tag:blogger.com,1999:blog-72703799118391938752024-03-13T03:11:00.887-07:00Benign MesotheliomaInformation about Benign Mesothelioma, Mesothelioma Threatments, Mesothelioma Type, Cancer.Shearhttp://www.blogger.com/profile/06260451169164951546noreply@blogger.comBlogger44125tag:blogger.com,1999:blog-7270379911839193875.post-27424538633028162092011-05-07T09:24:00.000-07:002011-05-07T09:24:05.926-07:00Symptoms, Causes, Diagnosis of Hairy Cell Leukemia<div dir="ltr" style="text-align: left;" trbidi="on"><div style="color: red; text-align: justify;"><a href="http://benign-mesothelioma-shear.blogspot.com/search/label/Symptoms%20or%20Signs"><u><b><span class="mw-headline" id="Symptoms">Symptoms</span></b></u></a></div><div style="text-align: justify;">In hairy cell <a href="http://benign-mesothelioma-shear.blogspot.com/search/label/Leukemia"><u style="color: red;"><i><b>leukemia</b></i></u></a>, the "hairy cells" (malignant B lymphocytes) accumulate in the bone marrow, interfering with the production of normal white blood cells, red blood cells, and platelets. Consequently, patients may develop infections related to low white blood cell count, anemia and fatigue due to a lack of red blood cells, or easy bleeding due to a low platelet count.<sup class="reference" id="cite_ref-11"><span></span><span></span></sup> Leukemic cells may gather in the spleen and cause it to swell; this can have the side effect of making the person feel full even when he or she has not eaten much.</div><div style="text-align: justify;"><br />
</div><div> </div><div style="text-align: justify;">Hairy cell leukemia is commonly diagnosed after a routine blood count shows unexpectedly low numbers of one or more kinds of normal blood cells, or after unexplained bruises or recurrent infections in an otherwise apparently healthy patient.</div><a name='more'></a><br />
<div style="text-align: justify;"> </div><div style="text-align: justify;">Platelet function may be somewhat impaired in HCL patients, although this does not appear to have any significant practical effect.<sup class="reference" id="cite_ref-pmid512041_12-0"><span></span><span></span></sup> It may result in somewhat more mild bruises than would otherwise be expected for a given platelet count or a mildly increased bleeding time for a minor cut. It is likely the result of producing slightly abnormal platelets in the overstressed bone marrow tissue.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"> </div><div style="text-align: justify;">Patients with a high tumor burden may also have somewhat reduced levels of cholesterol,<sup class="reference" id="cite_ref-13"><span></span><span></span></sup> especially in patients with an enlarged spleen.<sup class="reference" id="cite_ref-14"><span></span><span></span></sup> Cholesterol levels return to more normal values with successful treatment of HCL.<span class="mw-headline" id="Cause"> </span></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b><span class="mw-headline" id="Cause">Cause</span></b></u></div><div style="text-align: justify;"> </div><div style="text-align: justify;">As with many cancers, the cause of hairy cell leukemia is unknown. Exposure to tobacco smoke, ionizing radiation, or industrial chemicals (with the possible exception of diesel) does not appear to increase the risk of developing HCL.<sup class="reference" id="cite_ref-pmid7577624_15-0"><span></span><span></span></sup> Farming and gardening appear to increase the risk of HCL in some studies.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-pmid11083509_16-0"><span></span><span></span></sup></div><div style="text-align: justify;"> </div><div style="text-align: justify;">The U.S. Institute of Medicine (IOM) announced "sufficient evidence" of an association between exposure to herbicides and later development of chronic B-cell leukemias and lymphomas in general. The IOM report emphasized that neither animal nor human studies indicate an association of herbicides with HCL specifically. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">However, the IOM extrapolated data from chronic lymphocytic leukemia and non-Hodgkin lymphoma to conclude that HCL and other rare B-cell neoplasms may share this risk factor.<sup class="reference" id="cite_ref-17"><span></span><span></span></sup> As a result of the IOM report, the U.S. Department of Veterans Affairs considers HCL an illnesses presumed to be a service-related disability (see Agent Orange).</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"> </div><div style="text-align: justify;">Human T-lymphotropic virus 2 (HTLV-2) has been isolated in a small number of patients with the variant form of HCL.<sup class="reference" id="cite_ref-pmid16155606_18-0"><span></span><span></span></sup> In the 1980s, HTLV-2 was identified in a patient with a T-cell lymphoproliferative disease; this patient later developed hairy cell leukemia (a B cell disease), but HTLV-2 was not found in the hairy cell clones.<sup class="reference" id="cite_ref-pmid2827811_19-0"><span></span><span></span></sup> There is no evidence that HTLV-II causes any sort of hematological malignancy, including HCL.<span class="mw-headline" id="Diagnosis"> </span></div><div style="text-align: justify;"><br />
