Does your little one feel tired all the time, have a blue complexion, or have a fever all the time? Sometimes these can be just normal symptoms. But sometimes, these little things can be a sign of a serious condition inside the body. Today we are going to talk about a type of blood cancer that is especially common among young children, but can also affect adults. Its name is Acute Lymphoblastic Leukemia, or (ALL) for short. Don't worry, we will talk about everything in simple terms.
Simply put, what does ALL mean?
Acute Lymphoblastic Leukemia (ALL) is a type of cancer that develops in our blood. Our blood contains red blood cells, white blood cells, and platelets. One type of white blood cell is called lymphocytes. Just like our country's army, these cells protect us by fighting diseases and germs that enter our bodies.
These lymphocyte cells are produced in the bone marrow inside our bones. Sometimes, due to a genetic mutation in these lymphocyte cells, they start to become cancer cells instead of healthy cells. These cancer cells divide and multiply rapidly without control, crowding out healthy cells. This is simply called ALL.
These cancer cells don't just stay in the bone marrow. They can travel through the blood and spread (metastasize) throughout the body.
But the most important thing is that ALL, although a serious condition, is a completely curable disease with proper treatment. The cure rate is very high, especially among young children.
What are the main types of ALL?
When we talk about lymphocytes, there are two main types of them: B cells and T cells. ALL cancer develops from these two types of cells.
| Cancer type | Simple explanation |
|---|---|
| B-cell ALL (B-cell ALL) | This is the most common type. It accounts for about 85% of ALL in children and 75%-80% of ALL in adults. B cells are the type of cells that make antibodies against germs in our body. |
| T-cell ALL (T-cell ALL) | This is a little rare. About 25% of adults and 12%-15% of children develop this type. T cells are the type of cells that directly kill germs and help other cells in the immune system. |
In addition to these two types, there is also a very rare type called Natural Killer ALL. Your doctor will perform the necessary tests to find out exactly which type you or your child has.
What symptoms do we see?
When ALL develops, the body's healthy blood cells are depleted, causing a variety of symptoms. These symptoms can come on suddenly or develop gradually.
Important: Having these symptoms does not mean you have ALL. However, if you have these symptoms for more than two weeks, it is essential to see a doctor for advice.
| Symptom | What does that mean? |
|---|---|
| Constant tiredness and paleness | Due to a decrease in red blood cells in the body (anemia), even doing small tasks can be tiring, and the body may appear pale. |
| Getting sick frequently | As healthy white blood cells decrease, the body's ability to fight disease (immunity) decreases. As a result, illnesses such as fever and colds can occur frequently. |
| Bleeding and bruising | As the platelets that help blood clot decrease, nosebleeds, bleeding gums, and even minor injuries can cause large blue spots on the body. Women may bleed heavily during menstruation. |
| Red spots on the skin (petechiae) | Small red spots appear on the skin as if they were pricked by a pin, due to bleeding from the very fine blood vessels under the skin. |
| Bone and joint pain | As cancer cells fill the bone marrow, severe pain can occur in the bones and joints. |
| Swollen lymph nodes | Lumps (nodules) in places like the neck, armpits, and groin can swell without pain. |
| Other features | Symptoms such as loss of appetite, weight loss, night sweats, and difficulty breathing may also be seen. |
Why does this disease occur? What are the risk factors?
There is no single specific cause of ALL cancer. The main cause, as we discussed earlier, is genetic mutations that occur during the formation of blood cells. In young children, these mutations may occur before they are even born.
However, several factors have been identified that increase the risk of developing this disease.
- Age: The risk is highest among children under 15 years of age, especially those between 2-5 years of age, and adults over 50 years of age.
- Certain genetic disorders: People with certain genetic disorders, such as Down syndrome, have a slightly higher risk of developing ALL.
- Exposure to radiation: Exposure to high levels of radiation, for example, if you have previously had radiation therapy for another cancer, may increase your risk.
- Certain viruses: Certain viral infections, such as the Epstein-Barr virus, are also believed to increase the risk.
- Tobacco use: Among adults, exposure to carcinogens such as tobacco use may also be a factor.
