Tuesday, 20 December 2016

Diagnosis and treatment of leukemia

Diagnosis and treatment of leukemia
Diagnosis
In addition to a medical history and a physical exam to look for signs of leukemia, the diagnosis of leukemia typically involves laboratory studies of a blood sample. Abnormal numbers of blood cells may suggest a diagnosis of leukemia, and the blood sample may also be examined under the microscope to see if the cells appear abnormal.
·         Physical exam. The doctor will look for physical signs of leukemia, such as pale skin from anemia, swelling of the lymph nodes, and enlargement of the liver and spleen.
·         Blood tests. By looking at a sample of the blood, the doctor can determine if the patient has abnormal levels of white blood cells or platelets — which may suggest leukemia.
·         Bone marrow test. A sample of the bone marrow may also be obtained to establish the diagnosis. For a bone marrow aspirate, a long, thin needle is used to withdraw a sample of bone marrow from the hip bone, under local anesthesia. A bone marrow biopsyinvolves insertion of a thick, hollow needle into the hip bone to remove a sample of the bone marrow, using local anesthesia.
Treatments for leukemia
As the various types of leukemias affect patients differently, their treatments depend on what type of leukemia they have. The type of treatment will also depend on the patient's age and his state of health. As treatment has improved, the aim of virtually all health care professionals should be complete remission - that the cancer goes away completely for a minimum of five years after treatment. Treatment for patients with acute leukemias should start as soon as possible, this usually involves induction therapy with chemotherapy, and takes place in a hospital. When a patient is in remission he will still need consolidation therapy or post induction therapy. This may involve chemotherapy, as well as a bone marrow transplant (allogeneic stem cell transplantation). If a patient has Chronic Myelogenous Leukemia (CML) his treatment should start as soon as the diagnosis is confirmed. He will be given a drug, probably Gleevec (imatinib mesylate), which blocks the BCR-ABL cancer gene. Gleevec stops the CML from getting worse, but does not cure it. There are other drugs, such as Sprycel (dasatinib) and Tarigna (nilotinb), which also block the BCR-ABL cancer gene. Patients who have not had success with Gleevec are usually given Sprycel and Tarigna. All three drugs are taken orally.

Symptoms and risk factors of leukemia

Symptoms and risk factors of leukemia
Symptoms of leukemia
§  Poor blood clotting: As immature white blood cells crowd out blood platelets, which are crucial for blood clotting, the patient may bruise or bleed easily and heal slowly - he may also develop petechiae.
§  Affected immune system: The patient's white blood cells, which are crucial for fighting off infection, may be suppressed or not working properly. The patient may experience frequent infections, or his immune system may attack other good body cells.
§  Anemia: As the shortage of good red blood cells grows the patient may suffer from anemia - this may lead to difficult or labored respiration (dyspnea) and pallor.
§  Other symptoms: Patients may also experience nausea, fever, chills, night sweats, flu-like symptoms, and tiredness. If the liver or spleen becomes enlarged the patient may feel full and will eat less, resulting in weight loss. Headache is more common among patients whose cancerous cells have invaded the CNS (central nervous system).

Causes
Scientists don't understand the exact causes of leukemia. It seems to develop from a combination of genetic and environmental factors. In general, leukemia is thought to occur when some blood cells acquire mutations in their DNA. Certain abnormalities cause the cell to grow and divide more rapidly and to continue living when normal cells would die. Over time, these abnormal cells can crowd out healthy blood cells in the bone marrow, leading to fewer healthy white blood cells, red blood cells and platelets, causing the signs and symptoms of leukemia
The following are either known causes, or strongly suspected causes:
§  Artificial ionizing radiation
§  Viruses - HTLV-1 (human T-lymphotropic virus) and HIV (human immunodeficiency virus)
§  Benzene and some petrochemicals
§  Alkylating chemotherapy agents used in previous cancers
§  Maternal fetal transmission (rare)
§  Hair dyes
§  Genetic predisposition - some studies researching family history and looking at twins have indicated that some people have a higher risk of developing leukemia because of a single gene or multiple genes.
§  Down syndrome - people with Down syndrome have a significantly higher risk of developing leukemia, compared to people who do not have Down syndrome. Experts say that because of this, people with certain chromosomal abnormalities may have a higher risk.
§  Electromagnetic energy - studies indicate there is not enough evidence to show that ELF magnetic (not electric) fields that exist currently might cause leukemia.


