Childhood Leukemia

Overview

Leukaemia is a cancer of the blood-forming cells. In childhood leukaemia, young white blood cells grow out of control in the bone marrow, the soft tissue inside bones that makes blood. These abnormal cells crowd out healthy red blood cells, white blood cells, and platelets. This can cause tiredness, infections, and bleeding problems. Leukaemia is not contagious.

Leukaemia is the most common childhood cancer, but childhood cancer itself is rare. Most children with leukaemia do not have a family history of it.

It can affect children of any age, but it is most often diagnosed in young children. Boys are slightly more likely to be affected than girls. It is not caused by anything a parent did or did not do.

Symptoms

Common symptoms

• Feeling very tired or weak, or looking pale
• Fever that keeps coming back, or infections that are frequent or slow to clear
• Easy bruising or bleeding, such as nosebleeds or bleeding gums
• Bone or joint pain, sometimes causing a limp or refusal to walk
• Swollen lymph nodes in the neck, armpit, or groin
• Poor appetite, weight loss, or a swollen or uncomfortable belly
• Headaches, dizziness, or changes in behaviour

Symptoms in children

• A child may be irritable, sleep more than usual, or lose interest in play
• A child may complain of leg or back pain, or start limping
• A child may have repeated infections or take longer than expected to recover
• A child may have tiny red or purple spots on the skin, called petechiae, caused by bleeding under the skin
• A child may have swelling in the face, belly, or lymph nodes

Symptoms in older adults

• This article is about childhood leukaemia, so this section does not apply to older adults.
• Adults can develop leukaemia, but the types, tests, and treatments are different.
• An older adult with concerning symptoms should ask their own doctor for age-appropriate advice.

Causes

Main causes

• Childhood leukaemia happens when gene changes inside blood-forming cells make them grow and divide abnormally.
• In most children, the exact cause is not known, and nothing the family did caused it.
• Leukaemia is not infectious and cannot be passed from child to child.

Risk factors

• Previous treatment with chemotherapy or radiation for another cancer
• Some rare inherited genetic conditions, such as certain chromosome or immune system disorders
• Exposure to very high doses of radiation, such as in some medical treatments
• Age, with a peak in young children, and sex, with boys slightly more affected
• Most children with leukaemia have no known risk factor

When to see a doctor

See a doctor urgently if:

• Your child has a fever and is having cancer treatment, or has a fever with unusual sleepiness or confusion
• Your child has new bruising, bleeding, or tiny red or purple spots on the skin
• Your child has severe bone pain, a new limp, or swelling that is getting worse
• Your child is very pale, very tired, or breathing faster than usual
• Your child has swollen lymph nodes that are getting bigger or feel hard

Book a routine appointment if:

• Your child has tiredness, poor appetite, or repeated minor infections that do not seem to settle
• Your child has bone or joint pain that lasts more than a few days
• You are worried about a change in your child's health, even if you are not sure what it means
• A close family member has a known genetic condition linked to cancer and you want advice

Diagnosis

A doctor will ask about your child's symptoms and health history and examine them. If leukaemia is suspected, they will arrange blood tests and usually refer your child to a specialist children's cancer team. The team may take a small sample of bone marrow to confirm the diagnosis and find out the exact type of leukaemia.

Tests that may be done

• Blood tests to count red cells, white cells, and platelets and to look at the cells under a microscope
• Bone marrow biopsy or aspiration, where a small sample of marrow is taken, usually with pain relief or sedation
• Lumbar puncture, sometimes called a spinal tap, to check whether leukaemia cells are in the fluid around the brain and spinal cord
• Imaging scans such as X-ray, ultrasound, CT, or MRI if the team needs more information
• Genetic and molecular tests on the leukaemia cells to guide treatment

What to expect at your appointment

Tests may take several days to come back. Your child may need to stay in hospital for some tests, and young children may be given sedation so they are comfortable. The specialist team will explain each step and support you while you wait for results.

