Introduction

• The term leukemia refers to cancer of white blood cells.
• It is the most common cancer seen in children, accounting for ~ 30% of childhood cancers
• The bone marrow is responsible for producing our blood cells i.e. red blood cells, white blood cells and platelets. Each type has its own function.
• The red blood cells are responsible for carrying oxygen. The white cells help us to fight infection and the platelets help to control bleeding.
• In leukemia, large numbers of abnormal white blood cells are produced in the bone marrow
• These abnormal and immature cells cannot perform the normal function of white blood cells resulting in a decrease ability to fight infection.
• These cells occupy the marrow space and prevent adequate production of red blood cells and platelets. As a result the child becomes pale, lethargic with poor appetite and tends to bleed easily. The bleeding can be in the skin in the form of pinpoint pricks or petechiea or bruises. They can also bleed from the gums, nose or into the intestinal tract or even the brain.
• Leukemia can be acute (rapidly developing)   and chronic(slowly developing
• In children > 95%  of leukemia are acute
• Acute leukemia is also divided into acute lymphoblastic leukemia (ALL) which accounts for about 75-80% of cases and acute myelogenous leukemia (AML) which is seen in about 20%.

Diagnosis of Leukemia

• Physical examination- The doctor will examine the child to look for signs of pallor, bleeding and whether there are any enlarged lymph nodes He will examine the abdomen to see if there is an enlarged liver or spleen because they can become enlarged in leukemia.
• After this, a blood test will be done.
• When leukemia is suspected, a bone marrow aspiration and bone marrow biopsy will be done. In this procedure a needle is inserted into the hip bone at the back and a sample of marrow is drawn and sent to the laboratory for examination.
• The doctor will carry out a lumbar puncture. This involves taking a small amount of cerebrospinal fluid from the lower back to determine if the leukemia has spread to the brain and spinal cord.

Treatment of Leukemia

• Leukemia is a systemic disease. Unlike solid tumors, there is no stage in leukemia.
• Treatment involves the use of chemotherapy which is the use of drugs to kill the malignant cells. This is given in the form of oral, intravenous and intramuscular.  The age of the child and the white cell count at diagnosis are some factors that will determine the intensity of treatment needed.
• In addition, the child will require intrathecal treatment. In this procedure, chemotherapy is instilled directly into the cerebrospinal fluid to prevent leukemia from returning to the nervous system.
• In certain high risk cases radiotherapy (the use of high energy rays) is given to the brain in addition to intrathecal therapy.

Updated:: 25/03/2013 [amir_peli] Updated:: 18/12/2013 [ctfarhanah]