Leukemia is the cancer of the body’s blood-forming tissues, including the bone marrow, blood, and lymphatic system, and the spleen. There is an abnormal increase in the immature white blood cells. It is the most common cancer among children and teens, accounting for one out of three cancer cases. There are various types of leukemia that affect children, with acute lymphocytic leukemia (ALL) being the most common one
In this post, we tell you about the classification, types, signs and symptoms, diagnosis, treatments, and outcomes of leukemia in teens.
Classification Of Leukemia
Leukemia is classified based on the types of cell involved and the speed of progression.
Depending on the speed of progression, leukemia can be classified into (2):
- Acute leukemia: The cancerous cells multiply rapidly. These abnormal cells, also called blast cells or immature cells, are not capable of carrying out normal cell functions. The rapid growth of these cells may result in sudden worsening of the disease, and the teenager may require aggressive therapies immediately.
- Chronic leukemia: This involves slower multiplication of cells, and they may function normally for some time. It can be asymptomatic for a long time since the abnormal cells are mature cells and may continue to function normally.
Based on the type of cell involved, leukemia can be classified into (2):
- Lymphocytic leukemia: Acute lymphocytic leukemia is a cancer of the bone marrow. Early and abnormal cells of the bone marrow grow rapidly and replace the normal cells with cancerous cells. Lymphocytes are formed in bone marrow, but migrate to lymphatic tissue. There are two types of lymphocytes, B-lyphocytes and T-lyphocytes. These cells play a crucial role in a person’s immune system.
- Myelogenous leukemia: Myeloid cells are affected here. These cells are precursor cells for erythrocytes (red blood cells, leukocytes (white blood cells)), and platelets.
Types Of Leukemia
Leukemia can be of different types. Based on duration and progression, it can be classified into (3):
- Acute lymphocytic leukemia (ALL): This is a rapidly progressing leukemia with lymphocyte abnormalities. It is the most common type of leukemia seen in children, and can also be present in adults.
- Acute myelogenous leukemia (AML): Rapid progression of the myeloid cells are seen in this type of leukemia. Although it is seen in adults, it can also occur in children.
- Chronic lymphocytic leukemia (CLL): This type of leukemia is seen in adults, and the affected person can be asymptomatic for years without treatments.
- Chronic myelogenous leukemia (CML): This can be asymptomatic for years until the cells start to grow rapidly. This is more common in adults than in children.
- Hairy cell leukemia (HCL): This rare subtype of CLL builds up slowly. The affected B lymphocytes look hairy, and the number of healthy cells is reduced during the acute stages.
Signs And Symptoms Of Leukemia In Children And Teens
Leukemia can remain asymptomatic for years. The signs and symptoms can be different in each type of leukemia, depending on the cells involved.
The following signs and symptoms are generally noticed in children and teens with leukemia (4):
- Recurrent and severe infections: Teens with leukemia have a shortage of normally functioning white blood cells that fight pathogens. This could make them vulnerable to new infections and take longer to recover than others.
- Fever and chills: An infection can be the cause of fever in teens with leukemia. However, this may also happen without infection in a few.
- Tenderness and pain of the bones and joints: Leukemia cells may accumulate over the surface of the bones and in the joints, resulting in pain and tenderness.
- Weakness and continuous fatigue: Increased amount of blood cells could make the blood thicker and cause a reduction in the movement of blood, especially in the small vessels of the brain. This circulatory deficiency can be the reason for extreme fatigue and indistinct speech.
- Enlarged spleen and liver: Leukemia cells may accumulate in the liver and spleen, causing them to enlarge. The common symptoms include a feeling of fullness or a swollen abdomen.
- Weight loss: The enlarged spleen or liver might also exert pressure on the stomach and cause a lack of appetite or early satiety, thus resulting in weight loss.
- Nose bleeding, petechiae (red spots) on the skin, and gum bleeding: These symptoms may indicate a low amount of platelets due to the cancer cells affecting the production of platelet-forming cells in the body.
- Swollen lymph nodes: This may occur due to the accumulation of cancer cells in the bone marrow or due to the production of white blood cells during the acute phase or lymphoma. Besides, some infections can also cause swelling of the lymph nodes, which can often be tender and painful and disappear in two weeks. Lymph nodes may be hard and painless in leukemia.
