In most cases, an AAA causes no noticeable symptoms. However, if it becomes large, some
people may develop a pain or a pulsating feeling in their abdomen (tummy) or
persistent back pain.
An AAA doesn't usually pose a serious threat to health, but there's a risk that a larger
aneurysm could burst (rupture).
A ruptured aneurysm can cause massive internal bleeding, which is usually fatal. Around 8 out
of 10 people with a rupture either die before they reach hospital or don't survive surgery.
The most common symptom of a ruptured aortic aneurysm is sudden and severe pain in the
abdomen.
If you suspect that you or someone else has had a ruptured aneurysm, call 999 immediately and
ask for an ambulance.
Read more about the symptoms of an AAA.
In most cases, an unruptured abdominal aortic aneurysm (AAA) will cause no symptoms, unless
it becomes particularly large.
Symptoms of an unruptured AAA may include:
a pulsating feeling in your stomach (abdomen), usually near your belly button,
that’s usually only noticeable when you touch it
persistent back pain
persistent abdominal pain
If you have any of the symptoms above, you should see your GP as soon as possible.
It’s not known exactly what causes the aortic wall to weaken, although increasing age
and being male are known to be the biggest risk factors.
There are other risk factors you can do something about, including smoking and having high
blood pressure and cholesterol level.
Having a family history of aortic aneurysms also means that you have an increased risk of
developing one yourself.
Read more about the causes of an AAA.
The aorta is the largest blood vessel in the body. It transports oxygen-rich blood away from
the heart to the rest of the body.
An abdominal aortic aneurysm (AAA) occurs when part of the aorta wall becomes weakened and
the large amount of blood that passes through it puts pressure on the weak spot, causing it to
bulge outwards to form an aneurysm.
The abdominal aorta is usually around 2cm wide about the width of a garden hosepipe
but can swell to over 5.5cm, which is what doctors classify as a large aneurysm.
Because AAAs usually cause no symptoms, they tend to be diagnosed either as a result of screening or during a routine examination for example, if a GP notices a pulsating sensation in your abdomen.
The screening test is an ultrasound scan, which allows the size of your abdominal aorta to be measured on a monitor. This is also how an aneurysm will be diagnosed if your doctor suspects you have one.
Read more about diagnosing an AAA.
An abdominal aortic aneurysm (AAA) usually causes no symptoms. Therefore, they tend to be diagnosed as a result of screening, or during a routine physical examination when a GP notices a distinctive pulsating sensation in your abdomen.
A diagnosis can be confirmed using an ultrasound scan. Ultrasound can also determine the size of the aneurysm, which is an important factor in deciding on a course of treatment.
If a large AAA is detected before it ruptures, most people will be advised to have treatment,
to prevent it rupturing.
This is usually done with surgery to replace the weakened section of the blood vessel with a
piece of synthetic tubing.
If surgery is not advisable or if you decide not to have it there are a number of
non-surgical treatments that can reduce the risk of an aneurysm rupturing.
They include medications to lower your cholesterol and blood pressure, and quitting smoking.
You will also have the size of your aneurysm checked regularly with ultrasound scanning.
Read more about treating AAAs.
Treatment for an abdominal aortic aneurysm (AAA) depends on several factors, including the
aneurysm’s size, your age and general health.
In general, if you have a large aneurysm (5.5cm or larger) you will be advised to have
surgery, either to strengthen the swollen section of the aorta or to replace it with a piece
of synthetic tubing.
This is because the risk of the aneurysm rupturing is usually greater than the risk of having
it repaired.
If you have a small (3.0-4.4cm) or medium (4.5-5.4cm) aneurysm, you will be offered regular
scans to check its size.
You will also be given advice on how to slow its growth and reduce the risk of it
rupturing for example, stopping smoking and perhaps medications to reduce your
blood pressure and cholesterol level.
Emergency treatment for a ruptured AAA is based on the same principle as preventative
treatment. Grafts are used to repair the ruptured aneurysm.
The decision on whether to perform open or endovascular surgery is made on a case-by-case
basis by the surgeon carrying out the operation.
The best way to prevent getting an aneurysm or reduce the risk of an aneurysm growing
bigger and possibly rupturing is to avoid anything that could damage your blood vessels,
such as:
smoking
eating a high-fat diet
not exercising regularly
being overweight or obese
Read more about preventing aneurysms.
The best way to prevent getting an aneurysm, or reduce the risk of an aneurysm growing bigger
and possibly rupturing, is to avoid anything that could damage your blood vessels.
This includes:
smoking
eating a high-fat diet
not exercising regularly
being overweight or obese
If your GP finds out you have high blood pressure or a high cholesterol level, you may be
prescribed medication for both. This will reduce the risk of developing an abdominal aortic
aneurysm (AAA).
Acne is most commonly linked to the changes in hormone levels during puberty, but can start at any age.
Certain hormones cause the grease-producing glands next to hair follicles in the skin to produce larger amounts of oil (abnormal sebum).
This abnormal sebum changes the activity of a usually harmless skin bacterium called P. acnes, which becomes more aggressive and causes inflammation and pus.
The hormones also thicken the inner lining of the hair follicle, causing blockage of the pores (opening of the hair follicles). Cleaning the skin doesn’t help to remove this blockage.
Other possible causes
Acne is known to run in families. If both your mother and father had acne, it’s likely that you’ll also have acne.
Hormonal changes, such as those that occur during the menstrual cycle or pregnancy, can also lead to episodes of acne in women.
There’s no evidence that diet, poor hygiene or sexual activity play a role in acne.
Read more about the causes of acne, including some common acne myths.
Acne is caused when tiny holes in the skin, known as hair follicles, become blocked.
Sebaceous glands are tiny glands found near the surface of your skin. The glands are attached to hair follicles, which are small holes in your skin that an individual hair grows out of.
Sebaceous glands lubricate the hair and the skin to stop it drying out. They do this by producing an oily substance called sebum.
In acne, the glands begin to produce too much sebum. The excess sebum mixes with dead skin cells and both substances form a plug in the follicle.
If the plugged follicle is close to the surface of the skin, it bulges outwards, creating a whitehead. Alternatively, the plugged follicle can be open to the skin, creating a blackhead.
Normally harmless bacteria that live on the skin can then contaminate and infect the plugged follicles, causing papules, pustules, nodules or cysts.
Teenage acne is thought to be triggered by increased levels of a hormone called testosterone, which occurs during puberty. The hormone plays an important role in stimulating the growth and development of the penis and testicles in boys, and maintaining muscle and bone strength in girls.
The sebaceous glands are particularly sensitive to hormones. It’s thought that increased levels of testosterone cause the glands to produce much more sebum than the skin needs.
Your pharmacist can diagnose acne by looking at your skin. This involves examining your face and possibly your chest and back for different types of spot, such as blackheads or sore, red nodules.
How many spots you have and how painful and inflamed they are will help determine how severe your acne is. This is important in planning your treatment.
4 grades can be used to measure the severity of acne:
grade 1 (mild) – acne is mostly confined to whiteheads and blackheads, with just a few papules and pustules
grade 2 (moderate) – there are multiple papules and pustules, which are mostly confined to the face
grade 3 (moderately severe) – there’s a large number of papules and pustules, as well as the occasional inflamed nodule, and the back and chest are also affected by acne
grade 4 (severe) – there’s a large number of large, painful pustules and nodules
More severe acne can affect the back and neck.Source: https://dermnetnz.org/
Pharmacy First Scotland: Acne treatment from your pharmacyIf you have acne you can get advice and treatment directly from a pharmacy. Find your local pharmacy on Scotland’s Service Directory.Search for a pharmacy near you
Acne isn’t usually serious and can be treated by a pharmacist. If your acne is severe or appears on your chest and back, it may need to be treated with antibiotics or stronger creams that are only available on prescription. Your pharmacist can advise on whether you need to see your GP for further treatment.
If you develop nodules or cysts, they need to be treated properly through your GP to avoid scarring. Try to resist the temptation to pick or squeeze the spots, as this can lead to permanent scarring.