Leukemia

Leukemia
Leukemia is cancer of the body's blood-forming tissues, including the bone marrow and the lymphatic system. The DNA of immature blood cells, mainly white cells, becomes damaged in some way. This abnormality causes the blood cells to grow and divide uncontrollably. Normal blood cells die after a while and are replaced by new cells which are produced in the bone marrow. The abnormal blood cells do not die so easily, and accumulate, occupying more and more space. As more and more space is occupied by these faulty blood cells there is less and less space for the normal cells - and the sufferer becomes ill. Quite simply, the bad cells crowd out the good cells in the blood. There are different types of leukemia, based upon how quickly the disease develops and the type of abnormal cells produced. Leukemia is called an acute leukemia if it develops rapidly. Large numbers of leukemia cells accumulate very quickly in the blood and bone marrow, leading to symptoms such as tiredness, easy bruising, and susceptibility to infections. Acute leukemia requires fast and aggressive treatment.
The Types of Leukemia
The onset of leukemia can be acute (sudden onset) or chronic (slow onset). In acute leukemia, cancer cells multiply quickly. In chronic leukemia, the disease progresses slowly and early symptoms may be very mild.
Leukemia is also classified according to the type of cell. Leukemia involving myeloid cells is called myelogenous leukemia. Myeloid cells are immature blood cells that would normally become granulocytes or monocytes.Leukemia involving lymphocytes is called lymphocytic leukemia. There are four main types of leukemia:
Acute Myelogenous Leukemia (AML)
Acute myelogenous leukemia (AML) can occur in children and adults. According to National Cancer Institute (NCI), about 21,000 new cases of AML are diagnosed annually in the United States. This is the most common form of leukemia.
Acute Lymphocytic Leukemia (ALL)
Acute lymphocytic leukemia (ALL) occurs mostly in children. About 6,000new cases of ALL are diagnosed annually.


Chronic Myelogenous Leukemia (CML)
Chronic myelogenous leukemia (CML) affects mostly adults. About 7,000new cases of CML are diagnosed annually.
Chronic Lymphocytic Leukemia (CLL)
Chronic lymphocytic leukemia (CLL) is most likely to affect people over the age of 55. It’s very rarely seen in children. About 15,000 new cases of CLL are diagnosed annually.
Hairy cell leukemia is a very rare subtype of CLL. Its name comes from the appearance of the cancerous lymphocytes under a microscope.

Cervical cancer symptoms, diagnosis and treatment

Cervical cancer symptoms, diagnosis and treatment
Cervical cancer may not produce any symptoms or signs. Symptoms may develop when the cervical cancer cells start to invade surrounding tissues. Symptoms and signs of cervical cancer include:
  • Abnormal vaginal bleeding
  • Vaginal bleeding after menopause
  • Vaginal bleeding after sex
  • Bleeding or spotting between periods
  • Longer or heavier menstrual periods than usual
  • Other abnormal vaginal discharge
  • Pain during sexual intercourse
It is important to note that these symptoms are not specific for cervical cancer and can be caused by a variety of conditions.
Diagnosis
§  Biopsy: A small section of tissue is taken under general anesthetic.
§  HPV DNA test:This test determines whether the patient is infected with any of the HPV types that are most likely to cause cervical cancer. This involves collecting cells from the cervix for lab testing.
§  Colposcopy: A speculum is placed to hold the vagina open as the gynecologist looks at the cervix through a colposcope - a lighted magnifying instrument.
§  Cone biopsy: A small cone-shaped section of abnormal tissue is taken from the cervix for examination.
§  LLETZ: A diathermy (wire loop with an electric current) is used to remove abnormal tissue. The tissue is sent to the lab to be checked.
§  Blood tests: measures number of blood cells, and can identify any liver or kidney problems.
§  Examination under anesthetic (EUA): This allows the doctor to examine the vagina and cervix more thoroughly.
§  CT scan: The patient consumes a barium drink that appears white on the scan. Just before the scan, a tampon may be placed into the vagina, and a barium liquid may be inserted into the rectum.
§  MRI: By using high-MRI with a special vaginal coil, a technique to measure the movement of water within tissue, researchers may be able to identify cervical cancer in its early stages.
§  Pelvic ultrasound: This is a device that uses high-frequency sound waves to create an image on a monitor of the target area.
Treatment
Cervical cancer treatment options include surgery, radiotherapy, chemotherapy, or combinations. Deciding on the kind of treatment depends on several factors, such as the stage of the cancer, as well as the patient's age and general state of health.
Treatment for early stage cervical cancer has a good success rate. The further the cancer has spread out of the area it originated from, the lower the success rate tends to be.

