Recognize the early symptoms and treatment of leukemia in children

Case report.

Girls aged 2 years, come to the emergency room with the main complaints:

• Eyes more prominent since 1 month before go to the hospital.

Current medical history :

• Both eyes protrude, accompanied by swelling in the cheek area.
• Have a fever up and down for 2 months with a body temperature > 35°C.
• Repeated pale and ever got a transfusion.
• There is a bluish color on the skin.
• There is no history of vomiting and seizures.
• The patient becomes less active and does not want to play.

Physical examination :

• The patient is conscious.
• Does not look crowded.
• TD 90/60 mmHg.
• Regular rate of pulse 100 times / minute.
• Breath rate 32 times / minute.
• There is no retraction.
• Body temperature 38,3°C.
• Pale conjunctiva.
• There is proptosis and mass on the cheeks.
• Feels lymphadenopathy in several locations, especially in the neck.
• There is hepatosplenomegaly in the stomach.
• The skin is ptakiae and ecchymosis.
• Movement equipment is not abnormal.
• There is no neurological deficit.

Supporting investigation :

Complete peripheral blood examination ➡

• Hb 5.0 g / dL.
• Leukocytes 132,000/uL.
• Platelets 15,000/uL.
• Blast 44%.
• Peripheral blood picture: there is a blast.
• Bone marrow aspiration: according to Acute Lymphoblastic Leukemia. 

Characteristics of leukemia blast cells:

• Its size is much bigger than a normal cell.
• Having a core child.

Cancer in children is divided into 2, namely :

Blood Cancer ➡

• Acute lymphoblastic leukemia and chronic myelostic leukemia. 
• Epidemiologically most often occurs in children (percentage 30-40%).
• Most cases in children aged 3-6 years.

Solid tumor ➡

• Retinoblastoma: tumor of the retina.
• Lymphoma: tumor of the lymph nodes.
• Rhabdomiosarcoma: tumor in the muscles.
• Wilms tumor.
• Osteosarcoma: a tumor in the bone.

Cancer in children is important to watch out for, because :

• The incidence of blood cancer continues to increase every year.
• Become a serious cause of morbidity and mortality in children.
• Leukemia can be treated if symptoms are known early and treated at an early stage, so there are no other abnormalities that aggravate the patient's condition when getting therapy.
• Severe psychological effects.

Differences in childhood and adult cancers.

Cancer in children ➡

• Attack : network.
• Diagnosis : generally diagnosed after cancer has developed 80% and has spread to other tissues.
• Detection : generally difficult to detect and most are detected accidentally or slowly.
• Screening : there is no specific screening for childhood cancer.
• Therapeutic response : cell turnover in children is faster, so the response to chemotherapy is better.
• Prevention : generally occurs incidentally so prevention is difficult.

Cancer in adulthood ➡

• Attacking : organs.
• Diagnosis : generally diagnosed in one location.
• Detection : can be detected by screening or counseling.
• Screening : adequate.
• Therapeutic response : slower responding to chemotherapy.
• Prevention : prevention can be done.

Cause.

• Genetic and familial (5-15%).
• Environment (<5-10%).
• No known cause (75-90%) ➡ multi factorial.
• Exposed to radiation during pregnancy resulting in damage to genes in the fetus.

Cancer cell properties :

• Proliferation : from one cell develops into two cells and so on.
• Develops quickly so that it meets the affected organ / tissue.
• Infiltration: damage to other organs to blood vessels.

• The more cancer cell counts are diagnosed, the slower the treatment response.
• The earlier it is diagnosed before the cancer cells develop, the faster the treatment response.

Diagnosis.

The diagnosis of cancer is made as early as possible before the risk of morbidity and mortality increases.

Components that play a role:

• The time between the onset of symptoms and medical treatment.
• Time between medical staff and oncologist.
• The time between the oncologist and the patient receive treatment.

Symptoms of leukemia in children :

• Pale.
• Prolonged / recurrent fever.
• Bleeding.
• There is a mass in the abdominal cavity / organomegaly.
• Enlarged lymph nodes.
• Bone and joint pain.
• Swelling of the gums.

Delay in diagnosis:

• The patient has experienced a severe infection.
• There has been infiltration in the central nervous system.
• Metabolic disorders.
• Suffers from malnutrition.

Clinical symptoms of suspected malignancy in children:

• Weight loss.
• Headache.
• Mass formed.
• Bleeding.
• Frequent infections.
• Gag.
• Child's movements are not active.
• Pale.
• Prolonged / recurrent fever.

Diagnosis procedure.

• Complete peripheral blood examination.
• Bone marrow aspiration.
• Lumbar puncture: to detect infiltration in the brain and form of therapeutic treatment of leukemia in children.

Treatment. 

• Chemotherapy.

Supportive therapy ➡

• Infection control.
• Nutritional support.
• Blood transfusion.
• Psychosocial.

The success of treatment is very determined ➡

• Chemotherapy response.
• Supportive therapy.
• Regular treatment of patients.

Palliative care : to improve the quality of life of patients.

Conclusion. 

• Early leukemia (pale, long-term fever, bleeding, bone pain, organomegaly) refer immediately.
• Leukemia in children from incurable diseases can be treated, if fully and appropriately approved.
• Family, volunteers and government. Assistance of facilities and infrastructure for patient care.