</div><div style="color: red; text-align: justify;"><a href="http://benign-mesothelioma-shear.blogspot.com/search/label/Diagnosis"><u><b><span class="mw-headline" id="Diagnosis">Diagnosis</span></b></u></a></div><div style="text-align: justify;"> </div><div style="text-align: justify;">The diagnosis of HCL may be suggested by abnormal results on a complete blood count (CBC), but additional testing is necessary to confirm the diagnosis. A CBC normally shows low counts for white blood cells, red blood cells, and platelets in HCL patients. However, if large numbers of hairy cells are in the blood stream, then normal or even high lymphocyte counts may be found.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"> </div><div style="text-align: justify;">On physical exam, 80–90% of patients have an enlarged spleen, which can be massive.<sup class="reference" id="cite_ref-Wintrobe_21-0"><span></span><span></span></sup> This is less likely among patients who are diagnosed at an early stage. Peripheral lymphadenopathy (enlarged lymph nodes) is uncommon (less than 5% of patients), but abdominal lymphadenopathy is a relatively common finding on computed tomography (CT) scans.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-Wintrobe_21-1"><span></span><span></span></sup></div><div style="text-align: justify;"> </div><div style="text-align: justify;">The most important lab finding is the presence of hairy cells in the bloodstream.<sup class="reference" id="cite_ref-Wintrobe_21-2"><span></span><span></span></sup> Hairy cells are abnormal white blood cells with hair-like projections of cytoplasm; they can be seen by examining a blood smear or bone marrow biopsy specimen. The blood film examination is done by staining the blood cells with Wright's stain and looking at them under a microscope. Hairy cells are visible in this test in about 85% of cases.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-Wintrobe_21-3"><span></span><span></span></sup></div><div style="text-align: justify;"> </div><div style="text-align: justify;">Most patients require a bone marrow biopsy for final diagnosis. The bone marrow biopsy is used both to confirm the presence of HCL and also the absence of any additional diseases, such as Splenic marginal zone lymphoma or B-cell prolymphocytic leukemia. The diagnosis can be confirmed by viewing the cells with a special stain known as TRAP (tartrate resistant acid phosphatase).</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"> </div><div style="text-align: justify;">It is also possible to definitively diagnose hairy cell leukemia through flow cytometry on blood or bone marrow. The hairy cells are larger than normal and positive for CD19, CD20, CD22, CD11c, CD25, CD103, and FMC7.<sup class="reference" id="cite_ref-22"><span></span><span></span></sup> (CD103, CD22, and CD11c are strongly expressed.)</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-pmid18798068_23-0"><span></span><span></span></sup></div><div style="text-align: justify;"> </div><div style="text-align: justify;">Hairy cell leukemia-variant (HCL-V), which shares some characteristics with B cell prolymphocytic leukemia (B-PLL), does not show CD25 (also called the Interleukin-2 receptor, alpha). As this is relatively new and expensive technology, its adoption by physicians is not uniform, despite the advantages of comfort, simplicity, and safety for the patient when compared to a bone marrow biopsy. The presence of additional lymphoproliferative diseases is easily checked during a flow cytometry test, where they characteristically show different results.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-24"><span></span><span></span></sup></div><div style="text-align: justify;"> </div><div style="text-align: justify;">The differential diagnoses include: several kinds of anemia, including myelophthisis and aplastic anemia,<sup class="reference" id="cite_ref-titleeMedicine_-_Hairy_Cell_Leukemia_:_Article_by_Emmanuel_C_Besa_25-0"><span></span><span></span></sup> and most kinds of blood neoplasms, including hypoplastic myelodysplastic syndrome, atypical chronic lymphocytic leukemia, B-cell prolymphocytic leukemia, or idiopathic myelofibrosis.