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Childhood Leukemia Onconurse.com Fact Sheet Childhood Leukemia The word leukemia literally means “white blood.” fungi. WBCs are produced and stored in the bone mar- Leukemia is the term used to describe cancer of the row and are released when needed by the body. If an blood-forming tissues known as bone marrow. This infection is present, the body produces extra WBCs. spongy material fills the long bones in the body and There are two main types of WBCs: produces blood cells. In leukemia, the bone marrow • Lymphocytes. There are two types that interact to factory creates an overabundance of diseased white prevent infection, fight viruses and fungi, and pro- cells that cannot perform their normal function of fight- vide immunity to disease: ing infection. As the bone marrow becomes packed with diseased white cells, production of red cells (which ° T cells attack infected cells, foreign tissue, carry oxygen and nutrients to body tissues) and and cancer cells. platelets (which help form clots to stop bleeding) slows B cells produce antibodies which destroy and stops. This results in a low red blood cell count ° foreign substances. (anemia) and a low platelet count (thrombocytopenia). • Granulocytes. There are four types that are the first Leukemia is a disease of the blood defense against infection: Blood is a vital liquid which supplies oxygen, food, hor- ° Monocytes are cells that contain enzymes that mones, and other necessary chemicals to all of the kill foreign bacteria. body’s cells. It also removes toxins and other waste products from the cells. Blood helps the lymph system ° Neutrophils are the most numerous WBCs to fight infection and carries the cells necessary for and are important in responding to foreign repairing injuries. Blood also contains important clotting bacteria. factors. ° Eosinophils respond to allergic reactions as Whole blood is made up of plasma, which is a clear well as foreign bacteria and parasites. fluid, and many other components, each with a specif- ° Basophils are the rarest of the white cells and ic task. The three main elements involved in leukemia play a special role in allergic reactions. are red blood cells, platelets, and white blood cells. The different types of leukemia are cancers of a specif- Red blood cells (erythrocytes or RBCs) contain hemo- ic white blood cell type. For instance, acute lym- globin, a protein that picks up oxygen in the lungs and phoblastic leukemia affects only lymphocytes. transports it throughout the body. RBCs give blood its red color. When leukemia cells in the bone marrow What is a blast? slow down the production of red cells, the child devel- “Blast” is a short name for an immature white blood cell ops anemia. Anemia can cause tiredness, weakness, irri- such as lymphoblast, myeloblast, or monoblast. Nor- tability, pale skin, and headache. mally, less than 5 percent of the cells contained in Platelets (thrombocytes) are tiny, disc-shaped cells that healthy bone marrow at any one time are blasts. Normal help form clots to stop bleeding. Leukemia can dramat- blasts develop into mature, functioning white blood ically slow down the production of platelets, causing cells, and are not usually found in the bloodstream. children to bleed excessively from cuts or in some cases Leukemic blasts remain immature, multiply continuous- from their nose or gums. Children with leukemia can ly, provide no defense against infection, and may be develop large bruises or small red dots (called petechi- present in large numbers in the bloodstream. ae) on their skin. White blood cells (leukocytes or WBCs) destroy foreign How does leukemia begin? substances in the body such as viruses, bacteria, and When a population of abnormal blasts appears in the bone marrow, they multiply rapidly and lose their abil- 1 Onconurse.com Fact Sheet Childhood Leukemia ity to grow up into normal white cells. They begin to merely an association. In cases where one identical twin crowd out the normal cells that usually develop there. has leukemia, the other twin has a 25 percent chance of After accumulating in the bone marrow, leukemic cells developing the disease within one year, but this risk spill over into the blood. Leukemic cells may also cross decreases with an older age at diagnosis and with time. the blood-brain barrier and invade the central nervous It is not known whether this is caused by an inherited system (brain and spinal cord). trait or a simultaneous exposure to the same carcino- gen. Leukemia is not contagious; it cannot be passed When the leukemic blasts begin to fill the marrow, pro- from one person to another. duction of healthy red cells, platelets, and white cells cannot be normally maintained. As the number of nor- Environmental factors mal cells decreases, symptoms appear. Low red cell Exposure to ionizing radiation and certain toxic chemi- counts cause fatigue and pale skin. Low platelet counts