Leukemia is also known as cancer of the blood. This cancer starts in the cells that would otherwise develop into different types of blood cells. Most leukemias start in the white blood cells although some may start in other types of blood cells.
There are various types of leukemia affecting children and are based on:
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It is important to understand the blood, bone marrow, and lymph systems to understand leukemia.
Platelets are cell fragments made by megakaryocytes; a type of bone marrow cell. They are responsible for stopping bleeding.
White blood cells help the body to fight off infections. White blood cells are divided into the following types:
Blood stem cells go through a series of changes to make new cells. These cells can either become lymphocytes or other blood-forming cells like myeloid cells. Myeloid cells develop into white blood cells, platelets, or red blood cells.
Leukemia begins in the bone marrow. The leukemia cells build up and crowd out normal cells. Leukemia cells often spill into the bloodstream quite fast. Some types of leukemia can spread to the spleen, testicles, lymph nodes, liver, central nervous system, or other organs.
Cancer of the white blood cells is the most common cancer in children and teens. In this case, there is the formation of abnormal white blood cells in the bone marrow. These abnormal cells move through the bloodstream and go on to crowd out the healthy cells.
It is very hard for parents whose children are diagnosed with cancer. However, there is good news. Treatment of childhood leukemia is mostly successful.
There are not many known risk factors for childhood leukemia.
If a parent develops leukemia in their adulthood, it does not increase the risk of their children developing leukemia.
However, more research is being done to give more specific information and confirm the findings.
The exact cause of childhood leukemia remains unknown. In most cases of childhood leukemia, there are no known risk factors. What is known is that changes in DNA inside normal bone marrow cells can trigger them to grow abnormally and become leukemia cells.
Mutations of DNA can turn off or turn on tumor suppressor genes. Changes in genes may be inherited or may be random. There is a type of DNA change that often leads to leukemia. This DNA change is known as a chromosome translocation.
Normally, the human DNA is packed into 23 pairs of chromosomes. When chromosome translocation occurs, DNA from one chromosome will break off and attach to a different chromosome.
The point where the breaking off happens can affect tumor suppressor genes or oncogenes. Nearly all cases of chronic myeloid leukemia in children are a result of translocation that leads to a swap of DNA between chromosomes 9 and 22.
Inherited versus acquired gene mutations
Several children are born with inherited DNA mutations. This increases their risk for cancers such as leukemia. Some cases of childhood leukemia are caused by certain inherited conditions though not all cases of childhood leukemia.
DNA mutations that are related to leukemia usually develop after conception and are not inherited. These are called acquired mutations. Some acquired mutations occur before birth. Exposure to cancer-causing chemicals or radiation may cause rare cases of acquired mutations.
Combination of genetic and environmental factors
Studies suggest that a lot of childhood leukemias are caused by a combination of environmental and genetic factors. Certain genes are responsible for controlling how bodies break down and get rid of harmful chemicals.
This version of genes may be different in some people and maybe less effective. When exposed to harmful chemicals, children who inherit these gene changes may not be able to break them down as they should. A combination of exposure and genetics might increase the risk of childhood leukemia.
Other studies suggest that some cases of childhood leukemia are caused by a combination of gene changes that occur in the early life of a child and late exposure to certain viruses also known as delayed infection.
This is because delayed infections are likely to affect the immune system in a manner that may cause leukemia. There is a lot of research that is still going on to establish further other possible causes of childhood leukemia.
Until now, the exact cause of childhood leukemia is not known. There is a need for more research because there is a possibility that the different types of childhood leukemia have different causes.
The good thing with the onset of the symptoms of leukemia is that they will always prompt a visit to the doctor. This means that in most cases, the disease is found earlier than it would have if the symptoms were not so worrying. This early diagnosis leads to more successful treatment.
Signs and symptoms of childhood leukemia begin soon as leukemia cells crowd out the normal cells. The most common symptoms of leukemia include:
Other symptoms of childhood leukemia include;
During diagnosis of childhood leukemia, the doctor will perform a physical exam and thoroughly check the medical history of the child. The doctor will also order tests that will help diagnose childhood leukemia as well as classify it.
Tests done to diagnose childhood leukemia include:
During a blood test, a pathologist will examine cells under a microscope. The pathologist will check samples of bone marrow to check the number of fat cells and blood-forming cells. Additional tests may also be done to diagnose childhood leukemia.
Carrying out these tests helps the doctor to predict how the leukemia is going to respond to treatment. After treatment, some tests may be repeated to see how the child is responding to treatment.
Treatment for childhood leukemia is usually overseen by the pediatric oncologist. He/she will work with the following pediatric health professionals:
Parents whose children have childhood leukemia should talk to their child’s doctor and other members of the cancer care team to discuss the best treatment option for their child. The method of treatment will depend on the type of leukemia and other factors.
Over time, survival rates for the majority of childhood leukemia have gone up. Treating childhood leukemia at special centers is more advantageous due to the specialized care given. Generally, childhood cancers respond better to treatment compared to adult cancers.
In some cases, it may be necessary to deal with illness complications before the cancer treatment starts. for instance, changes in blood cells may lead to severe bleeding, affect the amount of blood that gets to body tissues and even lead to infections. In such a scenario, treatment will involve blood transfusion, antibiotics, and other interventions to treat infections.
The main treatment for childhood leukemia is chemotherapy. Anticancer drugs will be administered by mouth or through the spinal cord or into a vein. Maintenance therapy in cycles for 2-3 years will be needed to prevent leukemia from coming back.
In some cases, the doctor may find it necessary to use targeted therapy. Targeted therapy works by targeting particular parts of cancer cells. It is different from chemotherapy. Targeted therapy is an effective treatment for particular types of childhood cancer. Its side effects are less severe.
An additional type of childhood leukemia treatment is radiation therapy. Radiation therapy uses high-energy radiation to shrink tumors and destroy cancer cells. Radiation therapy can treat childhood leukemia and prevent it from spreading to other body parts.
Surgery is rarely considered a treatment for childhood leukemia. In cases where standard treatment does not prove to be effective, the best option usually is a stem cell transplant. Stem cell transplant involves transplanting a blood-forming stem cell. This is done after radiation is done on the whole body combined with high-dose chemotherapy. This is done to destroy the bone marrow of the child.
Gene therapy has also been approved by the FDA as a treatment option for childhood leukemia. However, this treatment has only been approved for children and adults up to 25 years of age. A version for people above 25 years of age is still being worked on.
Another treatment option is CAR T-cell therapy. This treatment involves using the child’s T cells to treat leukemia. These T cells are taken out by the doctor and they are then changed by adding new genes to them. The new version of the T cells can work more effectively to locate and kill leukemia cells.
Phases of Childhood Leukemia Treatment
Treatment of childhood leukemia is done in the following phases:
Side effects that begin after treatment of childhood leukemia and continue for months or years are called late effects. Late effects of childhood leukemia treatment include:
The prognosis for childhood leukemia depends on the following:
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