The bone marrow makes infection-fighting white blood cells and red blood cells that carry oxygen to all tissues of the body, as well as platelets, which help blood clot and stop bleeding. When leukemia develops, abnormal immature blood cells take over and crowd out the healthy red and white blood cells. The cancer cells may also spread into the lymph nodes and other organs, causing them to swell. A child may have a fever, fatigue, pale skin, and swollen lymph nodes or liver and spleen (which can look like an enlarged belly). Some children with leukemia have repeated infections. They may have a runny nose, cough, and fever and bruise easily. Some have swollen eyelids or a swelling in the jaw (“nasal effusion”). Some people have pain in bones and joints that can feel like arthritis.
A physical exam and blood tests can find leukemia symptoms. The blood tests check how many normal red and white blood cells are in the body and how well they are working, as well as how much oxygen is in the blood. Other tests can tell if the leukemia is acute or chronic and what type it is. They can also tell if the cancer has spread to other parts of the body and how fast it is growing.
There are many kinds of leukemia, and the treatment depends on the type. For some types of leukemia, the cancer may come back after treatment — this is called relapse.
When the leukemia comes back, treatment is usually different than before. The next step depends on whether the cancer is in the blood, brain, or spinal cord and how far it has spread at the time of relapse. It also depends on how long it has been since the first treatment and where the leukemia came back from.
A combination of treatments may be used. These can include chemotherapy, which uses strong medicines to kill cancer cells and other fast-growing cells in the body. It can be given by mouth or into a vein (intravenously, or “IV”) and through the skin. It can be given in the spine (intrathecal medication) or sprayed into the area around the spinal cord (radiation). Other treatments can include surgery, medicines to treat infection and other diseases, blood transfusions, and antibiotics.
Follow-up care is important after treatment for leukemia. This helps the doctor know how well treatment is working. It can also catch any late problems that might occur from the leukemia or the treatment. Research is ongoing to improve treatment and find new ways to prevent leukemia. For example, some doctors are using targeted therapy that focuses on the genes, proteins, or tissue environment that contribute to cancer growth and survival. They are also testing new ways to deliver treatment into the body. The goal is to cure the leukemia and reduce late effects.
