Acute Lymphocytic Leukemia (ALL)

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Symptoms & Diagnosis

Symptoms

ALL symptoms occur because the blood is deficient in the right types of healthy blood cells. Children will ALL may experience: 

  • Anemia -- not having enough red blood cells. This can cause them to feel tired, irritable, be short of breath, and even have a rapid heart beat.
  • Infections -- if the blood doesn't have enough white blood cells to fight off bacteria, infections may occur, and with that may be fevers as well.
  • Bruising or bleeding -- even from small injuries, may occur more easily because there aren't enough platelets to help the blood clot.
  • 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).

Diagnosis

To diagnose 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 blood stream
  • 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
  • Bone marrow aspiration 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 Then a teaspoon of bone marrow will be withdrawn with a needle (aspirate).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.

  • Lumbar puncture, or spinal tap: Doctors may do these tests to detect whether the cancer has spread to parts of your child’s body beyond the blood. If there are leukemic cells in the spinal fluid, doctors know the brain and spinal cord may be affected by the cancer.
  • Chest X-ray: This can provide a view into the chest area.
  • Biopsy of the testicles, ovaries, or skin: To help 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 early treatment.