Treatment for acne depends on how severe it is. It can take several months of treatment before acne symptoms improve.
The various treatments for acne are outlined below.
If you just have a few blackheads, whiteheads and spots, you should be able to treat them successfully with over-the-counter gels or creams (topical treatments) that contain benzoyl peroxide.
See your GP if your acne is more widespread, as you probably need prescription medication. For example, if:
you have a large number of papules and pustules
over-the-counter medication hasn’t worked
Prescription medications that can be used to treat acne include:
topical retinoids
topical antibiotics
azelaic acid
antibiotic tablets
in women, the combined oral contraceptive pill
isotretinoin tablets
If you have severe acne, your GP can refer you to an expert in treating skin conditions (dermatologist). For example, if you have:
a large number of papules and pustules on your chest and back, as well as your face
painful nodules
A combination of antibiotic tablets and topical treatments is usually the first treatment option for severe acne. If this doesn’t work, a medication called isotretinoin may be prescribed.
Hormonal therapies or the combined oral contraceptive pill can also be effective in women who have acne. However, the progestogen-only pill or contraceptive implant can sometimes make acne worse.
Many of these treatments can take 2 to 3 months before they start to work. It’s important to be patient and persist with a recommended treatment, even if there’s no immediate effect.
Benzoyl peroxide
Benzoyl peroxide works as an antiseptic to reduce the number of bacteria on the surface of the skin. It also helps to reduce the number of whiteheads and blackheads, and has an anti-inflammatory effect.
Benzoyl peroxide is usually available as a cream or gel. It’s used either once or twice a day. It should be applied 20 minutes after washing to all of the parts of your face affected by acne.
It should be used sparingly, as too much can irritate your skin. It also makes your face more sensitive to sunlight, so avoid too much sun and ultraviolet (UV) light, or wear sun cream.
Benzoyl peroxide can have a bleaching effect, so avoid getting it on your hair or clothes.
Common side effects of benzoyl peroxide include:
dry and tense skin
a burning, itching or stinging sensation
some redness and peeling of the skin
Side effects are usually mild and should pass once the treatment has finished.
Most people need a 6 week course of treatment to clear most or all of their acne. You may be advised to continue treatment less frequently to prevent acne returning.
Topical retinoids
Topical retinoids work by removing dead skin cells from the surface of the skin (exfoliating) which helps to prevent them building up within hair follicles.
Tretinoin and adapalene are topical retinoids used to treat acne. They’re available in a gel or cream and are usually applied once a day before you go to bed.
Apply to all the parts of your face affected by acne 20 minutes after washing your face.
It’s important to apply topical retinoids sparingly and avoid excessive exposure to sunlight and UV.
Topical retinoids aren’t suitable for use during pregnancy, as there’s a risk they might cause birth defects.
The most common side effects of topical retinoids are mild irritation and stinging of the skin.
A 6 week course is usually required, but you may be advised to continue using the medication less frequently after this.
Topical antibiotics
Topical antibiotics help kill the bacteria on the skin that can infect plugged hair follicles. They’re available as a lotion or gel that is applied once or twice a day.
A 6 to 8 week course is usually recommended. After this, treatment is usually stopped, as there’s a risk that the bacteria on your face could become resistant to the antibiotics. This could make your acne worse and cause additional infections.
Side effects are uncommon, but can include:
minor irritation of the skin
redness and burning of the skin
peeling of the skin
Azelaic acid
Azelaic acid is often used as an alternative treatment for acne if the side effects of benzoyl peroxide or topical retinoids are particularly irritating or painful.
Azelaic acid works by getting rid of dead skin and killing bacteria. It’s available as a cream or gel and is usually applied twice a day (or once a day if your skin is particularly sensitive).
The medication doesn’t make your skin sensitive to sunlight, so you don’t have to avoid exposure to the sun.
You’ll usually need to use azelaic acid for a month before your acne improves.
The side effects of azelaic acid are usually mild and include:
burning or stinging skin
itchiness
dry skin
redness of the skin
Several treatments for acne don’t involve medication.
These include:
comedone extractor – a small pen-shaped instrument that can be used to clean out blackheads and whiteheads
chemical peels – where a chemical solution is applied to the face, causing the skin to peel off and new skin to replace it
photodynamic therapy – where light is applied to the skin in an attempt to improve symptoms of acne
However, these treatments may not work and can’t be routinely recommended.
Treatments for acne scarring are regarded as a type of cosmetic surgery, which isn’t usually available on the NHS. However, in the past, exceptions have been made when it’s been shown that acne scarring has caused serious psychological distress.
See your GP if you’re considering having cosmetic surgery. They’ll be able to discuss your options with you and advise you about the likelihood of having the procedure carried out on the NHS.
Many private clinics offer treatment for acne scarring. Prices can vary widely (from £500 to more than £10,000) depending on the type of treatment needed.
The British Association of Plastic, Reconstructive and Aesthetic Surgeons website has more information about private treatment available in your area.
It’s important to have realistic expectations about what cosmetic treatment can achieve. While treatment can certainly improve the appearance of your scars, it can’t get rid of them completely.
After treatment for acne scarring, most people notice a 50-75% improvement in their appearance.
Some of the available treatments for acne scarring are explained below.
Dermabrasion
Dermabrasion involves removing the top layer of skin, either using lasers or a specially made wire brush.
After the procedure, your skin will look red and sore for several months, but as it heals you should notice an improvement in the appearance of your scars.
Laser treatment
Laser treatment can be used to treat mild to moderate acne scarring. There are 2 types of laser treatment:
ablative laser treatment – where lasers are used to remove a small patch of skin around the scar to produce a new, smooth-looking area of skin
non-ablative laser treatment – where lasers are used to stimulate the growth of new collagen (a type of protein found in skin), which helps to repair some of the damage caused by scarring, and improves the appearance
Punch techniques
Punch techniques are used to treat ice pick scars and boxcar scars. There are 3 types of punch technique:
punch excision – used to treat mild ice pick scars. The scar is surgically removed and the remaining wound is sealed. After the wound heals, it leaves a smoother and more even area of skin.
punch elevation – used to treat boxcar scars. The base of the scar is surgically removed, leaving the sides of the scar in place. The base is then reattached to the sides, but lifted up so it’s level with the surface of the skin. This makes the scar much less noticeable.
punch grafting – used to treat very deep ice pick scars. As with a punch excision, the scar is removed, but the wound is “plugged” with a sample of skin taken from elsewhere on the body (usually from the back of the ear).
Subcision
Subcision is a surgical treatment that can be used to treat rolling scars. During surgery, the upper layer of the skin is removed from the underlying scar tissue. This allows blood to pool under the affected area. The blood clot helps form connective tissue, which pushes up the rolling scar so it’s level with the rest of the surface of the skin.
Once subscision has been completed, additional treatment, such as laser treatment and dermabrasion, can be used to further improve the appearance of the scar.
Acne scarring can sometimes develop as a complication of acne. Any type of acne spot can lead to scarring, but it’s more common when the most serious types of spots (nodules and cysts) burst and damage nearby skin.
Scarring can also occur if you pick or squeeze your spots, so it’s important not to do this.
There are 3 main types of acne scars:
ice pick scars – small, deep holes in the surface of your skin that look like the skin has been punctured with a sharp object
rolling scars – caused by bands of scar tissue that form under the skin, giving the surface of the skin a rolling and uneven appearance
boxcar scars – round or oval depressions, or craters, in the skin
The affected part of the abdomen is usually extremely tender, and breathing deeply can make the pain worse.
Unlike some others types of abdominal pain, the pain associated with acute cholecystitis is usually persistent, and doesn’t go away within a few hours.
Some people may additional symptoms, such as:
a high temperature (fever)
nausea and vomiting
sweating
loss of appetite
yellowing of the skin and the whites of the eyes (jaundice)
a bulge in the abdomen
a high temperature (fever)
nausea and vomiting
sweating
loss of appetite
yellowing of the skin and the whites of the eyes (jaundice)
a bulge in the abdomen
The causes of acute cholecystitis can be grouped into 2 main categories: calculous cholecystitis and acalculous cholecystitis.
