Dealing with a teen is part and parcel of parenting. Though it can be frustrating at times, as parents, you want your kids to grow up healthy and normal so that they can enjoy their lives as adults and you can be proud of them. As such, it can be devastating for any parent to learn that your teen has leukemia. While your doctor is the best person to support you, here is some relevant information on Leukemia in teens, and what you can do to help your child.
Leukemia:
Leukemia is defined as a cancer in blood-forming tissues, which can include the bone marrow. While cancer is rare among kids and teens, leukemia is most commonly diagnosed in children and adolescents. Nearly one out of three childhood cancer cases is typically diagnosed as leukemia [1]. Teenagers and kids tend to develop acute lymphocytic leukemia (ALL), and acute myelogenous leukemia (AML). Children rarely develop chronic forms of leukemia.
[ Read: Cancer In Teens ]
Classification Of Leukemia:
Oncologists typically classify leukemia on how fast the malignancy progresses and the type of cells involved. This classification is necessary to devise the treatment plan for your adolescent.
Based on the speed of progress, leukemia is classified into the following two types:
1. Acute Leukemia:
In this type of leukemia, the abnormal blood cells do not mature. They stay immature and hence, they cannot function normally. These immature blood cells proliferate very quickly, causing the disease to worsen rapidly. As the progress of acute leukemia is rapid, it requires aggressive and prompt treatment.
2. Chronic Leukemia:
There are several types of chronic leukemia, and some do not have symptoms, and can remain undiagnosed for several years. Some types cause the production of too many cells, while other types inhibit cell production. Chronic leukemia afflicts more mature blood cells, which multiply slowly. These affected blood cells function normally for a particular time.
The other type of leukemia classification is according to the type of white blood cells that get affected. This classification includes:
1. Lymphocytic Leukemia:
In lymphocytic leukemia, lymphocytes or lymphoid cells that develop into lymphatic tissue or lymphoid get affected. Lymphatic tissue is an important part of a human body’s immune system.
2. Myelogenous Leukemia:
In this type of leukemia, your teen’s myeloid cells get affected. These cells are the building blocks of white blood cells, platelets, and red blood cells.
[ Read: Skin Cancer In Teens ]
Types Of Leukemia:
Once the oncologist classifies leukemia, it is time to identify the type. The type helps the specialist select the best possible treatment for your child. While there are several types of leukemia, some very rare, the major ones are as follows:
1. Acute Lymphocytic Leukemia (ALL):
This type of leukemia afflicts young children and teens more often than adults.
2. Acute Myelogenous Leukemia (AML):
AML can develop in kids, teens and adults. This is a common form of leukemia but tends to occur more commonly in adults than kids and teens.
3. Chronic Lymphocytic Leukemia (CLL):
This chronic leukemia afflicts adults, who can go for years without treatment or exhibit any symptoms.
4. Chronic Myelogenous Leukemia (CML):
This type of leukemia occurs mostly in adults. It hardly has any symptoms before becoming aggressive.
There are other types of leukemia but are rare. Teens can get these types, which include hairy cell leukemia, myeloproliferative disorders and myelodysplastic syndromes [2].
Causes Of Leukemia In Teens:
Researchers are still grappling in the dark to understand what causes leukemia in teenagers. However, they know for sure that environmental and genetic factors come into play.
Typically, your teen will develop leukemia if the DNA in his blood cells mutates. However, there could be some other changes in these cells that result in leukemia, but scientists are unaware of them. Leukemia, a type of cancer, develops when abnormalities in the blood cells cause them to grow and divide more quickly than normal blood cells, and these rapidly growing cells continue living even after the other healthy and normal blood cells die. This growth causes your teen’s bone marrow to end up with more abnormal cells than healthy red blood cells, white blood cells, and platelets. When this happens, the symptoms of blood cancer in teenagers develop.
Risk Factors For Leukemia:
It is impossible to predict if your teen will or will not develop leukemia in his lifetime. However, understanding the risk factors will help you guide your adolescent towards a healthier lifestyle and also keep an eye out for the signs and symptoms of leukemia.
The risk factors change depending on the type of leukemia your teen gets. But, some of the most common contributing factors include:
1. Age:
If you look at the statistics, people over the age of 65 are at a higher risk of developing leukemia. It’s why you, the parent, may overlook the signs of leukemia in your teenager.
2. Demographics:
Statistics reveal white (Caucasian) males are more susceptible to leukemia than other males. However, statistics aside, anyone can develop leukemia, including your adolescent.