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><span style="font-size: large;"><b>Wikipedia</b></span></u></div></div>Shearhttp://www.blogger.com/profile/06260451169164951546noreply@blogger.com0tag:blogger.com,1999:blog-7270379911839193875.post-52843366405248723512011-05-06T02:14:00.000-07:002011-05-06T02:14:53.598-07:00Hairy Cell Leukemia - Hairy Cell Leukemia Variant - Japanese Variant<div dir="ltr" style="text-align: left;" trbidi="on"><div style="text-align: justify;"><b>Hairy cell leukemia</b> is an uncommon hematological malignancy characterized by an accumulation of abnormal B lymphocytes. It is usually classified as a sub-type of chronic lymphoid leukemia. Hairy cell leukemia makes up approximately 2% of all leukemias, with fewer than 2,000 new cases diagnosed annually in North America and Western Europe combined.</div><div style="text-align: justify;"><br />
</div><div> </div><div style="text-align: justify;">Hairy cell leukemia was originally described as histiocytic <a href="http://benign-mesothelioma-shear.blogspot.com/search/label/Leukemia"><u style="color: red;"><i><b>leukemia</b></i></u></a>, malignant reticulosis, or lymphoid myelofibrosis in publications dating back to the 1920s. The disease was formally named leukemic reticuloendotheliosis and its characterization significantly advanced by Bertha Bouroncle and colleagues at The Ohio State University College of Medicine in 1958. Its common name, which was coined in 1966,<sup class="reference" id="cite_ref-0"><span></span><span></span></sup> is derived from the "hairy" appearance of the malignant B cells under a microscope.<span class="mw-headline" id="Classification"><a name='more'></a> </span></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b><span class="mw-headline" id="Classification">Classification</span></b></u></div><div style="text-align: justify;"> </div><div style="text-align: justify;">When not further specified, the "classic" form is often implied. However, two variants have been described: Hairy cell leukemia-variant,<sup class="reference" id="cite_ref-urlAmerican_Journal_of_Clinical_Pathology_1-0"><span></span><span></span></sup> which usually is diagnosed in men and a Japanese variant. The non-Japanese variant is more difficult to treat than either 'classic' HCL or the Japanese variant HCL.<span class="mw-headline" id="Hairy_cell_leukemia-variant"> </span></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b><span class="mw-headline" id="Hairy_cell_leukemia-variant">Hairy cell leukemia-variant</span></b></u></div><div style="text-align: justify;"> </div><div style="text-align: justify;"><b>Hairy cell leukemia-variant</b>, or HCL-V, is usually described as a prolymphocytic variant of hairy cell leukemia.<sup class="reference" id="cite_ref-bloodjournal.hematologylibrary.org_2-0"><span></span><span></span></sup> It was first formally described in 1980 by a paper from the University of Cambridge's Hayhoe lab.<sup class="reference" id="cite_ref-pmid7206776_3-0"><span></span><span></span></sup> About 10% of HCL patients have this variant form of the disease, representing about 60-75 new HCL-V patients each year in the U.S. While classic HCL primarily affects men, HCL-V is somewhat more evenly divided between males and females.<sup class="reference" id="cite_ref-pmid11243388_4-0"><span></span><span></span></sup> While the disease can appear at any age, the median age at diagnosis is over 70.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-pmid15737038_5-0"><span></span><span></span></sup></div><div style="text-align: justify;"> </div><div style="text-align: justify;">Similar to B-PLL in Chronic Lymphocytic Leukemia, HCL-V is a more aggressive disease. It is less likely to be treated successfully than classic HCL and remissions tend to be shorter. Many treatment approaches, such as Interferon-alpha, CHOP and common alkylating agents like cyclophosphamide provide very little benefit.<sup class="reference" id="cite_ref-pmid11243388_4-1"><span></span><span></span></sup> Pentostatin and cladribine provide some benefit to many HCL-V patients, but with shorter remissions and lower response rates compared to classic HCL. More than half of patients respond partially to splenectomy.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-pmid11243388_4-2"><span></span><span></span></sup></div><div style="text-align: justify;"> </div><div style="text-align: justify;">In terms of B cell development, the prolymphocytes are less developed than lymphocyte cells or plasma cells, but are still more developed than their lymphoblastic precursors.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"> </div><div style="text-align: justify;">HCL-V differs from classic HCL principally in these respects:</div><div style="text-align: justify;"> </div><ul style="text-align: justify;"><li>High white blood cell counts, sometimes in excess of 100,000 cells per microliter;</li>