cals may predispose individuals to leukemia and other may result in bruising and bleeding problems. If mature problems involving the bone marrow. Many Japanese neutrophils and lymphoblasts are crowded out by the who were exposed to fallout from the atomic bomb blasts, the child will have little or no defense against during World War II and some of the people living near infections. the Chernobyl accident in the Ukraine have developed leukemia. Chronic exposure to benzene has been asso- Who gets leukemia? ciated with leukemia in adults. However, most children Acute leukemia is the most common childhood cancer. are not exposed to large amounts of radiation or indus- Although generally thought of as strictly a childhood trial chemicals. The data so far indicates that there is no disease, many more adults than children develop increased risk of leukemia from exposure to electro- leukemia. Each year in the United States, approximate- magnetic fields. Although scientists are examining asso- ly 25,000 adults and 2,500 children are diagnosed with ciations with many environmental factors, there are no acute leukemia. clear environmental causes of childhood leukemia. Childhood leukemia is most commonly diagnosed at Rates of childhood cancer have increased every year for ages two to seven, with the highest incidence at approx- the last three decades. In response to this and other imately four years of age. In the United States, leukemia threats to children’s health, in 1997 the US formed the is more common in whites than in blacks, and boys Federal Task Force on Protecting Children from Environ- have a slightly higher incidence than girls. Children with mental Health Risks and Safety Risks. Information on genetic diseases such as Down syndrome, Bloom’s syn- this task force can be found on the Internet at drome, or Fanconi’s anemia have a higher risk of devel- http://www.epa.gov/children/six.htm. oping leukemia than the general population. However, most children with these syndromes do not develop The US Environmental Protection Agency (EPA) has a leukemia. Children’s Health Resources branch that maintains pub- lications on children’s health topics, information on hot Although the exact cause of childhood leukemia is a lines, and links to Internet resources at (888) 372-8255 mystery, certain factors are known to increase the risk and on the Internet at http://www.epa.gov/children. of developing the disease. For information about the US government’s electromag- Genetic factors netic field (EMF) research efforts, including public infor- It is known that persons with extra chromosomes mation materials developed by the EMF RAPID pro- (genetic material contained in cells) or certain chromo- gram, refer to the EMF RAPID home page on the somal abnormalities have a greater chance of develop- Internet: http://www.niehs.nih.gov/emfrapid/home.htm. ing leukemia. It is uncertain whether this is a cause or 2 Onconurse.com Fact Sheet Childhood Leukemia Viral factors Children with AML are sometimes diagnosed after Viruses that cause leukemia in cows, cats, chickens, gib- developing a chloroma—a tumor arising from myeloid bons, and mice have been found. A T-cell virus has tissue and containing a pale green pigment. These are been identified which causes a rare type of leukemia- most often found under the skin of the skull. lymphoma in adults; however, no virus has been found To confirm a diagnosis of leukemia, bone marrow is which causes the types of leukemia commonly found in sampled and tested. The bone marrow is examined children. microscopically by a pediatric oncologist and/or a Currently, it is thought that a complex interaction pathologist, a physician who specializes in body tissue among genetic, environmental, immunologic, and pos- analysis. More than 25 percent blasts in the marrow sibly viral factors predisposes individuals to leukemia. confirms the diagnosis of leukemia. A portion of the The most important point for parents to remember is bone marrow (and chloroma biopsy if done) is sent to that at present there is no way to predict or prevent a specialized laboratory that analyzes many other fea- leukemia. Nothing that parents did or did not do caused tures of the leukemic cells to help determine which type or could have prevented the leukemia. of leukemia is present. How is leukemia diagnosed? How is leukemia best treated? A tentative diagnosis is made after a physical examina- At diagnosis, parents are often confused about how to tion of the child and microscopic analysis of a blood find the best doctors and treatment plan for their child. sample. Physical findings may include pale skin; bruis- The best care available in the US and Canada is ing or unusual bleeding; enlarged liver, spleen, or obtained from institutions that are part of the Children’s lymph nodes; ear or other infections (frequently resist- Cancer Group or the Pediatric Oncology Group.
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