Monday, May 24, 2010

Leukaemia (Blood Cancer)

Leukaemia is generally known as Blood Cancer.

Q. 1: What is leukemia?
Ans.: Leukemia is a type of cancer. Cancer is a group of many related diseases. All cancers begin in cells, which make up blood and other tissues. Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells replace them.

Sometimes this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. Leukemia is cancer that begins in blood cells.

Normal blood cells

Blood cells form in the bone marrow. Bone marrow is the soft material in the center of most bones.

Immature blood cells are called stem cells and blasts. Most blood cells mature in the bone marrow and then move into the blood vessels. Blood that flows through the blood vessels and heart is called the peripheral blood.


Q. 2: What are the types of leukemia?
Ans.: The types of leukemia are grouped by how quickly the disease develops and gets worse. Leukemia is either chronic (gets worse slowly) or acute (gets worse quickly):

* Chronic leukemia—Early in the disease, the abnormal blood cells can still do their work, and people with chronic leukemia may not have any symptoms. Slowly, chronic leukemia gets worse. It causes symptoms as the number of leukemia cells in the blood rises.


* Acute leukemia—The blood cells are very abnormal. They cannot carry out their normal work. The number of abnormal cells increases rapidly. Acute leukemia worsens quickly.

The types of leukemia are also grouped by the type of white blood cell that is affected. Leukemia can arise in lymphoid cells or myeloid cells. Leukemia that affects lymphoid cells is called lymphocytic leukemia. Leukemia that affects myeloid cells is called myeloid leukemia or myelogenous leukemia.


Q. 3: Who is at risk for Leukemia?
Ans. : No one knows the exact causes of leukemia. Doctors can seldom explain why one person gets this disease and another does not. However, research has shown that people with certain risk factors are more likely than others to develop leukemia. A risk factor is something that increases a person's chance of developing a disease.

Studies have found the following risk factors for leukemia:

* Very high levels of radiation —People exposed to very high levels of radiation are much more likely than others to develop leukemia. Very high levels of radiation have been caused by atomic bomb explosions (such as those in Japan during World War II) and nuclear power plant accidents (such as the Chernobyl [also called Chornobyl] accident in 1986).

Medical treatment that uses radiation can be another source of high-level exposure. Radiation used for diagnosis, however, exposes people to much lower levels of radiation and is not linked to leukemia.

* Working with certain chemicals—Exposure to high levels of benzene in the workplace can cause leukemia. Benzene is used widely in the chemical industry. Formaldehyde is also used by the chemical industry. Workers exposed to formaldehyde also may be at greater risk of leukemia.

* Chemotherapy—Cancer patients treated with certain cancer-fighting drugs sometimes later develop leukemia. For example, drugs known as alkylating agents are associated with the development of leukemia many years later.

* Down syndrome and certain other genetic diseases—Some diseases caused by abnormal chromosomes may increase the risk of leukemia.

* Human T-cell leukemia virus-I (HTLV-I)—This virus causes a rare type of chronic lymphocytic leukemia known as human T-cell leukemia. However, leukemia does not appear to be contagious.

* Myelodysplastic syndrome—People with this blood disease are at increased risk of developing acute myeloid leukemia.

In the past, some studies suggested exposure to electromagnetic fields as another possible risk factor for leukemia. Electromagnetic fields are a type of low-energy radiation that comes from power lines and electric appliances. However, results from recent studies show that the evidence is weak for electromagnetic fields as a risk factor.


Q. 4: Does leukaemia run in families?
Ans.: An increased risk of leukaemia can run in families. If one person in the family has leukaemia, the other members have three times the normal risk of getting the same type of leukaemia.

Q. 5 : What are symptoms of leukemia?
Ans.: Like all blood cells, leukemia cells travel through the body. Depending on the number of abnormal cells and where these cells collect, patients with leukemia may have a number of symptoms.

Common symptoms of leukemia:

* Fever or night sweat

* Frequent infections

* Feeling weak or tired

* Headache

* Bleeding and bruising easily (bleeding gums, purplish patches in the skin, or tiny red spots under the skin)

* Pain in the bones or joints

* Swelling or discomfort in the abdomen (from an enlarged spleen)

* Swollen lymph nodes, especially in the neck or armpit

* Weight loss


Q. 6: How many common types of leukaemia?
Ans.: There are four common types of leukemia:

* Chronic lymphocytic leukemia (chronic lymphoblastic leukemia, CLL) accounts for about 7,000 new cases of leukemia each year. Most often, people diagnosed with the disease are over age 55. It almost never affects children.

* Chronic myeloid leukemia (chronic myelogenous leukemia, CML) accounts for about 4,400 new cases of leukemia each year. It affects mainly adults.

* Acute lymphocytic leukemia (acute lymphoblastic leukemia, ALL) accounts for about 3,800 new cases of leukemia each year. It is the most common type of leukemia in young children. It also affects adults.

* Acute myeloid leukemia (acute myelogenous leukemia, AML) accounts for about 10,600 new cases of leukemia each year. It occurs in both adults and children.

Q. 7: Is leukaemia a children's cancer?
Ans.: About half of all cases of acute lymphocytic leukaemia are in children under 10 years old, with another quarter of cases occurring in adolescents. However, the other main types of leukaemia normally occurr in people over 50. There are many cases of leukaemia in the Asian subcontinent each year amongst children, with many of higher age groups,as well.

