Childhood+Leukemia



Introduction Leukemia is a cancer of the early blood-forming cells. Most often, leukemia is a cancer of the white blood cells, but some leukemia’s start in other blood cell types. Leukemia starts in the bone marrow (the soft inner part of bones, where new blood cells are made). In most cases, the leukemia invades the blood fairly quickly. From there it can go to other parts of the body such as the lymph nodes, spleen, liver, central nervous system, testes, or other organs. In order to understand the different types of leukemia, it helps to know about the blood and lymph systems.

Types of leukemia in children There are numerous types of leukemia found in children. Leukemia is often described as being either acute (growing quickly) or chronic (growing slowly). Most childhood leukemia is acute. Acute leukemia’s There are 2 main types of acute leukemia: · Acute lymphocytic (lymphoblastic) leukemia (ALL): This type of leukemia accounts for about 3 out of 4 cases of childhood leukemia. This leukemia starts from the lymphoid cells in the bone marrow.

· Acute myelogenous leukemia (AML): This type of leukemia, also called acute myeloid leukemia, acute myelocytic leukemia, or acute non-lymphocytic leukemia (ANLL), accounts for most of the remaining cases. This leukemia starts from the cells that form white blood cells, red blood cells, or platelets. Hybrid or mixed lineage leukemia’s: These are rare leukemia’s. The cells have features of both ALL and AML. They are generally treated like ALL and respond to treatment like ALL. Both ALL and AML can be further divided into different subtypes. Chronic leukemia’s chronic leukemia’s are much more common in adults than in children. They tend to grow more slowly than acute leukemia’s, but are also harder to treat. Chronic leukemia’s can also be divided into 2 types. Juvenile myelomonocytic leukemia (JMML)  This rare type of leukemia is neither chronic nor acute. It begins from myeloid cells, but does not grow as fast as acute myelogenous leukemia. It occurs most often in young children (under age 4). Symptoms can include pale skin, fever, cough, easy bruising or bleeding, trouble breathing, and an enlarged spleen and lymph nodes. Treatment  Childhood leukemia affects many children. There are several different treatments for children with different forms leukemia. The treatment for acute lymphocytic leukemia (ALL) is often chemotherapy, followed by radiation (Mayo, Clinic 2010). Chemotherapy is a chemical treatment. It is also known as the anti-cancer drug. There are over one hundred types of chemotherapy to treat leukemia (Clinic, 2005 ). Some forms of chemotherapy are taken by mouth, while others are given via injection or intravenously. Chemotherapy has many different side effects that affect children. These different side effects may include, but are not limited to, anemia, fatigue, hair loss, increased chance of bruising, bleeding, infection, nausea, vomiting. Chemotherapy also affects the intestines and stomach. Most people do not remember that chemotherapy is like poison to a body, and so every part and organ of the body is affected ( American, 2009 ). Children who go through chemotherapy treatment often get sores in their mouth, gums and throat. They also experience appetite and weight changes. They may have dry or discolored skin as well. If a child has been subject to a lot of chemotherapy, or has been subject to high doses of chemotherapy, they often run the risk of fertility issues because of effects on the reproductive organs ( American, 2009 ). After a child goes through chemotherapy, they will often go through radiation as well. Radiation treatment is type of treatment that uses high doses of radiation to kill cancer cells. Radiation therapy can be an internal, where it is put inside the body, or external, where a machine aims a beam with radiation at the cancer cells. ( (National Cancer, 2007). There are a few side effects of radiation, including fatigue, skin changes, and mouth and throat problems. Certain areas of the body can also be affected when treated with radiation, such as the brain, the lungs, the digestive tract, and the reproductive organs. ( American Cancer, 2009 <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman';">)
 * <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman';">Chronic myelogenous leukemia (CML): <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman';"> This leukemia is rare in children, but it does occur. It is also treated the same as in adults.
 * <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman';">Chronic lymphocytic leukemia (CLL): <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman';">This leukemia is extremely rare in children!

<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 18pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman';">How Does It Affect Children in School? <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman';">Childhood leukemia affects children that are in school because they will miss a lot of school. Children with cancer usually need to be out of school for different treatments or to be hospitalized. Leukemia usually affects a child for a long period of time, so as a teacher you may experience a child who has or who has had childhood leukemia behind in many different subjects. Overall, these children are very special and exceptional children who should be treated as so.

