Childhood leukemia is a type of leukemia, usually acute lymphocytic leukemia (ALL), and a type of childhood cancer. ALL is most commonly seen in boys between the age of 3-5.The cure rate of childhood leukemia is generally higher than adult leukemia, approaching 90%, although side effects of treatment last into adulthood. Leukemia is a hematological malignancy or a cancer of the blood. It develops in the bone marrow, the soft inner part of bones where new blood cells are made. When a child has leukemia, the bone marrow produces white blood cells that do not mature correctly. Normal healthy cells only reproduce when there is enough space for them. The body will regulate the production of cells by sending signals of when to stop production. When a child has leukemia, the cells do not respond to the signals telling them when to stop and when to produce cells, regardless of the available space.
Video Childhood leukemia
Symptoms
Most initial symptoms of leukemia are similar to symptoms for irregular bone-marrow function. Typically, most symptoms do not occur during the early stages of leukemia, and children may experience different symptoms. The following are symptoms of leukemia that lead doctors to look for different types of juvenile leukemia:
- feelings of fatigue
- repetitive viral or bacterial infections
- bone and joint pain
- abdominal pain which may cause loss of appetite and weight loss in a child
- swollen lymph nodes under the arms, in the groin, chest and neck.
- easy bleeding or bruising
- vomiting, rashes, gum problem
- weight loss
Maps Childhood leukemia
Causes
The exact cause of most cases of childhood leukemia is not known. Most children with leukemia do not have any known risk factors. Research by Melvyn Greaves suggests childhood leukemia is caused by a two-step process, starting with a prenatal genetic mutation and then exposure to infections. His research concluded that childhood leukemia and other autoimmune disorders could be prevented by priming the gene mutation. This would need to occur within the first year of life in order to prevent the cancerous cells growing later in life. There also appears to be some evidence linking childhood leukemia to x-ray exposure. In a 2010 study by the University of California, Berkeley's School of Public Health, researchers found that children with acute lymphoid leukemia (ALL) had almost twice the chance of having been exposed to three or more X-rays compared with children who did not have leukemia.
Diagnosis
Leukemia is diagnosed in a variety of ways. Some diagnostic procedures include:
- A bone-marrow aspiration and biopsy; marrow may be removed by aspiration or a needle biopsy.
- A complete blood count, which is a measurement of size, number, and maturity of different blood cells in blood.
- Blood tests may include blood chemistry, evaluation of liver and kidney functions, and genetic studies.
- A lymph-node biopsy; lymph node tissue is surgically removed to examine under a microscope, to look for cancerous cells.
- A spinal tap: a special needle is placed into the lower back into the spinal canal, which is the area around the spinal cord. Cerebral spinal fluid is fluid that bathes the child's brain and spinal cord. A small amount of cerebral spinal fluid is sent for testing to determine if leukemia cells are present.
Types of Leukemia
Leukemia is usually described either as "acute", which grows quickly, or "chronic", which grows slowly. One main type of acute leukemia is acute lymphocytic leukemia (ALL), which accounts for about 3 out of 4 cases of leukemia in children. ALL is a form of leukemia that affects the lymphocytes, a type of white blood cells which fights infection. When a patient has ALL, the bone marrow makes too many immature white blood cells and they do not mature correctly. Therefore, the white blood cells over-produce, crowding the other blood cells. The white blood cells also do not work correctly to fight infection.
Another type of acute leukemia is acute myelogenous leukemia (AML). AML is cancer of the blood in which too many myeloblasts, immature white blood cells, are produced in the bone marrow. The marrow continues to produce abnormal cells that crowd the other blood cells and do not work properly to fight infection. Almost all childhood leukemia is acute.
Chronic leukemias are more common in adults than in children, and although they tend to grow more slowly than acute leukemias, they are harder to treat. These chronic leukemias are divided into two types: chronic myelogenous leukemia (CML) and chronic lymphocytic leukemia (CLL). CML is rare in children, but does occur and is treatable in children the same as in adults. CML patients have too many immature white blood cells being produced, and the cells crowd the other healthy blood cells.
A specific chromosome rearrangement is also found in patients with CML, among the 46 chromosomes in human cells. Part of chromosome nine breaks off and attaches itself to chromosome 22, meaning there is an exchange of genetic material between chromosomes 9 and 22. The rearrangement of the chromosomes changes the positions and functions of certain genes, which causes uncontrolled cell growth.