Posted by Nihaar Gujjar at 10:24 PM 0 comments
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Cervix Cancer

Q. 1: What is cervix?

Ans.: Cervix is the lowest part of uterus which is an organ that only women have, and it is where a baby grows and develops when a woman is pregnant. During pregnancy, the uterus has an enormous increase in size. When a woman is not pregnant, the uterus is a small, pear-shaped organ that sits between a womans rectum and her bladder. The cervix connects the uterus with the birth canal (the vagina). The cervix can both be visualized and sampled by your doctor during a routine pelvic examination in his or her office.



Q. 2: What is cervical cancer?

Ans.: Cervical cancer starts in a woman's cervix, which is the lower, narrow part of the uterus. The uterus holds the growing fetus during pregnancy. The cervix connects the lower part of the uterus to the vagina and, with the vagina, forms the birth canal.

Cervical cancer develops when normal cells on the surface of the cervix begin to change, grow uncontrollably, and eventually form a mass of cells called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous).

At the outset, the changes in a cell are abnormal, not cancerous. Researchers believe, however, some of these abnormal changes are the first step in a series of slow changes that can lead to cancer. Some of the abnormal cells go away without treatment, but others can become cancerous. This phase of the disease is called dysplasia (an abnormal growth of cells). The precancerous tissue needs to be removed to stop cancer from developing. Often, the precancerous tissue can be removed or destroyed without harming healthy tissues, but in some cases, a hysterectomy (removal of the uterus and cervix) is needed to prevent cervical cancer. Treatment of a lesion (a precancerous area) depends on the following factors:

* How big the lesion is, and what type of changes have occurred in the cells

* If the woman wants to have children in the future

* The woman's age

* The woman's general health

* The preference of the woman and her doctor

If the precancerous cells change into true cancer cells and spread deeper into the cervix or to other tissues and organs, the disease is then called cervical cancer.

There are two main types of cervical cancer, named for the type of cell where the cancer started.

* Squamous cell carcinoma, which makes up about 80% to 90% of all cervical cancers

* Adenocarcinoma, which makes up 10% to 20% of all cervical cancers



Q. 3: What are the signs of cervical cancer?

Ans.: Women with cervical cancer may experience the following symptoms. Sometimes, women with cervical cancer do not show any of these symptoms. Or these symptoms may be caused by a medical condition that is not cancer.

Most women do not have any signs or symptoms of a precancer or early stage cervical cancer. Symptoms usually do not appear until the cancer has spread to other tissues and organs.

Any of the following could be signs or symptoms of cervical dysplasia or cancer:

* Blood spots or light bleeding between or following periods

* Menstrual bleeding that is longer and heavier than usual

* Bleeding after intercourse, douching, or a pelvic examination

* Pain during sexual intercourse

* Bleeding after menopause

* Increased vaginal discharge

Posted by Nihaar Gujjar at 10:22 PM 0 comments
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Testing for Cancer with a Biopsy

A biopsy is a medical procedure in which a tissue sample or a group of cells is removed for laboratory examination. There are several types of biopsies available, designed to compliment an array of different conditions and parts of the body. Many of these procedures are performed with a needle and syringe, requiring no sedation. In some cases, the removal of tissue will necessitate surgery. Biopsies are typically conducted alongside other diagnostic processes. This will yield a more accurate diagnosis. A microscopic evaluation of biopsied cells can definitively determine the presence of cancer, but imaging tests are usually needed to determine the stage and behavior of the cancer.

Biopsy Types

Needle Biopsy

Needle biopsies are frequently performed to analyze growths that can be felt through the skin. Such growths may include lumps in the breasts or testes. There are four main types of needle biopsy:

  • Fine-Needle Aspiration (FNA): In this procedure, a long, fine needle pierces the skin and is inserted into the suspicious tissue. A syringe is then used to extract cells from the tissue. Typically, the cells will be sent to a laboratory for a microscopic evaluation. When a cyst is drained with FNA, and the material is not sent away for laboratory evaluation, the procedure is called a cyst aspiration. FNA is relatively painless and can be performed in minutes.
  • Core Needle Biopsy: When solid tissue is biopsied, or when larger amounts of tissue are needled for evaluation, a hollow core needle is used to perform the procedure. This needle will extract a column of tissue from the suspect area. Sometimes, a small incision must be made in order to make way for this larger needle. When biopsy necessitates an incision, local anesthesia is used.
  • Vacuum-Assisted Biopsy: This procedure is similar to a normal core needle biopsy. However, in a vacuum-assisted biopsy, a special machine is used to draw even more cells from the suspect tissue.
  • Image-Guided Biopsy: When the suspect tissue cannot be felt through the skin, but is still a candidate for a needle biopsy, an image-guided biopsy is performed. In this procedure, the standard needle biopsy is guided with the aid of various imaging technologies, such as computed tomography (CT scan) or ultrasound.