<span style="color: black; font-family: Symbol; font-size: 12pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="color: black; font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: 150%; mso-fareast-font-family: 'Times New Roman';">Mayo, Clinic. (2010). //Leukemia//. Retrieved from [] <span style="font-family: Symbol; font-size: 12pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: 150%;">Clinic, Cleveland. (2005). //What is Chemotherapy?//. Retrieved from [] <span style="font-family: Symbol; font-size: 12pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: 150%;">American, Cancer Society. (2009, November 11). //Managing side effects//. Retrieved from [] <span style="font-family: Symbol; font-size: 12pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: 150%;">National Cancer, Institute. (2007, April 4). Questions and Answers About Radiation Therapy Retrieved from //[|Http://www.cancer.gov/cancertopics/radiation-therapy-and-you/page2]//. <span style="font-family: Symbol; font-size: 12pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="font-family: 'Arial','sans-serif'; font-size: 12pt; line-height: 150%;">American Cancer, Society. (2009, July 17). //Possible Side effects of radiation therapy//. Retrieved from [] • <span style="color: black; font-family: Constantia; font-size: 18pt; language: en-US; mso-ascii-font-family: Constantia; mso-bidi-font-family: +mn-cs; mso-color-index: 1; mso-fareast-font-family: +mn-ea; mso-font-kerning: 12.0pt;">The Nemours Foundation/KidsHealth®. (1995-2010). <span style="color: black; font-family: Constantia; font-size: 18pt; font-style: italic; language: en-US; mso-ascii-font-family: Constantia; mso-bidi-font-family: +mn-cs; mso-color-index: 1; mso-fareast-font-family: +mn-ea; mso-font-kerning: 12.0pt;">Childhood Leukemia. <span style="color: black; font-family: Constantia; font-size: 18pt; language: en-US; mso-ascii-font-family: Constantia; mso-bidi-font-family: +mn-cs; mso-color-index: 1; mso-fareast-font-family: +mn-ea; mso-font-kerning: 12.0pt;">Retrieved from <span style="color: black; font-family: Constantia; font-size: 18pt; language: en-US; mso-ascii-font-family: Constantia; mso-bidi-font-family: +mn-cs; mso-color-index: 1; mso-fareast-font-family: +mn-ea; mso-font-kerning: 12.0pt;">[|http://kidshealth.org/parent/medical/cancer/cancer_leukemia.html#]



<span style="font-family: Arial,Helvetica,sans-serif;">Notes Written By: Sara Leatherman

Childhood acute lymphoblastic leukemia (ALL) is a type of cancer in which the bone marrow makes too many lymphocytes. ALL is the most common cancer of the blood and bone marrow that usually gets worse if not treated quickly. In ALL, too many stem cells develop into lymphoblasts or lymphocytes. The cells are unable to fight infection and the number of lymphocytes increases. In turn the blood and bone marrow have less room for healthy white blood cells, red blood cells, and platelets. This may lead to infection, <span style="font-family: Arial,Helvetica,sans-serif; line-height: 14px; text-decoration: none;">[|anemia] <span style="font-family: Arial,Helvetica,sans-serif;">, and easy bleeding. There are also four basic subgroups of ALL. They are based on the type of blood cell that is affected. They include: · T-Cell ALL · Philadelphia chromosome positive ALL · ALL diagnosed in an infant · ALL diagnosed in children who are ages 10 and older Family history and exposure to radiation may increase the risk of developing childhood ALL. A few most common risk factors are: · Having a brother or sister with leukemia · Being white or Hispanic · Living in the United States · Being exposed to x-rays before birth · Exposure to radiation · Past treatments · Having certain genetic disorders The most typical signs of childhood ALL are fever and bruising. However, other conditions may cause the same symptoms. A doctor should be consulted right away if any of the following problems occur: · Fever · Easy bruising or bleeding · Bone or Joint pain · Painless lumps on areas of your body · Pain or feeling of fullness below the ribs · Loss of appetite · Weakness or tiredness That is just a brief explanation of some of the various types, signs, and symptoms of childhood leukemia. There is so much more to know and research on, but these are just the basic beginning research findings. <span style="font-family: Arial,Helvetica,sans-serif; line-height: 14px;">[] <span style="font-family: Arial,Helvetica,sans-serif;">

Notes Written By: Sara Leatherman

An ongoing question is how is childhood leukemia diagnosed? Most of the signs and symptoms that children with leukemia develop are due to the lack of normal blood cells. A child may appear very pale, have shortness of breath, or excessive tiredness. There are also other signs that a child may have leukemia. A child may even develop an infection that doesn’t respond to antibiotics, have a high fever, and become very sick. This is due to the lack of white blood cells. Other signs and symptoms include: · Bone and joint pain · Swelling of the abdomen · Swollen lymph nodes · Enlargement of the thymus · Headaches, seizures, vomiting and last but not least… · Rashes, fatigue, and weakness. Most of the symptoms are not unique and can be caused by other problems like infections. This calls for a much needed accurate diagnosis. Several diagnosis techniques include: · Blood cell counts and examinations · Bone marrow aspiration and biopsy · Lymph node biopsy · Lumbar puncture (spinal tap) · and several other tests There is also a variety of laboratory tests used diagnose and classify leukemia. During these tests, the doctor will examine the size, shape, and other aspects of the cells appearance. Cytochemistry, flow cytometry, immunocytochemistry, cytogenetics, and molecular genetic studies are a few tests used. To have a more in depth look at the imagery of the cells, the doctors use x-rays, ultrasounds, CT scans, MRIs, and Gallium and bone scans.

