As your faith is strengthened you will find that there is no longer the need to have a sense of control, that things will flow as they will, and that you will flow with them, to your great delight and benefit. ~Emmanuel
Cancer is a word that everyone dreads and is fearful of hearing; yet most of us have been touched by cancer whether it is you or a loved one has been diagnosed. Over the years research has done wonders. In many cases having cancer would mean that you have been diagnosed with a terminal illness. People today however have endless information that advises them of up-to-date information on treatments and prevention and cancer is no longer a death sentence.
Acute Lymphocytic Leukemia (ALL): ALL is a type of cancer that affects the blood and bone marrow and can be found in the spongy tissue inside bones where the blood cells are made. This illness got its name from a group of white blood cells that are called lymphocytic. Lymphocytic cells fight infection. The disease is called acute, because it progresses rapidly and affects immature blood cells rather than the mature ones.
ALL is also known as Acute Childhood Leukemia.
As a rule our bone marrow produces immature cells (stem cells) in a controlled way, which mature and specialize into various types of blood cells as required. When people have ALL, a number of immature, abnormal lymphocytes are produced and released into the bloodstream. This is due to the production process going astray, and when this process does not work correctly these cells multiply quickly and squeeze out the healthy blood cells, leaving the patient open to infection and easy bleeding. Leukemia cells also congregate in other areas of the body such as the central nervous system and spinal cord, causing serious health problems.
ALL is a type of cancer that affects more children than adults. Although the disease does get worse rapidly if not treated, it does respond well to the treatments.
Signs and Symptoms
In the early stages of the disease signs and symptoms are very similar to those of the flu or other ordinary illnesses.
Other signs are due to a shortage of properly functioning blood cells. This is due to the overcrowding of the leukemia cells. When this happens a group of different problems occur, depending on the type of blood cell affected.
Red blood cells carry oxygen from the lungs to all parts of the body. When there is shortage of these cells (anemia) it can cause fatigue, pale skin and shortness of breath. White blood cells are infection fighters; they help the body to ward off germs. When there is a shortage of these cells (leucopenia) or another type of white blood cells called neutrophils (neutropenia) it can result in frequent infections. Blood platelets are cells that control and prevent bleeding by inducing the blood to clot. A shortage of blood platelets (thrombocytopenia) results in easy bleeding and bruising. Other symptoms are severe nosebleeds, bleeding of the gums and small red marks that indicate bleeding into the skin (petechiae). ALL has been known to cause painless lumps in the lymph nodes around the neck, underarm, stomach or groin. It can also cause joint pain, bone pain and pain on the left side of the ribs due to the swelling of the spleen. It can spread outside the blood in to your central nervous system and other organs causing weakness, dizziness, vomiting, headaches, seizures and blurred vision.
T-Cell is a type of ALL that often causes swelling in an organ called a thymus which is situated in the chest near the heart. When the thymus swells it can press on the windpipe, causing shortness of breath and coughing or press on a large vein that carries blood from the arms and head to the heart causing swelling of the head or arms. This would cause a medical emergency that does respond to treatment. Possible risk factors are: • Children and adults who have undergone some kind or cancer therapy.
• People who have been exposed to high levels of radiation • Certain genetic disorders, for example Down syndrome, have been known to be a high risk. • People with siblings with ALL are slightly more likely to develop the disease also. Screening If any of the symptoms of leukemia are present, blood and bone marrow tests will be ordered. These tests will help identify which kind of leukemia is present since there are four main types and several subtypes.
Diagnosis & Tests Blood tests are done to check the red and white cell count. People with ALL usually have too many white cells and not enough red cells and platelets. Another indicator of ALL is the presence of “blast cells” these are immature cells usually found in the bone marrow but not circulating in the blood. These tests can only suggest there could be ALL present but the test below is also required. Bone marrow test is done to confirm the findings of the blood tests. The bone marrow test, is usually performed by either a nurse or doctor, who removes a sample of the bone marrow from the hip (posterior iliac crest) with a needle to check for leukemia cells. If leukemia is suspected then the patient may be referred to a doctor who specializes in cancer (oncologist) or one who specializes in blood and blood forming tissues (hematologist) for this procedure. If a child is the patient then they could be referred to a pediatric doctor and a pediatric cancer center. When a child is diagnosed with Leukemia, the first thing the doctors will want to do, is investigate whether or not the cancer has spread. To obtain that information they may consider the following tests.
• Chest X-ray • Ultra Sound • Spinal Tap • Additional blood tests.
The next step is to determine at what stage the cancer is; however ALL has no established staging system.
Adults with ALL: are classified as “untreated,” “remission” or “recurrent”
Children with ALL: the following risk groups are used instead of stages.
Age: Infants and children under 10 years of age are placed in a high-risk category.
White blood cell count: the higher the white blood cell counts the higher the risk.