Skin (Cutaneous) Biopsy

A skin biopsy is performed to remove cells from the skin, or other tissues on the body’s surface. Most skin cancers are diagnosed with a skin biopsy. There are several types of skin biopsy procedures available:

  • Shave Biopsy: This procedure can be performed with a small scalpel or a curved razor blade. With the tool, cells are scraped form the surface of the skin, after which they are sent away for analysis. You will not need stitches after this procedure. Shaving the skin is not the same as making an incision through the skin.
  • Punch Biopsy: In a punch biopsy, a physician will use rounded knife, ranging in size from 1mm to 8mm, to remove sections of the skin below the surface. Most punch biopsies are performed to extract tissues located about ¼ of an inch into the skin. Following a punch biopsy, the wound is usually stitched to ensure proper healing.
  • Incisional Biopsy: This procedure is performed to extract tissues located below the skin, into the subcutaneous fat. To extract these tissues, an incision is made with an elliptical scalpel, after which the wound will be stitched.
  • Excisional Biopsy: This procedure is a type of incisional biopsy in which the entire lesion or tumor is removed. In most biopsy procedures, only a portion of the suspect tissue is removed for analysis. Because an excisional biopsy removes all of the suspect tissue, it can sometimes provide curative, as well as diagnostic results. Many melanomas, though, are located on the face and cannot be completely excised in such a manner.

Curretage

In this procedure, the suspect tissue is scraped using a round curette blade. Sometimes this tool is used in a skin biopsy, but it can also be used to scrape cells from bone and other internal tissues.

Surgery

When suspect tissues are inaccessible using common biopsy procedures, a surgical biopsy is required. During a surgical biopsy, an incision is made through the skin, allowing the physician to access suspicious cells located within the body. This procedure is essentially the same thing as a needle, skin, or curretage biopsy; however, it utilizes a surgical incision as a means to penetrate the suspect tissue.

A Brief History of the Biopsy

  • Ernest Henri Besnier, the famed French dermatologist, introduced the word “biopsy” to the medical community in 1879.
  • The first biopsy used to diagnose a disease was performed in Russia in 1875 by M.M. Rudnev.
  • Historical evidence suggests that the Arabs may have been performing diagnostic biopsies as early as the 12th century AD. The Arab physician Abulcasim reportedly used a needle to extract material from a goiter (a swelling of the neck due to thyroid gland abnormalities). He used this material to characterize, or primitively diagnose the goiter.

Posted by Nihaar Gujjar at 12:37 PM 0 comments
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Diagnosing Cancer through Endoscopic Ultrasound (EUS) Imaging

Endoscopic ultrasound (EUS), also known as echo-endoscopy, combines the techniques of endoscopy with ultrasound imaging technologies. This combination of procedures and technologies allows doctors to visualize structures within the human body.

  • Endoscopy: This minimally invasive procedure involves inserting a long, flexible tube into a hollow organ. The tube is known as an endoscope. Various instruments, such as cameras and curettes (scalpel-like tools), can be attached to the endoscope to perform an array of tasks.
  • Ultrasound: This technology utilizes high-frequency sound waves to generate images of structures inside the body. SONAR, a technology developed for the U.S. military, similarly uses sound waves to generate images of structures deep in the ocean.

The endoscopic probe used in EUS procedures contains an ultrasound transmitter. This allows the high-frequency sound waves to travel through the body from an internal location, generating more accurate images. Traditional ultrasound transmits sound waves through the body from an external location. This method of ultrasound imaging is used to visualize a developing fetus in a woman’s womb.

To diagnose cancer, endoscopic ultrasound is used to locate tumors in the following inner-body locations:

Respiratory Tract

To diagnose cancers of the chest, such as lung cancer, an endoscopic ultrasound probe is inserted into the esophagus through the nose or mouth.

Lower Gastrointestinal (GI) Tract

To diagnose cancers of the rectum or colon, an endoscopic ultrasound probe is inserted into the large intestine via the anus.

Upper GI Tract

To diagnose cancers of the upper gastrointestinal tract, such as stomach cancer, esophageal cancer, pancreatic cancer, and various gastric malignancies, an endoscopic ultrasound probe is inserted into the esophagus, stomach, and the first section of the small intestine (duodenum).


What To Expect During an Endoscopic Ultrasound Procedure

EUS is generally performed while the patient is under general anesthesia. Although EUS is known as a minimally invasive procedure, it may affect the patient with mild to severe discomfort.

Very few preparatory measures need to be examined before an upper respiratory or upper GI tract endoscopic ultrasound Typically, you will be asked to fast (not eat) the night before the procedure. It is acceptable to drink clear fluids during this period of fasting.

For lower GI tract EUS procedures, you may be asked to take 2 fleet enemas on the morning of your exam. Fleet enemas clean the bowels by stimulating the processes of waist removal in the intestines.


Risk Factors

Endoscopic ultrasound involves a very low degree of risk. Rarely, however, an EUS procedure may result in the following complications:

  • Bleeding: Bleeding is often the result of scratches or abrasions caused by the endoscopic probe sliding against the lining of the esophagus, intestines, or stomach.
  • Puncturing: Very rarely, an endoscopic ultrasound probe will puncture the lining of the GI tract, which may cause severe bleeding, and a host of serious complications. If a puncture occurs, it is usually repaired with surgery.
  • Drug Reactions: Before you undergo an EUS procedure, inform your doctor of any drug allergies that you may have. Before, during, and after EUS, you doctor may prescribe certain medications to make the procedure more effective. It is important to ask questions about each of these medications and how they might influence your health.


After EUS

Following an EUS procedure, your doctor will recommend that you rest for a while in the recovery area. This rest will help you overcome any feelings of tiredness or nausea associated with the anesthesia. You may feel bloated or uncomfortable after an endoscopic ultrasound, but these feelings usually subside quickly. Some patients may experience a sore throat after EUS. This is rarely severe, and usually subsided in a matter of hours or days.

