Childhood Leukemia - Causes, Symptoms, Diagnosis, and Treatment

Introduction

Childhood leukemia is a kind of cancer that affects both the blood and bone marrow. It happens when the body generates too many abnormal WBCs (white blood cells). Leukemia is the most common form of cancer found in kids. Childhood leukemias commonly exhibit high remission rates, reaching up to 90 percent. This article gives a complete look at childhood leukemia, talking about what causes it, its symptoms, how it is diagnosed, and the ways it can be treated.

What Types of Leukemia Do Children Get?

Leukemia comes in different types, and some of them, known as acute types, grow fast. They can worsen quickly without treatment, and most childhood leukemias fall into this category:

1. Acute lymphocytic leukemia (ALL) is the most common type in children. It usually occurs when the bone marrow produces too many lymphocytes, a type of white blood cell.

2. Acute myeloid leukemia (AML) occurs when the bone marrow creates abnormal myeloblasts (a type of white blood cell), red blood cells, or platelets.

There are also chronic types of leukemia that grow slowly over a longer time, but these are rare in children:

1. Chronic lymphocytic leukemia (CLL) results in the bone marrow making abnormal lymphocytes. It is more common in teens than in younger children.

2. Chronic myeloid leukemia (CML) leads to the bone marrow producing abnormal granulocytes (a type of white blood cell). It is rarely seen in children.

What Are the Causes and Risk Factors for Childhood Leukemia?

Leukemia occurs due to alterations in the genetic material (DNA) within bone marrow cells. The exact reason of these genetic changes is still unclear. Specific factors can increase the likelihood of childhood leukemia. Children have higher chances of developing this condition if they:

• Have an identical twin with a history of leukemia at a young age.

• Have a non-identical twin or other siblings with leukemia.

• Underwent radiation therapy or chemotherapy for other types of cancer.

• Took medications to suppress their immune system after an organ transplant.

• Have genetic health conditions (Down syndrome, Klinefelter syndrome, neurofibromatosis, ataxia telangiectasia, and more).

What Are the Symptoms of Childhood Leukemia?

Common symptoms of childhood leukemia include:

• Fatigue and Weakness: Children with leukemia may experience persistent fatigue and weakness. This can be attributed to the reduced number of healthy RBCs (red blood cells), which results in inadequate oxygen transport to the body's tissues.

• Frequent Infections: Leukemia impairs the normal functioning of the immune system, making children more susceptible to infections. Repeated or severe infections, such as persistent fevers, respiratory infections, and others can be indicative of leukemia.

• Bruising and Bleeding: Abnormalities in the production of platelets (blood cells that are mainly responsible for blood clotting) can result in easy bruising and bleeding. Children with leukemia may bruise more easily, experience nosebleeds, or exhibit prolonged bleeding after minor injuries.

• Bone and Joint Pain: Leukemia cells can infiltrate the bone marrow and cause pain in the bones and joints. Children may complain of pain in the limbs, back, or pelvis. This pain is often described as a persistent, aching discomfort.

• Enlarged lymph nodes, particularly in the neck, armpit, or groin, can be a visible sign of leukemia. Leukemia cells can accumulate in these lymph nodes, causing them to swell.

• Anemia (low red blood cell count) is common in childhood leukemia. Pale skin and shortness of breath may result from decreased oxygen-carrying capacity in the blood.

• Abdominal Discomfort: Leukemia cells may spread to the liver and spleen, leading to abdominal discomfort or a feeling of fullness. This can sometimes be palpable during a physical examination.

• Weight Loss: Unexplained weight loss is one major symptom that may be associated with this leukemia.

• Headaches and Visual Disturbances: Leukemia cells can infiltrate the central nervous system, leading to symptoms such as headaches, visual disturbances, or even seizures. These symptoms may be more prominent in the advanced stages of the disease.

• Children with leukemia may tire easily during physical activities or play. This happens because the disease affects how much energy a person has and also their physical well-being.

How Common Is Childhood Leukemia?

Leukemia impacts both adults and children, with a slightly higher prevalence in boys than girls. The various types of leukemia tend to affect distinct age groups:

• Acute lymphoblastic leukemia (ALL) is most frequently observed in children aged 2 to 8 years.

• Acute myelogenous leukemia (AML) can occur at any age, but it is more common in children younger than 2 and teenagers.

• Chronic myelogenous leukemia typically affects teenagers.

• Juvenile myelomonocytic leukemia (JMML) primarily affects infants and toddlers.

How Is Childhood Leukemia Diagnosed?

The healthcare professional will generally begin the diagnosis by taking a detailed medical history, and asking about the child's symptoms, their duration, and any relevant family medical history. A thorough physical examination will be conducted to evaluate signs which include bruising, enlarged lymph nodes, or other abnormalities.

1. Blood Tests:

A complete blood count (CBC) is one of the initial tests performed. This blood test provides information about the number and characteristics of different blood cells, including red blood cells, white blood cells, and platelets. Abnormalities in the blood cell counts, such as an elevated white blood cell count or low platelet count, may raise suspicion of leukemia.

2. Bone Marrow Aspiration and Biopsy:

If the initial blood tests suggest the possibility of leukemia, a bone marrow aspiration and biopsy are typically performed. During this procedure, a small bone marrow sample is extracted from the hip bone or another large bone. The taken bone marrow samples are then examined under a microscope to identify the presence of leukemia cells, their type, and their percentage in the bone marrow.

3. Imaging Studies:

Imaging studies, such as X-rays, computed tomography (CT) scans, or magnetic resonance imaging (MRI), may be conducted to assess the extent of the disease and identify any abnormalities in the chest, abdomen, or other areas. These tests help in staging the leukemia and also assessing the spread of cancer to other regions of the body.

Other specific investigations include:

• Lumbar Puncture (Spinal Tap): In some cases, especially if acute lymphoblastic leukemia (ALL) is suspected, a lumbar puncture may be performed. This involves collecting a sample of cerebrospinal fluid from the space around the spinal cord.

• Cytogenetic and Molecular Testing: Cytogenetic and molecular tests may be performed to identify specific genetic abnormalities in the leukemia cells.

• Flow Cytometry: This technique is used to study the characteristics of individual cells. It can help identify specific markers on the surface of leukemia cells, aiding in the classification of leukemia.

How Is Childhood Leukemia Treated?

A pediatric oncologist, a doctor specializing in childhood cancer, leads the medical team responsible for a child with leukemia. This team collaborates with various specialists such as nurses, social workers, psychologists, and surgeons. The primary treatment for childhood leukemia is chemotherapy, with dosage and drug selection tailored to the child's age and the leukemia type. Other treatment options include:

1. Radiation Therapy: Involves using high-energy X-rays to eliminate cancer cells.

2. Targeted Therapy: Utilizes specific drugs to locate and attack cancer cells without harming normal cells.

3. Stem Cell Transplants: Involves introducing healthy stem cells into the body.

Conclusion

With appropriate treatment, the prognosis for children and teenagers diagnosed with leukemia is highly favorable. Remission indicates the absence of cancer cells as detected by doctors. Many children achieve a complete cure, entering a state of permanent remission. Successful treatment is frequently achieved for childhood leukemia; however, the interventions may lead to immediate or delayed complications. Survivors of childhood leukemia will require lifelong follow-up care to monitor and address any potential complications that may arise.