Immunophendype: refers to where the cancer began, the B-cell of ALL or the T-Cell of ALL
• Children with B-Cell or T-cell. B-Cell is a lower risk and T-Cell a high risk. • Cytogenetics refers to the changes in the chromosomes in the lymphocytes
Children with a particular kind of cancer that is hard to treat or who have sudden changes to their health are also placed in a high-risk category. Treatments Children with ALL have an eighty percent cure rate when they undergo treatments. Some of the newer treatments have been known to increase the child cure rate to as high as ninety percent. Adults with ALL have about a forty percent cure rate. Knowing the risk rate helps the doctors to determine the type of treatment required. ALL treatments fall into three stages: 1. Induction therapy: This first stage will destroy most of the leukemia cells in both blood and bone marrow. 2. Consolidation therapy: The second stage is a post – remission therapy and is aimed at destroying the remaining leukemia cells in the brain or spinal cord. 3. Maintenance therapy: in this third stage of treatment a lower dose of medication is given and prevents leukemia cells from re-growing.
Children with ALL usually receive treatments to destroy leukemia cells in the central nervous system during each stage of the therapy. This type of therapy is called: 1. Central Nervous System Sanctuary Therapy or 2. Central Nervous System Preventative Therapy 3. Intrathecal chemotherapy – this type of chemotherapy is injected directly into the fluid that covers the spinal cord. This treatment kills cancer cells that cannot be reached by chemotherapy drugs given through an intravenous line.
The three stages of treatments above usually take from two to three and a half years to complete.
Chemotherapy is the main form of “Remission Treatment Induction Therapy” given to children and adults with ALL. Each session lasts for approximately four weeks or more. During the induction cycle treatments it is usual for the patient to remain in hospital, due to the chemotherapy destroying a number of the normal blood cells while in the process of killing the leukemia cells; since this is known to cause anemia, infections and bleeding. Medications Children with low risk: usually receive the following three drugs during the first month of treatment – vincristine, L-asparaginase and a corticosteroid (prednisone or dexamethasone) Children with high risk: may also in addition to the above receive an anthracycline drug such as daunorubici. Melanoma One of the most deadly forms of skin cancer is called Melanoma, which develops in the cells that produce melanin (the pigment that gives the skin color.) The number of cases of melanoma is on the rise; although it makes up the lowest percentage of skin cancer, it does cause the largest number of deaths. This is due to the fact that it can spread to different areas of the body. Exposure to ultraviolet (UV) radiation from sunlight, tanning lamps and tanning beds increases the risk of developing melanoma although the precise cause is unclear. Knowing the warning signs of skin cancer and avoiding sun exposure can help to prevent melanomas making sure that cancerous changes are discovered and treated before they have a chance to spread. If caught early it can be treated successfully.
Signs and Symptoms: Although melanomas can grow anywhere on the body, they do usually grow in areas that have been exposed to the sun, for example the arms, legs, back, and face. However, melanoma has been known to grow in areas that do not receive much sun exposure such as the palms, hands, fingernail beds and soles of the feet. The changing of an existing mole or the growth of a new unusual looking growth on the skin is usually the first sign of melanoma.
Moles Most people have from ten to forty moles, which are usually developed before the age of twenty. Some moles may change over time, while some have been known to disappear with age. • Moles that are likely to become cancerous are those that are more than twelve millimetres or half an inch in diameter. • Look for flat moles with uneven borders and a mixture of color. • The medical name for these moles is “dysphasic nevi” and they are more likely to be malignant.
The American Academy of Dermatology has developed an ABCD guide for listing the characteristic of unusual moles that may indicate melanoma or other skin cancers. A – Asymmetrical shapes (moles of irregular shape ones with different looking halves) B – Irregular border (moles that have irregular, scalloped or notched borders) C – Changes in colour (moles that consist of many colours or uneven distribution of colour) D – Diameter (a mole that is larger than six millimetres or quarter of an inch)
Other changes to have checked include: • Itching • Change in texture • Scaling • Spreading of pigment • Bleeding.
Risk Factors Fair skin people usually have less pigment in the skin, which means they have less protection from UV rays. Blond or red haired, light-eyed people who burn easily in the sun are more likely to develop melanoma than those with darker complexions.
It is however important for those with dark complexions including black and Hispanic to be aware and to take precaution against UV rays since they usually have melanoma diagnosed in the later stage when lesions are deeper and more advanced.
Other cautionary signs: • History of sunburns – people who burn easily • Excessive sun exposure – to UV rays • Weakened immune system • Exposure to the following substances – wood preservative, creosote, coal, tar, arsenic compounds found in pesticides and radium. • Rare genetic disorder – xeroderma pigmentosum Skin Cancer Screening • Ask the doctor to make a skin examination part of the yearly physical check-up. • Monthly self-exams to become familiar with the moles, freckles and skin marks so that changes are noticed quickly.
For more information: Please visit the websites of the following organizations: The Canadian Cancer Society – http://www.cancer.ca The American Cancer Organization – http://www.cancer.org The Mayo Clinic – http://www.mayoclinic.com/health/childrens-health/MY00383
Written by Sylvia McGrath April, 2009
**Please note: that this e-book is just to serve as an information resource, this is not to be used for diagnosis. If you have any medical concerns or questions, please see your doctor for a proper diagnosis.