It is imprtant to have a friend or family member take you to and from your EUS exam. It is especially imperative for them to drive you home, because the effects of anesthesia can take up to 24 hours to wear off.

Posted by Nihaar Gujjar at 12:34 PM 0 comments
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Guide to Testing and Diagnosing Cancer

Prevention and early detection are the most important cancer-fighting tools. Research suggests that up to 35% of cancer related death could be avoided if more people would undergo regular cancer testing and screening procedures.

Many cancer tests are incapable of providing diagnostic results; instead, they indicate whether or not a patient should undergo more in-depth evaluation. For example, a mammogram may reveal a lump (mass of tissue) in the breast, but it cannot determine whether or not the lump is cancerous or benign (non-cancerous). A histological (microscopic) analysis of tissues from the lump is required to definitively diagnose cancer.

Types of Tests

After a series of basic physical examinations, the following tests are commonly used to definitively diagnose a cancer:

Biopsy

In a biopsy, a group of cells or an entire piece of tissue is removed for laboratory examination. The histological (microscopic) examination of biopsied tissue is the most effective and common method of cancer diagnosis. Most biopsies are performed in a doctor's office with a needle and syringe, requiring no anesthesia. Biopsying tissues located deep within the body may necessitate surgery.

...a complete guide to Biopsy

Bone Scan

In a bone scan, a radioactive substance (tracer) is injected into a vein, after which it will ultimately travel into the bones. Once the tracer has reached the bones, a special camera (gamma) is used to photograph the interaction between the radioactive tracer and the inside of the bones. Photographing this interaction allows physicians to analyze overall bone function.


Computerized Axial Tomography (CAT) Scan

This imaging test uses a computer to analyze the results of multiple x-rays, generating cross-sectional images of the body's internal structures. Computerized Axial Tomography (CAT) Scans are more commonly referred to as CT scans, or computerized tomography.

Endoscopic Ultrasound (EUS) Imaging

EUS imaging combines an endoscopy procedure with ultrasound technology to produce a detailed, cost-effective image of the gastrointestinal tract.

  • Endoscopy: This procedure involves the insertion of a long flexible tube into the mouth or anus. The tube is called an endoscope.
  • Ultrasound: Ultrasound technology is the use of high-frequency sound waves to produce images of the body’s internal structures. Ultrasound is similar to SONAR technology, which has been used for many years to detect structures under water.

Traditional ultrasound transmits sound waves through the body from an external location. In an endoscopic ultrasound, sound waves are transmitted through the body from the tip of the endoscope. Transmitting sound waves from within the body produces a much more detailed image.


Magnetic Resonance Imaging (MRI) Testing

An MRI test uses a powerful magnetic field with radio frequency pulses to produce detailed images of the body’s internal structures. This imaging test is non-invasive and, unlike CT scans, it does not use harmful ionizing radiation to produce an image. Furthermore, MRI testing almost always reveals a more detailed image than a CT scan, ultrasound, or traditional x-ray.

Positron Emission Tomography (PET) Scans

In a PET scan, a small amount of a radioactive substance (tracer) is injected into a vein. The tracer travels through the bloodstream and is absorbed by certain organs and tissues. Once absorbed, a series of x-rays are captured and analyzed by a computer, producing an image of the body’s internal structures. Tracers have been developed to interact with specific organs and tissues, allowing PET scans to target certain diseases and locations throughout the body.

Prostate-Specific Antigen (PSA) Testing

Prostate-specific antigen (PSA) is a protein generated by the cells in the prostate gland. In a PSA test, a physician will take a blood sample, and the amount of PSA in the blood will be evaluated in a laboratory. High levels of PSA in the blood may indicate the presence of a prostate tumor.

Thermography Imaging

Thermography, or thermal imaging, is a type of imaging test that captures light in the infrared range of the electromagnetic spectrum. The amount of infrared light emitted by an object increases with temperature. Because cancerous tissues grow faster than normal tissues, they require an ever-increasing supply of nutrients. This nutrient demand stimulates blood circulation around cancerous tissues, creating heat and giving off infrared light.


Posted by Nihaar Gujjar at 12:33 PM 0 comments
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Treating Cancer with Chemotherapy

Overview

Chemotherapy is the use of chemical agents to kill cells. In conversational usage, the term chemotherapy refers to the chemical treatment of cancer. But chemical agents are also used to treat multiple sclerosis (MS), various autoimmune diseases, and even arthritis.

Most people associate chemotherapy with a myriad of horrible side effects, such as hair loss and nausea. While these side effects do often accompany chemo regimens, millions of cancer patients have been able to enjoy long, vibrant lives because of this treatment option. Furthermore, chemotherapy side-effect management has progressed significantly over the past few decades. Many of chemo’s distressing side effects can be prevented completely, or controlled using today’s advanced treatment strategies.

More than 50% of people diagnosed with cancer are treated with chemotherapy. For some patients, chemo serves as their only treatment, whereas other patients are prescribed chemotherapeutic drugs alongside other treatment options.

How Does Chemo Work?

Chemotherapeutic drugs inhibit the process of mitosis, or cell division. Since malignant (cancer) cells divide without control or order, these drugs effectively target cancerous growths. Some chemo drugs cause cancer cells to die altogether by stimulating a process known as apoptosis (programmed cell-death).

