Leukemia

The term leukemia refers to cancers of the white blood cells (also called leukocytes or WBCs). Leukemias, as a group, make up about a quarter of all pediatric cancers. Luckily, with treatment, most children with leukemia will be free of the disease without it coming back.

Leukemias start in the bone marrow — the soft tissue found inside bones that produces blood cells. When a child is diagnosed with leukemia, it’s because the white blood cells in the body are producing abnormally. These cells (also known as blasts) start to crowd out the healthy cells in the bone marrow. Eventually, the healthy cells have no place to go, so they stop producing. When a child's body no longer produces enough healthy white blood cells it can cause anemia, swollen lymph nodes, and other symptoms of leukemia in children.

Leukemia is classified as being either acute (meaning it’s rapidly developing) or chronic (meaning it’s slowly developing). About 98% of pediatric leukemias are acute.

 
Types of Pediatric Leukemia
Types of leukemia in children include:
  • Acute lymphoblastic leukemia (ALL): This happens when too many lymphoblasts (a certain type of white blood cell) are produced.
    This is the most common type of leukemia, affecting nearly 60% of kids with leukemia.
  • Acute myelogenous leukemia (AML): This occurs when too many immature white blood cells (called myeloid blasts) are made.
    These leukemia cells are abnormal and can’t mature into normal white blood cells.
  • Chronic myelogenous leukemia (CML): This rare form of pediatric leukemia happens because there are too many mature white blood cells.

 
Signs and Symptoms of Leukemia in Children

Although the symptoms of leukemia in each individual child can vary, common symptoms of leukemia in children include:

  • anemia  (when the level of healthy red blood cells in the body becomes
    too low)
  • bleeding and/or bruising
  • frequent or reoccurring infections
  • bone and joint pain
  • abdominal pain
  • swollen lymph nodes (also called “swollen glands”)
  • difficulty breathing
  • excessive fatigue (more tired than usual)
  • poor appetite

IMPORTANT NOTE: Instances of the symptoms of leukemia in children listed above, either together or on their own, do not automatically mean that a child has leukemia or any other kind of cancer. Any or all of these symptoms could be a sign of something else.

 
Diagnosing Leukemia in Children

One of our Nemours pediatric hematologists-oncologists (doctors who treat blood disorders and cancers) will conduct a physical examination on your child to check for symptoms of leukemia in children such as signs of infection, anemia, abnormal bleeding, and swollen lymph nodes.

The doctor will also feel your child's abdomen to see if the liver or spleen is enlarged. We’ll also take a complete medical history by asking about your child’s symptoms, past health, your family's health history, any medications your child is taking, allergies, etc.

After this exam, the doctor will order a CBC (complete blood count) to measure the numbers of white cells, red cells, and platelets in your child's blood. Your child’s blood chemistries will also be checked.

Then, depending on what we find in the exam and blood tests, your child also may need a:

  • bone marrow biopsy and aspiration (when marrow samples are taken for testing, usually from the back of the hip)
  • lymph node biopsy (when lymph nodes are removed and examined under a microscope to look for abnormal cells)
  • lumbar puncture (also called a spinal tap, when a sample of spinal fluid is taken from the lower back and examined for evidence of abnormal cells. This test will show if the leukemia has spread to the brain and spinal cord.)

We know that tests can be scary – for you and your child. Whatever kind of tests your child might need, know that your Nemours pediatric leukemia care team will do everything we can to make the experience as comfortable as possible – physically and emotionally. We’ll give sedation or anesthesia as needed and offer support and guidance at every step.

Learn more about what to expect with certain medical tests »

 
Treating Leukemia in Children

Depending on your child’s age, overall health, extent of the disease, and other factors, treatment may include one or a combination of the following:

  • chemotherapy
  • radiation therapy   
  • blood or bone marrow transplant (also sometimes called a BMT, BBMT, stem cell transplant, or cord blood transplant)
  • medications/antibiotics
  • blood transfusions

At Nemours, we know that getting a cancer diagnosis can be very frightening and overwhelming for your whole family. That’s why Nemours’ board-certified pediatric hematologists-oncologists, specialty nurses, cancer researchers, and other cancer experts are focused on helping not only your child, but your family, as well.

From diagnosis to treatment (and beyond) we’ll be here to help guide your family through your pediatric leukemia journey – and to strive and hope, with you, for a better tomorrow.

Childhood Cancer

Every bodily cell is tightly regulated with respect to growth, interaction with other cells, and even its life span. Cancer occurs when a type of cell has lost these normal control mechanisms and grows in a way that the body can no longer regulate.

Different kinds of cancer have different signs, symptoms, treatments, and outcomes, depending on the type of cell involved and the degree of uncontrolled cell growth.

About Cancer

All kinds of cancer, including childhood cancer, have a common disease process — cells grow out of control, develop abnormal sizes and shapes, ignore their typical boundaries inside the body, destroy their neighbor cells, and ultimately can spread (or metastasize) to other organs and tissues.

As cancer cells grow, they demand more and more of the body's nutrition. Cancer takes a child's strength, destroys organs and bones, and weakens the body's defenses against other illnesses.

