Childhood Leukemia

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KEY POINTS

• Leukemia is a cancer of the blood and bone marrow affecting the white blood cells. The abnormal blood cells crowd out normal blood cells.
• Possible treatments include chemotherapy, bone marrow or stem cell transplant, radiation therapy, or biological therapy, along with medicine for pain and other symptoms.
• Ask your child’s healthcare provider how to take care of your child at home, what symptoms or problems you should watch for, and what to do if your child has them.

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What is leukemia?

Leukemia is a cancer of the blood and bone marrow. It affects white blood cells. These abnormal cells can go through the bloodstream and crowd out normal blood cells in the bone marrow.

There are 2 main types of leukemia. The first type is the fast-growing kind called acute leukemia. The second kind is slow growing and called chronic leukemia. Almost all the childhood cases are the fast-growing kind of leukemia.

The sooner cancer is found and treated, the better your child's chances for recovery. However, even advanced cancer can usually be treated. Treatment may slow or stop the growth of the cancer and ease symptoms for a time. Ask your healthcare provider what you can expect with the type of cancer that your child has.

What is the cause?

The cancer starts in the bone marrow. Marrow is the soft, fatty tissue inside hard bone. The marrow is where blood cells are formed.

• White blood cells help fight infection.
• Red blood cells carry oxygen and nutrition to your child's body.
• Platelets help blood clot.

With leukemia, your child's body makes too many abnormal cells that crowd out other, normal blood cells.

• The abnormal white cells cannot fight infections.
• Fewer red blood cells make your child tired and weak.
• Fewer platelets cause your child to bleed easily.

The cancer can also spread to other parts of your child's body.

The exact cause of leukemia is not known. Having a parent, brother, or sister with leukemia increases the risk. High levels of radiation or certain chemicals may result in changes to the genes in the blood cells and increase the risk.

What are the symptoms?

Your child may have no symptoms or just mild symptoms at first. The symptoms slowly get worse. Symptoms may include:

• Fever
• Easy bruising or bleeding
• Bone or joint pain
• Swollen lymph nodes in the neck, underarms, stomach, and groin
• Feeling weak and tired all the time
• Loss of appetite

How is it diagnosed?

Your child's healthcare provider will do a physical exam and ask about your child’s medical history, including symptoms and possible risk factors. Possible tests include:

• Blood tests
• A bone marrow biopsy, which uses a needle passed through the skin into the bone marrow to take a small sample of tissue for testing

When the blood and bone marrow tests confirm a diagnosis of leukemia, more tests may be done before your child starts treatment to see if the cancer has spread. Tests that may be done include:

• X-rays of the lungs and chest
• Lumbar puncture (also called a spinal tap), which is taking a small sample of fluid from the spine with a needle to check for spread of the cancer to the brain and spinal cord
• CT scan, which uses X-rays and a computer to show detailed pictures of the organs and lymph nodes

How is it treated?

You and your healthcare provider will discuss possible treatments for your child. You may also talk with a cancer specialist. Some things to think about when making treatment decisions are:

• Your child's age
• Your child's overall health
• The stage of the cancer (how advanced the cancer is)
• Whether the cancer has spread to other parts of your child's body, such as the brain

Possible treatments include:

• Chemotherapy (anticancer drugs), which uses medicine to kill cancer cells
• Stem cell or bone marrow transplant, which uses your child's own cells or cells from a donor
• Biological therapy, which uses medicines to help your child’s immune system fight the cancer
• Immunotherapy, which uses drugs or cells that have been designed to fight leukemia
• Radiation therapy, which uses high-energy X-rays to kill cancer cells

Your child's treatment will also include:

• Preventing infections
• Controlling pain or other symptoms
• Controlling the side effects from treatments
• Helping your child and your family cope with cancer

Often, more than 1 type of treatment is used. Your child will need to have regular follow-up visits with his or her healthcare provider.

Ask your healthcare provider about clinical trials that might be available to your child. Clinical trials are research studies to find effective cancer treatments. It’s always your choice whether your child takes part in one or not.

How can I take care of my child?

If your child has been diagnosed with leukemia:

• Talk about your child’s cancer and treatment options with your healthcare provider. Make sure you understand your choices.
• Follow the full course of treatment prescribed by your healthcare provider.
• Ask your healthcare provider:
  • How and when you will get your child’s test results
  • How long it will take your child to recover
  • If there are activities your child should avoid and when your child can return to normal activities
  • How to take care of your child at home
  • What symptoms or problems you should watch for and what to do if your child has them
• Make sure you know when your child should come back for a checkup.

It may also help if your child:

• Eats a healthy diet and gets regular exercise as recommended by your healthcare provider.
• Gets plenty of rest.
• Takes time for activities that your child enjoys. Tells you or your provider if treatment causes discomfort. Usually there are ways to help your child be more comfortable.

Counseling and support groups can help children and parents cope with the situation and help the family adjust to the changes in their lives.

For more information, contact:

• Leukemia and Lymphoma Society
  800-955-4572
  http://www.lls.org/