Although chemotherapeutic drugs are designed to target fast-dividing cancer cells, they inadvertently damage healthy cells. The faster a healthy cell divides, the more likely it is to be affected by chemo. This is why your hair may fall out during a chemo regimen. The cells that compose the hair follicles divide quickly.

Researchers have yet to determine all of the features unique to malignant cells and healthy cells. Identifying these specific features may someday open the door to chemotherapeutic drugs that target malignant cells exclusively, resulting in little to no side effects.

Chemotherapeutic drugs have been developed to target various rates of mitosis (cell division), but the slower the rate of division, the greater the risk of healthy cell damage. It is easier to differentiate aggressive malignancies from normal tissues, than it is to target a slow-growing malignancy in an environment of similarly slow-growing healthy cells. This makes aggressive cancers the best candidates for successful chemo treatment.

The Focus of Chemotherapy Treatment

Depending on the type, size, and location of your cancer, as well as your overall health, a doctor may focus chemotherapy to achieve any of the following goals:

  • Curative: Curative chemotherapy is intended to kill all the cancer cells in the body, curing the patient of cancer.
  • Palliative: This approach involves prolonging the patient's life by controlling cancer growth, spread, and invasion into other tissues. Palliative treatments are also used to help relieve cancer-related symptoms, improving the patient’s quality of life.
  • Adjuvant: This treatment strategy involves using chemotherapy alongside other cancer treatment options. Adjuvant chemotherapy is usually administered after surgery or radiotherapy to kill any remaining cancer cells in the body.
  • Neoadjuvant Chemotherapy: The focus of neoadjuvant chemotherapy is to reduce the size of a tumor preceding surgery or other treatment options.

Types of Chemotherapy

Chemotherapy drugs include:

Alkylating Agents

These chemical agents utilize the cellular property of electronegativity to add alkyl groups to cells. Electronegativity is a cell’s ability to attract electrons. When a cell inadvertently attracts alkyl groups, the alkyl alters the cell’s DNA, resulting in cell death or impaired mitosis.

The following chemotherapeutic drugs are alkylating agents:

  • Cisplatin
  • Carboplatin
  • Oxaloplatin
  • Mechlorethamine
  • Cyclophosphamide
  • Chlorambucil

Anti-Metabolites

These chemical agents mask themselves as purine (one of the building blocks of DNA). When a cell accepts the masked anti-metabolites, it becomes unable to incorporate genuine purine into its DNA. This results in cellular DNA damage. Anti-metabolites are among the most widely used chemotherapeutic drugs.

Plant Alkaloids

These chemical agents are derived from plant cells. They inhibit microtubule function in a cell. Microtubules are the structural components of a cell that are responsible for mitosis, among other cellular functions.

Antitumor Antibiotics

These chemical agents involve the patient’s own immune system in the inhibition of mitosis. Examples of these chemotherapeutic drugs include:

  • Trastuzumab (Herceptin)
  • Cetuximab
  • Rituximab

Side Effects of Chemotherapy

Although side effect management has come along way in recent years, chemotherapy drugs still affect healthy cells. Sometimes the effects of cell damage are temporary, but sometimes they are long-term or even permanent. Talk to your doctor about what to expect from your chemotherapeutic drugs.

Short-Term Side Effects

  • Hair Loss
  • Bleeding
  • Fatigue
  • Infertility
  • Cognitive Impairment
  • Sensory Abnormalities: Food tastes different, odors are perceived differently, etc.
  • Lung Damage
  • Nervous Tissue Damage
  • Liver Damage
  • Gastrointestinal Damage: Damage to the fast-dividing cells of your gastrointestinal tract (stomach, intestines, esophagus, and other digestive components) may result in a myriad of side effects, such as:
    • Temporary effects may include:
    • Nausea
    • Vomiting
    • Diarrhea
    • Dry Mouth
    • Constipation
    • Mouth Sores
    • Difficulty Swallowing
    • Loss of Appetite

The onset of these symptoms may also be the result of cellular damage elsewhere in the body.

Most of these side effects will diminish or disappear completely after you stop your chemo treatments. There are medications available to accompany your chemo treatments that may help reduce the negative effects of chemotherapy.

Long-Term Side Effects

Long-term Chemo effects are rare. As cancer patients live longer and longer lives, doctors are uncovering side effects that don't show until many years after treatment ends. Discuss the possibility off long-term effects with your doctor before beginning any treatment.

Long-term effects may include:

  • Nervous Tissue Damage: This may result in sensory abnormalities and impaired cognitive function. This is rare.
  • Hematuria: Blood in the urine.
  • Organ Damage: This typically involves heart, lung, or kidney impairment.
  • The Onset of Another Cancer: Studies have suggested a link between chemotherapy and the onset of Hodgkin’s disease, non-Hodgkin’s lymphoma, and leukemia. This link has not been properly identified, but it is probably due to the cellular DNA damage caused by chemotherapy.

History of Chemotherapy

In the 1940s, the United States Department of Defense recruited two pharmacologists, Louis S. Goodman and Alfred Gilman, to research the therapeutic properties of chemical warfare agents. Autopsy findings involving people exposed to nitrogen mustard (mustard gas) unveiled conditions in the body conducive to tumor suppression.