Calculous cholecystitis
Calculous cholecystitis is the most common, and usually less serious, type of acute cholecystitis. It accounts for around 95% of all cases.
Calculous cholecystitis develops when the main opening to the gallbladder, called the cystic duct, gets blocked by a gallstone or by a substance known as biliary sludge.
Biliary sludge is a mixture of bile (a liquid produced by the liver that helps digest fats) and small crystals of cholesterol and salt.
The blockage in the cystic duct results in a build-up of bile in the gallbladder, increasing the pressure inside it and causing it to become inflamed. In around 1 in every 5 cases, the inflamed gallbladder also becomes infected by bacteria.
Acalculous cholecystitis
Acalculous cholecystitis is a less common, but usually more serious, type of acute cholecystitis. It usually develops as a complication of a serious illness, infection or injury that damages the gallbladder.
Acalculous cholecystitis is often associated with problems such as accidental damage to the gallbladder during major surgery, serious injuries or burns, blood poisoning (sepsis), severe malnutrition or AIDS.
To diagnose acute cholecystitis, your GP will examine your abdomen.
They will probably carry out a simple test called Murphy’s sign. You will be asked to breathe in deeply with your GP’s hand pressed on your tummy, just below your rib cage.
Your gallbladder will move downwards as your breathe in and, if you have cholecystitis, you will experience sudden pain as your gallbladder reaches your doctor’s hand.
If your symptoms suggest you have acute cholecystitis, your GP will refer you to hospital immediately for further tests and treatment.
Tests you may have in hospital include:
blood tests to check for signs of inflammation in your body
an ultrasound scan of your abdomen to check for gallstones or other signs of a problem with your gallbladder
Other scans – such as an X-ray, a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan – may also be carried out to examine your gallbladder in more detail if there is any uncertainty about your diagnosis.
Contact your GP practice if:
you develop sudden and severe abdominal pain, particularly if the pain lasts longer than a few hours or you have other symptoms, such as jaundice and a fever
If your GP practice is closed, phone 111.
It’s important for acute cholecystitis to be diagnosed as soon as possible, because there is a risk that serious complications could develop if the condition is not treated promptly.
If you are diagnosed with acute cholecystitis, you will probably need to be admitted to hospital for treatment.
Initial treatment
Initial treatment will usually involve:
fasting (not eating or drinking) to take the strain off your gallbladder
receiving fluids through a drip directly into a vein (intravenously) to prevent dehydration
taking medication to relieve your pain
If you have a suspected infection, you will also be given antibiotics. These often need to be continued for up to a week, during which time you may need to stay in hospital or you may be able to go home.
With this initial treatment, any gallstones that may have caused the condition usually fall back into the gallbladder and the inflammation often settles down.
Surgery
In order to prevent acute cholecystitis recurring, and reduce your risk of developing potentially serious complications, the removal of your gallbladder will often be recommended at some point after the initial treatment. This type of surgery is known as a cholecystectomy.
Although uncommon, an alternative procedure called a percutaneous cholecystostomy may be carried out if you are too unwell to have surgery. This is where a needle is inserted through your abdomen to drain away the fluid that has built up in the gallbladder.
If you are fit enough to have surgery, your doctors will need to decide when the best time to remove your gallbladder may be. In some cases, you may need to have surgery immediately or in the next day or 2, while in other cases you may be advised to wait for the inflammation to fully resolve over the next few weeks.
Surgery can be carried out in two main ways:
laparoscopic cholecystectomy – a type of keyhole surgery where the gallbladder is removed using special surgical instruments inserted through a number of small cuts (incisions) in your abdomen
open cholecystectomy – where the gallbladder is removed through a single, larger incision in your abdomen
Although some people who have had their gallbladder removed have reported symptoms of bloating and diarrhoea after eating certain foods, you can lead a perfectly normal life without a gallbladder.
The organ can be useful but it’s not essential, as your liver will still produce bile to digest food.
It’s not always possible to prevent acute cholecystitis, but you can reduce your risk of developing the condition by cutting your risk of gallstones.
One of the main steps you can take to help lower your chances of developing gallstones is adopting a healthy, balanced diet and reducing the number of high-cholesterol foods you eat, as cholesterol is thought to contribute to the formation of gallstones.
Being overweight, particularly being obese, also increases your risk of developing gallstones. You should therefore control your weight by eating a healthy diet and exercising regularly.
However, low-calorie, rapid weight loss diets should be avoided, because there is evidence they can disrupt your bile chemistry and actually increase your risk of developing gallstones. A more gradual weight loss plan is best.
Read more about preventing gallstones.
Without appropriate treatment, acute cholecystitis can sometimes lead to potentially life-threatening complications.
The main complications of acute cholecystitis are:
the death of the tissue of the gallbladder, called gangrenous cholecystitis, which can cause a serious infection that could spread throughout the body
the gallbladder splitting open, known as a perforated gallbladder, which can spread the infection within your abdomen (peritonitis) or lead to a build-up of pus (abscess)
In about 1 in every 5 cases of acute cholecystitis, emergency surgery to remove the gallbladder is needed to treat these complications.
Symptoms of acute lymphoblastic leukaemia usually begin slowly before rapidly getting severe as the number of blast cells (immature white blood cells) in your blood increases.
Most of the symptoms are caused by the lack of healthy blood cells in your blood supply.
Symptoms of acute lymphoblastic leukaemia include:
pale skin
feeling tired and breathless
having repeated infections over a short space of time
unusual and frequent bleeding, such as bleeding gums or nose bleeds
high temperature (fever) of 38C (100.4F) or above
night sweats
bone and joint pain
easily bruised skin
swollen lymph nodes (glands)
abdominal pain – caused by a swollen liver or spleen
unexplained weight loss
a purple skin rash (purpura)
In some cases of acute lymphoblastic leukaemia, the affected cells can spread from your bloodstream into your central nervous system. This can cause a series of neurological symptoms (related to the brain and nervous system), including:
headaches
seizures (fits)
vomiting
blurred vision
dizziness
Acute lymphoblastic leukaemia is caused by a DNA mutation in the stem cells causing too many white blood cells to be produced.
The white blood cells are also released from the bone marrow before they are mature and able to fight infection like fully developed white blood cells.
As the number of immature cells increases, the number of healthy red blood cells and platelets fall, and it’s this fall which causes many of the symptoms of leukaemia.
It is not known exactly what causes this DNA mutation to occur, but there are a few factors which may increase the risk of developing acute lymphoblastic leukaemia.
The first step in diagnosing acute lymphoblastic leukaemia is for your GP to check for physical signs of the condition, such as swollen glands, and to take a blood sample.
A high number of abnormal white blood cells in the blood sample could indicate the presence of acute leukaemia and you will then be referred to a haematologist (a specialist in treating blood conditions).
There are various additional tests that can be used to help reveal more information about the progress and extent of the leukaemia. They can also provide an insight into how the leukaemia should be treated. These tests are described below.
Cytogenetic testing
Cytogenetic testing involves identifying the genetic make-up of the cancerous cells. There are specific genetic variations that can occur during leukaemia, and knowing what these variations are can have an important impact on treatment.
Immunophenotyping
Immunophenotyping is a test to help identify the exact type of acute lymphoblastic leukaemia. A sample of blood, bone marrow or another type of fluid is studied.
This testing is important as the treatment needed may be slightly different for each type.
Polymerase chain reaction (PCR)
A polymerase chain reaction (PCR) test can be done on a blood sample. This is an important test to diagnose and monitor the response to treatment.
The blood test is repeated every three months for at least two years after starting treatment, then less often once remission is achieved.
Lymph node biopsy
If you have been diagnosed with acute leukaemia, further biopsies may be carried out on any enlarged lymph nodes that you have. These will be able to establish how far the leukaemia has spread.
CT scans
If you have acute leukaemia, a computerised tomography scan (CT scan) may be used to check that your organs, such as your heart and lungs, are healthy.