[] Copyright 2010 © American Cancer Society, Inc.

Notes Written By: Sara Leatherman Leukemia refers to <span style="font-family: Arial,Helvetica,sans-serif; font-size: 9pt;">cancers of the white blood cells, which are also referred to as **<span style="font-family: Arial,Helvetica,sans-serif;">leukocytes ** <span style="font-family: Arial,Helvetica,sans-serif; font-size: 9pt;"> or **<span style="font-family: Arial,Helvetica,sans-serif;">WBC ** <span style="font-family: Arial,Helvetica,sans-serif; font-size: 9pt;">s. When a child has leukemia, large numbers of abnormal white blood cells are produced in the bone marrow and causes defects and improper functioning. As leukemia progresses, the cancer interferes with the body's production of other types of blood cells, including red blood cells and platelets. This results in <span style="background-color: white; font-family: Arial,Helvetica,sans-serif; font-size: 9pt; text-decoration: none;">[|anemia] <span style="font-family: Arial,Helvetica,sans-serif; font-size: 9pt;"> (low numbers of red cells) and bleeding problems. There are two main categories of leukemia found in children. They include: acute **<span style="font-family: Arial,Helvetica,sans-serif;">lymphocytic leukemia ** <span style="font-family: Arial,Helvetica,sans-serif; font-size: 9pt;"> (ALL) and **<span style="font-family: Arial,Helvetica,sans-serif;">acute myelogenous leukemia ** <span style="font-family: Arial,Helvetica,sans-serif; font-size: 9pt;"> (AML). Approximately 60% of children with leukemia have ALL, and about 38% have AML. <span style="font-family: Arial,Helvetica,sans-serif;">

There are several causes linked to childhood leukemia. They consist of having an identical twin who was diagnosed with the illness before age 6, children who have inherited certain genetic problems - such as Li-Fraumeni syndrome, Down syndrome, etc.-, and children who have received prior radiation or chemotherapy for other types of cancer. In most cases you cannot prevent the factors that contribute to leukemia. However, you can just take precautions such as regular checkups to spot early symptoms of leukemia. Symptoms to look for are repeated fevers and infections. The child may also become anemic due to lack of oxygen-carrying red blood cells. This makes them appear pale, and abnormally tired and out of breath. Children with leukemia may also bruise and bleed very easily. Other symptoms of leukemia may include: pain in joints or bones, swollen lymph nodes, and poor appetite. Diagnoses includes a doctor performing a physical examination checking for the symptoms listed above. After this exam, the doctor will order a CBC (complete blood count). Then depending on the results, your child may need further examination. Treatment is a key component into getting better. The treatment depends on the severity of the leukemia. After treatment begins, the goal is remission. Once remission has occurred, maintenance of chemotherapy is usually used. With the proper treatment, the outlook is usually pretty good for the kids that are diagnosed. Most childhood leukemias have very high remission rates, and the majority of children can be cured - meaning that they are in permanent remission - of the disease.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 9pt;">[|http://kidshealth.org/parent/medical/cancer/cancer_leukemia.html#] //<span style="font-family: Arial,Helvetica,sans-serif;">© 1995-2010. The Nemours Foundation/KidsHealth ////<span style="font-family: Arial,Helvetica,sans-serif;">® ////<span style="font-family: Arial,Helvetica,sans-serif;">. Reprinted with permission. //

//<span style="font-family: Arial,Helvetica,sans-serif;">This information was provided by KidsHealth ////<span style="font-family: Arial,Helvetica,sans-serif;">® ////<span style="font-family: Arial,Helvetica,sans-serif;">, one of the largest resources online for medically reviewed health information written for parents, kids, and teens. For more articles like this, visit KidsHealth.org or TeensHealth.org. © 1995-2010. The Nemours Foundation/KidsHealth ////<span style="font-family: Arial,Helvetica,sans-serif;">® ////<span style="font-family: Arial,Helvetica,sans-serif;">. All rights reserved.

