The diagnosis of childhood leukemia

1. Big picture

Childhood leukemia is the most common pediatric malignancy, and the key exam skill is early recognition from nonspecific symptoms.

A child with leukemia often does not present saying “I have cancer.” The child presents with:

Fever + pallor + bruising/petechiae + bone pain + lymphadenopathy/hepatosplenomegaly

The diagnostic logic is:

Unexplained cytopenia(s) or blasts on blood film
→ suspect leukemia
→ urgent pediatric hematology referral
→ stabilize emergencies first
→ confirm by bone marrow examination
→ classify by flow cytometry + cytogenetics/molecular testing
→ assess CNS/testicular/extramedullary involvement
→ risk stratify before trea