Chest X-ray
An X-ray may be performed to examine the chest for any swollen lymph nodes.
Lumbar puncture
If it is felt that there is a risk that acute leukaemia has spread to your nervous system, a lumbar puncture may be carried out.
A lumbar puncture is a test where a needle is used under local anaesthetic to extract a sample of cerebrospinal fluid (fluid that surrounds and protects your spine) from your back. The fluid is tested to determine whether the leukaemia has reached your nervous system.
If you or your child has some or even all of these symptoms, it is still highly unlikely that acute leukaemia is the cause.
However, see your GP as soon as possible because any condition that causes these symptoms needs to be promptly investigated and treated.
Treatment for acute lymphoblastic leukaemia usually begins a few days after diagnosis as it’s an aggressive condition that develops rapidly.
Treatment for acute lymphoblastic leukaemia is carried out in stages:
induction – the aim of the initial stage of treatment is to kill the leukaemia cells in your bone marrow, restore the balance of cells in your blood and resolve any symptoms you may have
consolidation – this stage aims to kill any remaining leukaemia cells in your central nervous system
maintenance – the final stage involves taking regular doses of chemotherapy tablets to prevent the leukaemia returning
Maintenance only seems to be effective in treating acute lymphoblastic leukaemia; it’s not usually used in the treatment of acute myeloid leukaemia.
As well as chemotherapy and imatinib, other treatments are used in some circumstances. These are described below.
Dasatinib
Dasatinib is a new type of medication used to treat Philadelphia chromosome-positive acute lymphoblastic leukaemia, when all other treatments have proved unsuccessful.
Dasatinib blocks a protein called tyrosine kinase that helps stimulate the growth of cancer cells.
Dasatinib cannot cure acute leukaemia but it can slow its growth, helping to relieve symptoms and prolong life.
The National Institute for Health and Care Excellence (NICE) has not yet made a decision about whether the NHS should provide treatment with dasatinib for people with acute lymphoblastic leukaemia. This means it will be at the discretion of your local clinical commissioning group as to whether you will be offered the drug.
Radiotherapy
Radiotherapy involves using high doses of controlled radiation to kill cancerous cells. There are two main reasons why radiotherapy is usually used to treat acute leukaemia:
to sometimes treat advanced cases of acute lymphoblastic leukaemia that have spread to the nervous system or brain
to prepare the body for a bone marrow transplant (see below)
Side effects of both types of radiotherapy include:
hair loss
nausea
fatigue
The side effects should pass once your course of radiotherapy has been completed. However, your skin may be very sensitive to the effects of light for several months after the treatment has finished. If this is the case, avoid sunbathing or exposure to sources of artificial light, such as sunbeds, for several months.
Many younger children treated with radiotherapy will go on to have restricted physical growth during puberty.
A small number of people develop cataracts several years after radiotherapy. Cataracts are cloudy patches in the lens (the transparent structure at the front of the eye) that can make your vision blurred or misty. Cataracts can usually be successfully treated using surgery.
Read more about cataracts
Bone marrow and stem cell transplants
If you or your child do not respond to chemotherapy, a possible alternative treatment option is bone marrow or stem cell transplantation.
Transplantations are more successful if the donor has the same tissue type as you, so the ideal donor is usually a brother or sister.
Before transplantation can take place, the person receiving the transplant will need to have aggressive high-dose chemotherapy and radiotherapy to destroy any cancerous cells in their body.
This can put a big strain on the body so transplantations are usually only successful when they are carried out in children and young people, or older people who are in good health, and when there is a suitable donor, such as a brother or sister.
Read about bone marrow transplantation for more information
Being immunocompromised (having a weakened immune system) is a possible complication for some patients with acute leukaemia.
There are 2 reasons for this:
the lack of healthy white blood cells means that your immune system is less able to fight infection
many of the medicines used to treat acute leukaemia can weaken the immune system
This means that you are more vulnerable to developing an infection, and that any infection you have has an increased potential to cause serious complications.
You may be advised to take regular doses of antibiotics to prevent infections occurring. You should immediately report any possible symptoms of an infection to your GP or care team because prompt treatment may be required to prevent serious complications.
Symptoms of infection include:
high temperature (fever) of 38C (101.4F) or above
headache
aching muscles
diarrhoea
tiredness
Avoid contact with anyone who is known to have an infection, even if it is a type of infection that you were previously immune to, such as chickenpox or measles. This is because your previous immunity to these conditions will probably be lower.
While it is important to go outside on a regular basis, both for exercise and for your psychological wellbeing, avoid visiting crowded places and using public transport during rush hour.
Also ensure that all of your vaccinations are up-to-date. Your GP or care team will be able to advise you about this. You will be unable to have any vaccine containing activated particles of viruses of bacteria such as:
the mumps, measles and rubella (MMR) vaccine
the polio vaccine
the oral typhoid vaccine
the BCG vaccine (used to vaccinate against tuberculosis)
the yellow fever vaccine
As the leukaemia cells multiply in the bone marrow, the production of normal blood cells is reduced. Children may therefore become tired and lethargic because of anaemia, which is caused by a lack of red blood cells.
Children may develop bruises, and bleeding may take longer to stop because of the low number of platelets present in their blood (which help blood to clot). Sometimes, children suffer from infections because of low numbers of normal white blood cells.
A child is likely to feel generally unwell and may complain of aches and pains in the limbs or may have swollen lymph glands.
At first, the symptoms are just like those of a viral infection, but when they continue for more than a week or two, the diagnosis usually becomes clear.
The exact cause of ALL is unknown. Research is going on all the time into possible causes of this disease. Children with certain genetic disorders, such as Down’s syndrome, are known to have a higher risk of developing leukaemia. Brothers and sisters of a child with ALL (particularly identical twins) have a slightly increased risk of developing ALL themselves, although this risk is still small.
Like all cancers, ALL is not infectious and cannot be passed on to other people.
A blood test usually shows low numbers of normal white blood cells and the presence of the abnormal leukaemia cells. A sample of bone marrow is usually needed to confirm the diagnosis. A sample is also sent to the genetics department to look for any abnormal chromosomes, and for a test called MRD (minimal residual disease) analysis.
A test called a lumbar puncture is done to see if the spinal fluid contains any leukaemia cells. A chest X-ray is also done, which will show if there are any enlarged glands in the chest. Other tests may be necessary, depending on your child’s symptoms.
These tests will help to identify the precise type of leukaemia and help doctors decide on the best treatment.
The aim of treatment for ALL is to destroy the leukaemia cells and enable the bone marrow to work normally again. Chemotherapy is the main treatment for ALL and is given according to a treatment plan (often called a protocol or regimen).
The treatment is given in several phases, or ‘blocks’.
Induction
This phase involves intensive treatment, aimed at destroying as many leukaemia cells as possible and is usually started within days of being diagnosed. The induction phase lasts 4 to 6 weeks. A bone marrow test is taken at the end of induction treatment to confirm whether or not the child still has leukaemia. The sample that is taken is looked at under a microscope and when there is no evidence of leukaemia, the child’s condition is referred to as being in ‘remission’.
Consolidation and central nervous system (CNS) treatment
The next phase of treatment is aimed at maintaining the remission and preventing the spread of leukaemia cells into the brain and spinal cord (the central nervous system, or CNS). CNS treatment involves injecting a drug, usually methotrexate lumbar puncture.
After this consolidation treatment there is a recovery period which is called interim maintenance. This is when more drugs will be given to try to keep the leukaemia in remission. The exact details will depend on which arm of treatment your child follows and will be discussed in detail by your child’s doctor as it depends on your child’s response to treatment so far.
Further doses of chemotherapy treatment, called ‘delayed intensification’, are given to kill off any remaining leukaemia cells.
Maintenance treatment
This phase of treatment lasts for 2 years from the start of interim maintenance for girls and 3 years from the start of interim maintenance for boys. It involves the child taking daily and weekly tablets, some children also have monthly injections of chemotherapy and oral pulses of steroids and 3-monthly intrathecal treatment.
