you press a glass against it. Most bruises have everyday causes, but see a doctor if you bruise without a reason, especially with tiredness, paleness, fever or frequent infections; get an urgent appointment if this happens to your child.

What are the types of leukemia?

The 4 main types are acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), chronic lymphocytic leukemia (CLL) and chronic myeloid leukemia (CML). Acute types develop quickly and need treatment straight away. Chronic types develop slowly and may not need treatment straight away.

What causes leukemia?

It is not always clear what causes leukemia. According to the NHS, the risk is higher with older age for AML, CLL and CML, while ALL is most common in children aged 4 and under. Other risk factors include genetic conditions such as Down's syndrome, past chemotherapy or radiotherapy, regular exposure to high levels of benzene, smoking (for AML) and a family history (for CLL).

Can leukemia be cured?

It depends on the type. According to the NHS, acute myeloid and acute lymphoblastic leukemia are often treatable, and intensive treatment aims to cure the leukemia. Chronic lymphocytic leukemia cannot usually be cured, but treatment can control it for years. Chronic myeloid leukemia is mainly treated with targeted medicines called tyrosine kinase inhibitors (TKIs).

Is leukemia common in children in Malaysia?

Leukemia is the most common cancer in Malaysian children. According to the Malaysia National Cancer Registry Report 2017-2021, it made up 41.0% of cancers in boys and 39.8% in girls aged 0 to 14. According to the NHS, acute lymphoblastic leukemia is most common in children and young people, especially children aged 4 and under.

Disclaimer

This article is for general information only and is not a substitute for advice, diagnosis or treatment from a doctor. Symptoms listed here are common and usually caused by other conditions; only tests can diagnose leukemia. Health supplements are not intended to diagnose, treat, cure or prevent any disease.

References

• Symptoms of acute myeloid leukaemia — NHS
• Causes of acute myeloid leukaemia — NHS
• Tests and next steps for acute myeloid leukaemia — NHS
• Treatment for acute myeloid leukaemia — NHS
• Symptoms of acute lymphoblastic leukaemia — NHS
• Causes of acute lymphoblastic leukaemia — NHS
• Treatment for acute lymphoblastic leukaemia — NHS
• What is chronic lymphocytic leukaemia? — NHS
• Symptoms of chronic lymphocytic leukaemia — NHS
• Treatment for chronic lymphocytic leukaemia — NHS
• Symptoms of chronic myeloid leukaemia — NHS
• Treatment for chronic myeloid leukaemia — NHS
• Leukaemia — Blood Cancer UK
• Acute Lymphoblastic Leukemia Treatment (PDQ), Patient Version — National Cancer Institute
• Malaysia National Cancer Registry Report 2017-2021 — National Cancer Institute, Ministry of Health Malaysia