Leukemia is the cancer of blood cells and usually originates in the bone marrow, where blood cells form. When a teen has leukemia, the cancer cells divide and abnormally grow in the bone marrow and then migrate to the bloodstream. The cells are mostly immature white blood cells that replicate rapidly, suppressing the functioning of normal cells. Leukemia in a teenager is the most common type of cancer, accounting for at least one in three childhood cancer diagnoses. Leukemia symptoms in teenagers may vary as per the type. Although most teens develop acute forms of leukemia, very few cases of chronic leukemia are reported (1). Read on to learn more about the types, causes, symptoms, diagnosis, treatment, and outcomes of leukemia in teens.
Types Of Leukemia In Teens
Most leukemias seen in teenagers are acute and must be diagnosed and treated quickly to avoid disease progression. Leukemia is classified based on the type of cells involved and speed of progression (2) (3). Leukemia is of two types based on the speed of progression.
Acute leukemia: Develops quickly due to the rapid multiplication of immature cancer cells. The symptoms may appear suddenly, with an immediate need for medical attention.
Chronic leukemia: Develops gradually due to the slow rate of multiplication in cells. The teenager might be asymptomatic for years. It is less common than acute leukemia.
Leukemias may be of two types based on the types of white blood cells involved.
Lymphocytic leukemia: The cells affected are T lymphocytes (T cells), B lymphocytes (B cells), or natural killer (NK) cells. These cells are an important part of the immune system, involved directly or indirectly in fighting infections.
Myeloid leukemia: It affects neutrophils and monocytes (white blood cells). These cells are involved in invading microorganisms such as bacteria and fungi.
Leukemias can be further divided into the following types based on the disease severity, duration, and progression.
Acute lymphocytic leukemia (ALL): It is a rapidly progressing leukemia of the lymphocytes. ALL is the most common type of leukemia seen in older children and adolescents.
Acute myelogenous leukemia (AML): This is a steadily progressing leukemia of the myeloid cells and accounts for other cases of childhood leukemia.
Chronic lymphocytic leukemia (CLL): It is a rare type of leukemia in teens with slow progression and affects the lymphocytes.
Chronic myelogenous leukemia (CML): This type of leukemia rarely affects children and teens. It is a slow-progressing type of leukemia of the myeloid cells. Hence, the child might be asymptomatic for years.
Causes Of Leukemia In Teens
There is no known specific cause of leukemia. Leukemia is considered to occur due to a combination of a diverse group of genetic and environmental factors such as those mentioned below (4) (5).
Mutations in genetic material and translocations (one part of the chromosome moves to another part or another chromosome, creating a fusion gene with deviating activity).
Abnormal cell growth and division, setting out an abnormal increase in the number of immature cells that hamper the normal cell functioning, potentially leading to leukemia.
Certain chemical and radiation exposure, such as ionizing radiation, benzene, pesticides, and hydrocarbons.
Risks Factors Of Leukemia In Teens
Studies have shown that the following factors might increase the risk of leukemia in children and adolescents (1) (6).
Having a family history of leukemia or siblings having leukemia Past treatment with chemotherapy Excess alcohol consumption and smoking
Illegal drug abuse Having a history of genetic disorders, such as Down syndrome Having an inherited autoimmune disorder
Symptoms Of Leukemia In Teens
The symptoms of leukemia in a teen depend on the type and duration of the disease. In some cases, the teen might remain asymptomatic for years. The common signs of leukemia in children and teens include the following (7) (8). Many symptoms of leukemia may resemble those of infections and other illnesses. Seek a doctor’s opinion to determine the underlying cause early.
Diagnosis Of Leukemia In Teens
The doctor will assess the symptoms and may provide medication initially. If the child shows no improvement with the initial medication and has no underlying infection, the doctor may suspect leukemia and suggest the following tests to confirm (9).
Physical examination and medical history: In a physical exam, your teen’s doctor will check for enlarged lymph nodes, abdominal swelling, bruising, signs of bleeding, and infection. In medical history evaluation, the doctor might ask your teen about family history, the duration of symptoms, and any possible exposure to chemicals, radiation, and other risk factors that may contribute to the development of leukemia.
Blood tests: A complete blood count includes tests performed to check for an abnormal count of blood cells, including red blood cells, white blood cells, and platelets. A blood smear can help visualize various cell types microscopically. Other blood tests such as complete metabolic panel (CMP), liver function test (LFT), and coagulation panel might be ordered by your teen’s doctor as well.