- Sweating at night: There is no definite explanation as to why the night sweats happen in certain cancers. It may be due to the changes in metabolism and hormones, or due to a fever caused by cancer.
Causes Of Leukemia In Teenagers
Leukemia can be caused by genetic factors such as chromosomal abnormalities, these include chromosome number, translocation, i.e., one piece of chromosome has moved onto another chromosome, or parts of the chromosome with important genetic material is absent. Environmental factors such as exposure to certain chemicals and radiation may increase the risk for leukemia, as well as infection with Epstein Barr virus infection and the development of B-cell ALL in certain developing countries. However, the exact cause is yet to be discovered.
It may happen as a result of mutations in DNA, which trigger abnormal cell growth and affect metabolism. These mutations could make the cells divide faster than the average rate and delay the process of natural cell death.
Risk Factors Of Leukemia In Children And Teens
The following factors may increase the risk for leukemia (5):
- Genetic diseases such as Down syndrome
- History of chemotherapy and radiation therapy for cancer
- Chemical exposure (benzene)
- Exposure to smoking
- Family history of leukemia
When To See A Doctor
You may seek medical attention if your teen has any signs and symptoms that require proper diagnosis.
The signs and symptoms of leukemia can be quite subtle and often ignored in earlier stages. In some cases, the symptoms may resemble common illnesses, such as flu. However, anorexia, fatigue, irritability, recurrent infections, and a low grade fever, with associated bone or joint pain may be a warning sign.
In a few cases, chronic leukemia can be accidentally discovered during the diagnosis of other diseases.
Diagnosis Of Leukemia
The healthcare provider may order a physical examination to look for signs of leukemia. Swollen lymph nodes, enlarged liver and spleen, and pale skin due to anemia are the most common physical signs of leukemia.
Your teen may undergo the following tests (7):
- Blood tests: These help determine the count of blood cells, including white cells, red blood cells, and platelets. Leukemia may cause an increase in the level of abnormal cells.
- Peripheral blood smear can be assessed under a microscope to look for abnormal cells, serum chemistries (ex: potassium, phosphorus, and calcium), uric acid levels, LDH level, and blood clotting studies.
- CXR: Looks for enlarged masses in the center of the chest, called the mediastinum.
- Ultrasound of the testes, especially in boys, to look for tumour infiltration and to assess the kidneys.
- Cardiac evaluation initially prior to starting any therapy, as therapies may affect the heart.
- Lumbar puncture to assess for brain involvement.
- Bone marrow examinations: Samples of the fluid in the bone marrow are collected using a needle; this is often performed on the hipbone. Sample analysis could help identify leukemia cells and their features. Bone marrow tests are crucial in deciding the treatment options.
Treatment For Leukemia
The treatment for leukemia is mainly decided based on the type of leukemia and the age and health status of your teen. The possibility of malignancy (spread to other body parts) is also a critical factor in deciding the type of treatment.
Usually, the following treatments are given to teens with leukemia (8):
- Chemotherapy: This is one of the most common therapies for treating leukemia, wherein drugs are used to kill cancer cells. Your teen’s doctor may choose a single or a combination of chemotherapeutic drugs based on the type of leukemia. A few of these drugs are administered orally, while others are given through intravenous injections.
- Biological therapy (immunotherapy): Also called biological response modifiers (BRMs) or biotherapy, this helps the immune system to find and attack the cancer cells. Biotherapy using drugs such as interferon alfa is often suggested if other therapies are contraindicated.
- Targeted therapy: This is a method of treatment using drugs that target specific proteins in cancer cells. Small molecular drugs and monoclonal antibodies are used in targeted therapy (9).
- Radiation therapy: This uses high-energy X-ray waves to manage and control the growth of cancer cells. The body area with a collection of leukemic cells receives radiation during this treatment. Total body radiation is given for a few patients before stem cell transplantation (10).
- Stem cell transplantation: This is the replacement of the affected bone marrow with a healthy marrow. High dose radiation or chemotherapy is given before this treatment to destroy the affected bone marrow. The blood-forming cells from a donor are then used to replace the damaged stem cells.