<span style="font-family: Arial,Helvetica,sans-serif; font-style: normal;">Notes Written By: Kryssie Quillin //

<span style="font-family: Arial,Helvetica,sans-serif;">Childhood Leukemia Childhood Leukemia is cancer of the white blood cells. It is the most common type of childhood cancer. The white blood cells help your body fight off infections. Leukemia can grow fast, which is acute leukemia. Leukemia can grow slow, which is chronic leukemia. Risk factors are: having a sibling with leukemia and having genetic disorders.

http://www.nlm.nih.gov/medlineplus/leukemiachildhood.html <span style="font-family: Arial,Helvetica,sans-serif; font-style: normal;">

Notes Written By: Kryssie Quillin

Childhood acute lymphoblastic leukemia: This is when the bone marrow makes too many lymphocytes, which is a certain type of white blood cell. These cells may also be called leukemic cells. These cells are not able to fight infections. As the number of leukemic cells increase, the number of healthy cells decrease. Children with ALL bruise very easily because of anemia. This is the most common type of cancer in children. Being exposed to x-rays before birth can contribute to ALL. http://www.cancer.gov/cancertopics/pdq/treatment/childALL/patient

Notes Written By: Kryssie Quillin

Article found by: Kryssie Quillin


 * <span style="font-family: Arial,Helvetica,sans-serif;">How is Childhood Leukemia Diagnosed? ||