Children will be able to take part in their normal daily activities as soon as they feel able to. Most children return to school before beginning maintenance treatment.
Bone marrow transplantation
Bone marrow treatment is only needed by a minority of patients and is used for children with ALL that is likely to come back following standard chemotherapy.
Testicular radiotherapy
In some situations, it may be necessary for boys to have radiotherapy to their testicles. This is because leukaemia cells can survive in the testicles despite chemotherapy.
Central nervous system (CNS) radiotherapy
Children who have leukaemia cells in their CNS when they are first diagnosed with ALL need more frequent lumbar punctures with intrathecal chemotherapy. Your child’s specialist will discuss with you which treatment and how much of it your child needs, and will answer any questions you have.
Side effects of treatment
Many cancer treatments will cause side effects. This is because while the treatments are killing the cancer cells, they can also damage some normal cells.
Some of the main side effects of chemotherapy are:
hair loss
reduction in the number of blood cells produced by the bone marrow, which can cause anaemia (increased risk of bruising, bleeding and infection
loss of appetite
feeling sick (nausea) and being sick (vomiting)
Steroid medicines can also cause side effects such as:
increased appetite
mood changes and irritability
weight gain
muscle weakness (especially in the legs)
Most side effects are temporary, and there are ways of reducing them and supporting your child through them. Your child’s doctor or nurse will talk to you about any possible side effects. It’s important to discuss any side effects your child is having with the team treating them, so that they know how your child is feeling.
Late side effects of treatment
A small number of children may develop late side effects, sometimes many years later. These include possible problems with puberty and fertility, a change in the way their heart works and a small increase in the risk of developing another cancer later in life. Your child’s doctor or nurse will talk to you about any possible late side effects.
Clinical trials
Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Specialist doctors carry out trials for ALL.
If appropriate, your child’s medical team will talk to you about taking part in a clinical trial and will answer any questions you have. Written information is provided to help explain things.
Taking part in a research trial is completely voluntary, and you’ll be given enough time to decide if it is right for your child.
Treatment guidelines
Sometimes, clinical trials are not available for your child. This may be because a recent trial has just finished, or because the condition is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the UK. The Children’s Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines.
Follow-up care
Most children with ALL are cured. If the leukaemia recurs after initial treatment, it usually does so within the first three years. Further treatment can then be given.
Long-term side effects (late side effects) are rare, and most children with ALL grow and develop normally.
If you have specific concerns about your child’s condition and treatment, it’s best to discuss them with your child’s doctor, who knows the situation in detail.
Many of the symptoms of ALL are caused by having fewer than normal healthy blood cells in the body. Symptoms can include:
looking paler than usual and feeling tired – because of too few red blood cells (anaemia)
bruises – you may bruise more easily and it could take longer for bleeding to stop, if you have less blood clotting cells (platelets) than normal
infections – because there are too few mature white blood cells to fight infection
aches and pains in your bones
swollen glands (lymph nodes) in your neck, under your arm or in your groin
feeling unwell and run down
fever and sweats – you may have a high temperature without any obvious cause, such as an infection
headaches and visual disturbance
There can be other reasons you may have these symptoms. But if you are worried that you may have ALL, you should speak to your GP. They’ll examine you and refer you to a hospital if they think you need to see a specialist doctor.
It’s not known exactly what causes ALL. Research is going on to try to find out.
Young people with some genetic conditions, such as Down’s syndrome or Li-Fraumeni syndrome, are at an increased risk of developing ALL. A genetic condition is something you are born with.
To understand leukaemia, it can help to know a little about the blood and bone marrow.
Leukaemia is a cancer of the white blood cells.
All blood cells are made in the bone marrow, which is like a blood cell factory inside bones. A type of cell in the bone marrow, called a stem cell, can make any kind of blood cell your body needs.
There are 3 main types of blood cells:
white blood cells – which help fight infection
red blood cells – which carry oxygen from the lungs around the body
platelets – which clot blood to stop cuts bleeding
The bone marrow normally makes millions of blood cells every day. To begin with, these new blood cells, called blasts, are not fully developed (they’re immature).
The main job of blast cells is to make more blood cells like themselves. They can’t do any of the jobs that mature blood cells can do, like carrying oxygen or fighting infection. Blast cells normally stay inside the bone marrow until they’ve matured into fully-developed blood cells.
Once blood cells are mature, they’re ready to do their jobs. They leave the bone marrow and go into the bloodstream, where they can be carried to wherever they’re needed.
It’s important to remember that the symptoms of ALL can be caused by lots of different things. But you should go to your GP if you’re worried. They can talk to you about your symptoms and arrange any tests they think you might need.
The main treatment for acute lymphoblastic leukaemia (ALL) is chemotherapy. This means having anti-cancer drugs to destroy the leukaemia cells. You’ll also have drugs called steroids, which help the chemotherapy to work.
The treatment for ALL is pretty intensive at times and can cause unpleasant side effects. But you’ll be in close contact with the hospital when you’re most likely to feel unwell and the staff will be able to help if things get tough. Don’t feel you have to be brave. Be honest about how you are feeling with your doctors and nurses. They can give you medicines that can help you feel better.
ALL is treated in 3 phases:
getting rid of the leukaemia – remission induction
keeping the leukaemia away – consolidation and delayed intensification therapy
keeping the leukaemia away long-term – continuing or maintenance therapy
You usually start chemotherapy pretty quickly after finding out that you have ALL.
You’ll be in hospital for your treatment to begin with. If you’re 18 or younger, you’ll be treated in a specialist Principal Treatment Centre (PTC) for teenagers and young adults (TYA). If you’re 19 or older, you’ll be offered the choice of having treatment at the PTC or another hospital closer to home called a TYA designated hospital.
You’ll be given chemotherapy as tablets, by injection and into your bloodstream (intravenously). You’ll also be given chemotherapy into the fluid around the spinal cord to make sure the leukaemia cells can’t hide there. This is called central nervous system (CNS) therapy. It’s also known as intrathecal therapy.
You’ll have a ‘line’ put in to one of your main veins to make it easier for you to have intravenous treatment. Your nurses and doctors can also use the line to take blood samples for blood tests. There are different kinds of lines.
Having chemotherapy can be hard. But the staff looking after you will give you medicines to help you cope with any side effects so you can stay strong enough to have treatment. And you’ll be given medicines to stop you feeling sick and antibiotics to help prevent infections.
There will probably be times when you feel rough and other times when you’ll feel better. You might also feel upset, down or irritable. Talking to someone you trust can help you cope with these feelings.
Being in hospital or coming up to hospital for clinics and treatment can be frustrating, especially when you miss out on stuff happening at school, college, university or work, or on things your friends are doing. You could try talking to your friends and family about this and see what they can do to help you. It can also help to talk to any new friends you’ve made who are going through similar experiences to you.
We have more information about chemotherapy that has been written for people of all ages, not just teens and young adults.
The symptoms of AML usually develop over a few weeks and become increasingly more severe. Symptoms can include:
pale skin
tiredness
breathlessness
frequent infections
unusual and frequent bleeding, such as bleeding gums or nosebleeds
In more advanced cases, AML can make you extremely vulnerable to life-threatening infections or serious internal bleeding.
Read more about the complications of AML
The symptoms of acute myeloid leukaemia (AML) usually develop over a few weeks, becoming more severe as the number of immature white blood cells (blast cells) in your blood increases.
Symptoms of AML can include:
pale skin
tiredness
breathlessness
a high temperature (fever)
excessive sweating
weight loss
frequent infections
unusual and frequent bleeding, such as bleeding gums or nosebleeds
easily bruised skin
flat red or purple spots on the skin (petechiae)
bone and joint pain
a feeling of fullness or discomfort in your tummy (abdomen), caused by swelling of the liver or spleen
In rare cases of AML, the affected cells can spread into the central nervous system. This can cause symptoms such as headaches, fits (seizures), vomiting, blurred vision and dizziness.
AML occurs when specialised cells called stem cells, which are found in the bone marrow (a spongy material inside the bones), produce too many immature white blood cells. These immature cells are known as blast cells.