Cancer affects only about 14 of every 100,000 children in the United States each year. Among all age groups, the most common childhood cancers are leukemia, lymphoma, and brain cancer. As kids enter the teen years, there is an increase in the incidence of osteosarcoma (bone cancer).

The sites of cancer are different for each type, as are treatment and cure rates.

Typically, factors that trigger cancer in kids usually differ from those that cause cancer in adults, such as smoking or exposure to environmental toxins. Rarely, there may be an increased risk of childhood cancer in kids who have a genetic condition, such as Down syndrome. Those who have had chemotherapy or radiation treatment for a prior cancer episode may also have an increased risk of cancer.

In most cases, however, childhood cancers arise from noninherited mutations (or changes) in the genes of growing cells. Because these errors occur randomly and unpredictably, there's no effective way to prevent them.

Sometimes, a doctor might spot early symptoms of cancer at regular checkups. However, some of these symptoms (such as fever, swollen glands, frequent infections, anemia, or bruises) are also associated with other infections or conditions that are much more common than cancer. Because of this, both doctors and parents might suspect other childhood illnesses when cancer symptoms first appear.

Once cancer has been diagnosed, it's important for parents to seek help from a medical center that specializes in pediatric oncology (treatment of childhood cancer).

Cancer Treatment

The treatment of cancer in children can include chemotherapy (the use of medical drugs to kill cancer cells), radiation (the use of radiant energy to kill cancer cells), and surgery (to remove cancerous cells or tumors). The type of treatment needed depends on the type and severity of cancer and the child's age.

Surgery

For children with leukemia or lymphoma, surgery generally plays a minor role. This is because leukemia and lymphoma involve the circulatory system and lymphatics, two systems that are located all throughout the body, making it difficult to treat by operating on one specific area.

In children with solid tumors that haven't spread to other parts of the body, however, surgery can often effectively remove cancer when used in combination with chemotherapy and/or radiation.

Chemotherapy

Chemotherapy is medication which is used as a tool to eliminate cancer cells in the body. Kids with cancer can be given the chemotherapy medications intravenously (through a vein) or orally (by mouth). Some forms of chemotherapy can be given intrathecally, or into the spinal fluid. The drugs enter the bloodstream and work to kill cancer in all parts of the body.

The duration of chemotherapy treatment and type and number of different of drugs used depends on the type of cancer and the child's response to the drugs. Every child's treatment differs, so a child may receive daily, weekly, or monthly chemotherapy treatments. The doctor may also recommend cycles of treatment, which allow the body to rest and recover between periods of chemo.

All of the medications used as chemotherapy also carry the risk of both short-term and long-term problems. Short-term side effects may include nausea, vomiting, hair loss, fatigue, anemia, abnormal bleeding, and increased risk of infection due to destruction of the bone marrow, as well as kidney damage and menstrual irregularities. Some drugs carry a risk of bladder inflammation and bleeding into the urine, hearing loss, and liver damage. Others may cause heart and skin problems. Longer-term effects can include infertility, growth problems, organ damage, or increased risk of other cancers.

Your doctor will use precautions as well as other medications to counteract as many of the side effects as possible.

Bone Marrow Transplants

Kids with certain types of cancer may receive bone marrow transplants. Bone marrow is a spongy tissue inside certain bones of the body that produces blood cells. If a child has a type of cancer that affects the function of blood cells, a bone marrow transplant (along with chemotherapy to kill the defective cells) may allow new, healthy cells to grow. Bone marrow transplant is also sometimes used to treat cancer that does not involve blood cells because it lets doctors use higher doses of chemo than would otherwise be tolerated.

Radiation

Radiation is one of the most common treatments for cancer. A child who receives radiation therapy is treated with a stream of high-energy particles or waves that destroy or damage cancer cells. Many types of childhood cancer are treated with radiation along with chemotherapy or surgery.

Radiation has many potential side effects (such as increased risk of future malignancy and infertility), which you should discuss with the doctor.

The primary goal when treating kids with cancer is to cure them; this takes priority over all other aspects of care. However, many medications and therapies can make kids more comfortable while undergoing treatment for cancer.

Coping With Cancer

When possible, older kids should be involved with their own cancer treatment. Facts about the specific type of cancer and its effects should be explained in language suitable for the child's age. However, when cancer affects younger children — toddlers and those under age 4 — simply telling them that they are "sick" and need "medicine" to get better is often enough explanation. For all age groups, the goal is to prevent fear and misunderstanding.

Many kids might feel guilty, as if the cancer is somehow their fault. Psychologists, social workers, and other members of the cancer treatment team can be a great help in reassuring and helping them with their feelings.

The cancer treatment team can guide patients and families through the pain, uncertainty, and disruptions caused by cancer. If necessary, team can also contact or visit the child's school to explain the diagnosis to teachers and classmates. Replacing fear and misunderstanding with compassion and information is a goal in helping kids with cancer cope with the illness.

The diagnosis and treatment of childhood cancers takes time, and there are both short-term and long-term side effects. But thanks to medical advances, more and more kids with cancer are finishing successful treatment, leaving hospitals, and growing up just like everybody else. Today, up to 70% of all children with cancer can be cured.

Reviewed by: Robin E. Miller, MD
Date reviewed: September 2010