<li>More aggressive course of disease that requires more frequent treatment;</li>
<li>Cells with an unusually large nucleolus for their size;</li>
<li>Little excess fibronectin (which is produced by classic hairy cells<sup class="reference" id="cite_ref-6"><span></span><span></span></sup>) to interfere with bone marrow biopsies; and</li>
<li>Low or no expression of CD25 (also called the Interleukin-2 [IL-2] receptor alpha chain or p55) on cell surfaces.<sup class="reference" id="cite_ref-7"><span></span><span></span></sup></li>
</ul><div style="text-align: justify;"> </div><div style="text-align: justify;">The lack of CD25, which is part of the receptor for a key immunoregulating hormone, may explain why HCL-V cases are normally resistant to treatment by immune system hormones.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-bloodjournal.hematologylibrary.org_2-1"><span></span><span></span></sup></div><div style="text-align: justify;"> </div><div style="text-align: justify;">HCL-V, which has a high proportion of hairy cells without a functional p53 tumor suppressor gene, is somewhat more likely to transform into a higher-grade disease, with Daniel Catovsky suggesting a typical transformation rate of 5% in the U.K., which is similar to the Richter's transformation rate for SLVL and CLL<sup class="reference" id="cite_ref-pmid11243388_4-3"><span></span><span></span></sup> and reporting 6% in one group of patients.<sup class="reference" id="cite_ref-pmid12670464_8-0"><span></span><span></span></sup> Among HCL-V patients, the most aggressive cases normally have the least amount of p53 gene activity.<sup class="reference" id="cite_ref-pmid10576509_9-0"><span></span><span></span></sup> Hairy cells without the p53 gene tend, over time, to displace the less aggressive p53+ hairy cells.<span class="mw-headline" id="Hairy_cell_leukemia-Japanese_variant"> </span></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b><span class="mw-headline" id="Hairy_cell_leukemia-Japanese_variant">Hairy cell leukemia-Japanese variant</span></b></u></div><div style="text-align: justify;"> </div><div style="text-align: justify;"> </div><div style="text-align: justify;"><b>Hairy cell leukemia-Japanese variant</b> or HCL-J. There is also a Japanese variant, which is more easily treated. Treatment with cladribine has been reported.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><span style="font-size: x-large;"><u><b>Wikipedia</b></u></span></div></div>Shearhttp://www.blogger.com/profile/06260451169164951546noreply@blogger.com0tag:blogger.com,1999:blog-7270379911839193875.post-29782185176300834782011-05-06T02:06:00.000-07:002011-05-06T02:06:28.042-07:00B-cell Chronic Lymphocytic Leukemia (a.k.a Chronic Lymphoid Leukemia) Treatments<div dir="ltr" style="text-align: left;" trbidi="on"><div style="text-align: justify;">CLL treatment focuses on controlling the disease and its <a href="http://benign-mesothelioma-shear.blogspot.com/search/label/Symptoms%20or%20Signs"><u style="color: red;"><i><b>symptoms</b></i></u></a> rather than on an outright cure. CLL is treated by chemotherapy, radiation therapy, biological therapy, or bone marrow transplantation. Symptoms are sometimes treated surgically (splenectomy removal of enlarged spleen) or by ("de-bulking" swollen lymph nodes).radiation therapy. Initial CLL <a href="http://benign-mesothelioma-shear.blogspot.com/search/label/Treatments"><u style="color: red;"><i><b>treatments</b></i></u></a> vary depending on the exact diagnosis and the progression of the disease, and even with the preference and experience of the health care practitioner. There are dozens of agents used for CLL therapy.<span class="mw-headline" id="Decision_to_treat"> </span></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b><span class="mw-headline" id="Decision_to_treat">Decision to treat</span></b></u></div><div> </div><div style="text-align: justify;">While generally considered incurable, CLL progresses slowly in most cases. Many people with CLL lead normal and active lives for many years—in some cases for decades. Because of its slow onset, early-stage CLL is, in general, not treated since it is believed that early CLL intervention does not improve survival time or quality of life. Instead, the condition is monitored over time to detect any change in the disease pattern.</div><a name='more'></a><br />