Blast cells don’t have the infection-fighting properties of healthy white blood cells, and producing too many can lead to a decrease in the number of red blood cells (which carry oxygen in the blood) and platelets (cells that help the blood to clot).
It’s not clear exactly why this happens and, in most cases, there’s no identifiable cause. However, a number of factors that can increase your risk of developing AML have been identified. These include:
previous chemotherapy or radiotherapy
exposure to very high levels of radiation (including previous radiotherapy treatment)
exposure to benzene – a chemical used in manufacturing that’s also found in cigarette smoke
having an underlying blood disorder or genetic disorder, such as Down’s syndrome
Read more about the causes of AML
Acute myeloid leukaemia (AML) is caused by a DNA mutation in the stem cells in your bone marrow that produce red blood cells, platelets and infection-fighting white blood cells.
The mutation causes the stem cells to produce many more white blood cells that are needed.
The white blood cells produced are still immature, so they don’t have the infection-fighting properties of fully developed white blood cells. These immature cells are known as ‘blast cells’.
As the number of immature cells increases, the amount of healthy red blood cells and platelets decrease, and it’s this fall that causes many of the symptoms of leukaemia.
In the initial stages of diagnosing acute myeloid leukaemia (AML), your GP will check for physical signs of the condition and arrange for you to have blood tests.
A high number of abnormal white blood cells, or a very low blood count in the test sample, could indicate the presence of leukaemia. If this is the case, you’ll be urgently referred to a haematologist (a specialist in treating blood conditions).
A haematologist may carry out further blood tests, in addition to some of the tests outlined on this page.
Additional tests can be used to reveal more information about the progress and extent of your AML. They can also provide insight into how the condition should be treated. These tests are described below.
Genetic testing
Genetic tests can be carried out on blood and bone marrow samples to identify the genetic makeup of the cancerous cells. There are many specific genetic variations that can occur in AML, and knowing the exact type of AML you have can help doctors make decisions about the most appropriate treatment.
For example, people who have a type of AML known as acute promyelocytic leukaemia (APML) are known to respond well to a medicine called All Trans-Retinoic Acid (ATRA).
Scans
If you have AML, a computerised tomography (CT) scan, X-ray or echocardiogram (an ultrasound scan of the heart) may be used to check that your organs, such as your heart and lungs, are healthy.
These tests are carried out because it’s important for doctors to assess your general health before they can decide on the most appropriate treatment for you.
Lumbar puncture
In rare situations where it’s thought there’s a risk that AML has spread to your nervous system, a lumbar puncture may be carried out. In this procedure, a needle is used to extract a sample of cerebrospinal fluid (which surrounds and protects your spine) from your back, so it can be checked for cancerous cells.
If cancerous cells are found in your nervous system, you may need to have injections of chemotherapy medication directly into your cerebrospinal fluid as part of your treatment.
AML is an aggressive type of cancer that can develop rapidly, so treatment usually needs to begin soon after a diagnosis is confirmed.
Chemotherapy is the main treatment for AML. It’s used to kill as many leukaemia cells in your body as possible and reduce the risk of the condition coming back (relapsing).
In some cases, intensive chemotherapy and radiotherapy may be needed, in combination with a bone marrow or stem cell transplant, to achieve a cure.
Read more about treating AML
See your GP if you or your child have these symptoms. Although it’s highly unlikely that AML is the cause, these symptoms need to be investigated and treated promptly.
Acute myeloid leukaemia (AML) is an aggressive condition that develops rapidly, so treatment will usually begin a few days after a diagnosis has been confirmed.
As AML is a complex condition, it’s usually treated by a multidisciplinary team (MDT) – a group of different specialists working together.
Treatment for AML is often carried out in 2 stages:
induction – the aim of this initial stage of treatment is to kill as many leukaemia cells in your blood and bone marrow as possible, restore your blood to proper working order and treat any symptoms you may have
consolidation – this stage aims to prevent the cancer returning (relapsing), by killing any remaining leukaemia cells that may be present in your body
The induction stage of treatment isn’t always successful and sometimes needs to be repeated before consolidation can begin.
If you have a relapse after treatment, both re-induction and consolidation may need to be carried out. This may be the same as your first treatment, although it’s likely to involve different medications or a stem cell transplant.
If you’re thought to have a high risk of experiencing complications of AML treatment – for example, if you’re over 75 years of age or have another underlying health condition – less intensive chemotherapy treatment may be carried out. This is less likely to successfully kill all of the cancerous cells in your body, but it can help control your condition.
Many other treatments are used for AML.
Radiotherapy
Radiotherapy involves using high doses of controlled radiation to kill cancerous cells. There are 2 main reasons why radiotherapy is usually used to treat AML:
to prepare the body for a bone marrow or stem cell transplant
to treat advanced cases that have spread to the nervous system and/or brain, although this is uncommon
Side effects of radiotherapy can include hair loss, nausea and fatigue. The side effects should pass once your course of radiotherapy has been completed.
Bone marrow and stem cell transplants
If chemotherapy doesn’t work, a possible alternative treatment option is a bone marrow or stem cell transplant.
Before transplantation can take place, the person receiving the transplant will need to have intensive high-dose chemotherapy and possibly radiotherapy to destroy the cells in their bone marrow. The donated stem cells are given through a tube into a blood vessel, in a similar way to chemotherapy medication.
This process can put an enormous amount of strain on the body and cause significant side effects and potential complications, so you’ll usually need to stay in hospital for a few weeks.
Transplantations have better outcomes if the donor has the same tissue type as the person receiving the donation. The best candidate to provide a donation is usually a brother or sister with the same tissue type.
Transplantations are most successful when they’re carried out on children and young people, or older people who are otherwise in good health, and when there’s a suitable donor, such as a brother or sister.
Read about bone marrow donation
Azacitidine
Azacitidine is a possible alternative treatment for adults with AML who can’t have a stem cell transplant.
It’s recommended by the National Institute for Health and Care Excellence (NICE) for use in certain circumstances – for example, depending on the characteristics of the person’s blood and bone marrow.
Azacitidine is a chemotherapy medication that’s given by injection under the skin. It interferes with the growth of cancer cells and destroys them, and also helps bone marrow to produce normal blood cells.
NICE has more information about azacitidine for the treatment of AML
In the UK, a number of clinical trials are currently underway that aim to find the best way of treating AML. Clinical trials are studies that use new and experimental techniques to see how well they work in treating, and possibly curing, AML.
As part of your treatment, your care team may suggest taking part in a clinical trial to help researchers learn more about the best way to treat your AML, and AML in general. Search for clinical trials for AML.
If you take part in a clinical trial, you may be offered medication that isn’t licensed for use in the UK and isn’t normally available. However, there’s no guarantee that the techniques being studied in the clinical trial will work better than current treatments.
Your care team can tell you whether there are any clinical trials available in your area, and can explain the benefits and risks involved.
If you have acute myeloid leukaemia (AML), you may experience a number of complications. These can be caused by the condition itself, although they can also occur as a side effect of treatment.
As the leukaemia cells multiply in the bone marrow, the production of normal blood cells is reduced. Children may therefore become tired and lethargic because of anaemia, which is caused by a lack of red blood cells.
Children may develop bruises, and bleeding may take longer to stop because of the low number of platelets present in their blood. Sometimes they may suffer from infections because of low numbers of normal white blood cells.
A child is likely to feel generally unwell and may complain of aches and pains in the limbs or may have swollen lymph glands.
At first, the symptoms are just like those of a viral infection, but when they continue for more than a week or two, the diagnosis usually becomes clear.
The exact cause of AML is unknown. Research into possible causes of this disease is ongoing. Children with certain genetic disorders, such as Down’s syndrome or Li-Fraumeni syndrome, are known to have a higher risk of developing leukaemia. Brothers and sisters of a child with AML have a slightly increased risk of developing it, although this risk is still small. Other non-cancerous conditions, such as aplastic anaemia or the myelodysplastic syndromes (MDS), may increase a child’s risk of developing AML.
