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A look at leukemia

Scrutinizing the most common childhood cancer.

By Stef dela Cruz, M.D.

APRIL 2013 

Cancer is the next hypertension. That’s true figuratively and literally, with cancer second only to cardiovascular disease as the most common cause of death, according to preliminary 2011 statistics from the Centers for Disease Control and Prevention. And with cancer almost bagging first place, it’s about time we learned about the most common cancer in children: leukemia.

One out of every three children with cancer is diagnosed with leukemia, reports a 2009 article by Jose Maria Rivera, M.D. and colleagues, published in Hematology/Oncology Clinics of North America. “To give kids a fighting chance, moms must learn to detect leukemia early on,” stresses Amy Goleta-Dy, M.D. Head of the Department of Pediatric Hematology and Oncology at both St. Luke’s Medical City-Global City and the University of the Philippines-Philippine General Hospital. And in an era where leukemia tops all other cancers in kids, learning about it is every parent’s duty.

“There are approximately 3,500 new cases of cancer every year in the Philippines—and about 35 percent of these are due to leukemia,” Dr. Goleta-Dy states. “Educating health professionals and parents on how to detect leukemia in kids is a vital step in fighting this cancer.”

Blood and bone

Leukemia is a cancer of the bone marrow or blood; its signs and symptoms therefore reflect the activity of different blood cells. The white cells help fight infection, the red blood cells transport oxygen, and platelets help in blood clotting. It then makes sense that leukemia will manifest as an infection, anemia, or bleeding.

“Fever is one of the most common symptoms of leukemia,” Dr. Goleta-Dy explains. “But this is the kind of fever that doesn’t just go away despite adequate antibiotic therapy. If a child has been treated with antibiotics several times but his fever keeps coming back, we must always consider the possibility of leukemia.”

Aside from continuous or on-and-off fever, paleness can be another tell-tale sign. “Sometimes, kids with leukemia are first seen in the clinic because they are weak and pale, especially if their symptoms persist despite continuous iron treatment,” reveals Dr. Goleta-Dy. “Even with a supposedly harmless symptom such as anemia, we should always maintain a high index of suspicion. After all, a quick blood test can point to leukemia early on.”

Bruising in covered areas may be a sign of leukemia, too. “Kids get bruises all the time! But they usually get these on their extremities. If the bruises appear in protected areas, such as the trunk, thighs, neck and face, then it’s prudent to suspect leukemia,” Dr. Goleta-Dy says.

Enlarged lymph nodes and a large abdomen are signs of leukemia as well. “Many kids get enlarged nodes from infection. Many kids get enlarged abdomens from intestinal parasites,” shares Dr. Goleta-Dy. “But is it always just an infection or a case of worms? Again, a thorough physical exam and a simple blood count can help us diagnose cancer early.”

A complete blood count (CBC) in a child with leukemia usually reveals a classic picture: a high white cell count, low red cell and hemoglobin levels, and a low platelet count. Once leukemia is suspected, a bone marrow sample is taken to confirm the diagnosis.

The blood cells from the bone marrow are then examined under the microscope. Other tests, such as flow cytometry and cytogenetics, may be performed to determine which cell types and chromosomes are involved.

The culprit

“Genes and other factors can make a child prone to leukemia,” reveals Dr. Goleta-Dy. “A strong history of cancer in the family can point to genetic abnormalities that predispose them to many types of cancer. Exposure to radiation and chemicals—even chemotherapy drugs—can lead to leukemia.”

Acute leukemia comprises the majority of cases in children. “The most common type is acute lymphoblastic leukemia (ALL), responsible for about three-fourths of all cases,” says Dr. Goleta-Dy. “Acute myeloblastic leukemia (AML), on the other hand, causes 20 percent of childhood leukemia cases.”

Chronic leukemia is relatively uncommon. “For instance, chronic myeloid leukemia (CML) is responsible for only three percent of pediatric cases,” said Dr. Goleta-Dy.

ALL usually occurs in kids 2 to 5 years old, while AML is more common in newborns and adolescents.

What does a parent do when her child gets leukemia? Find out more about treatment options and support available for those afflicted with this deadly but curable disease in the April issue of HealthToday.

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