Children's Cancer

Leukaemia (also spelled leukemia) is cancer that affects the blood and bone marrow. It happens when the bone marrow makes too many white blood cells (lymphocytes). Lymphocytes are part of the body’s immune system, which helps fight infections.

If you have leukaemia, your white blood cells don’t work properly. Leukaemia cells don’t fight infections very well. They can also take up a lot of space in the bone marrow. This means there is less room for healthy blood cells.

Types of leukaemia are named after:

• the type of stem cells involved
• how fast the cancer cells grow

Leukaemia affects two main stem cell types: lymphoid stem cells and myeloid stem cells. Most childhood leukaemias are acute, which means the cancer cells grow quickly.

Acute lymphocytic leukaemia (ALL)

Acute lymphocytic leukaemia (ALL) is also known as acute lymphoblastic leukaemia. ALL is the most common type of leukaemia in children. About seven to eight out of 10 children with leukaemia have ALL.¹ Most children with ALL are between two and four years old.

ALL affects lymphoid stem cells and grows quickly.

Acute myeloid leukaemia (AML)

Acute myeloid leukaemia (AML) makes up most of the other childhood leukaemias. AML affects myeloid stem cells and grows quickly. You might also hear it called:

• acute myelogenous leukaemia
• acute myeloblastic leukaemia
• acute granulocytic leukaemia
• acute nonlymphocytic leukaemia

Other leukaemias

You might have heard of other types of leukaemia. These are rare in children under the age of 14:

• chronic lymphocytic leukaemia (CLL)
• chronic myeloid leukaemia (CML)

You might also have heard of ‘mixed lineage leukaemias’. These leukaemias are a combination of AML and ALL. These are usually treated like ALL.²

References

[1] https://www.cancer.org/cancer/leukemia-in-children/about/what-is-childhood-leukemia.html, https://www.childrenwithcancer.org.uk/childhood-cancer-info/cancer-types/acute-lymphoblastic-leukaemia/

[2] https://www.cancer.org/cancer/leukemia-in-children/about/what-is-childhood-leukemia.html

Chance of a cure

One of your biggest concerns on learning your child has cancer may be about their chance of being cured.

Due to major advances in treatment, many children treated for cancer now survive into adulthood. Children diagnosed with cancer between 2004 and 2012 have a 5-year survival rate of 85%. In the 1980s, the 5-year survival rate for all cancers was about 73%.¹

Talk to your child’s doctor about your child’s diagnosis, treatments and long-term survival. Long-term survival is also called the outlook or prognosis. It on depends several things, including:

• age of your child at diagnosis
• extent or stage of the cancer
• how the cancer cells look under a microscope (the shape, function and structure of the cells)
• how the cancer responds to treatment
• cancer or tumour biology, which includes
  • the patterns of the cancer cells
  • how different the cancer cells are from normal cells
  • how fast the cancer cells are growing.

To learn more about survival for leukaemia in children, visit Australian Cancer Childhood Statistics Online

References

[1] https://cancerqld.blob.core.windows.net/content/docs/Childhood-Cancer-in-Australia-1983-2015.pdf

Clinical trials

It’s possible that your child may be able to be part of a clinical trial. Clinical trials are research investigations to test new treatments, interventions or tests to prevent, detect, treat, or manage various diseases or medical conditions. The patients involved in clinical trials are volunteers.¹

With regard to cancer, researchers run clinical trials to test new ways to:

• treat cancer
• find and diagnose cancer
• manage cancer symptoms and treatment side effects.

If a trial is available, taking part in one will be entirely the family’s decision

It’s important to note that any new treatments are strictly regulated and must be approved before they can be used in a clinical trial. Your child’s doctor will explain everything about the trial and give you detailed written information. If you wish your child to be part of the trial, you will need to give permission.

Participating in a clinical trial may or may not directly benefit your child. However, the results of clinical trials today help children with cancer in the future. If you’re interested in participating in a clinical trial, ask your child’s doctor if there are any suitable for your child.

You can find further information on our Clinical trials and research page.

References

[1] https://www.australianclinicaltrials.gov.au/what-clinical-trial

Diagnosis

When your child is diagnosed with cancer, it can feel overwhelming. This phase involves finding out if your child has cancer and determining the type of cancer they have. Children’s cancer can be difficult to diagnose, as many symptoms are similar to those caused by less serious conditions, or injuries. This means that your child may need several tests and medical appointments before you receive confirmation that your child has cancer.

If your doctor thinks your child has leukaemia, your child will undergo several tests, including:

• medical history and physical exam
• blood tests
• lumbar puncture (spinal tap)
• bone marrow aspiration and biopsy
• medical imaging, such as
  • chest X-ray
  • ultrasound
  • bone scan
  • computed tomography (CT) scan
  • magnetic resonance imaging (MRI)
  • positron emission tomography (PET) scan.

You can find more details about these tests on our page How is cancer diagnosed?.

Staging

Doctors use staging to describe how much the cancer has grown. Your doctor will use this information to determine which treatments to use. Staging also gives doctors an idea of how well these treatments are likely to work (prognosis).

Leukaemia staging is different to that for other types of cancer. Leukaemia starts in the bone marrow and spreads to the blood quickly. This means that it spreads to the rest of the body quickly as well.

Leukaemia staging includes information such as:

• whether the leukaemia cells have built up in certain organs or areas of the body, such as the
  • liver
  • spleen
  • lymph nodes
  • central nervous system
• the types of cells that are involved in the leukaemia.

