Guest: Dr. Robert K. Stuart - Hematologist/Oncologist
Host: Dr. Linda Austin
Dr. Linda Austin: I am Dr. Linda Austin. I am talking today with Dr. Robert K. Stuart, who is Professor of Medicine and is a Hematologist/Oncologist at the Hollings Cancer Center at the Medical University of South Carolina. Welcome to our show Dr. Stuart.
Dr. Robert K. Stuart: It’s a pleasure.
Dr. Linda Austin: You are quite a well known expert in the area of leukemia. When I was a child that was certainly a dreaded word, but a lot of people don’t really understand what leukemia is much less all the progress we have made, what is leukemia?
Dr. Robert K. Stuart: Leukemia is a cancer that involves the bone marrow and it’s usual to think of the bone marrow as a factory that continuously produces blood cells that we need to replace all through life. Red blood cells live about a 100 days and they carry oxygen and are very important to allow us to function normally. White blood cells mainly fight infection and the bone marrow-produced white blood cells really only last a few hours once they leave the bone marrow, so there is continuous production all through life and there is a third blood cell called the platelet cell, which is a little plug that helps us to stop bleeding when we have injury and they last about a week in the circulation. So, you can see that all through life, you have to produce literally billions and billions of blood cells all the time. Well, it’s not surprising that mistakes can be made and one of the types of mistakes that leads to leukemia is when the production of these blood cells is no longer regulated appropriately, either there is an overproduction of cells as you typically see in the acute leukemias or the cells don’t die when they are supposed to and they accumulate and that’s what you see in chronic leukemias.
Dr. Linda Austin: Now, you are an adult hematologist and so you treat adult patients then with both types, both acute and chronic leukemia, are there further classifications?
Dr. Robert K. Stuart: Yes the acute and chronic leukemias can be further subdivided into what are called myeloid leukemias, which mainly involve the bone marrow and blood are lymphoid leukemias, which can also involve lymph nodes in the body or the spleen for instance. The distinction is not made by physical examination, but by actually detailed analysis of the leukemia cells that’s not in the laboratory.
Dr. Linda Austin: How would somebody know that they had a leukemia, what are some of the earliest symptoms that patients talk to their doctors about?
Dr. Robert K. Stuart: Well ironically, the symptoms of leukemia, especially their early symptoms are not really due to the presence of the leukemia cells, but are due to the relative absence of normal blood cells because as the bone marrow becomes diseased and fills up with leukemia cells, the normal daily production of normal blood cells is compromised. The most common presenting symptom is actually anemia and this can be very, very subtle, so people might notice that whereas they could normal walk, you know a certain distance in a parking lot at the mall, now they finally have to stop and huff and puff and breath hard for a few minutes to make a trip that was easy for them before, so those kinds of symptoms of anemia. Another presenting symptom can be easy bruising or bleeding, not a nosebleed that stops right away because everybody gets those, but a nosebleed that just doesn’t quit bleeding and continues and continues and continues, that’s a sign that the platelets are low and the other way that you can present this within a bad infection or a series of recurrent infections again as a sign that your normal white blood cells are not present in sufficient numbers to defend you from infection.
Dr. Linda Austin: So, I would guess that it is quite a shock when one gets that diagnosis. You may think you just run down or you may think you are bruising easily or may be have a bad cold that doesn’t seem to go away in 03:40 leukemia.
Dr. Robert K. Stuart: Virtually no one is expecting that diagnosis and it’s exactly as you say and the acute leukemias do tend to produce more rapid progression of symptoms, so people realize they are ill. Some of the chronic leukemias progress so slowly that people may in fact in retrospective have the disease for months or years and not realize that until they finally, let’s say have an annual physical and the doctor decided to do a blood test.
Dr. Linda Austin: Are any special subpopulations at particular risk age wise, gender, ethnic background, or anything like that?
Dr. Robert K. Stuart: Well, certainly age is an important factor. All of the leukemias increase in incidence with age and again sort of this idea that you in your lifetime, trillions and trillions of new cells are produced, so the longer you live, the more likely it is that one of those events will produce a mutation that creates a disease, so all of the leukemias actually end up being more common in the older population and this is a special interest of mine because as you probably know, coastal South Carolina is becoming a very popular retirement community and we do have an aging population along the coast of South Carolina. So, we are seeing a lot of older people with particularly acute leukemias, but also with the chronic leukemias and the ability to treat older individuals is really a very important research question right now and it is something that we are heavily involved in.
Dr. Linda Austin: Are there any genetic or familial factors involved?
Dr. Robert K. Stuart: Most cases of acute leukemia are simply accidents. There is no real inherited form of leukemia, but you do have some families that have clusters. One of our patients is man whose father died of acute myeloid leukemia, his daughter developed in the childhood acute lymphoid leukemia and he is a long-term survivor adult now and then he himself developed acute myeloid leukemia. So, that’s the exception that stands out. Most of the time there isn’t any genetic factor. There is a slightly increased risk with radiation exposure, but that’s a very rare thing in our society because radiation hazards are well known and people are protected from that. There is also some evidence that heavy exposure to petrochemicals or certain pesticides, but you know, can also increase the risk, but most people and I mean 99% of people that develop leukemia really don’t have any sign that we can point to and say that’s what caused it.
Dr. Linda Austin: Dr. Stuart, thank you so much for talking with us this about leukemias and we will talk about the treatment of this important illness in another segment.
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