Treatment

Treatment is planned by a specialist children's cancer team. It depends on the type of leukaemia, the child's age, and how the leukaemia responds. The aim is to clear the leukaemia cells, keep the child safe during treatment, and reduce the chance of the leukaemia coming back. Treatment usually lasts many months and sometimes several years.

Self-care at home

• Keep all appointments and follow the cancer team's advice about medicines, tests, and when to call them
• Help your child wash hands often and avoid people who are clearly unwell, especially during times when their immune system is low
• Ask the team before giving any medicine, vitamin, supplement, or herbal remedy
• Keep a simple note of symptoms, temperatures, and side effects so you can report changes clearly
• Accept practical help from family and friends, and ask the hospital social worker for support with transport, money, and school

Medical treatments

Doctors use chemotherapy, which means medicines that kill cancer cells. Chemotherapy may be given into a vein, by mouth, or sometimes into the fluid around the spine. Some children also need targeted therapy, immunotherapy, radiation therapy, or a stem cell transplant. The team adjusts treatment to the child's risk group and manages side effects such as infection, tiredness, nausea, and mouth sores. Treatment is given in phases, and the team will explain what each phase involves.

When is surgery considered?

Surgery is not usually used to treat leukaemia itself because leukaemia is a disease of the blood and bone marrow. Surgery may be needed for other reasons, such as placing a central line, a thin tube used to give treatment and take blood tests, or to take a biopsy sample.

Living with this condition

Life during treatment often revolves around hospital visits, tests, and recovery from treatment. Children may need time away from school, and routines may change for the whole family. Keep life as predictable as you can with simple routines, favourite foods, and time for rest and play.

Lifestyle tips

• Stay active in gentle ways when your child feels well, and rest when they need to
• Keep the home clean, wash hands often, and avoid crowded places when the cancer team advises it
• Follow the team's advice about school, pets, gardening, and contact with people who are unwell
• Ask before using public pools, travel, or taking part in contact sports during treatment
• Keep up with appointments and call the team early if you are worried about a symptom

Diet and exercise

A balanced diet helps children cope with treatment, but appetite can change. Offer small, frequent meals and safe, well-cooked food. Ask the hospital dietitian for advice if eating is difficult. Gentle exercise, such as short walks or play, can help when your child feels well, but follow the cancer team's advice about what is safe.

Mental health and emotional wellbeing

A cancer diagnosis is stressful for the child, parents, and siblings. Children may feel scared, angry, or withdrawn, and parents may feel exhausted or anxious. These feelings are normal. If you or your child ever have thoughts of self-harm or suicide, get crisis help right away by calling your local emergency number or a local crisis service. Ask the hospital team for psychological support for the whole family.

Prevention

There is no proven way to prevent childhood leukaemia. Most cases happen without any known risk factor, and nothing a parent did caused the illness. Families should not blame themselves.

Vaccines

No vaccine prevents leukaemia. Children should keep up with routine vaccinations, but ask the cancer team before any vaccine during or after treatment, because some vaccines are not safe while the immune system is low.

Screening programmes

There is no routine screening test for childhood leukaemia. If a child has a rare genetic condition linked to cancer, the specialist team may recommend regular check-ups.

Complications

If left untreated

• Low red blood cells, called anaemia, causing severe tiredness and breathlessness
• Low healthy white blood cells, leading to serious infections
• Low platelets, leading to bruising and dangerous bleeding
• Spread of leukaemia cells to other organs, such as the brain, liver, spleen, or lymph nodes
• Death, because leukaemia can be life-threatening without treatment

Long-term outlook

Most children with the most common type of childhood leukaemia are cured, and survival has improved greatly over recent decades. Treatment can be long and intense, and every child is different. The specialist team can give you the most accurate information about your child's type and outlook. Many children go on to live full lives, with long-term follow-up to watch for late effects.

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