<div style="text-align: justify;"> </div><div style="text-align: justify;"> </div><div style="text-align: justify;">The decision to start CLL <a href="http://benign-mesothelioma-shear.blogspot.com/search/label/Treatments"><u style="color: red;"><i><b>treatment</b></i></u></a> is taken when the patient's clinical symptoms or blood counts indicate that the disease has progressed to a point where it may affect the patient's quality of life. Clinical "staging systems" such as the Rai 4-stage system and the Binet classification can help to determine when and how to treat the patient.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-NCI-CLL-page2_2-1"><span></span><span></span></sup></div><div style="text-align: justify;"> </div><div style="text-align: justify;">Determining when to start treatment and by what means is often difficult; studies have shown there is no survival advantage to treating the disease too early. The National Cancer Institute Working Group has issued guidelines for treatment, with specific markers that should be met before it is initiated.</div><div style="text-align: justify;"> <span class="mw-headline" id="Chemotherapy"> </span></div><div style="text-align: justify;"><u><b><span class="mw-headline" id="Chemotherapy">Chemotherapy</span></b></u></div><div style="text-align: justify;"> </div><div style="text-align: justify;">Combination <a href="http://benign-mesothelioma-shear.blogspot.com/search/label/Chemotherapy"><u style="color: red;"><i><b>chemotherapy</b></i></u></a> regimens are effective in both newly-diagnosed and relapsed CLL. Combinations of fludarabine with alkylating agents (cyclophosphamide) produce higher response rates and a longer progression-free survival than single agents:</div><div style="text-align: justify;"> </div><ul style="text-align: justify;"><li><b>FC</b> (fludarabine with cyclophosphamide)<sup class="reference" id="cite_ref-pmid16219797_17-0"><span></span><span></span></sup></li>
<li><b>FR</b> (fludarabine with rituximab)<sup class="reference" id="cite_ref-pmid12393429_18-0"><span></span><span></span></sup></li>
<li><b>FCR</b> (fludarabine, cyclophosphamide, and rituximab)<sup class="reference" id="cite_ref-pmid15767648_19-0"><span></span><span></span></sup></li>
<li><b>CHOP</b> (cyclophosphamide, doxorubicin, vincristine and prednisolone)</li>
</ul><div style="text-align: justify;"> </div><div style="text-align: justify;">Although the purine analogue fludarabine was shown to give superior response rates to chlorambucil as primary therapy,<sup class="reference" id="cite_ref-pmid11114313_20-0"><span></span><span></span></sup><sup class="reference" id="cite_ref-pmid16856041_21-0"><span></span><span></span></sup> there is no evidence early use of fludarabine improves overall survival, and some clinicians prefer to reserve fludarabine for relapsed disease.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"> </div><div style="text-align: justify;"> </div><div style="text-align: justify;">Alkylating agents approved for CLL include bendamustine and cyclophosphamide. Monoclonal antibodies, such as alemtuzumab (directed against CD52), rituximab (directed against CD20), and ofatumumab (Arzerra ) (directed against CD20) are also used.<span class="mw-headline" id="Stem_cell_transplantation"> </span></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b><span class="mw-headline" id="Stem_cell_transplantation">Stem cell transplantation</span></b></u></div><div style="text-align: justify;"> </div><div style="text-align: justify;">Allogeneic bone marrow (stem cell) transplantation is rarely used as a first-line treatment for CLL due to its risk. There is increasing interest in the use of reduced-intensity allogeneic stem cell transplantation, which offers the prospect of cure for selected patients with a suitable donor.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-Dreger_22-0"><span></span><span></span></sup></div><div style="text-align: justify;"> </div><div style="text-align: justify;">Younger patients that are at high risk for dying from CLL might consider hematopoietic stem cell transplantation (HSCT). Autologous stem cell transplantation, a lower-risk form of treatment using the patient's own blood cells, is not curative. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Myeloablative (bone marrow killing) forms of allogeneic stem cell transplantation, a high-risk treatment using blood cells from a healthy donor, may be curative for some patients, but most patients cannot tolerate the treatment. An intermediate level, called <i>reduced-intensity conditioning allogeneic stem cell transplantation</i>, may be better tolerated by older or frail patients.<span class="mw-headline" id="Refractory_CLL"> </span></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b><span class="mw-headline" id="Refractory_CLL">Refractory CLL</span></b></u></div><div style="text-align: justify;"> </div><div style="text-align: justify;">"Refractory" CLL is a disease that no longer responds favorably to treatment. In this case more aggressive therapies, including lenalidomide, flavopiridol, and bone marrow (stem cell) transplantation, are considered.