Goodman and Gilman first began testing the effects of nitrogen mustard on mice. These tests allowed them to officially demonstrate the antitumor properties of nitrogen mustard. After the mice tests, Goodman and Gilman collaborated with thoracic surgeon Gustav Linskog to inject mustine (a molecular variation of nitrogen mustard) into a human with non-Hodgkin’s lymphoma. This caused the patient’s malignant masses to decrease in size. The patient was not cured, but this was a major stepping-stone in the treatment of cancer with chemical agents.

After World War II, the scientific community embarked on a number of cancer treatment research projects. These projects included the groundbreaking use of folate analogues to treat Indian children with leukemia in 1948. Folate anologues antagonize folic acid in cells. Folic acid is a vital component of cellular metabolism. When cellular metabolism is impaired, cellular division is disrupted, or the cell dies. Using folate analogues was the first demonstration of remission in all patients that were given the chemical agent.

In the 1950’s, the U.S. government began incentivizing pharmaceutical companies to develop anticancer drugs. Since this initial “push” to support cancer research and drug development, cancer has been receiving an enormous amount of political and social attention around the world. This much-needed attention has led to many breakthrough tests and treatment options.


The Future of Chemotherapy

The future of chemotherapy involves the development of chemical agents that can target malignant cells more precisely. This will reduce or eliminate healthy cell damage, resulting in fewer side effects. Researchers are also hard at work developing chemotherapy drugs aimed at treating slow-growing malignancies that are currently less sensitive to chemical agents.

Posted by Nihaar Gujjar at 12:28 PM 0 comments
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Sunday, May 23, 2010

Breast Cancer – Types of Breast Cancer

Breast cancer is a cancer that starts in the cells of the breast Worldwide, breast cancer is the second most common type of cancer after lung cancer (10.4% of all cancer incidence, both sexes counted) and the fifth most common cause of cancer death. Worldwide, breast cancer is by far the most common cancer amongst women, with an incidence rate more than twice that of colorectal cancer and cervical cancer and about three times that of lung cancer. However breast cancer mortality worldwide is just 25% greater than that of lung cancer in women. In 2005, breast cancer caused 502,000 deaths worldwide (7% of cancer deaths; almost 1% of all deaths).The number of cases worldwide has significantly increased since the 1970s, a phenomenon partly blamed on modern lifestyles in the Western world.

In most cases, it isn’t clear what causes normal breast cells to become cancerous. Doctors do know that only 5 percent to 10 percent of breast cancers are inherited. Families that do have genetic defects in one of two genes, breast cancer gene 1 (BRCA1) or breast cancer gene 2 (BRCA2), have a much greater risk of developing both breast and ovarian cancer. Other inherited mutations — including the ataxia-telangiectasia mutation gene, the cell-cycle checkpoint kinase 2 (CHEK-2) gene and the p53 tumor suppressor gene — also make it more likely that you’ll develop breast cancer. If one of these genes is present in your family, you have a 50 percent chance of having the gene.

Inflammatory breast cancer is a type of breast cancer that involves the skin of the breast. This type of cancer comprises less than 4% of all breast cancers diagnosed each year in the US. The physical symptoms of inflammatory breast cancer include redness of the skin of the breast and a general swelling of the breast. In some cases, a lump may be present.

Types of Breast Cancer

Tumor grade: If the cancer is an invasive type, the pathologist assigns it a grade. The grade is based on how closely cells in the sample tissue resemble normal breast tissue under the microscope. The grading information, along with the cell type, helps your doctor determine treatment options.

Tubular carcinoma: This rare type of breast cancer gets its name from the appearance of the cancer cells under a microscope. Though it’s an invasive breast cancer, the outlook is more favorable than it is for invasive ductal carcinoma or invasive lobular carcinoma.

Metaplastic carcinoma: Met plastic carcinoma represents less than 1 percent of all newly diagnosed breast cancers. This lesion tends to remain localized and contains several different types of cells that are not typically seen in other forms of breast cancer. Prognosis and treatment is the same as for invasive ductal carcinoma.

Lobular Carcinoma In Situ is NOT cancer. But it’s a sign that the woman who has it is 6 to 7 more times likely to develop cancer, over the course of her lifetime, than a woman who doesn’t have LCIS: the same risk you’d be at if your mother and sister both had cancer.

Most lumps turn out to be fibrocystic changes. The term “fibrocystic” refers to fibrosis and cysts. Fibrosis is the formation of fibrous (or scar-like) tissue, and cysts are fluid-filled sacs. Fibrocystic changes can cause breast swelling and pain. This often happens just before a period is about to begin. Your breasts may feel lumpy and, sometimes, you may notice a clear or slightly cloudy nipple discharge.

Posted by Nihaar Gujjar at 10:30 AM 0 comments
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Lymphoma - Overview

Overview

The term “lymphoma” identifies more than 67 subtypes of cancer that affect the lymphatic system. These 67 subtypes are divided into two groups of lymphoma:

  • Hodgkin Lymphoma: Representing 6 types of lymphoma and more than 800 annual diagnoses
  • Non-Hodgkin Lymphoma (NHL): Representing at least 61 types of lymphoma and more than 66,000 annual diagnoses.

Hodgkin lymphoma and NHL differ in the way they originate, proliferate, and are treated.


Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma develops in the lymphatic system, which plays a vital role in the body’s ability to fight off infection. In NHL, lymphocytes (a type of white blood cell) undergo anomalous mutations that cause tumors to develop.

