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The term leukemia is defined as cancer of white blood cells which are also referred as leukocytes or wbcs. White blood cells acts as defence mechanism fights against infections. These wbcs are formed in bone marrow .when a child is effected large no of abnormal white blood cells are produced in the bone marrow. These cells crowd out the health blood cells, making it hard for blood to do its work. They cannot perform their proper role of protecting the body against disease because they are defective.
Blood cell development. A blood stem cell goes through several steps to become a red blood cell, platelet, or white blood cell.
In the later stage the cancer interferes with body production of other types of blood cells, including red blood cells and platelets.
Types of leukemia;
In general leukemias are classified into two types acute(fast growing) and chronic(slow growing). Children with leukemia most often have acute type ,chronic leukemia is rarely seen in children.
Acute childhood leukemia is further divided into two sub groups depending on the specific white blood cells lymphocytes or myelocytes which are linked to immune defence.
a)acute lymphocytic leukemia (ALL)
b) acute myelogenous leukemia(AML)
chronic leukemia is divided into , these are very rarely seen in childern
a)chronic lymphocytic leukemia(CLL)
b) chronic myeloid leukemia(CML)
Juvenile myelomonocytic leukemia (JMML)
This rare type of leukemia is neither chronic nor acute. It begins from myeloid cells, but isn't as fast growing as acute myelogenous leukemia or as slow as chronic myeloid leukemia. It occurs most often in young children (under age 4).
Most leukemia arises from non-inherited mutations in the genes of growing blood cells,thes errors occur randomly and unpredictably.
In cases of identical twins chances of developing ALLorAML is around 20%to25%in case of early diagnosis at age 6.childern with inherent genetic problems like Li-Fraumeni syndrome, Down syndrome, Kleinfelter syndrome,neurofibromatosis, ataxia telangectasia, or Fanconi's anemia - have a higher risk of developing leukemia.
Children who have recived prior radiation or chemotherapy for other types of cancer also have higher risk of leukemia in first 8 years if treatment.
Any thing that increases the risk of getting disease is called as risk factor risk factors for leukemia include
Having a brother or sister with leukemia.
Being exposed to x-rays before birth.
Being exposed to radiation.
Past treatment with chemotherapy or other drugs that weaken the immune system
Having certain changes in genes or genetic disorders, such as Down syndrome
As leukemia is infection to wbc child immune system fails to fight aganist various infections and shows symptoms like fever with or without an infection, anemia (effect on rbc )which makes them appear pale ,nose bleeding and also bruise and bleed very easily (excess production of blood cells
Other symptoms include:
Petechiae (flat, pinpoint, dark-red spots under the skin caused by bleeding).
Bone or joint pain.
Painless lumps in the neck, underarm, stomach, or groin.
Pain or feeling of fullness below the ribs.
Weakness, feeling tired, or looking pale
Loss of appetite
Physical examination and history:
Diagnosis include examination of signs of infections like anaemia , abnormal bleeding, and swollen lymph nodes. Medical history of child should be considered such as past health, family's health, previous medications, any allergies reactions, and other issues.
Complet blood count(CBC); in this a sample of blood is drawn and checked for the following
a)the number of red blood cells and platelets
b)the number and type of white blood cells
c) theamount of haemoglobin in rbc
d)the portion of the sample made up of red blood cells.
Bone marrow aspiration and biopsy: the removal of bone marrow ,blood,and a small piece of bone by inserting a hollow needle into the hipbone ot breastbone to examin under microscope for signs of cancer.
A lumbar puncture (spinal tap): in this a small amount of spinal fluid is removed from the lower back and examined for evidence of abnormal cells. This will show whether the leukemia has spread to the central nervous system(brain and spinal cord)
Cytogenetic analysis: a laboratory test in which the cells in a sample of blood or bone marrow are viewed under a microscope to look for certain changes in the chromosomes in the lymphocytes .