Your doctor will also consider whether the leukaemia is new, or whether it has been treated before but has come back (relapsed).

Risk factors

A risk factor is anything that increases a person’s chance of getting a certain condition or disease.

In adults, lifestyle and environmental factors (such as smoking or exposure to certain chemicals) can be significant risk factors for developing certain types of cancer. Researchers know about some risk factors that increase the chance of developing cancer in children. But, for most children with cancer, the underlying cause is unknown.

What we do know is that if a child develops cancer, it’s not because of something they, or their parents did to cause it. No one is to blame if a child develops cancer.

Even if your child has a risk factor, it does not mean they will develop cancer. Many children with a risk factor will never develop cancer, while others with cancer may have had no known risk factors. Even if a child with a risk factor develops cancer, it is usually hard to know how much that risk factor contributed to the cancer.

Researchers don’t completely understand what causes leukaemia. But there are some things linked to a higher chance of developing the condition.

Family history

Children who have a brother or sister with leukaemia have a slightly higher chance of developing leukaemia. This is especially true if a child has a twin.

Genetic conditions

Some changes in a child’s chromosomes or genes can lead to leukaemia. Certain genetic conditions can also increase a child’s risk of developing leukaemia, including:

• Down syndrome
• Klinefelter syndrome
• Shwachman syndrome
• Bloom syndrome
• Li–Fraumeni syndrome
• Noonan syndrome
• Wiscott–Aldrich syndrome
• neurofibromatosis type
• Fanconi anaemia
• ataxia-telangiectasia.

If your child has one of these genetic conditions, they will need specific care. Your health care team will talk to you about which ongoing tests your child will need.

Cancers in children that are linked to genetic conditions may also affect the risk for other family members. You can ask your child’s treatment team if you or your family should get genetic counselling.

For more information about genetic conditions, see the children’s cancer glossary or the Centre for Genetics Education.

Exposure to radiation

High doses of radiation will increase a child’s risk of getting leukaemia. This includes children who were X-rayed before they were born.

Children who have previously had radiation therapy (radiotherapy) to treat cancer also have a higher chance of developing leukaemia.

Previous chemotherapy

Children who have been treated with chemotherapy have a higher risk of getting leukaemia.

Support and more information

A diagnosis of cancer in a child is difficult for you and your family. It’s normal for you and your family to feel overwhelmed, scared, anxious or angry.

If you or others around you are having trouble coping, make sure you speak to your child’s treatment team. They have helped and supported many other families who have been through what you’re currently going through. Sometimes just letting other people know how you’re feeling helps you feel less alone. If you feel supported, then you will feel more able to support your child.

Most children’s hospitals will allocate a social worker to each family to provide support throughout treatment. If you need support, contact your hospital-based social worker to let them know how you’re feeling and to see what support can be made available to you and your family, including music therapists, play therapists or education support staff.

The following webpages and organisations also offer support and/or extra information for kids with cancer and their families:

• Living with children’s cancer has information about physical, emotional and practical issues during and after diagnosis and treatment. 
• Organisations that can provide support and information.
• Redkite is a national organisation that provides emotional support, financial assistance, information and resources to families who have a child with cancer. You can reach them through their support line 1800 733 548 (1800 REDKITE), which is open (9am-7pm AEST), email support@redkite.org.au or live chat on www.redkite.org.au
• Canteen provides a service called Canteen Connect, an online community for young people aged 12-25 dealing with their own or a close family member’s cancer, and Parent Connect, an online community with resources, information and peer support on parenting through cancer. Online counselling is available seven days a week, including evenings. Visit https://canteenconnect.org or call 1800 835 932.
• The Cancer Council in your state or territory can give you: 
  • general information about cancer 
  • information on resources and support groups in your area. 
  • Call the Cancer Council Helpline from anywhere in Australia on 13 11 20.
• Any of the major children’s hospitals and networks in your state or territory can provide information about childhood cancer.

For more information about childhood liver tumours, see:

• Childhood liver cancer treatment (PDQ®), from the National Cancer Institute (United States) 
• Childhood liver tumours, from Rare Cancers Australia.

Note that information from international organisations may not always apply to children in Australia.

Symptoms

Many conditions can cause the symptoms below, not just cancer. If your child has any of these symptoms and you are worried, talk to your child’s doctor. The earlier cancer is found, the better.

Symptoms of leukaemia may include:

• fever
• night sweats
• bruising or bleeding easily
• flat, pinpoint red spots under the skin, caused by bleeding under the skin
• pain in the bones or joints, or under the ribs
• tiredness or weakness
• pale skin
• dry skin rash
• loss of appetite
• painless lumps in the neck, underarm, stomach or groin, or around the eyes
• feeling of fullness or swelling in the belly.

Treatment

Your team of doctors, called a multidisciplinary team (MDT), will care for and treat your child, and will ensure that all your child’s needs are considered while they have cancer treatment.

Treatment for leukaemia depends on:

• the age of your child
• how well it responds to the initial treatment
• whether it has spread into the fluid around the brain and spinal cord
• other factors.

Your doctor will suggest treatments based on your child’s situation. Treatment may involve one or more of the following:

• chemotherapy
• radiation therapy
• targeted therapy
• stem cell transplant
• other treatments.

The section called The treatment team has further information about this.