Childhood Cancer: Acute Lymphoblastic Leukaemia

Question 1

What are haematological cancers?

Answer 1

cancers affecting the blood, bone marrow and lymph nodes

• leukaemia
• lymphoma
• myeloma

Question 2

What are the most common types of solid tumours in children?

Answer 2

• brain tumours
• neuroblastoma
• rhabdomyosarcoma
• Wilm’s tumour
• osteosarcoma

Question 3

What is the most common type of cancer in children in the UK?

Answer 3

leukaemia

Question 4

What is the most common type of leukaemia diagnosed in children?

Answer 4

acute lymphoblastic leukaemia

Question 5

Describe the process of acute lymphoblastic leukaemia

Answer 5

• bone marrow produces too many lymphoid blast cells
  
  • immature
  • unable to become normal lymphocytes

Question 6

What are the two types of acute lymphoblastic leukaemia?

Answer 6

• T cell
• B cell

Question 7

Where do lymphoblasts tend to spread in acute lymphoblastic leukaemia?

Answer 7

• lymph nosed
• liver
• spleen
• central nervous system
• testicles

Question 8

What are the symptoms of acute lymphoblastic leukaemia

Answer 8

• breathlessness, pale appearance, fatigue
  
  • tired even after a good nights sleep
• bruising or bleeding easily for no reason
  
  • nosebleeds
  • bleeding gums
  • small dark red spots on skin
  • blood in poo
  • very heavy periods
  • due to lack of platelets
• high temperature or picking up infections
  
  • coughs and colds
  • infections lasting a long time
  • fever
• swollen lymph nodes
  
  • neck
  • armpit
  • groin
• irritability
  
  • fractious
  • difficult to settle
• bone pain
  
  • limping or refusing to walk
  • most commonly in long bones
  • can affect the back and joints
• loss of appetite
  
  • eating smaller amounts than usual
  • won’t eat favourite foods
• fullness in tummy
  
  • discomfort
  • jump a clothes size
  • due to swollen liver or spleen
• swollen testicles
  
  • leukaemia cells collect
  • not usually painful

Question 9

What teams make up the multi-disciplinary team for patients with acute lymphoblastic leukaemia?

Answer 9

• paediatric oncologist
• paediatric haematologist
• paediatric dentist
• GP
• paediatric cancer nurse specialists
• play specialists
• psychologists
• social workers

Question 10

What are the treatment options for acute lymphoblastic leukaemia management?

Answer 10

• chemotherapy
• stem cell transplant

Question 11

Describe how chemotherapy is used to treat acute lymphoblastic leukaemia

Answer 11

• a number of different chemotherapy agents
  
  • treatment protocols strictly followed
• 3 phases of treatment
  
  • induction
  • consolidation
  • maintenance
• results in immunosuppression and deranged blood profiles

Question 12

Describe how stem cell transplant or bone marrow transplant can be used to treat acute lymphoblastic leukaemia

Answer 12

• chemotherapy and radiotherapy
  
  • eliminate host immune system
• transplant of health stem cells/bone marrow
• results in immunosuppression and deranged blood profiles

Question 13

What oral problems must be considered for patients receiving treatment for acute lymphoblastic leukaemia?

Answer 13

• increased infection risk
  
  • during treatment
• oral and pharyngeal mucositis
  
  • associated pain and bleeding
  • taste dysfunction
• dry mouth
  
  • salivary gland dysfunction
• increased caries rate
• gingival hyperplasia and bleeding gums
• ORN and MRONJ
• trismus
• opportunistic infections
  
  • candidiasis
  • herpes simplex

Question 14

What considerations must be made for dental treatment for patients undergoing treatment for acute lymphoblastic leukaemia?

Answer 14

• prioritise prevention
• timing of appointments
  
  • around cancer treatment
• immunosuppression and bleeding risk
• anxiety
• fatigue with care
• aggressive treatment planning with regards to infection risk
• wider social and familial circumstances
• dental care for family
  
  • is it a priority?