Coughing or trouble breathing: Some types of leukemia can affect structures in the
middle of the chest, such as lymph nodes or the thymus (a small organ in front of the
trachea, the breathing tube that leads to the lungs). An enlarged thymus or lymph nodes
in the chest can press on the trachea, causing coughing or trouble breathing. In some
cases where the white blood cell count is very high, the leukemia cells can build up in the
small blood vessels of the lungs, which can also cause trouble breathing.
Swelling of the face and arms: The superior vena cava (SVC), a large vein that carries
blood from the head and arms back to the heart, passes next to the thymus. An enlarged
thymus may press on the SVC, causing the blood to “back up” in the veins. This is
known as SVC syndrome. It can cause swelling in the face, neck, arms, and upper chest
(sometimes with a bluish-red skin color). It can also cause headaches, dizziness, and a
change in consciousness if it affects the brain. The SVC syndrome can be lifethreatening,
and needs to be treated right away.
Headache, seizures, vomiting: A small number of children have leukemia that has
already spread to the brain and spinal cord when they are first diagnosed. This can lead to
symptoms such as headache, trouble concentrating, weakness, seizures, vomiting,
problems with balance, and blurred vision.
Rashes, gum problems: In children with acute myelogenous leukemia (AML), leukemia
cells may spread to the gums, causing swelling, pain, and bleeding. If it spreads to the
skin, it can cause small, dark spots that look like common rashes. A collection of AML
cells under the skin or in other parts of the body is called a chloroma or granulocytic
sarcoma.
Extreme fatigue, weakness: A rare but very serious consequence of AML is extreme
tiredness, weakness, and slurring of speech. This can occur when very high numbers of
leukemia cells cause the blood to become too thick and slow the circulation through small
blood vessels of the brain.
Again, most of the symptoms above are more likely to be caused by something other than
leukemia. Still, it’s important to have these symptoms checked by a doctor so the cause
can be found and treated, if needed.
How is childhood leukemia diagnosed?
Most of the signs and symptoms of childhood leukemia are more likely to have other
causes, such as infections. Still, it’s important to let your child’s doctor know about such
symptoms right away so that the cause can be found and treated, if needed.
Exams and tests will be done to determine the cause of the symptoms. If leukemia is
found, further tests will be needed to find out what type it is and decide how it should be
treated.
It’s important to diagnose childhood leukemia as early as possible and to determine what
type of leukemia it is so that treatment can be tailored to provide the best chance of
success.
Medical history and physical exam
If your child has signs and symptoms that might suggest leukemia, the doctor will want to
get a thorough medical history to learn about the symptoms and how long your child has
had them. The doctor may also ask about exposure to possible risk factors. A family
history of cancer, especially leukemia, may also be important.
During the physical exam, the doctor will focus on any enlarged lymph nodes, areas of
bleeding or bruising, or possible signs of infection. The eyes, mouth, and skin will be
looked at carefully, and a nervous system exam may be done. The abdomen (belly) will
be felt for signs of an enlarged spleen or liver.
Tests to look for leukemia in children
If the doctor thinks your child might have leukemia, samples of your child’s blood and
bone marrow will need to be checked to be sure of the diagnosis. Your child’s doctor
may refer you to a pediatric oncologist, a doctor who specializes in childhood cancers
(including leukemias), to have some of these tests done. If leukemia is found, other body
tissue and cell samples may also be taken to help guide treatment.
Blood tests
The first tests done to look for leukemia are blood tests. The blood samples are usually
taken from a vein in the arm, but in infants and younger children they may be taken from
other veins (such as in the feet or scalp) or from a “finger stick.”
Blood counts and blood smears are the usual tests done on these samples. A complete
blood count (CBC) is done to determine how many blood cells of each type are in the
blood. For a blood smear, a small sample of blood is spread on a glass slide and looked at
under a microscope. Abnormal numbers of blood cells and changes in the way these cells
look may make the doctor suspect leukemia.
