Understanding ALL: Acute Lymphocytic Leukemia in Childhood

06/14/2006

When a child is diagnosed with cancer, the first reaction is often shock and disbelief. After that fades, the question of "why" tends to linger. It seems unfair that a kid would get a disease mostly associated with adults and the elderly. But in the midst of their care-free youth, kids who are diagnosed with any type of cancer have to learn how to grow up fast and face some very adult decisions.

As the most common form of malignant pediatric cancer, acute lymphocytic leukemia (ALL) will be diagnosed in over 2,500 children and adolescents this year. In contrast to chronic forms of leukemia, acute leukemia tends to develop very quickly and spread. Left unchecked, it can be fatal in only a few months. Here is a guide to what you need to know about this disease:

What is ALL?

All forms of leukemia begin when cancer develops within the bone marrow, the soft tissue inside all of your bones. However, as the cancer grows, it spreads to other parts of the body, including the lymph nodes, spleen, liver and nervous system.

Since the normal bone marrow becomes crowded by the cancerous cells, it cannot produce blood cells normally. Thus, most early symptoms of the disease are a result of not having enough of a specific type of blood cell. Having too few red blood cells causes anemia; too few white blood cells raises the risk of infections; too few platelets leads to abnormal bruising and bleeding. If the cancer spreads, other symptoms, such as headaches, weakness, seizures, blurred vision and vomiting may also occur.

Unlike many other cancers, ALL is not linked to any specific lifestyle factor. According to the American Cancer Society, for most people, "the cause of their leukemia remains unknown at this time. Because the cause is not known, there is no way to prevent most cases of ALL."

How is ALL Diagnosed?

If any suspicious symptom presents, it is essential that a doctor is seen immediately. The sooner ALL is diagnosed, the more quickly treatment can be given, raising the chances for survival.

In general, ALL is diagnosed with a bone marrow test, in which a small amount of bone marrow is taken from the hipbone with a thin needle to look for signs of cancer. Blood tests will also be taken to track the changes in the number of blood cells and to help diagnose the specific type of leukemia. In most ALL patients, there are too many white blood cells and not enough red blood cells or platelets.

What is Treatment Like?

In most cases of ALL, chemotherapy is the primary treatment option. Chemotherapy works by killing all rapidly dividing cells, which is the main characteristic of cancer cells. Since ALL tends to spread aggressively, treating this cancer usually requires the use of several types of chemotherapeutic drugs over a long period of time to be certain that all of the cancer cells are killed.

Because chemotherapy kills any rapidly-dividing cells, not specifically cancer cells, and spreads throughout the body, there are many side effects to this treatment, including hair loss, mouth sores, infection, bruising, tiredness, nausea, loss of appetite and vomiting. There are ways that doctors can help minimize the impact of these side effects and they tend to go away when treatment ends.

There are also some newer methods currently being testing for their effectiveness on ALL. These include drugs that more specifically target cancer cells and also stem cell transplantation that helps the body to regenerate new bone marrow after high doses of chemotherapy.

What if the Cancer Returns?

Once beaten, ALL may return, referred to as cancer recurrence. If this happens, doctors will likely recommend treatment to try to beat the cancer once again. Unfortunately, if ALL returns once after chemotherapy, it is likely that it will keep returning. Therefore, the American Cancer Society suggests trying a stem cell transplant or other experimental drug to try to beat the cancer in a different way.

If there aren't any other options for trying to treat ALL, doctors often shift their focus to trying to control the cancer's spread and alleviating some of the side-effects of living with cancer, including loss of appetite and depression.

Fortunately, most of the time, once ALL goes into remission, it will not return. In fact, the National Cancer Institute estimates that as many as 85 percent of children with ALL survive free of cancer for at least five years, at which point the cancer is considered to have been cured.