Leukemia (blood Cancer)

Patient Education

What is childhood leukemia?

Leukemia is a cancer of the blood cells. However, Cancer in Children & adolescents is rare.

What happens in leukemia?

Abnormal cancer cells (also called blast cells) accumulate in the bone marrow. They begin to crowd out the normal blood cells that develop there causing anemia, bleeding, and infections. These cancer cells may also spread to other parts of the body such as the lymph nodes, liver, spleen, joints & bones ultimately leading to death.

What are the causes of leukemia?

The cause of blood cancer still remains unknown. However, a few factors have been implicated. The incidence of leukemia is high in patients.

• Exposed to radiation
• Exposed to Benzene, pesticides and herbicides.
• Patients given Chemotherapeutic agents previously.
• Exposed to infectious agents such as Ebstein Barr virus, HTLV I & II virus etc.
• Patients with Bloom's syndrome
• Patients with Fanconi's anemia
• Patients with Down's syndrome
• Patients with Klinefelter's syndrome
• Patients with Wiskott - Aldrich syndrome
• Patients with Ataxia Telangiectasia

How is leukemia diagnosed?

On clinical suspicion, a variety of tests are done:- blood tests, bone marrow aspiration & biopsy, etc.

However, the primary diagnosis is made by bone marrow examination.

How is a patient with leukemia treated?

A patient with leukemia is essentially treated by agents that kill the abnormal cancer cells. This is done by either cancer drugs (also called as chemotherapeutic drugs or chemotherapy) or by radiation (radiotherapy).

How is chemotherapy given?

Some drugs are given intravenously and some drugs are given orally. Some chemotherapeutic agents are given as an injection in the to destroy the cancer cells in the brain and the spinal cord.

All pediatric oncology centers have treatment protocols for cancers.

What are the side effects of these agents?

Since they act on rapidly dividing cells, their major toxic effects are seen on the bone marrow, GI tract, and skin, and hair. Most of these agents cause nausea, vomiting, Bleeding Gums, bone marrow suppression (leading to low blood count and predisposing to infection), hair loss, and diarrhea. Other specific side effects are due to particular agents.

What is radiation therapy?

Radiation therapy is treatment with high-energy x-rays. High levels of radiation can kill cells and keep them from growing and dividing. There is no pain or discomfort during the treatment. It is like having an ordinary x-ray taken except that the child needs to be held still for a few minutes.

The area to be irradiated is marked with a dye. This dye should not be washed off for the duration of therapy as it serves as a guide for aiming the radiation. While radiation therapy is being received, soap or lotion should not be used on these lines or within the radiation field, where the skin becomes tender. The area should also be kept dry.

What are the side effects of radiation therapy?

There are various side effects of radiation therapy-

• Skin damage - The skin in the treated area may be sensitive and therefore should be protected against sunlight and irritation. Sun blocking lotion containing PABA should be used to prevent burning. If the head is affected, soft hats and scarves may be worth it. Body power, cornstarch, topical antibiotics, or steroids may relieve itching, pain, and speed healing.
• Sore throat
• Hair loss - is usually temporary with hair growth beginning about 3 months after completion of treatment.
• Nausea, vomiting & headaches - These last for about 4-5 hours and are relieved by anti-emetics.
• Diarrhea - It is usually after radiation to the abdomen or pelvic area. It usually responds to simple measures.
• Late effects - Following irradiation to the brain/CNS, some children may be drowsy. This symptom may begin at various times and may be seen as late as 5-7 weeks after therapy has been completed. It usually lasts about 5 to 10 days.
• Long term effects - Radiation therapy to the head may affect intelligence/coordination. Also, growth may be affected. There is an increased possibility of developing a secondary tumor at the radiation site.

What are the precautions advised to patients?

The following precautions are advised to the patients while on therapy:
Immunization - Live vaccines are contraindicated during chemotherapy. In most cases, routine childhood vaccination can be given 3- 6 months after the completion of chemotherapy.

Mouth care - Teeth should be brushed after each meal using a soft toothbrush. To prevent the severe tooth decay that can result when saliva flow is reduced from radiation to the head and neck, fluoride mouthwash may be recommended. Infants and toddlers may be given mouth care by wrapping a soft cloth around the parent's finger and gently wiping the teeth and gums with a solution of mouth rinse. When a patient has low blood counts, mouth care should be gentle.

Bleeding - Contact sports should be avoided. To control bleeding, apply pressure with a clean cloth till bleeding stops.

Danger signs - If the child shows any of the following symptoms, the parents should immediately notify the child's physician.

• A fever or other sign of infection or just "not looking well".
• Exposure to a contagious infection especially chicken pox or measles, unless the child is immune from prior exposure.
• Persistent headaches, pain or discomfort anywhere in the body.
• Difficulty in walking or bending.
• Pain during urination or bowel movements.
• Reddened or swollen areas.
• Vomiting unless post chemo/radiotherapy.
• Problems with eyesight such as blurred or double vision.
• Bleeding or multiple bruises.
• Marked depression or a sudden change in behavior.

What are the chances a complete cure in a patient with leukemia?

Blood Cancer stands a high chance of cure. However, the prognosis depends upon a lot of factors including the type of cancer, the age at onset, the white blood count at the time of diagnosis, and the spread of cancer.

Problems Faced by Post-cancer Patients

Cancer patients in remission & post-therapy face both medical and psychosocial problems. Among the medical problems, the most common side effects are:

1. Second tumors
2. Short stature
3. Learning disabilities
4. Specific organ dysfunction is related to the type of primary cancer and specific anticancer therapy.

Psychosocial problems include issues of school performance, vocational training, employment opportunity, marriage, reproduction, and interfamily interactions.

It is very important to know what the most common post-cancer sequelae are and when intervention is required.

Patients should follow up with their doctor at least yearly. The evaluation may include complete blood count, urine analysis, measurement of height & weight, assessment of pubertal development, measurement of blood pressure, assessment of thyroid function & other endocrine evaluation as indicated, monitoring for relapse/second tumors, fertility counseling, and assessment of psychosocial status.