AML, like all types of cancer, is not infectious and cannot be passed on to other people.
A blood test usually shows low numbers of normal white blood cells and the presence of abnormal leukaemia cells. A sample of bone marrow is needed to confirm the diagnosis. The bone marrow sample is also examined to check for any abnormalities in the chromosomes of the leukaemia cells.
A test called a lumbar puncture is done to see if the spinal fluid contains any leukaemia cells. A chest X-ray is also done, which will show if there are any enlarged glands in the chest. Other tests may be necessary, depending on your child’s symptoms.
These tests will help to identify the precise type of leukaemia, and help doctors to decide on the best treatment.
The aim of treatment for AML is to destroy the leukaemia cells and enable the bone marrow to work normally again. Chemotherapy is the main treatment for AML. Usually a combination of chemotherapy drugs is given, according to a treatment plan (often called a protocol or regimen).
The treatment usually has different phases.
Induction
This phase involves intensive treatment, aimed at destroying as many leukaemia cells as possible. It usually involves 2 courses (cycles) of a combination of chemotherapy drugs.
A bone marrow test is taken at the end of induction treatment to confirm whether or not the child still has leukaemia. When there is no evidence of leukaemia, the child’s condition is referred to as being in remission.
Post-remission treatment
When there are no signs of the leukaemia in the blood or bone marrow, further treatment is often given. This phase of the treatment aims to destroy any leukaemia cells that may be left and to help stop the AML from coming back. This treatment usually involves 2 more courses of chemotherapy.
Bone marrow transplant
This treatment is usually only used for children with AML that is likely to come back or has come back (recurred) following standard chemotherapy.
Central nervous system (CNS) treatment
AML may sometimes develop in the brain and spinal cord. This can be prevented by injecting chemotherapy drugs directly into the spinal fluid during a lumbar puncture (intrathecal chemotherapy). Intrathecal chemotherapy is usually given after each of the first 2 courses of chemotherapy. Sometimes a more intensive treatment is needed, and the intrathecal drugs are given more frequently until all the regular chemotherapy has been completed. Occasionally, radiotherapy to the brain is also necessary.
Side effects of treatment
Many cancer treatments will cause side effects. This is because while the treatments are killing the cancer cells, they can also damage some normal cells.
Some of the main side effects are:
hair loss
reduction in the number of blood cells produced by the bone marrow, which can cause anaemia (increased risk of bruising, bleeding and infection)
loss of appetite and weight
feeling sick (nausea) and being sick (vomiting)
Most side effects are temporary, and there are ways of reducing them and supporting your child through them. Your child’s doctor or nurse will talk to you about side effects.
Late side effects of treatment
A small number of children may develop late side effects, sometimes many years later. These include possible problems with puberty and fertility, a change in the way the heart works, and a small increase in the risk of developing a second cancer in later life. Your child’s doctor or nurse will talk to you about any possible late side effects.
Clinical trials
Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Specialist doctors carry out trials for AML. If appropriate, your child’s medical team will talk to you about taking part in a clinical trial and will answer any questions you have. Written information is often provided to help explain things.
Taking part in a research trial is completely voluntary, and you’ll be given plenty of time to decide if it’s right for your child.
Treatment guidelines
Sometimes, clinical trials are not available for your child’s cancer. This may be because a recent trial has just finished, or because the cancer is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Children’s Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines.
Follow-up care
Many children with AML are cured. If the leukaemia comes back after initial treatment, it usually does so within the first 3 years. Most children with AML grow and develop normally.
If you have specific concerns about your child’s condition and treatment, it’s best to discuss them with your child’s doctor, who knows the situation in detail.
Many of the symptoms of AML are caused by having fewer than normal healthy blood cells in the body. Symptoms can include:
looking paler than usual and feeling tired – because of too few red blood cells (anaemia)
bruises or bleeding – you may bruise more easily and it could take longer for bleeding to stop, if you have less blood clotting cells (platelets) than normal
infections – because there are too few mature white blood cells to fight infection
aches and pains in your bones
swollen glands (lymph nodes) in your neck, under your arm or in your groin
feeling unwell and run down
fever and sweats – you may have a high temperature without any obvious cause, such as an infection
headaches and blurred vision – because of too many white blood cells
breathlessness – because of too many white blood cells.
It’s not known exactly what causes AML. Research is going on to try to find out. We do know some things might increase the risk of AML:
some genetic conditions, like Down’s Syndrome (a genetic condition is something you are born with)
some non-cancerous conditions of the bone marrow, such as aplastic anaemia or myelodysplastic syndromes
To understand leukaemia, it can help to know a little about the blood and bone marrow.
Leukaemia is a cancer of the white blood cells.
All blood cells are made in the bone marrow, which is like a blood cell factory inside bones. A type of cell in the bone marrow, called a stem cell, can make any kind of blood cell your body needs.
There are 3 main types of blood cells:
white blood cells – which help fight infection
red blood cells – which carry oxygen from the lungs around the body
platelets – which clot blood to stop cuts bleeding
The bone marrow normally makes millions of blood cells every day. To begin with, these new blood cells, called blasts, are not fully developed (they’re immature).
The main job of blast cells is to make more blood cells like themselves. They can’t do any of the jobs that mature blood cells can do, like carrying oxygen or fighting infection. Blast cells normally stay inside the bone marrow until they’ve matured into fully-developed blood cells.
Once blood cells are mature, they’re ready to do their jobs. They leave the bone marrow and go into the bloodstream, where they can be carried to wherever they’re needed.
You should speak to your GP as soon as possible if you think you have some of the symptoms of AML. But remember that the symptoms of AML can be caused by other things.
The main treatment for acute myeloid leukaemia (AML) is chemotherapy. This means having anti-cancer drugs to destroy the leukaemia cells. You’ll also have drugs called steroids, which help the chemotherapy to work.
The treatment for AML is pretty intensive at times and can cause unpleasant side effects. But you’ll be in hospital when you’re most likely to feel unwell, and the staff can help if things get tough. Don’t feel you have to be brave. Be honest about how you’re feeling with your doctors and nurses. They can give you medicines to help you feel better.
There are different phases of treatment for AML:
getting rid of the leukaemia – remission induction
keeping the leukaemia away – consolidation and delayed intensification therapy
central nervous system (CNS) therapy (mainly for teenagers under 16)
Very often, treatment is given as part of a clinical trial or research study, but it will be your decision whether to take part in the trial or not. Clinical trials help doctors to keep improving treatment for leukaemia.
You usually start chemotherapy pretty quickly after finding out that you have AML.
You’ll be in hospital for your treatment to begin with. If you’re 18 or younger, you’ll be treated in a specialist Principal Treatment Centre (PTC) for teenage and young adults (TYA). If you’re 19 or older, you’ll be offered the choice of having treatment at the PTC or another hospital closer to home called a TYA designated hospital.
Most chemotherapy for AML is given into the bloodstream (intravenously). So you’ll have a ‘line’ put into one of your main veins to make it easier for you to have intravenous chemotherapy. There are different kinds of lines.
You’ll also be given chemotherapy into the fluid around your spinal cord and brain. This is to get rid of any leukaemia cells that might be hiding there. This type of treatment is called central nervous system (CNS) therapy.
Having chemotherapy can be hard, but the staff looking after you will give you medicines to help you cope with any side effects so you can stay strong enough to have treatment. And you’ll be given medicines to help you feel less sick and antibiotics to help prevent infections.
There will probably be times when you feel rough and other times when you’ll feel better. You might also feel upset, down or irritable. Talking to someone you trust can help you cope with these feelings.
Being in hospital for long periods can be frustrating, especially when you miss out on stuff happening at school, college, university or work or on things your friends are doing. You could try talking to your friends and family about this and see what they can do to help you.
This phase of treatment is sometimes also called consolidation or intensification treatment. It’s given to prevent the leukaemia from returning (known as a relapse).
When you’re in remission, it means the doctors can’t see any leukaemia cells in your blood or bone marrow samples under the microscope. But there may still be leukaemia cells hiding in your body, so further treatment is needed to get rid of these cells.