Signs and Symptoms

  • Swollen Lymph Nodes in the neck, armpit, or groin
  • Night Sweats
  • Fatigue
  • Weight Loss
  • Abdominal Pain or Swelling
  • Itchy Sensations
  • Chest Pain
  • Trouble Breathing
  • Fever
  • Coughing

Learn More

Understand the signs and symptoms, risk factors, diagnosis and staging, treatment, and prognosis of Non-Hodgkin Lymphoma by visiting the Lymphoma Research Foundation. Also, visit the Know Cancer Community and Education pages to share your stories and learn more about the effects and future of non-Hodgkin lymphoma.


Hodgkin Lymphoma

Hodgkin lymphoma, also known as Hodgkin’s disease, is a cancer that originates in the lymph tissue of the lymph nodes, spleen, liver, and bone marrow. It is distinguished from other forms of lymphoma by the presence of the Reed-Sternberg cell.

Signs and Symptoms

The signs and symptoms associated with Hodgkin’s lymphoma are flu-like in nature. As a result, many patients ignore their symptoms, wrongfully assuming that they can be treated with over-the-counter flu and cold remedies. Symptoms may include:

  • Fever
  • Fatigue
  • Night Sweats
  • Weight Loss
  • Itchy Skin

Posted by Nihaar Gujjar at 10:09 AM 0 comments
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Mantle cell lymphoma

Epidemiology

Non-Hodgkin’s lymphomas (NHLs) are a very heterogeneous group of cancers that develop in the lymph nodes present throughout the body. There are over 25 subtypes of NHL, and mantle cell lymphoma accounts for 6 to 8% of these cases. In older staging systems, mantle cell lymphoma was classified as indolent because it was (and still is) generally incurable with chemotherapy. It also occurs more often in elderly patients, which is more characteristic of indolent NHL. However, the average survival is significantly shorter than with other types of indolent lymphomas, only two to three years. Currently, most oncologists view mantle cell lymphoma as an aggressive type and treat it accordingly. Approximately 4600 patients are diagnosed with mantle cell lymphoma in the United States each year.

Risk Factors

The exact cause of mantle cell lymphoma is most often unknown. As with most cancers, a family history increases a patient’s risk to some extent. In addition, suppression of the immune system may lead to the development of mantle cell lymphoma. This includes immune suppression associated with organ transplant (from the drugs taken to prevent organ rejection) and with HIV/AIDS infection. Occupational exposures, notably pesticides, also increase the risk of mantle cell lymphoma. In fact, the Midwest, where farming is prevalent, has the highest incidence of NHL in the United States. Finally, infection with viruses, such as hepatitis C and the Epstein-Barr virus, may increase the risk of developing mantle cell lymphoma.

Signs and Symptoms

Enlarged (swollen) lymph nodes are the most common presenting sign in patients with mantle cell lymphoma. The swollen lymph nodes are usually hard, fixed in place, and painless to the touch. In addition, some patients also have non-specific symptoms, such as fevers, drenching night sweats, and unexplained weight loss greater than 10% of body weight. These are termed "B" symptoms and indicate the presence of more advanced disease. Patients with mantle cell lymphoma tend to have bone marrow and spleen involvement more often than patients with other types of aggressive NHL. In addition, the gastrointestinal tract (most notably the colon) may be involved.

Diagnosis and Staging

The most important diagnostic procedure in patients suspected of having lymphoma is the lymph node biopsy. Many cancers can be diagnosed by inserting a small needle into the tumor mass and withdrawing cells for examination under a microscope. This is called a “fine needle aspiration” or FNA. For lymphoma diagnosis, however, the preferred technique is removal of the entire affected lymph node for examination by a pathologist. It is of the utmost importance that these biopsies are examined by a pathologist who is experienced in diagnosing lymphomas. Knowing the subtype of NHL is crucial for determining long-term prognosis and treatment options.

Once the diagnosis of mantle cell lymphoma is established, patients should undergo tests to determine the extent of disease. This should include CT scans of the chest, abdomen, and pelvis, a bone marrow biopsy, a complete blood count, serum chemistries (including lactate dehydrogenase (LDH) and uric acid), and an HIV test. Because the colon is frequently involved in mantle cell lymphoma, a colonoscopy is recommended as routine work-up as well. Hepatitis B testing is also recommended due to reports of hepatitis reactivation during chemotherapy. Finally, a baseline echocardiogram or MUGA scan to evaluate heart function should be done prior to chemotherapy, as some drugs can damage the heart.

All of the above testing leads physicians to establish a "stage" of mantle cell lymphoma for each patient. Stages for mantle cell lymphoma include the following:

  • Stage I: One involved lymph node group
  • Stage II: Two or more involved lymph node groups on the same side of the diaphragm
  • Stage III: Multiple lymph node groups involved on both sides of the diaphragm
  • Stage IV: Disseminated involvement of extra-nodal sites, such as the liver or bone marrow

An "A" or "B" is added to the stage number to indicate the presence or absence of the "B" symptoms previously described. For example, a person with mantle cell lymphoma with bone marrow involvement, as well as recurrent night sweats and weight loss, would be considered to have "Stage IVB" disease.