Radiation Therapy For Leukemia
Radiation therapy is not always recommended for the treatment of leukemia in children. This is typically used in the following clinical situations (10):
- To prevent the spread of leukemia to the brain
- To treat testicular leukemia
- To treat tracheal (windpipe) tumors that may interfere with breathing
- For full-body radiation in order to prepare for stem cell therapy
Planning of radiation therapy or simulation usually involves imaging tests to identify the exact location of the cancer. Your teen’s doctor will determine the location, dose, and angle of radiation based on the severity and affected area.
Radiation therapy is painless and may last a few minutes. Sedatives are often given before the treatment to avoid body movements during radiation.
The high energy x-ray beams may cause a few short-term or long-term side effects in your teen and are often associated with location and dose of radiation.
The short-term side effects of radiation therapy may include (10):
- Hair loss
- Skin rashes like sunburns
- Increased risks for contracting infections
These may disappear in a few days. However, radiation therapy may cause long-term side effects in some teens.
The possible late and long-term side effects of radiation therapy include (11):
- Increased risk for developing cancers in later life
- Risk of developing heart or lung problems in the future
- Learning disabilities
- Growth and developmental delays
- Thyroid problems
- Fertility and sexual problems
- Osteoporosis (thinning of the bones) and other bone damages
- Emotional and psychological problems during and after therapies
Some teens may develop a few long-term side effects of leukemia in later life. You may need to follow up with your doctor at the recommended periods for further evaluations. Regular follow-ups could help identify any adverse effects in the early stages and help you take necessary steps.
Prognosis Of Leukemia In Teens
Depending on the severity and type of leukemia, your teen’s doctor may discuss its prognosis or outcomes.
In general, teens who are free of the disease for five years after the treatment of acute leukemia are considered cured cases since it is not common to develop leukemia after this time frame (12).
Regular follow-ups may improve the survival years, and early diagnosis and therapeutic interventions may also have a more significant positive impact on the outcome.
Preventing Leukemia In Teens
There are no known methods to prevent leukemia in teens at present. Most teens who develop the disease do not have any risk factors (13).
Your doctor may choose among radiation therapy, chemotherapy, or organ transplantation and compare the risks and benefits and the chances of secondary cancers after treatment. The treatment is given since the risk for developing leukemia due to therapies is very low in later life.
Radiologic imaging tests use very low energy radiation during prenatal and childhood examinations, and this may not pose an increased risk for leukemias. However, doctors recommend CT scans and X-rays children. Lifestyle-related factors are unlikely to cause leukemia in children.
Although it can be devastating for parents, it is essential for you to stay strong. Over time, you may become strong enough to cope and support the child. Try to learn and discuss with your child’s doctor about leukemia and its outcomes. This can be helpful in making important treatment decisions.
You can also seek support from friends and family to deal with it. If needed, you may attend counseling sessions to share your worries. Your positive attitude towards the illness may have better impacts during your child’s recovery.
Doctors recommend children to continue their education during the treatment days since they may get support from peers.
Thanks significant advances in treatment, most children treated for leukemia now live into adulthood
2. Leukemia: Classifications; Herbert Irving Comprehensive Cancer Center;Columbia University Medical Center; National Cancer Institute
3. Types of Leukemia; Memorial Sloan Kettering Cancer center; National Cancer Institute–designated Comprehensive Cancer Centers
4. Signs and Symptoms of Acute Lymphocytic Leukemia (ALL); The American Cancer Society
5. Leukemia in Children; Cedars-Sinai Medical Center
6. What Causes Childhood Leukemia; The American Cancer Society
7. Leukaemia; Cancer Council; Victoria
8. Treatment for leukaemia; Cancer Council; Victoria
9. How Targeted Therapies Are Used to Treat Cancer; The American Cancer Society
10. Radiation Therapy for Acute Lymphocytic Leukemia (ALL); The American Cancer Society
11. Late Effects of Childhood Cancer Treatment; The American Cancer Society
12. Survival Rates for Childhood Leukemias; The American Cancer Society
13. Can Childhood Leukemia Be Prevented?; The American Cancer Society
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