Most of the signs and symptoms that children with leukemia develop result from a lack of normal blood cells caused by crowding out of normal blood cell-producing bone marrow by the leukemia cells. A child may complain of shortness of breath, excessive tiredness, or the skin may appear pale because of anemia (a shortage of red blood cells). <span class="t11" style="font-family: arial,helvetica,sans-serif; font-size: 12pt;">**<span style="font-family: Arial,Helvetica,sans-serif;">Infection: ** <span style="font-family: Arial,Helvetica,sans-serif;"> A child with leukemia may develop an infection that doesn't respond to antibiotics, have a high fever, and become very sick. This is because of a deficiency of normal white blood cells, particularly mature granuloctyes. Although leukemia is a cancer of white blood cells and children with leukemia may have very high white blood cell counts, the leukemic cells do not protect against infection the way normal white blood cells do. <span class="t11" style="font-family: arial,helvetica,sans-serif; font-size: 12pt;">**<span style="font-family: Arial,Helvetica,sans-serif;">Easy bleeding or bruising: ** <span style="font-family: Arial,Helvetica,sans-serif;"> A child with leukemia may bruise easily or have increased bleeding from small cuts and nosebleeds. There may be pinhead-sized red spots on the skin that represent bleeding from tiny blood vessels. This results from poor production of blood platelets, which are important for plugging holes in damaged blood vessels. <span class="t11" style="font-family: arial,helvetica,sans-serif; font-size: 12pt;">**<span style="font-family: Arial,Helvetica,sans-serif;">Bone pain: ** <span style="font-family: Arial,Helvetica,sans-serif;"> About ? of the children will have bone pain. A smaller number will have joint pain. This is due to accumulation of the leukemia cells underneath the covering of the surface of the bone or inside the joint. Some children will also have a lack of appetite. <span class="t11" style="font-family: arial,helvetica,sans-serif; font-size: 12pt;">**<span style="font-family: Arial,Helvetica,sans-serif;">Swelling of the abdomen: ** <span style="font-family: Arial,Helvetica,sans-serif;"> Leukemia often causes enlargement of the liver and spleen. Enlargement of these organs would be noticed as a fullness, or even swelling, of the belly. The lower ribs usually cover these organs but when they are enlarged, the doctor can feel them. <span class="t11" style="font-family: arial,helvetica,sans-serif; font-size: 12pt;">**<span style="font-family: Arial,Helvetica,sans-serif;">Swollen lymph nodes: ** <span style="font-family: Arial,Helvetica,sans-serif;"> Leukemia can also spread to lymph nodes. The child, a parent, or a health care professional may notice swollen nodes that are close to the surface of the body (lymph nodes on the sides of the neck, in the groin, underarm areas, above the collarbone, etc.). Swelling of lymph nodes inside the chest or abdomen may also occur. These are sometimes detected only by imaging tests, such as CT or MRI scans. <span class="t11" style="font-family: arial,helvetica,sans-serif; font-size: 12pt;">**<span style="font-family: Arial,Helvetica,sans-serif;">Enlargement of the thymus: ** <span style="font-family: Arial,Helvetica,sans-serif;"> The T-cell type of ALL often involves the thymus. Enlargement of the thymus or of lymph nodes inside the chest can compress the nearby trachea (windpipe). This can lead to coughing, shortness of breath, or even suffocation. The superior vena cava (SVC), a large vein that carries blood from the head and arms back to the heart, passes next to the thymus. Growth of the leukemia cells may compress the SVC causing swelling and bluish-red discoloration of the head, arms, and upper chest. This is known as SVC syndrome, and can affect the brain and threaten the child's life. Patients with SVC syndrome need immediate treatment. <span class="t11" style="font-family: arial,helvetica,sans-serif; font-size: 12pt;">**<span style="font-family: Arial,Helvetica,sans-serif;">Headache, seizures, vomiting: ** <span style="font-family: Arial,Helvetica,sans-serif;"> Leukemia cells can spread outside the bone marrow. This is called "extramedullary spread." It may involve the central nervous system (brain and spinal cord), the testicles, ovaries, kidneys, lungs, heart, intestines, or other organs. Spread to the central nervous system (CNS) at the time of initial diagnosis is seen in 10% to 12% of patients with AML, and about twice as often as in ALL. Headache, poor school performance, weakness, seizures, vomiting, difficulty in maintaining balance, and blurred vision can be symptoms of CNS leukemia. <span class="t11" style="font-family: arial,helvetica,sans-serif; font-size: 12pt;">**<span style="font-family: Arial,Helvetica,sans-serif;">Rashes, fatigue, weakness: ** <span style="font-family: Arial,Helvetica,sans-serif;"> AML can cause some unique symptoms. Leukemia cells may spread to the gums, causing swelling, pain, and bleeding. Spread to the skin can cause small darkly colored spots that can resemble common rashes. A collection of AML cells under the skin or other parts of the body is called a chloroma or granulocytic sarcoma. One unusual but very serious consequence of AML is extreme tiredness, weakness, and slurring of speech, which occurs when very high numbers of leukemic cells make the blood too "thick" and interfere with circulation through small blood vessels of the brain. <span class="t7" style="font-family: arial,helvetica,sans-serif; font-size: 14pt;">**<span style="font-family: Arial,Helvetica,sans-serif;">Types of Specimens Used to Diagnose Children with Leukemia ** <span style="font-family: Arial,Helvetica,sans-serif;"> Most of the symptoms of leukemia are not unique. Some of these symptoms can also be caused by other problems like infections. For these reasons, an accurate diagnosis is needed and the best way to do this is for your doctor to take cells samples from the child's blood and bone marrow. <span class="t11" style="font-family: arial,helvetica,sans-serif; font-size: 12pt;">**<span style="font-family: Arial,Helvetica,sans-serif;">Blood cell counts and blood cell examination: ** <span style="font-family: Arial,Helvetica,sans-serif;"> Changes in the numbers of different cell types in the blood and the appearance of these cells under the microscope often make the doctor suspect leukemia. Most children with acute leukemia (ALL or AML) will have either too many white cells in their blood and not enough red blood cells (oxygen-carrying cells) and/or not enough platelets (cells that help plug up small holes in blood vessels and stop bleeding from cuts and bruises). In addition, many of the white blood cells in these children's blood will be blasts, a type of cell normally found in the bone marrow but not in circulating blood. Even though these findings may make your doctor suspect that leukemia is present, usually the disease cannot be diagnosed for sure without obtaining a sample of bone marrow cells. <span class="t11" style="font-family: arial,helvetica,sans-serif; font-size: 12pt;">**<span style="font-family: Arial,Helvetica,sans-serif;">Bone marrow aspiration and biopsy: ** <span style="font-family: Arial,Helvetica,sans-serif;"> Bone marrow aspiration involves removing a small amount of bone marrow. Usually the sample is taken from the back of the pelvic bone. The bone is numbed with xylocaine, a local anesthetic. In some cases, the child is also given medications to reduce pain or even put her or him to sleep during the procedure. The needle is then put through the outer bone into the marrow space, and some marrow is removed. A biopsy follows, during which a small cylindrical piece of bone and bone marrow (about 1/16-inch in diameter and 1/2-inch long) is removed. Both samples generally are taken at the same time. These tests are used for the initial diagnosis and are repeated later to tell if the leukemia is responding to therapy. <span class="t11" style="font-family: arial,helvetica,sans-serif; font-size: 12pt;">**<span style="font-family: Arial,Helvetica,sans-serif;">Other blood tests: ** <span style="font-family: Arial,Helvetica,sans-serif;"> Children with leukemia will have tests done to measure the amount of certain chemicals in the blood, in order to evaluate how well their liver and kidneys are working. These tests are not used to diagnose leukemia. But, in children already known to have leukemia, these tests help detect liver or kidney problems due to damage caused by the spread of leukemic cells or the side effects of certain chemotherapy drugs. Tests may also be done to check for spread of infections to the child's bloodstream. Prompt and accurate diagnosis and treatment of infections is important for children with leukemia, because their weakened immune system allows infections to spread quickly. <span class="t11" style="font-family: arial,helvetica,sans-serif; font-size: 12pt;">**<span style="font-family: Arial,Helvetica,sans-serif;">Lymph node biopsy: ** <span style="font-family: Arial,Helvetica,sans-serif;"> A surgeon cuts through the skin to remove the entire lymph node (excisional biopsy). If the node is near the skin surface, this is a simple operation that can be done with local anesthesia (numbing medication) in the older, cooperative child. But if the node is inside the chest or abdomen, general anesthesia is used (the child is asleep). This procedure is important in diagnosing lymphomas, but is rarely needed for children with leukemias. <span class="t11" style="font-family: arial,helvetica,sans-serif; font-size: 12pt;">**<span style="font-family: Arial,Helvetica,sans-serif;">Lumbar puncture (spinal tap): ** <span style="font-family: Arial,Helvetica,sans-serif;"> A small needle is inserted into the spinal cavity in the lower back to withdraw some cerebrospinal fluid (CSF) look for leukemia cells. A lumbar puncture is also used to administer chemotherapy drugs into the spinal fluid to prevent or treat spread of leukemia to the spinal cord and brain. <span class="t7" style="font-family: arial,helvetica,sans-serif; font-size: 14pt;">**<span style="font-family: Arial,Helvetica,sans-serif;">Laboratory Tests Used to Diagnose and Classify Leukemia ** <span style="font-family: Arial,Helvetica,sans-serif;"> Using a microscope, a doctor will examine all bone marrow aspirates and biopsy specimens, all lymph node biopsy specimens, all CSF specimens, and any blood smears with significant abnormalities. This doctor has special training in recognizing cells from blood and lymphoid tissue diseases. The doctor may be a pathologist (doctor specializing in diagnosis of disease by laboratory tests) or a hematologist/oncologist (doctor specializing in medical treatment of cancer and blood diseases). The doctors will look at the size and shape of the cells and other aspects of their appearance. <span class="t11" style="font-family: arial,helvetica,sans-serif; font-size: 12pt;">**<span style="font-family: Arial,Helvetica,sans-serif;">Cytochemistry: ** <span style="font-family: Arial,Helvetica,sans-serif;"> After cells from a sample are placed on glass microscope slides, they are stained with dyes that are attracted to certain chemicals only present in some types of leukemia cells. For example, one stain causes the granules of most AML cells to appear as black spots under the microscope, but it does not cause ALL cells to change colors. <span class="t11" style="font-family: arial,helvetica,sans-serif; font-size: 12pt;">**<span style="font-family: Arial,Helvetica,sans-serif;">Flow cytometry: ** <span style="font-family: Arial,Helvetica,sans-serif;"> This technique is sometimes used to examine the cells from bone marrow, lymph nodes, and blood samples. It is very accurate in determining the exact type of leukemia. The cells being examined by flow cytometry are treated with selected antibodies and passed in front of a laser beam. Each antibody sticks only to certain types of leukemia cells. If the sample contains those cells, the laser will cause them to give off light, which is measured and analyzed by a computer. Flow cytometry is also used to estimate the amount of DNA in the leukemia cells. ALL cells with high DNA content, more than 16% above normal, are more sensitive to chemotherapy. <span class="t11" style="font-family: arial,helvetica,sans-serif; font-size: 12pt;">**<span style="font-family: Arial,Helvetica,sans-serif;">Immunocytochemistry: ** <span style="font-family: Arial,Helvetica,sans-serif;"> As in flow cytometry, cells from the bone marrow aspiration or biopsy sample are treated with special laboratory antibodies. But instead of using a laser and computer for analysis, the sample is treated so that certain types of cells change color. The color change is detectable under a microscope. Like flow cytometry, it is helpful in distinguishing different types of leukemia from one another and from other diseases. <span class="t11" style="font-family: arial,helvetica,sans-serif; font-size: 12pt;">**<span style="font-family: Arial,Helvetica,sans-serif;">Cytogenetics: ** <span style="font-family: Arial,Helvetica,sans-serif;"> Normal human cells contain 46 chromosomes (pieces of DNA and protein that control cell growth and metabolism). In certain types of leukemia, part of one chromosome may be attached to part of a different chromosome. This change, called a translocation, can usually be detected under a microscope. Recognizing these translocations helps in identifying certain types of ALL and AML and is important in determining prognosis. Some types of leukemia have an abnormal number of chromosomes. For example, ALL cells with over 50 chromosomes are more sensitive to chemotherapy, and those with less than 46 are more resistant to it. <span class="t11" style="font-family: arial,helvetica,sans-serif; font-size: 12pt;">**<span style="font-family: Arial,Helvetica,sans-serif;">Molecular genetic studies: ** <span style="font-family: Arial,Helvetica,sans-serif;"> Certain substances, called antigen receptors, occur on the surface of lymphocytes. These receptors are important in initiating a response from the immune system. Normal lymphoid cells have many different antigen receptors which help the body respond to many types of infection. Lymphocytic leukemias, such as ALL, however, start from a single abnormal lymphocyte, so all the cells in each patient's leukemia have the same antigen receptor. Laboratory tests of the DNA sequences that contain information on each cell's antigen receptors are a very sensitive way to diagnose ALL. Because different subtypes of ALL cells have different antigen receptor features, this test is sometimes helpful in ALL classification. However, the test is quite complex and expensive, and it is not necessary in most cases. <span class="t11" style="font-family: arial,helvetica,sans-serif; font-size: 12pt;">**<span style="font-family: Arial,Helvetica,sans-serif;">Molecular genetic studies ** <span style="font-family: Arial,Helvetica,sans-serif;"> Tests of leukemia cell DNA can also detect most translocations that are visible under a microscope in cytogenetic tests. DNA tests such as polymerase chain reaction (PCR) or fluorescent in situ hybridization (FISH), can also find some translocations involving parts of chromosomes too small to be seen with usual cytogenetic testing under a microscope. This sophisticated testing is sometimes helpful in leukemia classification because many subtypes of ALL and AML have distinctive translocations. Information about these translocations may be useful in predicting response to treatment. See "What's New In Childhood Leukemia Research and Treatment?" for information on recent advances in genetics. <span class="t7" style="font-family: arial,helvetica,sans-serif; font-size: 14pt;">**<span style="font-family: Arial,Helvetica,sans-serif;">Imaging Studies ** <span class="t11" style="font-family: arial,helvetica,sans-serif; font-size: 12pt;">**<span style="font-family: Arial,Helvetica,sans-serif;">X-rays: ** <span style="font-family: Arial,Helvetica,sans-serif;"> A chest x-ray and bone x-ray are frequently obtained to diagnose and evaluate a child with leukemia. These may show a mass in the chest, or evidence that the leukemia has caused changes in the bone or, rarely, the joint. <span class="t11" style="font-family: arial,helvetica,sans-serif; font-size: 12pt;">**<span style="font-family: Arial,Helvetica,sans-serif;">Ultrasound: ** <span style="font-family: Arial,Helvetica,sans-serif;"> This test uses sound waves which, when reflected by organs, allow a mass or other abnormalities to be detected. It is useful in determining if the leukemia involves the kidney, spleen, or liver. <span class="t11" style="font-family: arial,helvetica,sans-serif; font-size: 12pt;">**<span style="font-family: Arial,Helvetica,sans-serif;">Computed tomography (CT scan): ** <span style="font-family: Arial,Helvetica,sans-serif;"> This is a special x-ray procedure, in which the x-ray beam moves around the body, taking pictures from different angles. A computer combines these views to produce a cross-sectional picture of the inside of the body. <span class="t11" style="font-family: arial,helvetica,sans-serif; font-size: 12pt;">**<span style="font-family: Arial,Helvetica,sans-serif;">Magnetic resonance imaging (MRI): ** <span style="font-family: Arial,Helvetica,sans-serif;"> This procedure uses large magnets and radio waves to produce computer-generated pictures of internal organs. The pictures look very similar to a CT scan but are more detailed. MRI will be used when there is concern about leukemia involving the brain. <span class="t11" style="font-family: arial,helvetica,sans-serif; font-size: 12pt;">**<span style="font-family: Arial,Helvetica,sans-serif;">Gallium scan and bone scan: ** <span style="font-family: Arial,Helvetica,sans-serif;"> For this procedure, the radiologist injects a radioactive chemical that accumulates in areas of cancer or infection in the body. This area can then be viewed with a special camera. These tests are useful when a patient has bone pain that might be due to bone infection or cancer involving bones. If the patient has already been diagnosed with leukemia, there is no need for this study. || **<span style="font-family: Arial,Helvetica,sans-serif;">http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_How_is_leukemia_diagnosed_24.asp **
 * <span class="t7" style="font-family: arial,helvetica,sans-serif; font-size: 14pt;">**<span style="font-family: Arial,Helvetica,sans-serif;">Signs and Symptoms of Childhood Leukemia ** <span style="font-family: Arial,Helvetica,sans-serif;">

