A diagnosis of cancer often gives us a big blow. It sets back our lives and plans. The rise in industrialization, increased use of pesticides, the ever-increasing pollution are some of the reasons why the cases of cancer are on the rise. There are different types of cancer depending upon the location and the type of cell that is involved. All organisms, no matter how tiny they may be, are a compilation of cells.
A person is said to have cancer when a particular type of cell becomes rogue. This means, it changes its shape and starts to multiply in great numbers, stunting the normal growth of surrounding cells. One such type of cancer is chronic eosinophilic leukemia, which in regular terms translates to cancer of blood involving a particular type of blood cell. Can it be caught in a routine blood examination?
1. What Are Eosinophils?
There is a famous saying, blood is thicker than water. There is a reason why blood is thicker than water. Blood is made of four components. These are:
- Red blood cells are cells that help the blood carry oxygen from one part of the body to another.
- White blood cells are defense cells of the body.
- Platelets are the part of the blood that helps in the clotting of blood at the site of injury.
- Plasma is the liquid part of the blood. It makes up 55% of blood.
There are two types of white blood cells. One, which on microscopic evaluation presents with granules, and the other has none. Each kind has cells that perform a specific function.
Eosinophil is a white blood cell that has granules. About 1-3% of white blood cells are known to be eosinophils. Eosinophils are formed in the bone marrow and released into the blood.
Their formation is complete in the bone marrow and undergoes no division or any other changes once released into the blood. The absolute eosinophil count is 0-450 cells per cubic millimeter.
A complete blood count gives the entire picture of all concentrations in which the various blood cells are present.
2. How does Eosinophils Function?
Eosinophils are that part of the body’s immune system that helps protect the body from parasitic infections and some other infections as well. These cells of the immune system get activated in case of an allergy or asthma.
The number of these blood cells can also indicate cancer.
There are certain tissues in the body where these blood cells are also found. Ovaries, the uterus, the spleen, and the lower part of the digestive system are tissues where eosinophils can be found.
However, if this type of white blood cell is found in the lungs, skin, and esophagus which is the food pipe, it is indicative of some kind of infection. These are sites where eosinophils should not be normally found.
Low eosinophil count as well as too many eosinophils, is indicative of an underlying issue that needs attention. Eosinophil counts do not necessarily diagnose a disease, it can, however, point toward the problem. Like, if a doctor suspects an allergic reaction in the throat, a rise in eosinophil counts seen on analysis of the tissue can be indicative of the same.
3. What Causes a Decrease in Eosinophil Count?
When the eosinophil count is below normal, it is known as eosinopenia. This low eosinophil count is indicative of:
3.1 Cushing’s Syndrome
This syndrome entails the increased production of cortisol, which is important for the maintenance of blood sugar and also plays a role in providing a stress response. It is also characterized by a low eosinophil level. The person suffering may be predisposed to diabetes, hypertension, or chronic inflammatory diseases like systemic erythematous lupus (SLE).
When infection spreads in blood it is known as sepsis. In cases where sepsis has started to set in, the eosinophil levels also decrease.
3.3 Respiratory Conditions
In patients with respiratory conditions like chronic obstructive pulmonary disease, eosinopenia further aggravates the disease.
Certain medications given to alleviate symptoms of eosinophilic asthma can decrease the amount of eosinophils leading to eosinopenia.
4. What Causes an Increase in Eosinophil Count?
An increased number of eosinophils is referred to as eosinophilia. The eosinophils are part of the body’s immune system. Anytime the immune system is involved in protecting the body from agents which invoke a reaction from eosinophils, their number rises, to present a formidable fight.
- In allergic reactions, eosinophilia is a common sight. Along with the increase in eosinophils, another type of white blood cell called basophil is also seen to increase in number.
- In asthma, tissue eosinophils are also common, which is the presence of eosinophils in the lungs apart from blood. This is a clear indication of eosinophilic asthma.
- The rise in eosinophil as mentioned earlier is a sign of a parasitic infection. Therefore, if there is an infection in the body and eosinophilia is detected, the causative agent is a parasite. The treatment can be instituted accordingly.
The interesting fact however is, that eosinophilia is also a sign of cancer. But how much should the eosinophil count rise in order to point toward cancer?
5. What Level of Eosinophils Indicate Cancer?
When the number of eosinophils becomes more than 500 cells per cubic millimeter, is when the alarm signs go off. There are various forms of cancer that a raised level of eosinophils can predict. Some examples are myeloid leukemia, Hodgkin’s lymphoma, and chronic eosinophilic leukemia.
The most common type of cancer associated with eosinophilia is chronic eosinophilic leukemia (CEL).
There are three levels of eosinophil count that medical professionals use to identify the possible underlying issue.
- Mild eosinophilia- 500-1500 cells/mm3
- Moderate eosinophilia-1500-5000 cells/mm3
- Severe eosinophilia- more than 5000 cells/mm3
The absolute eosinophil count for a doctor to reach the diagnosis of eosinophilic leukemia is more than 5000 cells/mm3 along with other symptoms. This means a person with chronic eosinophilic leukemia has eosinophils in excessive amounts.
This type of cancer is a type of blood cancer that falls under the umbrella of chronic myeloproliferative neoplasms. It is a rare type of cancer. Some researchers believe chronic eosinophilic leukemia to be a hypereosinophilic syndrome wherein there is severe eosinophilia with no obvious knowledge of why it is exactly happening. But that is just one school of thought.