3. Exposure To Radiation:
Getting exposed to radiation can increase your teen’s chances of developing leukemia. It explains why some teens get other types of cancer in their adulthood. Radiation therapy is a common form of treatment for teen leukemia.
4. Prior Cancer Treatment:
If your child received chemotherapy or radiation therapy previously for cancer, it could increase the likelihood of him developing leukemia.
5. Genetic Disorders:
Certain genetic disorders, such as Down syndrome and blood disorders, can increase the chances of your teenager developing leukemia.
6. Family History Of Leukemia:
Like all cancers, the chances of your adolescent getting leukemia increase if there is a family history of this cancer.
7. Environmental Factors:
Exposure to industrial solvents, pesticides, and tobacco smoke are other contributing factors for leukemia.
Based on this information, if you think your teenager is at risk for leukemia, you should consult your doctor immediately. And, you should note that leukemia often remains undetected in the initial stages, when the chances of recovery are greater. Request your doctor to take a blood sample of your teen. This is the only way to identify whether he has leukemia.
Symptoms Of Leukemia In Teens:
You need to know the symptoms of leukemia so that you can consult the physician early and get the right treatment for your child. Some common symptoms that teens and kids develop include:
- Susceptibility to bleeding
- Fever for a long time
- Bleeding that takes a long time to clot
- Chronic fatigue
These are general symptoms that you shouldn’t ignore. The two types of leukemia that afflict kids and teens are Acute Lymphocytic Leukemia and Acute Myelogenous Leukemia, and both have very similar symptoms. The symptoms that you should keep an eye out for include:
- Your teen will have fewer red blood cells than what is normal. This will cause him to look pale and feel tired constantly.
- Due to low numbers of platelets, which aid in blood clotting, your teenager may bruise more easily and also bleed for a longer time before his blood clots.
- Since your teen does not have sufficient mature white blood cells, his immunity will not be the best. This means he will contract infections more often.
- Your child will also complain of aches and pains in the bone due to a problem with the bone marrow.
- He may have swollen lymph nodes in the groin region, under the arms and in the neck.
- Your child may develop a high fever for no reason, and suffer from cold sweats.
- He may complain of a general feeling of malaise.[3]
If your child has one or more of these symptoms, don’t ignore them. Instead, take him to see your family doctor. If the doctor suspects leukemia after examining your teen, he will refer you to a specialist.
[ Read: Lung Cancer In Teens ]
Diagnosing Leukemia In Teens:
To accurately diagnose leukemia, the doctor will request for blood tests and bone marrow test. The technicians will perform the following tests on your adolescent:
1. Physical Examination And Health History:
The specialist will examine your teen to look for general signs of his health. This is the time the physician also will look for anything unusual, including lumps. He will ask you about your child’s health history, like his previous illnesses, the treatments he received for them, and your teen’s health habits.
2. Complete Blood Count And Differential:
A nurse or phlebotomist will draw some blood from your teen’s vein, and this sample will be checked for the following:
- The number of white blood cells in the blood
- The number of red blood cells and platelets in the blood
- The amount of hemoglobin in the red blood cells. Hemoglobin is a protein that is responsible for transporting oxygen in the body
- How many red blood cells are present in the blood sample
3. Bone Marrow Biopsy:
A qualified lab technician or specialist will remove your child’s bone marrow from the hipbone or breastbone. Also, they will take a small sample of the bone and also blood. The technician uses a hollow needle to remove bone marrow and bone sample which the pathologist checks under a microscope to determine the presence of leukemia.
4. Cytogenetic Analysis:
The pathologist checks the bone marrow or blood sample under the microscope for chromosomal changes, like Philadelphia chromosome, where a part of one chromosome affixes to another chromosome. The pathologist may perform other cytogenetic tests, such as fluorescence in-situ hybridization, to check for other changes in your kid’s chromosome.
5. Blood Chemistry:
The pathologist checks the blood sample to find levels of certain substances that different organs and tissue release in the blood. The level of each substance will allow the pathologist to figure out whether the substance-releasing organ or tissue has a disease.
6. Immunophenotyping:
Here, the pathologist checks the blood or bone marrow sample under the microscope to find out whether the leukemia started in the B or T lymphocytes. Usually, this test is reserved for ALL.