CLL is another form of chronic leukemia, but is extremely rare in children. Juvenile myelomonocytic leukemia (JMML) is a form of leukemia that is neither chronic nor acute and occurs most often in children under the age of four. JMML begins from myeloid cells, but is not as fast-growing as AML or as slow as CML.
Treatment
The treatment a child will undergo is based on the child's age, overall health, medical history, their tolerance for certain medications, procedures, and therapies, along with the parents' opinion and preference.The older aggressive treatments of cranial irradiation and anthracyclines (such as doxorubicin) caused increased risk of solid tumors, heart failure, growth retardation, and cognitive defects.
Treatment today is broken down into three sections; Induction, Consolidation/Intensification, and Maintenance. Induction is intended to kill the cancerous cells, consolidation/Intensification is used to kill any remaining cells that have the potential to become cancerous, and maintenance is used to kill any cells that are still remaining. There are four specific types of treatments that are used within the sections above, those include Chemotherapy, Stem cell transplant, Radiation therapy and Targeted therapy.
Chemotherapy is a treatment that uses chemicals to interfere with the cancer cells ability to grow and reproduce. Chemotherapy can be used alone or in combination with other therapies. Chemotherapy can be given either as a pill to swallow orally, an injection into the fat or muscle, through an IV directly into the bloodstream or directly into the spinal column.
Stem cell transplant is a process by which healthy cells are infused into the body. A stem-cell transplant can help the human body produce more healthy white blood cells, red blood cells, or platelets. It also reduces the risk of life-threatening conditions such as anemia, or hemorrhage. Stell cell transplants can be done by obtaining cells via bone-marrow transplant orumbilical-cord blood transplant, depending on the source. Stem cell transplants can use the cells from one's self, called an autologous stem cell transplant or they can use cells from another person, known as an allogenic stem cell transplant. In some cases, the parents of a child with leukemia may conceive a saviour sibling by preimplantation genetic diagnosis to be an appropriate match for the HLA antigen.
Radiation therapy uses various types of radiation to get rid of the cancerous cells and prevent them from enlarging.
Targeted therapy is the use of medication to specifically kill the cancerous cells. The medication is able to leave healthy normal cells alone while it targets the cancer.
After Effects
Neurological: Survivors of ALL are at risk for various neurocognitive and neuropsychological issues that effect their quality of life. These include issues with attention span, vision, processing speed, memory, growth failure, malnutrition, obesity, reduced fertility, psychiatric problems and early death. All of the latent effects listed impact patients and create a low quality of life. Lower quality of life is directly related to depression and other psychiatric problems.
Emotional: Childhood leukemia is a very taxing disease, on the caregiver and the child. The emotional distress and post traumatic stress which it causes is very deep; studies show that only 3% of parents have to deal with their child becoming severely ill. It is common to experience stress, depression, and anxiety throughout and after cancer treatment.
Many people find it helpful to talk about their feelings with family and friends, health professionals, other patients, members of the clergy, and counselors or therapists. Being part of a support group can provide another outlet for people to share their feelings. Relaxation techniques, such as guided imagery and slow rhythmic breathing, can also help to ease negative thoughts or feelings. Reaching out to others, by participating in volunteer activities, can help people to feel stronger and more in control.
References
- Sources
- "Chronic Myelogenous Leukemia." Disease Information. 13 November 2009. The Leukemia and Lymphoma Society. 17 November 2009 <www. lls.org>.
- "Juvenile Myelomonocytic Leukemia." My Child Has. 2006. Children's Hospital Boston. 17 November 2009 <www. childrenshospital.org>.
- "What is Childhood Leukemia?." Cancer Reference Information. 14 May 2009. American Cancer Society. 17 November 2009 <www.cancer.org>.
- "What are the Differences Between Cancer in Adults and Children?." Cancer Reference Information. 14 May 2009. American Cancer Society. 17 November 2009 <www.cancer.org>.
- Pöder U, Ljungman G, von Essen L (May 2008). "Posttraumatic stress disorder among parents of children on cancer treatment: a longitudinal study". Psychooncology. 17 (5): 430-7. doi:10.1002/pon.1263. PMID 17847123.
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