Friday, 9 December 2016

Cervical cancer

Cervical cancer
Cervical cancer starts in the cells lining the cervix. This is sometimes called the uterine cervix. The cervix connects the body of the uterus to the vagina. The part of the cervix closest to the body of the uterus is called the endocervix. The 2 main types of cells covering the cervix are squamous cells (on the exocervix) and glandular cells (on the endocervix). These 2 cell types meet at a place called thetransformation zone. If detected early, cervical cancer has a very high cure rate. Vaccination against HPVs, which are known to cause cervical cancer, is an effective preventive measure. Almost all cervical cancers are caused by longstanding infection with one of the HPVs. HPV infection is very common, and most people with HPV infection do not develop cancer.
However, there are some risk factors which are known to increase the risk of developing cervical cancer. These risk factors include:
§  HPV (human papillomavirus): a sexually transmitted virus. There are over 100 different types of HPVs, at least 13 of which can cause cervical cancer. There are over 100 types of HPVs, and only certain types have been linked to cancers. Other HPV types cause benign warts on the skin or genitals. 
§  Many sexual partners or becoming sexually active early:  Women who have had many sexual partners generally have a higher risk of becoming infected with HPV, which raises their risk of developing cervical cancer.
§  Smoking: increases the risk of developing many cancers, including cervical cancer.
§  Weakened immune system: such as those with HIV/AIDS, or transplant recipients taking immunosuppressive medications.
§  Long-term mental stress: Women who experience high levels of stress over a sustained period may be less able to fight off HPV.
§  Several pregnancies: Women who have had at least three children in separate pregnancies are more likely to develop cervical cancer compared with women who never had children.
§  Giving birth at a very young age: Women who gave birth before the age of 17 are significantly more likely to develop cervical cancer compared with women who had their first baby when they were aged 25 or over.
§  Contraceptive pill: Long-term use of some common contraceptive pills slightly raises a woman's risk.
§  Socio-economic status: Studies in several countries have revealed that women in deprived areas have significantly higher rates of cervical cancer.
§  Other sexually transmitted diseases (STD): Women who become infected with chlamydia, gonorrhea, or syphilis have a higher risk of developing cervical cancer.

Gastric cancer diagnosis and treatment

Gastric cancer diagnosis and treatment
The goal of obtaining laboratory studies is to assist in determining optimal therapy. Potentially useful tests in patients with suspected gastric cancer include the following:
·         CBC: May be helpful to identify anemia, which may be caused by bleeding, liver dysfunction, or poor nutrition
·         Liver function tests
·         Electrolyte panels
·         Tumor markers such as CEA and CA 19-9: Elevated CEA in 45-50% of cases; elevated CA 19-9 in about 20% of cases
Imaging studies that aid in the diagnosis of gastric cancer in patients in whom the disease is suggested clinically include the following:
·         Esophagogastroduodenoscopy (EGD): To evaluate gastric wall and lymph node involvement
·         Double-contrast upper GI series and barium swallows: May be helpful in delineating the extent of disease when obstructive symptoms are present or when bulky proximal tumors prevent passage of the endoscope to examine the stomach distal to an obstruction
·         Chest radiography: To evaluate for metastatic lesions
·         CT scanning or MRI of the chest, abdomen, and pelvis: To assess the local disease process and evaluate potential areas of spread
·         Endoscopic ultrasonography (EUS): Staging tool for more precise preoperative assessment of the tumor stage
Biopsy of any ulcerated lesion should include at least six specimens taken from around the lesion because of variable malignant transformation. In selected cases, endoscopic ultrasonography may be helpful in assessing depth of penetration of the tumor or involvement of adjacent structures.
Treatment
Surgery
Surgery remains the mainstay treatment for localised gastric adenocarcinoma (confined to the stomach). The exact procedure performed is determined by the size and location of the tumour as well as the ability to achieve surgical margins clear of disease. The surgical approach in gastric cancer depends on the location, size, and locally invasive characteristics of the tumor.
Types of surgical intervention in gastric cancer include the following:
·         Total gastrectomy, if required for negative margins
·         Esophagogastrectomy for tumors of the cardia and gastroesophageal junction
·         Subtotal gastrectomy for tumors of the distal stomach
·         Lymph node dissection
Chemotherapy
Chemotherapy has been shown to increase survival and the time it takes the disease to progress, compared to best supportive care alone. An improved quality of life with chemotherapy compared to best supportive care has also been demonstrated. Antineoplastic agents and combinations of agents used in managing gastric cancer include the following:
·         Platinum-based combination chemotherapy
·         Trastuzumab
·         Ramucirumab