7. Chest X-ray:
A chest X-ray allows the doctor to check the organs and bones in the chest region to determine whether they are healthy.[4]
Treating Leukemia In Teens:
Treatment for leukemia in teens is quite intensive because this type of cancer is aggressive. Hence, you need to be supportive as your teen will require all the encouragement and motivation to get through the treatment sessions.
Typically, leukemia in teens requires treatment in three phases:
Phase I: Remission Induction:
This is the treatment phase where oncologists work to get the body rid of the cancer
Phase II: Consolidation And Delayed Intensification Therapy:
This treatment phase looks to keep the leukemia away
Phase III: Continuing Or Maintenance Therapy:
The last phase of leukemia treatment works to keep the cancer away on a long-term basis
If your teen is younger than 16 years, he will receive another form of treatment besides the regular chemotherapy. Called the Central Nervous System Therapy, this therapy looks to eliminate cancer cells lurking in the spinal cord, cerebrospinal fluid, and brain.
Once the oncologist diagnoses leukemia, your teenager will begin chemotherapy will quickly. The treatment requires hospitalization, and your adolescent will have to stay in children’s ward of the hospital. Chemotherapy can in the form of tablets, muscular injections or intravenous injections.
1. Remission Induction:
The first phase of the treatment works to get your teen’s body of the leukemia. So doctors will give him chemotherapy to kill as many cancerous cells as possible. In this stage, your child will receive several drugs besides the chemotherapy drugs.
- Chemotherapy drug to kill the malignant cells. This is the stage when your little one will also have Central Nervous System Therapy
- Steroids to make sure the chemotherapy works effectively
- Drugs to protect your teen’s kidney, as renal problems may arise when too many cancerous cells are killed simultaneously
During this phase of the treatment, patients stay in the hospital so that oncologists can monitor them closely. It takes about five weeks (sometimes it can be a little longer) for a patient to go into remission. Staying so long in the hospital can be tough for a child, and it is best to prepare your teen so that he knows the different ways to cope with this situation.
2. Central Nervous System Therapy:
While the drugs your child receives orally or intravenously can kill leukemia cells, they don’t have the ability to reach your child’s spinal cord or brain. Hence, he will receive Central Nervous System Therapy during the Remission Induction treatment. It will continue all the way until the maintenance therapy comes to an end.
In this therapy, your child will receive the chemotherapy drug in his spine. It is injected into the cerebrospinal fluid surrounding the spinal cord. The oncologist will place the needle between two vertebrae at the base of your kid’s spine and inject the drug.
Central Nervous System Therapy usually doesn’t have side effects, but some teenagers can experience dizziness, headaches, blurry vision and tiredness for a few hours after each therapy session.
3. Consolidation And Delayed Intensification Therapy:
After your teen goes into remission and the oncologist cannot find any leukemia cells in the bone marrow and blood, he will continue receiving treatment. This is because cancerous cells could still be lurking in the body. This treatment is called Consolidation and Delayed Intensification Therapy.
During this phase of the treatment, your child will receive different types of chemotherapy drugs. This prevents the cancerous cells from developing resistance to the drugs. This phase will continue for about five to six months. The good news is your child will not require hospitalization.
4. Maintenance Therapy:
This phase of your teen’s leukemia treatment prevents relapse. Your child receives low doses of the chemotherapy drug which keeps the disease from returning.
Your teenager will receive maintenance therapy in 12-week cycles, but it will be outpatient treatment, and your teen can do daily living activities with worries. Your teenager will receive maintenance therapy for a minimum of two years, but this duration increases if the adolescent is a boy. Typically, boys receive the treatment for over three years, while girls for just over two years. This also will involve receiving central nervous system therapy every 12 weeks.
Be prepared to take your teen for checkups every week or two weeks. During the checkup, the oncologist will decide whether the dose of the chemo drug needs adjustment. Also, your teen may have blood tests, as well.
[ Read: Breast Cancer In Teens ]
Radiotherapy For Leukemia In Teens:
Your adolescent will receive radiotherapy only if in the initial checkup the oncologist finds the presence of cancer cells in the cerebrospinal fluid. You child may also receive this therapy if he is due for bone marrow transplant. Radiotherapy helps prepare the body for the transplant.
Your teen will receive high doses of radiation to kill the malignant cells.
The treatment has unpleasant side effects, including hair loss, fatigue, and nausea. Also, your child may have sensitive skin for several months after finishing the treatment. So make sure he doesn’t decide to sit under the sun for a long period. If your teen is just hitting puberty, his physical growth will be affected adversely [5].