Other tests like fluorescence in situ hybridization (FISH) may also be done to look for certain changes in chromosomes.
Immunophenotyping: a test in which the cells in a sample of blood or bone marrow are looked at under microscope to find out if malignant lymphocytes began from the B lymphocytes or the T lymphocytes
Blood chemistry studies: Aprocedure in which a blood sample is checked to measure the amount of certain substance released into the blood by organs and tissues in the body.
chest x-ray :an xray of organ and bones insice the chest . its is a type of energy beam that cab go through the body and onto film,making a picture of areas inside the body.
The intensity of treatment is determined using various features such as age and initial white blood cell count, to achieve the best chances of cure .
Chemotherapy: chemotherapy is most common treatment ,it refers to medicines that help fight cancer. They are given by mouth, in the vein, in the muscle or under the skin.
Intrathecal medication: this involves inserting medications through a needle into the fluid-filled space surrounding the spinal cord.
Radiation therapy: involves use of high energy waves such as x-rays to kill or shink cancer cells. Also used in extrem cases to treat leukemia in the central nervous system, eyes or the testes.
For children whose leukemia has returned or has not responded to standard treatments, a bone marrow transplant may be required. Stem cells, which are immature blood cells, are taken from the bone marrow of the patient before cancer treatment (autologous), or from a donor whose marrow most closely matches the patient (allogeneic).
How is leukemia treated?
Treatment usually begins by addressing the signs and symptoms your child has such as anemia, bleeding and/or infection. In addition, treatment for leukemia may include some or all of the following:
Blood and marrow transplantation
Biological therapy medications
Chemotherapy refers to medicines that help fight cancer. They are given by mouth, in the vein, in the muscle or under the skin. Intrathecal chemotherapy is chemotherapy that is injected into the spinal fluid to prevent or treat leukemia in the brain and spinal cord.
Intrathecal medications/chemotherapy involves inserting medications through a needle into the fluid-filled space surrounding the spinal cord.
Radiation therapy uses high-energy waves such as x-rays to kill or shrink cancer cells. It is sometimes used to treat leukemia in the central nervous system or other places such as the eye or the testes.
Blood and marrow transplantation; For children whose leukemia has returned or has not responded to standard treatments, a bone marrow transplant may be required. this involves three steps a)collection of Stem cells, which are immature blood cells, are taken from the bone marrow of the patient before cancer treatment (autologous), or from a donor whose marrow most closely matches the patient (allogeneic).b)administration of heigh dose of chemotherapy and possibly radiation therapy to kill any remaining leukemia cells c)infusion of healthy stem cell through an intravenous line to produce normal blood forming cells.
Biological therapy: this treatmentis to protect other cells or organs from damage caused by treatmentby infusion of high doses of hormones or other proteins.
Blood transfusions: anemia patients cannot make their own red blood cells. Various blood cells like platelets, white blood cells, plasma are transfused to keep normal properties of blood
Antibiotics: Antibiotics are used to prevent or treat infections.
Treatment of leukemia takes months or years and takes place in three or more stages,
Induction: the first stage of treatment a combination of chemotherapeutic drugs is given to reduce the number of leukemia cells in the marrow to less than 5%and to make room for the return of normal red blood cells, white blood cells and platelets. this stage is called as remission. this phase may last for one month can be repeated if goal is no achieved.
Consolidation: this involves drug therapy, which may last for one to months. after this we can still expect leukemia cells which are not detectable in blood test and bone marrow examination.
Intensification: it involves prolonged treatment of chemotherapy combinations similar to those used in induction and consolidation .it may involve bone marrow or stem cell transplantation or heigher-dose chemotherapy.
Maintenance: This treatment stage further reduce the number of leukemia cells through the use of repeted courses of less intense chemotherapy periodically every 28 days for 18and30 months for girls and boys respectively. regular check up to determine response to treatment,detect any recurrent disease and manage any side effects of the treatment.