You start post-remission treatment soon after you complete remission induction. You’ll usually have 2 courses of treatment. You might be given the same chemotherapy drugs you’ve had before (perhaps at similar or higher doses) or you might be given different chemotherapy drugs.
When your doctors decide what chemotherapy treatment plan to give you, they will take into account:
how well your leukaemia responded to the first lot of treatment (remission induction)
the results of the tests that were done when you were diagnosed
The following drugs may be used to treat you:
cytarabine (ara-C)
methotrexate
The main symptom of acute pancreatitis is a severe, dull pain around the top of your stomach that develops suddenly.
This aching pain often gets steadily worse and can travel along your back or below your left shoulder blade. Eating or drinking may also make you feel worse very quickly, especially fatty foods.
Leaning forward or curling into a ball may help to relieve the pain, but lying flat on your back often increases the pain.
Acute pancreatitis caused by gallstones usually develops after eating a large meal. If the condition is caused by alcohol, the pain often develops 6 to 12 hours after drinking a significant amount of alcohol.
Other symptoms of acute pancreatitis can include:
nausea (feeling sick) or vomiting
diarrhoea
indigestion
a high temperature (fever) of 38C (100.4F) or above
jaundice – yellowing of the skin and the whites of the eyes
tenderness or swelling of the abdomen (tummy)
It’s thought that acute pancreatitis occurs when a problem develops with some of the enzymes (chemicals) in the pancreas, which causes them to try to digest the organ.
Acute pancreatitis is most often linked to:
gallstones – which accounts for around half of all cases
alcohol consumption – which accounts for about a quarter of all cases
By reducing your alcohol intake and altering your diet to make gallstones less likely, you can help to reduce your chances of developing acute pancreatitis.
Read more about the causes of acute pancreatitis and preventing acute pancreatitis.
Most cases of acute pancreatitis are closely linked to gallstones or to alcohol consumption, although the exact cause isn’t always clear.
Less common causes of acute pancreatitis include:
accidental damage or injury to the pancreas – for example, during a procedure to remove gallstones or examine the pancreas
certain types of medication, such as some antibiotics or chemotherapy medication – acute pancreatitis can be an unexpected side effect of these in a small number of people
a viral infection – such as mumps or measles
a complication of cystic fibrosis
certain rare conditions – including hyperparathyroidism, Reye’s syndrome and Kawasaki disease
Once the condition is under control, the underlying cause may need to be treated.
Gallstones
If a gallstone is responsible for the pancreatitis, you may need a procedure called endoscopic retrograde cholangiopancreatography (ERCP), or your gallbladder may need to be removed.
Gallbladder removal surgery may be done while you’re in hospital, or it may be planned for several weeks’ time. Having your gallbladder removed should have no significant effect on your health, other than making it more difficult to digest certain foods, such as fatty or spicy foods.
An ERCP procedure is an alternative treatment for gallstones. It involves using a narrow, flexible tube known as an endoscope, which has a camera on one end.
X-rays guide the endoscope into your digestive system, and surgical instruments are passed down the endoscope to remove the gallstones.
Alcohol consumption
After recovering from acute pancreatitis, alcohol should be completely avoided if this was the cause of the condition. If you find this difficult, you’ll probably need additional treatment.
Treatment options for alcohol dependence include:
one-to-one counselling
self-help groups – such as Alcoholics Anonymous
a medication called acamprosate – which helps to reduce your alcohol cravings
Most cases of acute pancreatitis are diagnosed in hospital because of the risk of serious complications.
The doctor in charge of your care will ask you about the history of your symptoms. They may also carry out a physical examination. If you have acute pancreatitis, certain areas of your abdomen will be very tender to touch.
A blood test will be carried out to help confirm a diagnosis. This can detect signs of acute pancreatitis, such as a high level of 2 chemicals called lipase and amylase.
At first, it can be difficult to tell whether your acute pancreatitis is mild or severe. You’ll be monitored closely for signs of serious problems, such as organ failure.
People with mild acute pancreatitis tend to improve within a week and experience either no further problems or problems that resolve within 48 hours. People with severe acute pancreatitis develop persistent serious problems.
Several tests may be used to help determine the severity of your condition and assess your risk of developing more serious complications.
You may have any of the following tests:
a computerised tomography (CT) scan – where a series of X-rays are taken to build up a more detailed, 3D image of your pancreas
a magnetic resonance imaging (MRI) scan – where strong magnetic fields and radio waves are used to produce a detailed image of the inside of your body
an ultrasound scan – where high-frequency sound waves are used to create an image of part of the inside of the body
endoscopic retrograde cholangiopancreatography (ERCP)
An ERCP uses a narrow, flexible tube known as an endoscope, which has a camera on one end. The endoscope will be passed through your mouth and towards your stomach. A special dye that shows up on X-rays is then injected through the endoscope into your bile and pancreatic ducts. After the dye has been injected, X-rays will be taken.
This test can be useful in cases of gallbladder-associated acute pancreatitis, because it can pinpoint exactly where the gallstone is located. In some cases, it may be possible to pass surgical instruments down the endoscope, so the gallstone can be removed.
Contact your GP immediately if you suddenly develop severe abdominal pain. If this isn’t possible, contact NHS 24’s 111 service or your local out-of-hours service for advice.
Treatment for acute pancreatitis focuses on supporting the functions of the body until the inflammation has passed.
This usually involves admission to hospital so you can be given fluids into a vein (intravenous fluids), as well as pain relief, nutritional support and oxygen through tubes into your nose.
Most people with acute pancreatitis improve within a week and are well enough to leave hospital after 5 to 10 days.
However, recovery takes longer in severe cases, as complications that require additional treatment may develop.
Read more about treating acute pancreatitis.
Contact your GP immediately if you suddenly develop severe abdominal pain. If this isn’t possible, contact NHS 24 111 Service or your local out-of-hours service for advice.
Acute pancreatitis is treated in hospital, where you’ll be closely monitored for signs of serious problems and given supportive treatment, such as fluids and oxygen.
Many people are well enough to leave hospital after 5 to 10 days.
In severe cases, complications can develop that require specific additional treatment and you’ll need to be admitted to a high dependency unit or intensive care unit (ICU). In these cases, recovery may take much longer, and the condition can be fatal.
Read about the potential complications of acute pancreatitis for more information on severe cases.
Once the condition is under control, the underlying cause may need to be treated.
Gallstones
If a gallstone is responsible for the pancreatitis, you may need a procedure called endoscopic retrograde cholangiopancreatography (ERCP), or your gallbladder may need to be removed.
Gallbladder removal surgery may be done while you’re in hospital, or it may be planned for several weeks’ time. Having your gallbladder removed should have no significant effect on your health, other than making it more difficult to digest certain foods, such as fatty or spicy foods.
An ERCP procedure is an alternative treatment for gallstones. It involves using a narrow, flexible tube known as an endoscope, which has a camera on one end.
X-rays guide the endoscope into your digestive system, and surgical instruments are passed down the endoscope to remove the gallstones.
Alcohol consumption
After recovering from acute pancreatitis, alcohol should be completely avoided if this was the cause of the condition. If you find this difficult, you’ll probably need additional treatment.
Treatment options for alcohol dependence include:
one-to-one counselling
self-help groups – such as Alcoholics Anonymous
a medication called acamprosate – which helps to reduce your alcohol cravings
As acute pancreatitis is often caused by gallstones or excessive alcohol consumption, a healthy lifestyle can reduce your chances of developing the condition.
About 4 out of 5 cases of acute pancreatitis improve quickly and don’t cause any serious further problems. However, 1 in 5 cases are severe and can result in life-threatening complications, such as multiple organ failure.
In severe cases where complications develop, there’s a high risk of the condition being fatal.
If a person survives the effects of severe acute pancreatitis, it’s likely to be several weeks or months before they’re well enough to leave hospital.
Read more about the possible complications of acute pancreatitis.
Although most people with acute pancreatitis recover without experiencing further problems, severe cases can have serious complications.