What is Childhood Leukemia?
Leukemia starts in the bone marrow (the soft inner part of bones, where new blood cells are made). In most cases, the leukemia invades the blood fairly quickly. From there it can go to other parts of the body such as the lymph nodes, spleen, liver, central nervous system, testes, or other organs. In order to understand the different types of leukemia, it helps to know about the blood and lymph systems. =<span style="font-family: Arial,Helvetica,sans-serif;">Types of leukemia in children = <span style="font-family: Arial,Helvetica,sans-serif;">There are numerous types of leukemia found in children. Leukemia is often described as being either acute (growing quickly) or chronic (growing slowly). Most childhood leukemia is acute. There are 2 main types of acute leukemia: · **<span style="font-family: Arial,Helvetica,sans-serif;">Acute lymphocytic (lymphoblastic) leukemia (ALL): ** <span style="font-family: Arial,Helvetica,sans-serif;"> This type of leukemia accounts for about 3 out of 4 cases of childhood leukemia. This leukemia starts from the lymphoid cells in the bone marrow.
 * <span style="font-family: Arial,Helvetica,sans-serif;">Leukemia is a cancer of the early blood-forming cells. Most often, leukemia is a cancer of the white blood cells, but some leukemias start in other blood cell types.
 * <span style="font-family: Arial,Helvetica,sans-serif;">Acute leukemias **<span style="font-family: Arial,Helvetica,sans-serif;">