How does a doctor accurately diagnose this disease?
When you go to see a doctor with the symptoms you mentioned above, he will first ask you a detailed question about your symptoms. He will then perform a physical examination and order several tests to confirm the diagnosis.
- Blood tests: A routine Full Blood Count (FBC) test can detect abnormalities in the number of cells in the blood.
- Bone marrow biopsy: This is the main test used to confirm the diagnosis. A small sample of bone marrow is taken from a site such as the hip bone under anesthesia and examined under a microscope. This can determine exactly whether cancer cells are present and, if so, what type.
- Imaging tests: CT scans and PET scans may be done to see if the cancer has spread to other parts of the body, for example, to the chest cavity.
- Spinal tap/Lumbar puncture: If there is any doubt that cancer cells have spread to the brain or spinal cord, a small amount of spinal fluid is taken from the spine and tested.
What are the treatments for ALL?
There are several treatments for ALL. Your doctor will determine the best treatment plan for you based on many factors, including your age, the type of disease, and the genetic markers in your cancer cells.
Main treatment: Chemotherapy
Chemotherapy is a powerful drug that kills cancer cells. It is the main treatment for ALL. This treatment is given in several stages, lasting from a few months to two to three years.
| Treatment stages | What is happening? |
|---|---|
| 1. Initial phase (Remission Induction) | This takes about 4-6 weeks. The main goal is to destroy as many cancer cells as possible as quickly as possible. During this time, you will often have to stay in the hospital. |
| 2. Treatment of the nervous system (CNS-directed therapy) | This treatment is given to prevent cancer cells from spreading to the brain and spinal cord, or to destroy them if they have spread. This is often done in the first stage. |
| 3. Consolidation phase | After the disease is in remission, this phase begins to destroy any remaining cancer cells. You will be hospitalized for a few days every few weeks for several months and receive intravenous (IV) medications. |
| 4. Maintenance phase | This is the final and longest stage. It takes about 2-3 years. The goal here is to prevent the disease from coming back. Most often, oral medications and intravenous medications are given at the clinic. There is no need to go to the hospital often. |
Other treatments
- Targeted therapy: This involves giving drugs that attack specific genetic changes found only in cancer cells. For example, this treatment is very effective in people with a genetic change called the Philadelphia chromosome.
- Immunotherapy: This involves stimulating our own immune system to destroy cancer cells. CAR-T cell therapy is a modern treatment method that falls under this category.
- Radiation therapy: Radiation therapy may be used in cases where the cancer does not respond to chemotherapy or when the disease recurs.
- Bone marrow transplant: If other treatments are not successful or the risk of the disease returning is very high, you may be referred for a bone marrow transplant from a healthy person.
What are the chances of curing this disease?
This is the biggest question on everyone's mind. ALL is a cancer that responds very well to treatment.
In children, the results are very promising. 98% of children who receive proper treatment achieve complete remission of the disease. The survival rate after 5 years after the disease is cured is as high as 90%.
This percentage is slightly lower among adults. The 5-year survival rate for adults is between 30% - 40%.
But it's important to understand that these are just statistics. The way someone responds to treatment can be very different from another. So don't be alarmed by these numbers. Only the doctor who treats you can give you the best information about your or your child's condition.
It's normal to feel like your life is falling apart when you're diagnosed with cancer. Especially if it's your child. But remember, ALL is a much more curable disease than many other types of cancer. Trust your medical team. They will be with you on this journey, providing you with all the support and explanations you need.
Take-Home Message
- Acute Lymphoblastic Leukemia (ALL) is a cancer that develops in lymphocytes, a type of white blood cell.
- Although this disease is most common among young children, it can develop in anyone of any age.
- If you experience symptoms such as constant fatigue, paleness, frequent illness, blueness of the body, and bone pain for more than two weeks, seek medical advice immediately.
- Although ALL is a serious disease, it is completely curable with treatments such as chemotherapy. The cure rate is very high, especially among children.
- The treatment process can be long and tiring, but don't be afraid of it, trust your doctors, and follow their instructions exactly.
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