Symptoms & Diagnosis
Acute lymphocytic leukemia (ALL) and acute myelogenous leukemia (AML) have similar signs and symptoms because in both types of leukemia the cancerous cells crowd out healthy blood cells. The same symptoms can also be caused by other noncancerous conditions. So it’s important to have a doctor investigate if your child has these symptoms:
- Fever, which may be a sign of infection
- Easy bruising or bleeding, even from small injuries
- Petechiae, which are pinpoint spots of blood under the skin caused by tiny broken blood vessels
- Bone or joint pain, from leukemic cells collecting there
- Painless lumps in the neck, underarm, stomach, groin and possibly around the eyes
- Pain and fullness under the ribs, from enlargement of the liver and spleen
- Weakness and fatigue
- Loss of appetite
- Shortness of breath or coughing, from swelling of the thymus (a gland in the neck that is related to the immune system)
To find out whether your child has leukemia, your child’s doctor will first do a thorough physical exam and ask about your child’s health history. Next the doctor will probably perform a series of blood tests to tell whether any blood cells are unhealthy and, if so, which type. Common blood tests to check for leukemia include the following:
- Complete blood count, or CBC: to determine how many cells of each type are circulating in the bloodstream
- Peripheral blood smear: to look at the appearance of the blood cells
- Blood chemistry: to look for chemicals in the blood that can be abnormal in people who have cancer
For a clear diagnosis, doctors may need to perform a bone marrow aspirate and sometimes a bone marrow biopsy. A small area of skin over the pelvis (the bone that makes up part of the hip) will be cleaned and numbed. Then, a teaspoon of bone marrow will be withdrawn with a needle (aspirate). Your child will receive medicines to help with any pain or discomfort associated with this procedure.
More specific laboratory tests of the blood can give your child’s doctors more information about the type of cells affected. These include tests that identify proteins on the surface of the leukemic cells and tests that look at the arrangement of chromosomes in the leukemic cells.
Doctors may do further tests to detect whether the cancer has spread to parts of your child’s body beyond the blood. For instance, a lumbar puncture, or spinal tap, may be done to remove cerebrospinal fluid (CSF) from the spinal column using a needle. If there are leukemic cells in the CSF, doctors know the brain and spinal cord may be affected by the cancer. A chest X-ray can provide a view into the chest area. A biopsy of the testicles, ovaries or skin helps doctors determine whether the cancer has spread there.
Based on what they learn through their diagnostic tests, doctors may classify your child’s leukemia into a category. The categories are designed to help doctors select the most appropriate treatment for each child.
With ALL, the treatment is based on the child’s age, white blood count, the type of lymphoblasts (T cell or B cell), the chromosomes in the leukemia and the response to therapy. In general there are three groups:
- Standard risk: This applies to children ages 1 to 10 whose white blood cell count at the time of diagnosis is less than 50,000 per cubic millimeter.
- High risk: This applies to children who are 10 years old or older, and to children whose white blood cell count at the time of diagnosis is 50,000 or more per cubic millimeter.
- Very high risk: This applies to infants, children with some abnormal chromosomes in the leukemia cells, and those who do not go into remission quickly.
With AML, there are no risk groups assigned at the time of diagnosis. Certain features of the leukemia can make the disease higher risk. These features include poor response to initial therapy and some chromosomal abnormalities of the leukemia.