· **<span style="font-family: Arial,Helvetica,sans-serif;">Acute myelogenous leukemia (AML): ** <span style="font-family: Arial,Helvetica,sans-serif;"> This type of leukemia, also called acute myeloid leukemia, acute myelocytic leukemia, or acute non-lymphocytic leukemia (ANLL), accounts for most of the remaining cases. This leukemia starts from the cells that form white blood cells, red blood cells, or platelets. **<span style="font-family: Arial,Helvetica,sans-serif;">Hybrid or mixed lineage leukemias: ** <span style="font-family: Arial,Helvetica,sans-serif;"> These are rare leukemias. The cells have features of both ALL and AML. They are generally treated like ALL and respond to treatment like ALL. Both ALL and AML can be further divided into different subtypes. Chronic leukemias are much more common in adults than in children. They tend to grow more slowly than acute leukemias, but are also harder to treat. Chronic leukemias can also be divided into 2 types. This rare type of leukemia is neither chronic nor acute. It begins from myeloid cells, but does not grow as fast as acute myelogenous leukemia. It occurs most often in young children (under age 4). Symptoms can include pale skin, fever, cough, easy bruising or bleeding, trouble breathing, and an enlarged spleen and lymph nodes.
 * <span style="font-family: Arial,Helvetica,sans-serif;">Chronic leukemias **<span style="font-family: Arial,Helvetica,sans-serif;">
 * **<span style="font-family: Arial,Helvetica,sans-serif;">Chronic myelogenous leukemia (CML): ** <span style="font-family: Arial,Helvetica,sans-serif;"> This leukemia is rare in children, but it does occur. It is also treated the same as in adults.
 * **<span style="font-family: Arial,Helvetica,sans-serif;">Chronic lymphocytic leukemia (CLL): ** <span style="font-family: Arial,Helvetica,sans-serif;">This leukemia is extremely rare in children!
 * <span style="font-family: Arial,Helvetica,sans-serif;">Juvenile myelomonocytic leukemia (JMML) **<span style="font-family: Arial,Helvetica,sans-serif;">

