Childhood leukemia, the most common type of cancer in children and teens, is a cancer of the white blood cells. Abnormal white blood cells form in the bone marrow. They quickly travel through the bloodstream and crowd out healthy cells. This raises the body's chances of infection and other problems.
As tough as it is for a child to have cancer, it's good to know that most children and teens with childhood leukemia can be successfully treated.
Things That Make Childhood Leukemia More Likely
Doctors don't know exactly what causes most cases of childhood leukemia. But certain things may raise the chances of getting it. Keep in mind, though, that having one of these things does not necessarily mean a child will get leukemia. In fact, most children with leukemia don't have any known risk factors.
The risk for childhood leukemia increases if your child has:
- An inherited disorder such as Li-Fraumeni syndrome, Down syndrome, or Klinefelter syndrome
- An inherited immune system problem such as ataxia telangiectasia
- A brother or sister with leukemia, especially an identical twin
- A history of being exposed to high levels of radiation, chemotherapy, or chemicals such as benzene (a solvent)
- A history of immune system suppression, such as for an organ transplant
Although the risk is small, doctors say children who have things that make leukemia more likely should get regular checkups to spot any problems early.
Types of Childhood Leukemia
Almost all cases of childhood leukemia are acute, which means they develop rapidly. A tiny number are chronic and develop slowly.
Types of childhood leukemia include:
- Acute lymphoblastic leukemia (ALL), also called acute lymphocytic leukemia. ALL accounts for 3 out of every 4 cases of childhood leukemia.
- Acute myelogenous leukemia (AML). AML is the next most common type of childhood leukemia.
- Hybrid or mixed lineage leukemia. This is a rare leukemia with features of both ALL and AML.
- Chronic myelogenous leukemia (CML). CML is rare in children.
- Chronic lymphocytic leukemia (CLL). CLL is very rare in children.
- Juvenile myelomonocytic leukemia (JMML). This is a rare type that is neither chronic nor acute and happens most often in children under age 4.
Symptoms of Childhood Leukemia
Symptoms of leukemia often prompt a visit to the doctor. This is a good thing, because it means the disease may be found earlier than it otherwise would. Early diagnosis can lead to more successful treatment.
Many signs and symptoms of childhood leukemia happen when leukemia cells crowd out normal cells.
Common symptoms include:
- Fatigue or pale skin
- Infections and fever
- Easy bleeding or bruising
- Extreme fatigue or weakness
- Shortness of breath
Other symptoms may include:
- Bone or joint pain
- Swelling in the abdomen, face, arms, underarms, sides of neck, or groin
- Swelling above the collarbone
- Loss of appetite or weight loss
- Headaches, seizures, balance problems, or abnormal vision
- Gum problems
Diagnosing Childhood Leukemia
To diagnose childhood leukemia, the doctor will take a thorough medical history and do a physical exam. Tests are used to diagnose childhood leukemia as well as classify its type.
Initial tests may include:
- Blood tests to measure the number of blood cells and see how they appear
- Bone marrow aspiration and biopsy, usually taken from the pelvic bone, to confirm a diagnosis of leukemia
- Lumbar puncture, or spinal tap, to check for spread of leukemia cells in the fluid that bathes the brain and spinal cord
A pathologist examines cells from the blood tests under a microscope. This specialist also checks bone marrow samples for the number of blood-forming cells and fat cells.
Other tests may be done to help determine which type of leukemia your child may have. These tests also help the doctors know how likely the leukemia is to respond to treatment.
Certain tests may be repeated later to see how your child responds to treatment.
Treatments for Childhood Leukemia
Have an honest talk with your child's doctor and other members of the cancer care team about the best options for your child. Treatment depends mainly upon the type of leukemia as well as other things.
The survival rates for most types of childhood leukemia have gone up over time. And treatment at special centers for children and teens has the advantages of specialized care. Childhood cancers tend to respond to treatment better than adult cancers do, and children's bodies often tolerate treatment better.
Before cancer treatment begins, sometimes a child needs treatment to address illness complications. For example, changes in blood cells can lead to infections or severe bleeding and may affect the amount of oxygen reaching the body's tissues. Treatment may involve antibiotics, blood transfusions, or other measures to fight infection.
Chemotherapy is the main treatment for childhood leukemia. Your child will get anticancer drugs by mouth, or into a vein or the spinal fluid. To keep leukemia from returning, there may be maintenance therapy in cycles over a period of 2 or 3 years.
Sometimes, targeted therapy is also used. This therapy targets specific parts of cancer cells, working differently than standard chemotherapy. Effective for certain types of childhood leukemia, targeted therapy often has less severe side effects.
Other types of treatment may include radiation therapy. This uses high-energy radiation to kill cancer cells and shrink tumors. It can also help prevent or treat the spread of leukemia to other parts of the body. Surgery is rarely an option to treat childhood leukemia.
If standard treatment is likely to be less effective, a stem cell transplant may be the best option. It involves a transplant of blood-forming stem cells after whole body radiation combined with high-dose chemotherapy happens first to destroy the child's bone marrow.
The FDA has approved a type of gene therapy for children and young adults up to age 25 whose B-cell ALL doesn't get better with other treatments. Scientists are working on a version of this treatment for people over 25 and for other kinds of cancer.
CAR T-cell therapy uses some of your own immune cells, known as T cells, to treat your cancer. Doctors take the cells out of your blood and change them by adding new genes. The new T cells can work better to find and kill cancer cells.