Most children with leukemia will have too many white blood cells and not enough red
blood cells and/or platelets. Many of the white blood cells in the blood will be blasts, an
early type of blood cell normally found only in the bone marrow. Even though these
findings may make a doctor suspect that a child has leukemia, usually the disease can’t be
diagnosed
Coughing or trouble breathing: Some types of leukemia can affect structures in themiddle of the chest, such as lymph nodes or the thymus (a small organ in front of thetrachea, the breathing tube that leads to the lungs). An enlarged thymus or lymph nodesin the chest can press on the trachea, causing coughing or trouble breathing. In somecases where the white blood cell count is very high, the leukemia cells can build up in thesmall blood vessels of the lungs, which can also cause trouble breathing.Swelling of the face and arms: The superior vena cava (SVC), a large vein that carriesblood from the head and arms back to the heart, passes next to the thymus. An enlargedthymus may press on the SVC, causing the blood to “back up” in the veins. This isknown as SVC syndrome. It can cause swelling in the face, neck, arms, and upper chest(sometimes with a bluish-red skin color). It can also cause headaches, dizziness, and achange in consciousness if it affects the brain. The SVC syndrome can be lifethreatening,and needs to be treated right away.Headache, seizures, vomiting: A small number of children have leukemia that hasalready spread to the brain and spinal cord when they are first diagnosed. This can lead tosymptoms such as headache, trouble concentrating, weakness, seizures, vomiting,problems with balance, and blurred vision.Rashes, gum problems: In children with acute myelogenous leukemia (AML), leukemiacells may spread to the gums, causing swelling, pain, and bleeding. If it spreads to theskin, it can cause small, dark spots that look like common rashes. A collection of AMLcells under the skin or in other parts of the body is called a chloroma or granulocyticsarcoma.Extreme fatigue, weakness: A rare but very serious consequence of AML is extremetiredness, weakness, and slurring of speech. This can occur when very high numbers ofleukemia cells cause the blood to become too thick and slow the circulation through smallblood vessels of the brain.Again, most of the symptoms above are more likely to be caused by something other thanleukemia. Still, it’s important to have these symptoms checked by a doctor so the causecan be found and treated, if needed.How is childhood leukemia diagnosed?Most of the signs and symptoms of childhood leukemia are more likely to have othercauses, such as infections. Still, it’s important to let your child’s doctor know about suchsymptoms right away so that the cause can be found and treated, if needed.Exams and tests will be done to determine the cause of the symptoms. If leukemia isfound, further tests will be needed to find out what type it is and decide how it should betreated.It’s important to diagnose childhood leukemia as early as possible and to determine whattype of leukemia it is so that treatment can be tailored to provide the best chance ofsuccess.Medical history and physical examIf your child has signs and symptoms that might suggest leukemia, the doctor will want toget a thorough medical history to learn about the symptoms and how long your child hashad them. The doctor may also ask about exposure to possible risk factors. A familyhistory of cancer, especially leukemia, may also be important.During the physical exam, the doctor will focus on any enlarged lymph nodes, areas ofbleeding or bruising, or possible signs of infection. The eyes, mouth, and skin will belooked at carefully, and a nervous system exam may be done. The abdomen (belly) willbe felt for signs of an enlarged spleen or liver.Tests to look for leukemia in childrenIf the doctor thinks your child might have leukemia, samples of your child’s blood andbone marrow will need to be checked to be sure of the diagnosis. Your child’s doctormay refer you to a pediatric oncologist, a doctor who specializes in childhood cancers(including leukemias), to have some of these tests done. If leukemia is found, other bodytissue and cell samples may also be taken to help guide treatment.Blood testsThe first tests done to look for leukemia are blood tests. The blood samples are usuallytaken from a vein in the arm, but in infants and younger children they may be taken fromother veins (such as in the feet or scalp) or from a “finger stick.”Blood counts and blood smears are the usual tests done on these samples. A completeblood count (CBC) is done to determine how many blood cells of each type are in theblood. For a blood smear, a small sample of blood is spread on a glass slide and looked atunder a microscope. Abnormal numbers of blood cells and changes in the way these cellslook may make the doctor suspect leukemia.Most children with leukemia will have too many white blood cells and not enough redblood cells and/or platelets. Many of the white blood cells in the blood will be blasts, anearly type of blood cell normally found only in the bone marrow. Even though thesefindings may make a doctor suspect that a child has leukemia, usually the disease can’t bediagnosed
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