LEUKEMIA

• Also known as Blood cancer.

• As previously discussed, (in respective sections) blood consists of the Red blood cells( haemoglobin) , Platelets( to control bleeding) and White cells( army of cells to fight bacteria, virus).

• The total number of these cells are constantly controlled.

• There are genes (Like programs written for computers) within each cell that control these.

• Occasionally the white cell number goes out of control. This is the basis of leukaemia.

• When a large number of cells are produced, they need more energy to survive, begin forming a mass within the body, don’t perform their actual role and also produce more waste.

• When these cells start multiplying in excess,  they can affect the production of other cells. Hence the other normal cells can decrease.

• At a much later stage, the bone marrow(site of production of cells) may tire out and give up, producing no cells at all.

They are divided into different varieties based on the type of abnormal cell

TYPES

ALL- Acute lymphoblastic leukaemia-

• Common between the age of 2 to 8 years.
• This variant is most common (up to 70% of all leukaemia)

AML- Acute myeloid leukaemia-

• occurs from birth to teens.

Chronic variants- Like CML, CLL.

• They are less common in children and very slow growing.

CAUSE

The reason abnormal cells are produced is that the Gene to control cell type is abnormal.Various causes are suspected

• Genetic predisposition

• Immunity problems- children with inborn immunity problems are more prone

• Radiation- X Ray and other radiations( especially before birth).

• Certain syndromes like Down’s are more likely to be associated

• Radiations, chemicals, alcohol, smoking during pregnancy

 

SYMPTOMS

• Low-grade fever may be present

• Bone pain – as the bone marrow is being overworked, there is pain. Pain can be so severe that it may wake the child from sleep

• Weakness/ Pale colour- as red cells are less produced

• Infections- as there are defective white cells, there is more risk of infections

• Easy bleeding

• Abdomen pain- the organs in abdomen like ; liver, spleen enlarged causing constant pain.

• Small glands( lymph nodes) can enlarge all over the body- especially under chin, neck

• If the cells enter the brain then there can be headaches, vomiting or other signs

 

DIAGNOSIS

• Once you have seen your doctor, certain tests are done

• Bloods- to see the type of cell and count. Also, chemicals released by cells(LDH) are assessed

• Bone marrow aspiration- the bone marrow(Factory of cell production) is aspirated and examined for abnormal cells

• Lumbar puncture- Fluid from the back(spine) is collected by putting a thin needle and fluid is examined

• Biopsy- biopsy is taking a small piece of the organ (lymph nodes)and examined

• Ultrasounds, X Rays, CT/MRI

 

TREATMENT

The success depends on

• The age of presentation- Older children may be difficult to treat
• Severity of abnormal cells-
• Response to treatment

The aim of therapy is that The cancer cells in bone marrow that are multiplying have to be killed.

Chemotherapy- Medications are given through the vein and by mouth. These medications try to stop production of abnormal cells

Stages of chemotherapy

INDUCTION–

• The abnormal cells in bone marrow are tried to eradicate. This treatment goes on for weeks( 4 to 6 weeks) .

• If the cancer cells have infected the brain ( as diagnosed by Checking the fluid from back) then injections are given into the spinal fluid( fluid in back)

INTENSIFICATION–

• Here therapy is continued for another 3 to 6 months with various drugs

MAINTENANCE THERAPY–

• Final stage goes on for 2-3 years
• Different countries use different treatment regimes based on evidence-based studies.

• Radiation- Using Rays, the cancer cells are destroyed
• Surgery- occasion they are surgically resected

SUPPORTIVE TREATMENT

• The child may be started on medications like allopurinol to help the kidneys clear the waste products from the cancer cells

• Repeated blood transfusions, platelet transfusions may be needed to maintain health

• Antibiotics on regular basis is started as the child’s immunity( resistance) is compromised

 

PROGNOSIS

• As previously discussed, the outcome depends on various factors. your doctor will give you a rough estimate based on individual consideration

PRECAUTIONS

• The blood of the affected child needs regular monitoring  ( once in 2 weeks)

• Any fever (temp > 37.5-degree centigrade generally) should be taken seriously and started on intravenous antibiotics with blood culture(a type of blood test) should be taken.

• Buy a thermometer and regularly monitor temperature

• Any bruise on skin, abnormal paleness should be assessed by medical staff

• Talk to your doctor about regular pain relief. Normal painkillers like paracetamol are not used as they mask fever.

• Any affected child with signs of infection should be completely examined with X Rays, scans, Sputum tests, urine tests and blood tests.

• Once admitted, antibiotics are stopped after 48 hours of being infection free with negative blood culture( decided by your doctor)

• Most of these children require repeated blood test. Some places put a central line( a long tube that runs from the vein to the heart) This line can be used for repeated blood tests and to transfuse blood. Ask your doctor/ surgeon about it

• Always consider fungal infection if the child does not respond to regular antibiotics and investigate it. Common locations are thrush( white patch in the mouth with ulcers), urine ( separate investigation for urine ).

• If the child complains of difficulty swallowing or ulcers in the mouth , local acting painkiller gels are used with mouth hygiene and antifungal applications when needed.

• If eating becomes a problem then a tube from the nose to the stomach by passing the mouth is passed and child is fed through that. In extreme cases, if the child is losing weight and unable to recover in the next few days(5-7 days) then TPN( Total parenteral nutrition – mixture of protein, fat, carbohydrate) is given through the central line

• The doctor should always strongly investigated the suspected infection and start antibiotics. and should not stop them without a proper explanation

 

RELAPSE

• If the disease recurs after completion of treatment completely, it’s called relapse.

• Treatment of relapse may be Induction again with different new medications and stem cell ( the bone marrow transplantation – bone marrow is transplanted from acceptable donor to the patient)