Prognostic Factors

Mantle cell lymphoma itself is considered a poor prognosis in patients with aggressive types of NHL, with an average survival of only two to three years. In addition, stage at the time of diagnosis is a crucial prognostic factor in patients with mantle cell lymphoma: A higher stage indicates more advanced lymphoma, and therefore has a worse prognosis. Unfortunately, 70% of patients with mantle cell lymphoma present with stage IV disease. Other poor prognostic factors include presence of "B" symptoms, concurrent HIV/AIDS infection, age greater than 60 years, high LDH level time of diagnosis (indicative of more advanced disease), and poor performance status (inability to care for oneself).

First-Line Treatment of Mantle Cell Lymphoma

As discussed, mantle cell lymphoma responds significantly less well to standard chemotherapy than other types of aggressive NHL. There is no standard first-line therapy, and all patients with this diagnosis should consider participation in a clinical trial.

Few patients present with localized mantle cell lymphoma, therefore clinical studies of treatments are limited to case series. Most guidelines recommend radiation to the sites of lymphoma, with or without combination chemotherapy such as R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone).

Occasionally, patients may present with aymptomatic, advanced mantle cell lymphoma. Because advanced mantle cell lymphoma is not curable, these patients may be observed carefully until the disease progresses and/or symptoms occur.

Most patients with mantle cell lymphoma present with symptomatic advanced disease (stages III and IV). Treatment should consist of combination chemotherapy plus rituxumab. Rituximab is a monoclonal antibody drug that specifically kills B-cell lymphomas. It is synergistic with chemotherapy, meaning that the two types of medications work better together. All of the regimens used to treat other types of aggressive NHL, such as R-CHOP, have been used to treat mantle cell lymphoma as well. It should be noted that although up to 70% of patients will have a response to these regimens, none are curative in patients with advanced disease.

The regimen R-HyperCVAD has shown higher response rates (up to 80%) and the potential for prolonged survival compared to other regimens. This treatment includes the drugs rituximab, cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating in cycles with high-dose methotrexate and cytarabine. R-Hyper-CVAD should be used very cautiously in patients over the age of 65 years due to toxicity risks. The addition of "R" or rituximab, in the regimens used to treat mantle cell lymphoma does significant increase the percentage of patients responding to treatment, but it is unclear if this drug actually improves overall survival.

The incurability of mantle cell lymphoma with standard doses of chemotherapy has lead many clinicians to consider hematopoietic stem cell transplant (also called bone marrow transplant) as part of first-line therapy in good performance status patients. The most common type of bone marrow transplant is an autologous transplant, in which the patient’s own blood stem cells are harvested, then re-infused following very-high-dose chemotherapy. Most studies to date have primarily included patients younger than 65 years. In these patients, bone marrow transplant produces durable remissions, with more than 80% of patients living at least three years.

Treatment of Recurrent/Refractory Mantle Cell Lymphoma

Regardless of the initial treatment given, almost all patients with mantle cell lymphoma have recurrent disease. The average time to recurrence of 18 months. Many salvage chemotherapy regimens have been studied for recurrent mantle cell lymphoma. None has proven superior to another, and patients are not cured with these standard-dose regimens. Participation in a clinical trial is always a good choice for patients with relapsed mantle cell lymphoma.

Most salvage regimens include the agent fludarabine:

  • FC: fludarabine, cyclophosphamide
  • FMR: fludarabine, mitoxantrone, rituximab
  • FCMR: fludarabine, cyclophosphamide, mitoxantrone, rituximab

Other agents that have activity in recurrent mantle cell lymphoma include chemotherapy drugs such as cladribine and bendamustine, bortezomib (an agent which disrupts cellular homeostasis and has activity in indolent NHL as well), and anti-angiogenesis drugs such as thalidomide and lenalidomide, which inhibit blood vessel formation by the lymphoma cells.

Bone marrow transplant is also a treatment option for patients with a good performance status who have recurrent or refractory mantle cell lymphoma. This treatment strategy can improve the time patients are without active lymphoma, but bone marrow transplant is not a curative procedure in relapsed mantle cell lymphoma. If the patient has previously undergone an autologous bone marrow transplant as part of first-line therapy, then an allogeneic bone marrow transplant (blood stem cells from another person, usually a sibling) may be offered. Bone marrow transplant, especially the allogeneic type, is associated with a high degree of toxicity and should only be performed at cancer centers with staff experienced and skilled in this procedure.

Supportive Care Issues

Tumor lysis syndrome leading to kidney failure and heart arrhythmias is a risk in mantle cell lymphoma patients with advanced disease. These patients can be identified by a high LDH level, high uric acid level, and/or bulky disease (greater than 10 cm). Patients at high risk for tumor lysis syndrome usually receive their cycle or two of chemotherapy in the hospital.

Infections due to bone marrow involvement with lymphoma and/or chemotherapy immune suppression are common in mantle cell lymphoma patients. Prophylaxis with antibiotics may be appropriate in some, and patients should always contact their oncologist if they develop a fever.

Although they are important drugs for the treatment of mantle cell lymphoma, doxorubicin and mitoxantrone have the potential to cause congestive heart failure. Patients at highest risk are those receiving cumulative doses of doxorubicin greater than 450 mg/m2 or of mitoxantrone greater than 160 mg/m2, age greater than 70 years, and those with a history of heart disease. All patients receiving doxorubicin and/or mitoxantrone should have their heart function monitored regularly, and if there is evidence of heart failure, therapy should be stopped. Once damage to the heart occurs, it is generally not reversible.

Posted by Nihaar Gujjar at 10:02 AM 0 comments
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