The reason why this cancer occurs is relatively unknown. It sees an unprecedented rise in the eosinophils in blood, bone marrow, and other tissues as well. This results from an enhanced proliferation of eosinophilic precursors in the bone marrow.
6. Types of Eosinophilic Leukemia
Eosinophilic leukemia can be broadly classified into three categories, namely
6.1 Genetic Type
This type of eosinophilic leukemia occurs due to changes in the genetic makeup of the particular genes that are involved in the growth of eosinophils.
6.2 Unknown type
Chronic eosinophilic leukemia of unknown type is the one where no reason can be attributed for cancer. No genetic or secondary cause like allergy can be pinned as the reason for leukemia.
6.3 Reactive type
As rare as eosinophilic leukemia is on its own, it occurring in conjunction with another type of blood cancer is even rare. There are three kinds of blood cancer, of which the most aggressive is acute lymphocytic leukemia (ALL). Chronic eosinophilic leukemia can occur in association with ALL.
7. How Does Eosinophilic Leukemia Present Itself?
Eosinophilic leukemia can present with generic symptoms like:
- Night sweats
- Lack of energy
- Shortness of breath
- Lymph nodes might be swollen
- Unexplained weight loss
- Easy bruising or bleeding
A person suffering from eosinophilic leukemia may start undergoing organ damage which can present with symptoms specific to those organs. These organs could be the heart, lungs, and the digestive tract.
8. What Tests Help in Identifying Eosinophilic Leukemia?
The process of diagnosing eosinophilic leukemia requires certain tests to be conducted. These tests include:
8.1 Complete Blood Count
This is a blood test, which evaluates the number of various types of blood cells and their concentrations present.
8.2 Blood Tests
Blood tests to just know the concentration of eosinophils can also be done. Sometimes when the generic symptoms get worse and the other symptoms in tandem with disrupted organ function appear, the need for more aggressive testing is required. Following are the more invasive tests that are performed
8.3 A Bone Marrow Biopsy
It is a more specific test where bone marrow aspiration is performed to obtain the said bone marrow, which is then analyzed to see if the number of eosinophils is increased at the source as well.
8.4 Molecular Testing
A diagnostic test performed is molecular testing which helps the doctor find any genetic cause for the occurrence of eosinophilic leukemia.
Biopsy of the muscle, skin, or any other organ to find signs of eosinophilia
Sometimes a bronchoscopy, which is looking into the passage to the lungs through a camera, is done to rule out the possibility of granulomas in the respiratory system.
9. What Are the Treatment Options for Eosinophilic Leukemia?
The right treatment modality can be applied when the cause of chronic eosinophilic leukemia is found. However, sometimes it becomes essential to start treatment once the diagnosis is made in order to prevent the condition from worsening.
9.1 Treatment with Steroids
The first line of therapy before the seriousness of the chronic disease is determined along with the cause, is corticosteroids. These work by reducing the activity of the immune system. In chronic eosinophilic leukemia, eosinophils transform into cancer cells, in possession of abnormal properties. Thus, corticosteroids decrease the activity of the eosinophils protecting the organs from damage by them.
9.2 Targeted Drug Therapy
Targeted therapy with drugs like Imatinib which is an anti-cancer drug. It helps in reducing the growth of cancer cells or killing them altogether.
Chemotherapy drugs damage and kill cancerous cells or simply reduce their growth. A person with chronic eosinophilic leukemia needs to go for regular sessions till a significant improvement is observed.
9.4 Stem Cell Transplant
Stem cell transplant involves the eradication of the existing bone marrow by a very high dose of chemotherapy. This kills both healthy and cancerous cells, followed by replacement with a donor’s stem cells from which healthy cells can form.
9.5 Treatment for Any Particular Organ Involved or Affected
If any particular organ is involved, therapy targeting the improvement of the functioning of that organ is instituted. For example, heart surgery can help repair the damage done by the increased levels of eosinophils.
10. Helpful Measures to Tackle the Disease
When suffering from a disease, a holistic approach must be taken to deal with it especially when dealing with a chronic disease.
10.1 Proper Intake of Prescription Drugs
Taking the prescription drugs on time is important. Going for chemotherapy sessions, and dealing with the side effects along with the symptoms of the disease can all be much to take in.
10.2 Communicating with A Healthcare Professional
Talking to a doctor about the side effects you are dealing with is always helpful as more insight into dealing with and managing them can be helpful.
10.3 Taking Care of Your Mental Health
In this ordeal of dealing with the physical symptoms, mental health should not be ignored. It is necessary to speak to someone regarding the toll the disease might be taking on your mental health. Support from people around you is important during this time. Prioritize your health, both mental and physical, over everything else.
11. Frequently Asked Questions
11.1 What is eosinophilia? What are eosinophilic disorders?
Answer: Eosinophils are white blood cells that provide immunity. An increase in the number of eosinophils is called eosinophilia. Eosinophilic disorders are conditions that may arise due to a rise in the number of eosinophils. The rise in eosinophils affects various organs which can present as symptoms pertaining to those particular organs.
11.2 What is the prognosis of eosinophilic leukemia?
Answer: The prognosis of eosinophilic leukemia is dependent on the time when the disease is detected and how much damage has already occurred.
11.3 Can chemotherapy help in dealing with eosinophilic leukemia?
Answer: Chemotherapy is one of the commonly used modalities for the treatment of eosinophilic leukemia. It can prove to be a good method for treating leukemia.
11.4 Can early detection help?
Answer: If caught early, the chances of treating cancer increase many folds.