[|__http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_is_childhood_leukemia_24.asp__] || = = || Leukemia starts in the bone marrow (the soft inner part of bones, where new blood cells are made). In most cases, the leukemia invades the blood fairly quickly. From there it can go to other parts of the body such as the lymph nodes, spleen, liver, central nervous system, testes, or other organs. In order to understand the different types of leukemia, it helps to know about the blood and lymph systems. =<span style="color: #0000ff; font-family: 'Calibri','sans-serif'; font-size: 10pt; line-height: 115%;">Types of Childhood Leukemia = There are numerous types of leukemia found in children. Leukemia is often described as being either acute (growing quickly) or chronic (growing slowly). Most childhood leukemia is acute. There are 2 main types of acute leukemia: · ** Acute lymphocytic (lymphoblastic) leukemia (ALL): ** This type of leukemia accounts for about 3 out of 4 cases of childhood leukemia. This leukemia starts from the lymphoid cells in the bone marrow.
 * What is Childhood Leukemia? **
 * Leukemia is a cancer of the early blood-forming cells. Most often, leukemia is a cancer of the white blood cells, but some leukemias start in other blood cell types.
 * __Acute leukemias__ **

· ** Acute myelogenous leukemia (AML): ** This type of leukemia, also called acute myeloid leukemia, acute myelocytic leukemia, or acute non-lymphocytic leukemia (ANLL), accounts for most of the remaining cases. This leukemia starts from the cells that form white blood cells, red blood cells, or platelets. Both ALL and AML can be further divided into different subtypes. Chronic leukemias are much more common in adults than in children. They tend to grow more slowly than acute leukemias, but are also harder to treat. Chronic leukemias can also be divided into 2 types. This rare type of leukemia is neither chronic nor acute. It begins from myeloid cells, but does not grow as fast as acute myelogenous leukemia. It occurs most often in young children (under age 4). Symptoms can include pale skin, fever, cough, easy bruising or bleeding, trouble breathing, and an enlarged spleen and lymph nodes. || By: Sara Leatherman || <span style="font-family: Arial,Helvetica,sans-serif;">Sara Leatherman
 * Hybrid or mixed lineage leukemias: ** These are rare leukemias. The cells have features of both ALL and AML. They are generally treated like ALL and respond to treatment like ALL.
 * Chronic leukemias **
 * ** Chronic myelogenous leukemia (CML): ** This leukemia is rare in children, but it does occur. It is also treated the same as in adults.
 * ** Chronic lymphocytic leukemia (CLL): ** This leukemia is extremely rare in children!
 * Juvenile myelomonocytic leukemia (JMML) **