Bone marrow examinations: The tests include bone marrow aspiration and biopsy. Bone marrow samples are usually collected from the hip bone and evaluated for the presence of leukemia. The test is performed under anesthesia.
Histological assays: The tests include flow cytometry and immunohistochemistry. These tests are often done on bone marrow cells to identify the type and localization of cancer.
Lumbar puncture: This test is helpful to visualize the presence of leukemia in the brain or spinal cord by analyzing the cerebrospinal fluid (CSF). The samples are taken from the spine area by applying a numbing cream. The teen might also be given anesthesia for the procedure.
Chromosomal analysis: These tests are used to identify the changes at the chromosomal level and help in analyzing the treatment outlook. The tests may include fluorescent in situ hybridization (FISH) and next-generation sequencing (NGS) to check for genetic changes involved in causing leukemia.
Imaging: These tests include X-rays, CT scans, MRI scans, and ultrasounds. These imaging modalities are useful in determining leukemia-related structural and functional abnormalities in the body.
Early diagnosis of leukemia in adolescents is vital to determine the type of leukemia and provide suitable treatments, facilitating early and successful recovery.
Treatment For Leukemia In Teens
Your teen may need treatments for infections and low blood counts before the commencement of leukemia treatment. The treatment for leukemia is designed by your teen’s doctor based on the type and severity of leukemia and the age and health status of your teen (10). Below are the various treatment options for leukemia in teenagers.
Chemotherapy: Chemotherapy is a primary treatment option for most leukemias in children and adolescents. Anti-cancer medications might be given orally or intravenously in this therapy to destroy cancer cells. There are three main phases in chemotherapy — induction, consolidation, and maintenance.
Targeted therapy: Targeted therapy uses drugs that destroy cancer cells with the help of target-specific proteins.
Immunotherapy: Immunotherapy, also known as biotherapy, uses medications to help the immune system recognize and destroy cancer cells. Several types of immunotherapy, such as immunotherapy with interferon, are used to treat leukemia.
Stem cell transplantation: The stem cell transplant, also known as bone marrow transplant, is a procedure where the affected bone marrow is replaced with a healthy one. High-dose chemotherapy or radiation therapy is given to destroy the affected bone marrow. Blood-forming stem cells are then transplanted to replace the damaged cells.
Radiation therapy: This therapy uses strong, high-energy radiation to destroy cancerous cells. It may be considered to avoid the further spread of leukemia to the brain. This therapy may not always be recommended to treat leukemia in children due to side effects such as nausea, vomiting, hair loss, skin changes, headaches, diarrhea, and fatigue. These side effects may be temporary or persist for a prolonged period in some teens (11).
Regular follow-ups with your teen’s doctor are paramount to evaluate the treatment prognosis and identify any side effects of medications.
Prognosis Of Leukemia In Teens
The outcomes or prognosis of leukemia depends on the type, severity, duration, and treatment responsiveness. Early diagnosis, tailored treatment interventions, and frequent follow-ups have significantly impacted the prognosis of this disease (12). In most cases, teens free from any disease symptoms for five years after treatment are considered to be cured since relapse after this duration is less common.
Complications Of Leukemia In Teens
The possible complications of leukemia in children and teens may include the following (13).
Infections and bleeding Risk of developing other types of cancer Emotional and mental disorders
Heart, lung, and kidney diseases Fertility problems
The teen may have late or long-term complications from the treatments, which may include the following (1) (14).
Learning disabilities Growth and developmental delays Higher risk of osteoporosis Behavioral problems Trouble in vision and hearing Thyroid disorders Risk of heart and lung diseases Increased risk of cavities and gum diseases Emotional and psychological problems
You may need regular visits during and after treatments to ensure their effectiveness with minimal adverse effects.
Prevention Of Leukemia In Teens
There are no known ways to prevent leukemia in children or teens. Most teens who develop leukemia have no known risk factors. Nevertheless, the risk of developing cancer can be reduced by following certain lifestyle changes such as quitting smoking and assuring low levels of exposure to radiation. Furthermore, The American Cancer Society supports preventive programs that suppress tobacco use and promote a nutritious diet, regular exercise, and a healthy lifestyle in children and teens (15).
