What is leukaemia?

Leukaemia is cancer that affects the white blood cells (lymphocytes). It affects the blood and bone marrow, where blood cells are made. Leukaemia may be acute, appearing fast and growing quickly, or chronic, appearing gradually and growing slowly. Most childhood leukaemias are acute.

Children with leukaemia usually need treatment for 2 to 3 years, as well as ongoing regular check-ups to monitor and treat any late effects.

There are several types of leukaemia seen in children, including:

• acute lymphoblastic leukaemia (ALL), also called acute lymphocytic leukaemia — this is the most common type in children
• acute myeloid leukaemia (AML), also called acute myeloblastic leukaemia
• chronic lymphocytic leukaemia (CLL), the most common type of leukaemia in adults but rare in children
• chronic myeloid leukaemia (CML), which is very rare in children but more common in teenagers

Types of leukaemia differ in the type of cell they originate from, as well as in the way they are treated and their chance of successful treatment.

Watch this video from Cancer Australia about what it can be like to have cancer as a child:

What are the symptoms of childhood leukaemia?

For acute types of childhood leukaemia — ALL and AML — symptoms include:

• anaemia, causing paleness, weakness, breathlessness and tiredness
• repeated infections, for example mouth sores, infected cuts and scratches
• unexplained bruising and bleeding
• bone or joint pain
• other symptoms — such as enlarged lymph nodes (glands), chest pain and abdominal discomfort due to a swollen spleen or liver

The symptoms of leukaemia are similar to that of some other common conditions. If you notice any of these symptoms, it doesn't mean your child has leukaemia, but it's a good idea to see your doctor.

What causes leukaemia?

The exact causes of leukaemia in children are not known, but it is likely that several factors are involved. Factors that may put some children at higher risk of genetic damage that can lead to leukaemia include:

• infections: delayed exposure to common childhood infections or an abnormal response by the child’s immune system to these infections
• radiation: exposure to large doses of ionising radiation (energy from x-rays and radioactive materials) before birth or in the early years
• chemicals: exposure to high levels of certain chemicals, such as benzene
• congenital disorders: like Down syndrome and Fanconi anaemia

How is childhood leukaemia diagnosed?

Many symptoms of childhood leukaemia are general and can be caused by a range of illnesses. To make a definite diagnosis of leukaemia, a number of tests need to be done.

Your doctor will most likely give your child a physical examination and take a sample of their blood so it can be examined under a microscope. If the blood test shows large numbers of abnormal white blood cells, and low numbers of healthy blood cells, more tests will be done to confirm the diagnosis.

Tests to find leukaemia

There are several tests that can be done to confirm a diagnosis of leukaemia, and to work out which type it is:

• Bone marrow biopsy — a syringe is used to take a sample of bone marrow, usually from the hip bone, for examination under the microscope and genetic testing.
• Lumbar puncture — sometimes called a spinal tap. A needle is put into the space between the bones of the lower back and fluid from around the spinal cord is removed for examination under the microscope to look for abnormal white blood cells.

Staging and further tests

The 'stage' of leukaemia describes how far the cancer has spread. Doctors conduct staging with tests including a chest x-ray, CT scan or lumbar puncture. They may also look for chromosomal changes in your child’s blood.

How is childhood leukaemia treated?

The main treatment given to children with leukaemia is chemotherapy (a combination of medicines), usually as tablets or injections. Radiotherapy may also be used to kill cancer cells in the brain, and in some cases, a stem cell or bone marrow transplant may also be necessary.

Other treatments include:

• antibiotics to prevent infections
• immunotherapy to use the body's own immune system to fight cancer cells
• targeted therapy, medicine that targets cancer cells but with fewer side effects than chemotherapy
• blood products to restore the normal contents of the blood

What are the side effects of treatment?

Treatments for leukaemia in children, as with adults, can cause a range of short-term side effects, such as nausea and loss of hair. Longer-term effects, called 'late effects', can also develop any time after treatment, so ongoing check-ups are needed.

Living with childhood leukaemia

Children with leukaemia can need treatment for up to 3 years. During this time, it's important they have the opportunity to live as normal a life as possible. Whenever feeling well enough, they should be encouraged to do their usual activities, like having playtime, and going to school or day care.

Caring for a child with leukaemia can be very challenging and stressful. Many support services exist to help families, including Cancer Councils in each state and territory (call 13 11 20), and the Leukaemia Foundation.

Resources and support

For more information and support, try these resources:

• Visit the Leukaemia Foundation’s website for a wide range of information about childhood leukaemia, including practical and emotional support, referral services and books explaining blood cancers to children. Call 1800 620 420 to arrange to talk to a Blood Cancer Support Coordinator.
• Visit the Cancer Council’s website for information about leukaemia symptoms, diagnosis and treatment or call the Cancer Council on 13 11 20 for information about leukaemia and support.
• Visit the Canteen website for emotional and practical support or call 1800 835 932.
• Kids with Cancer Foundation Australia provides financial assistance to children with cancer and their families.
• The Children’s Cancer Foundation provides family support and information about the latest treatments.
• Cancer Australia has links to support organisations for children with cancer and their families. It can also help you find clinical trials that your child could join and has a list of children’s hospitals in Australia.
• Canteen's and Camp Quality's online community Parenting through cancer provides free expert advice, counselling and a chance to connect with other parents in similar situations.