<sup class="reference" id="cite_ref-24"><span></span><span></span></sup> The monoclonal antibody, alemtuzumab (directed against CD52), may be used in patients with refractory, bone marrow-based disease.<span class="mw-headline" id="Complications"> </span></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b><span class="mw-headline" id="Complications">Complications</span></b></u></div><div style="text-align: justify;"> </div><div style="text-align: justify;">Chronic lymphocytic leukemia may transform into Richter's syndrome, a term used to describe the development of fast-growing diffuse large B cell lymphoma, prolymphocytic leukemia, Hodgkin's lymphoma, or acute leukemia in a patient who has chronic lymphocytic leukemia. Its incidence is estimated to be around 5%</div><br />
<u><span style="font-size: x-large;"><b>Wikipedia</b></span></u></div>Shearhttp://www.blogger.com/profile/06260451169164951546noreply@blogger.com0tag:blogger.com,1999:blog-7270379911839193875.post-55969798600857755812011-05-06T01:53:00.000-07:002011-05-06T01:53:03.561-07:00B-cell Chronic Lymphocytic Leukemia (a.k.a Chronic Lymphoid Leukemia) Diagnosis<div dir="ltr" style="text-align: left;" trbidi="on"><div style="text-align: justify;">The disease is easily diagnosed. CLL is usually first suspected by the presence of a <a href="http://benign-mesothelioma-shear.blogspot.com/2011/05/b-cell-chronic-lymphocytic-leukemia-aka.html"><u style="color: red;"><i><b>lymphocytosis</b></i></u></a>, an increase in one type of the white blood cell, on a complete blood count (CBC) test. This frequently is an incidental finding on a routine physician visit. Most often the lymphocyte count is greater than 4000 cells per microliter (µl) of blood, but can be much higher. The presence of a lymphocytosis in an elderly individual should raise strong suspicion for CLL, and a confirmatory diagnostic test, in particular flow cytometry, should be performed unless clinically unnecessary.</div><div style="text-align: justify;"><br />
</div><div> </div><div style="text-align: justify;">The <a href="http://benign-mesothelioma-shear.blogspot.com/search/label/Diagnosis"><u style="color: red;"><i><b>diagnosis</b></i></u></a> of CLL is based on the demonstration of an abnormal population of B lymphocytes in the blood, bone marrow, or tissues that display an unusual but characteristic pattern of molecules on the cell surface. This atypical molecular pattern includes the coexpression of cells surface markers cluster of differentiation 5 (CD5) and cluster of differentiation 23 (CD23). In addition, all the CLL cells within one individual are clonal, that is, genetically identical. In practice, this is inferred by the detection of only one of the mutually exclusive antibody light chains, kappa or lambda, on the entire population of the abnormal B cells. </div><a name='more'></a><br />
<div style="text-align: justify;">Normal B lymphocytes consist of a stew of different antibody-producing cells, resulting in a mixture of both kappa and lambda expressing cells. The lack of the normal distribution of kappa and lambda producing B cells is one basis for demonstrating clonality, the key element for establishing a diagnosis of any B cell malignancy (B cell non-Hodgkin lymphoma).</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"> </div><div style="text-align: justify;">The combination of the microscopic examination of the peripheral blood and analysis of the lymphocytes by flow cytometry to confirm clonality and marker molecule expression is needed to establish the diagnosis of CLL. Both are easily accomplished on a small amount of blood. A flow cytometer is an instrument that can examine the expression of molecules on individual cells in fluids. This requires the use of specific antibodies to marker molecules with fluorescent tags recognized by the instrument. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">In CLL, the lymphocytes are genetically clonal, of the B cell lineage (express marker molecules cluster of differentiation 19 (CD19) and CD20), and characteristically express the marker molecules CD5 and CD23. These B cells resemble normal lymphocytes under the microscope, although slightly smaller, and are fragile when smeared onto a glass slide, giving rise to many broken cells (smudge cells).<span class="mw-headline" id="Differential_diagnosis"> </span></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b><span class="mw-headline" id="Differential_diagnosis">Differential diagnosis</span></b></u></div><div style="text-align: justify;"> </div><div style="text-align: justify;">Hematologic disorders that may resemble CLL in their clinical presentation, behavior, and microscopic appearance include mantle cell lymphoma, marginal zone lymphoma, B cell prolymphocytic leukemia, and lymphoplasmacytic lymphoma.</div><div style="text-align: justify;"> </div><ul style="text-align: justify;"><li>B cell prolymphocytic leukemia (B PLL), a related, but more aggressive disorder, has cells with similar phenotype, but are significantly larger than normal lymphocytes and have a prominent nucleolus. The distinction is important as the prognosis and therapy differs from CLL.</li>
