Leukemia: How to diagnose the silent killer

By Agnes Kyotalengerire

FIVE-year-old Moses Alinaitwe lies on his hospital bed groaning in pain. His eyes and lips are pale, his limbs very thin and his head bald.

Alinaitwe is undergoing blood transfusion.

With teary eyes, his mother narrates that for eight months, Alinaitwe has been battling cancer of the blood, also known as leukaemia.

Like Alinaitwe, many children are battling the cancer.

According to James Kafeero, an oncologist at the Uganda Cancer Institute, Mulago Hospital, childhood leukaemia is on the rise.

“We diagnose, at most, two cases at the institute every day. Leukaemia cases contribute to about 15% of childhood cancers in Uganda,” he adds.

Cause Kafeero notes that leukaemia is among the curable childhood cancers, if diagnosed early and treated in time.

It comes about when large numbers of abnormal white blood cells are produced in the bone marrow, flooding the blood, he explains.

The abnormal cells fail to protect the body against diseases because they are defective. As the cancer progresses, it interferes with the production of cells, including red blood cells and platelets.

Accumulation of the ineffective white blood cells results in anaemia, necessitating frequent blood transfusions, says Peter Barongo, an oncologist (cancer specialist).

Signs

These include body weakness and fatigue, bleeding from the gums and under the skin, pain in the long bones, progressive weight loss and low appetite.

Other symptoms are sweating at night, frequent fevers, infections which do not respond to medication, abdominal swelling caused by the swelling of the spleen and visual blurring, or headaches.

Kafeero says leukemia can be acute (rapid developing) or chronic (slowly developing). The commonest form of leukemia among young children is acute lymphoblastic leukemia, where the bone marrow makes too many white blood cells.

Diagnosis

Barongo says a blood and bone marrow test has to be done. Once a child presents with leukemia symptoms, a thin film or blood test is done to ascertain the number of immature white blood cells.

If the number of cells is above what is normal, then a bone marrow test is done to confirm. Bone marrow test and film analysis are free at Mulago Hospital. In private clinics, the cost of bone marrow test ranges from sh250,000 to sh300,000, while sh50,000 is charged for a film analysis.

The cost of a blood test is about sh15,000 in private clinics.

Risk factors

Kafeero says having a first degree relative, for example a brother or sister who has had leukemia is a risk factor.

Children with underlying genetic disorders, for instance Downs’s syndrome, previous exposure to ionizing radiations like X-rays and atomic/nuclear reaction exposure also predisposes one to leukemia.

Other risk factors are previous exposure to chemotherapy regimens, insecticides and herbicides containing benzene compounds.

Care and treatment

“The biggest control strategy of childhood leukemia is early diagnosis and treatment because most childhood cancers are curable,” says Barongo.

Treatment, however, varies from supportive treatment to chemotherapy and surgery. Kafeero recommends supportive treatment, for example blood transfusion, control and treatment of infections and good nutrition.

Chemotherapy: Cancer drugs are given to children with leukemia in different phases to prevent recurrence of the disease.

This may last about three months, with a dose given every month.

Surgery: This involves doing a bone marrow transplant. “In Uganda, we are not yet able to do these transplants though this is the most effective way to treat childhood leukemia,” says Kafeero

Cancer, being a long-standing illness, makes treatment quite expensive. The expenses include hospitalisation costs, including the attendants,’ investigation expenses, drug costs as well as blood supplies and transportation costs.

However treatment is free at the Uganda Cancer Institute.