Welcome to MAKNA {A Meaning to Life}

Children & leukaemia

Leukaemia is a rare disease in children. However, it is the most common form of childhood cancer. According to the most recent Cancer Incidence in Peninsular Malaysia, 2003 – 2005 report, leukaemia remained the most frequent cancer incidence among male and female Malaysian children from birth up to 14 years. However, over the last decade, there have been major advances in the treatment of leukaemia in children. As a result, a considerable number of children can now be effectively cured. However, some forms of leukaemia can be treated more successfully than others.

---------------------------------------

What is leukaemia?
Leukaemia is a blood disease, often termed "cancer of the blood". The term also describes a group of closely-related malignant disorders arising from immature blood-forming cells. There are many different types of leukaemia – all of which prevent the body from producing its normal defences against various types of infections. All of them can be fatal.

How are blood cells produced?
All types of blood cells are produced by bone marrow – the spongy centre of bones that acts as a carefully controlled factory producing three types of cells:

	Red blood cells – these contain a protein called haemoglobin that carry oxygen to all tissues of the body.
	White blood cells – there are three main types: monocytes, granulocytes and lymphocytes. Each of these cells is vital for the body to fight infections.
	Platelets – these are essential for the clotting of blood.

How does leukaemia affect blood cells?
When leukaemia occurs, normal control mechanisms break down and the bone marrow starts to produce large numbers of abnormal cells of a single cell type. The cell type affected is almost always one of the white cells. These abnormal leukaemia cells begin to multiply uncontrollably to take over the bone marrow and spill into the bloodstream and the lymph system.

They may even infiltrate vital organs. The bone marrow is no longer able to maintain its production of the normal cell type and this causes the whole balance of blood to be disturbed.

What causes leukaemia?
The cause of leukaemia is unknown despite ongoing global research. There is no scientific proof that leukaemia is hereditary. The disease is not infectious and there is no evidence to suggest that anything parents have done or failed to do has ever contributed to the development of the disease. It is never anyone's fault that leukaemia has developed in a child.

What types of leukaemia are there?

There are many types of leukaemia, which can be broadly divided into:

	Myeloid – This form of leukaemia affects cells involved in the production of either monocytes or granulocytes.
	Lymphoid – This type of leukaemia affects the lymphocytes.

These two forms can both be subdivided into either:

	Acute – acute leukaemia has a speedy onset and runs a rapid, unrelenting course if left untreated.
	Chronic – chronic leukaemia is slow and gradual, and may run a more prolonged course, sometimes for years without detection.

Which types of leukaemia affect children?
Acute lymphoblastic leukaemia (ALL) is the usual diagnosis for about 85 per cent of child leukaemia cases. The remainder of cases are mostly acute myeloid leukaemia (AML). Chronic lymphotic leukaemia does not occur in children and chronic myeloid leukaemia is very rarely seen in children.

What are the signs and symptoms of leukaemia?
These symptoms can develop over weeks or months:

	history of loss of energy and pallor from anaemia (lack of red cells).
	persistent or recurrent infections such as sore throats, ear infections and boils from the lack of normal white cells.
	nose bleeds and excessive bruising, often with no obvious cause.
	blood spots on the skin from lack of platelets.
	swelling under the arms, in the groin or around the neck when leukaemia cells accumulate in the lymph glands.
	swollen abdomen due to enlargement of the liver or spleen with leukemic cells.
	pain in the bones or joints due to leukemic cells in the bone marrow within the bones.
	difficulty in breathing due to an accumulation of leukaemic cells in the chest.

How is leukaemia diagnosed?

Blood examination
Although the symptoms above are not specific to leukaemia, all of them would require an examination of the blood. This will establish, in most cases, not only the presence of anaemia and the lack of normal white cells and platelets, but also the presence of leukaemic cells. A blood examination does enable a provisional diagnosis of acute leukaemia.

Bone marrow examination
If no leukemic cells are seen in the blood, diagnosis can be made by examining the bone marrow. The bone marrow should be examined in every case, whether or not there are any traces of leukaemic cells in the blood. This is to ensure that the type of acute leukaemia is established as accurately as possible.

How is a bone marrow examination done?
A child is put under general anaesthetic and a small amount of bone marrow is removed, usually through a syringe puncture in the hip bone, or through:

a chest x-ray.

an ultrasound of the abdomen.

A chest x-ray or an ultrasound will need to be done along with various biochemical tests before treatment can begin. A careful physical examination will also be required to see if there is any need for additional special tests.

Is leukaemia treatable?
Leukaemia is a treatable disease, although some forms are more easily treated than others. As with all types of cancer, it is vital for the patient to receive treatment promptly and expertly to ensure the best results.

There are many types of leukaemia and each patient’s disease is slightly different. The exact treatment will therefore vary from one individual to another. Any treatment recommended should be fully discussed with the patient and his family.