Symptoms of leukemia in children

Leukemia is the most common form of cancer in children and teenagers. Most childhood leukemias are a type called acute lymphocytic leukemia (ALL).

Common early symptoms include tiredness, flu-like symptoms, and bruising. Knowing what to look for can allow you to seek treatment as early as possible.

What is leukemia?

Leukemia is the term for some forms of cancer that start in the blood cells in blood-forming tissues, such as the bone marrow, and it accounts for almost one-third of all cancers in children and teens. The role of bone marrow is to produce cells that will develop into white and red blood cells and platelets.

These blood cells and platelets play important roles in the body:

• White blood cells are responsible for fighting off infections.
• Red blood cells are responsible for delivering oxygen around the body from the lungs.
• Platelets help the blood to clot.

When you have leukemia, the bone marrow creates large numbers of irregular blood cells, usually white blood cells. These are unable to fight infection and stop the bone marrow from producing red blood cells and platelets. They then spill into the bloodstream.

In some cases, leukemia can also spread to other parts of the body.

Types of leukemia in children

Childhood leukemia falls into three main categories:

• acute leukemia
• chronic leukemia
• juvenile myelomonocytic leukemia (JMML)

Acute leukemias are either ALL, which makes up about 80% of leukemia diagnoses in children and teens, or acute myeloid leukemia (AML), which makes up the remaining 20% of cases.

ALL is most common in early childhood and most often affects children ages 2–5 years. AML is more common during the first 2 years and teenage years.

Chronic leukemias such as chronic myeloid leukemia (CML) are rare in children and tend to occur more in teenagers than in younger children.

JMML is also rare. It usually occurs in children about 2 years old and is slightly more common in boys than in girls.

Early symptoms of leukemia in children

It may be difficult to spot early symptoms of childhood leukemia as they can seem similar to other, more minor illnesses.

Some of these early warning signs may include:

Persistent bruises

If a child often bruises or experiences frequent nosebleeds or bleeding from the gums, this may point to a lack of platelets that help stop bleeding, which is a symptom of leukemia.

Frequent flu-like symptoms

These symptoms may include:

• night sweats
• fever
• fatigue
• body aches

However, unlike flu symptoms, which usually improve as the child gets better, leukemia symptoms may last longer.

Tiredness and weakness

In some rare cases, leukemia may lead to tiredness or a lack of energy (lethargy), weakness, and slurred speech. This may happen because the leukemia cells that collect in the blood cause the blood to thicken, slowing its circulation through small vessels in the brain.

Regular infections

Frequent infections may indicate that the child does not have enough healthy white blood cells. This is due to a shortage of regular white blood cells because leukemia causes more irregular white blood cells to develop.

Bone or joint pain

A buildup of leukemia cells can collect close to the surface of the bones or inside joints, leading to pain and discomfort.

Unusual swelling

Leukemia may cause swelling in various parts of the body, such as the abdomen or the lymph nodes.

Irregular cells may collect in the liver or spleen, causing the abdomen to swell. Additionally, there may be small bean-sized lumps on the sides of the neck, underarms, or around the collarbone due to the leukemia spreading to the lymph nodes.

Loss of appetite and weight loss

A child’s swollen liver, kidneys, or spleen may press against other organs like the stomach. This can cause the child to feel full after eating small amounts of food, which, in turn, may lead to a loss of appetite and weight.

Coughing or difficulty breathing

Some types of leukemia may affect the lymph nodes or the thymus, an organ in the middle of the chest. If these enlarge, they may press on the windpipe and cause coughing or breathing issues.

If the child has a very high white blood cell count, the leukemia cells may build up in the small blood vessels of the lungs, which may also create breathing difficulties.

Rashes

Leukemia can cause a skin rash that looks like small dots or bruising. This happens because small blood vessels in the skin might burst. And, as leukemia damages platelets, the blood doesn’t clot as it should, causing it to leak into layers of the skin and resulting in the rash.

Treatments

Once a healthcare professional diagnoses someone with leukemia, they will want to start treatment as soon as possible. The treatment will depend on the type of leukemia.

If the child has low blood counts, bleeding, or infections, they may need to receive:

• blood transfusions with red blood cells if they have low blood counts
• blood transfusions with platelets to stop bleeding
• antibiotics to treat infection

Treatments for leukemia include:

Chemotherapy

This is the main treatment for childhood leukemia. Specialized cancer doctors called oncologists usually inject chemotherapy drugs over a period of time. Some chemotherapy is available as an oral medication.

Some common drugs are:

• vincristine (Oncovin)
• L-asparaginase (Elspar)
• methotrexate (Trexall)
• etoposide (Vepesid) or teniposide (Vumon)

The child will also take steroid drugs like prednisone (Rayos) or dexamethasone (Dexasone).

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Radiation

Radiation treatment may be necessary if oncologists are trying to prevent or treat leukemia spreading to the brain or treat testicular leukemia. This resembles an X-ray, but the radiation is much stronger. It should be painless, lasting a few minutes.

High dose chemotherapy with a stem cell transplant

This is where healthcare professionals take stem cells from the body and replace them after high doses of chemotherapy. This process causes damage to the child’s bone marrow but improves the chances of curing leukemia.

Targeted therapy

Oncologists use this form of therapy if chemotherapy does not work. They may use it for children with CML. Common drugs in targeted therapy include tyrosine kinase inhibitors like:

• imatinib (Gleevec)
• dasatinib (Sprycel)
• nilotinib (Tasigna)

Immunotherapy

This form of treatment helps the body’s own immune system attack the cancer cells and involves using the drug tisagenlecleucel (Kymriah). Oncologists use this if ALL has returned or the child is no longer responding to other treatments.

Summary

Leukemia starts in the bone marrow and is the most common form of cancer in children.

Early symptoms of leukemia in children may be difficult to spot as they resemble other common childhood illnesses, such as the flu. However, unlike the flu, these symptoms last a lot longer. You might also notice persistent bruising.

Treatment varies depending on the type of leukemia a child has. Oncologists will provide the most suitable treatment once they have a diagnosis.

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