Prognosis Of Leukemia In Teens:
It is important to realize that long-term survival of teens with leukemia varies from one adolescent to another. It is dependent on several factors, such as the age of the child and the kind of leukemia he has.
Statistics reveal remission rate for leukemia in teens is high, about 90 percent [6]. However, the cure rate varies and is based on the specific features of the cancer. This said, most teens can experience permanent remission if they receive prompt treatment. But a large proportion of teens who get completely cured experience health issues in the future. This includes problems like premature cardiovascular disease, obesity and second cancer. These health problems can reduce your teen’s life expectancy in the future by 25 percent [7].
Survival Rate In Teens With Leukemia:
The American Cancer Society states that the survival rate in teens with leukemia has improved significantly due to advances in treatment protocols.
The five-year survival rate for kids with acute lymphocytic leukemia is 85 percent, whereas for older teens it is 50 percent [8]. When it comes to acute myelogenous leukemia, the five-year survival rate is about 60 to 70 percent. However, the rate of survival depends on the type of acute myelogenous leukemia the teenager has.
The rates for chronic leukemia are hard to come by because teenagers get chronic leukemia very rarely. Also, more often than not, a teen can have chronic leukemia for years without being cured. In the past, the five-year survival rate for chronic leukemia is around 60 to 80 percent due to better treatment measures.
Leukemia In Teens: Statistics:
As mentioned earlier, leukemia is the most common cancer among teens and kids. It accounts for one out of three cancers. However, overall, leukemia among teenagers is a rare disease.
Statistics from the American Cancer Society show that three out of four leukemia cases in teens is acute lymphocytic leukemia and the remaining are acute myelogenous leukemia [9].
In 2014 in the United States, 15,780 teens and kids between the ages of 0 and 19 were diagnosed with cancer [10]. Out of these around 1,960 will succumb to the disease. Also, Hispanic and Caucasian teens have a higher chance of getting cancer, including leukemia, compared to African-American and Asian-American teenagers, and boys are more likely to develop cancer compared to girls. However, acute myelogenous leukemia is a equally prevalent in boys and girls of all races.
Preventing Leukemia In Teens:
It is not possible to prevent leukemia in teens, as cancer is not a single disease. It is a group of diseases, and it is affected by several factors – your teen’s health, genetics, and the environment. If a close relative in your family has had cancer, it is prudent to get your adolescent checked every few months to ensure he is healthy and disease-free.
Helping Your Adolescent Cope Up With Leukemia:
Leukemia, for that matter any serious health problem, is never easy to handle. Hence, it is important you create a supportive environment for your child, as the treatment for leukemia in teens will be a long, drawn-out one.
Here are some tips to help your teenager cope with his illness:
- Be honest and give your child age-appropriate details about his disease
- Encourage your child to speak to you about his fears and concerns. Answer his questions honestly
- Take the various emotions and behaviors in your stride without over-reacting. Your child needs to know that inappropriate behaviors – temper tantrums, anger, rage and violence – will not be tolerated
- Keep reinforcing that you will be around as much as possible. When your child is hospitalized, stay in touch through phone, emails and even photographs
- Let your teen know why doctors and nurses are doing any test or procedure
- Before the treatment begins, introduce your teen to the treatment team so that he can get comfortable with them
- Encourage your teen to stay connected with his friends through phone calls, personal visits to the hospital, letters, photos and emails
- Get your kid’s teacher to visit, write a personal note or make a phone call to your teen
- It is important your child feels he is in control. So let him make choices, like which pill to take first, what movie to watch, which book to read, and what food to eat
- Your teen needs an outlet to express his feelings about what is happening to him. Encourage him to have journal where he can write what he feels and thinks
- If your child is finding it particularly difficult to adjust to the treatment or diagnosis, consult the oncologist[8]
[ Read: Colon Cancer In Teens ]
In Conclusion:
As a parent, it is frightening even if your child get mild fever. So when the doctor informs you your adolescent has leukemia, you will be devastated. However, medical science has advanced tremendously in the last few decades, and today even diseases like leukemia can be treated successfully.
Make sure you and your teen follow the doctor’s orders to the T and always maintain an open channel of communication with your kid’s oncology team and primary caregiver so that your doubts and fears can also be addressed. In the mean time, help your teen cultivate a healthy lifestyle. This is especially true after the treatment ends. If needed, take help of professionals so that your child learns the importance of health lifestyle and endeavors to maintain it.
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