<li>Hairy cell leukemia is also a neoplasm of B lymphocytes, but the neoplastic cells have a distinct morphology under the microscope (hairy cell leukemia cells have delicate, hair-like projections on their surface) and unique marker molecule expression.</li>
</ul><div style="text-align: justify;"> </div><div style="text-align: justify;">All the B cell malignancies of the blood and bone marrow can be differentiated from one another by the combination of cellular microscopic morphology, marker molecule expression, and specific tumor-associated gene defects. This is best accomplished by evaluation of the patient's blood, bone marrow and occasionally lymph node cells by a pathologist with specific training in blood disorders. A flow cytometer is necessary for cell marker analysis, and the detection of genetic problems in the cells may require visualizing the DNA changes with fluorescent probes by FISH.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><span style="font-size: x-large;"><u><b>Wikipedia</b></u></span></div></div>Shearhttp://www.blogger.com/profile/06260451169164951546noreply@blogger.com0tag:blogger.com,1999:blog-7270379911839193875.post-83995934620586546472011-05-06T01:48:00.000-07:002011-05-06T01:48:35.065-07:00B-cell Chronic Lymphocytic Leukemia (a.k.a Chronic Lymphoid Leukemia)<div dir="ltr" style="text-align: left;" trbidi="on"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggftt1LnE6-SB_DXMkHVLrCM-i2Dh0Mk5TaPV9upX22T1rR7ZY0aWSsv6D6Rkh5vPDiQnaWeJgfBnDVRJb4JEYgM6Tro1qwJ0qw3o9lZVxOhSeu0qV3YS0mn5qZpXVFv1h_hxCBZzd4R4/s1600/Peripheral+blood+smear+showing+CLL+cells.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="241" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggftt1LnE6-SB_DXMkHVLrCM-i2Dh0Mk5TaPV9upX22T1rR7ZY0aWSsv6D6Rkh5vPDiQnaWeJgfBnDVRJb4JEYgM6Tro1qwJ0qw3o9lZVxOhSeu0qV3YS0mn5qZpXVFv1h_hxCBZzd4R4/s320/Peripheral+blood+smear+showing+CLL+cells.jpg" width="320" /></a></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><b>B-cell chronic lymphocytic leukemia</b> (<b>B-CLL</b>), also known as <b>chronic lymphoid leukemia</b> (CLL), is the most common type of leukemia. <a href="http://benign-mesothelioma-shear.blogspot.com/search/label/Leukemia"><u style="color: red;"><i><b>Leukemia</b></i></u></a>s are <a href="http://benign-mesothelioma-shear.blogspot.com/search/label/Cancer"><u style="color: red;"><i><b>cancer</b></i></u></a>s of the white blood cells (leukocytes). CLL affects B cell lymphocytes. B cells originate in the bone marrow, develop in the lymph nodes, and normally fight infection by producing antibodies. In CLL, the DNA of a B cell is damaged, so that it cannot produce antibodies. </div><a name='more'></a><br />
<div style="text-align: justify;">Additionally, B cells grow out of control and accumulate in the bone marrow and blood, where they crowd out healthy blood cells. CLL is a stage of <b>small lymphocytic lymphoma</b> (SLL), a type of B-cell lymphoma, which presents primarily in the lymph nodes.<sup class="reference" id="cite_ref-pmid10577857_0-0"><span></span><span></span></sup> CLL and SLL are considered the same underlying disease, just with different appearances.</div><div style="text-align: justify;"><br />
</div><div> </div><div style="text-align: justify;"> </div><div style="text-align: justify;">CLL is a disease of adults, but, in rare cases, it can occur in teenagers and occasionally in children (inherited). Most (>75%) people newly diagnosed with CLL are over the age of 50, and the majority are men. Most people are diagnosed without symptoms as the result of a routine blood test that returns a high white blood cell count, but, as it advances, CLL results in swollen lymph nodes, spleen, and liver, and eventually anemia and infections. Early CLL is not treated, and late CLL is treated with chemotherapy and monoclonal antibodies.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"> DNA analysis has distinguished two major types of CLL, with different survival times. CLL that is positive for the marker ZAP-70 has an average survival of 5 years. CLL that is negative for ZAP-70 has an average survival of more than 25 years. Patients with slowly-progressing disease can be reassured and may not need any treatment in their lifetimes.</div><div style="text-align: justify;"> </div><div style="text-align: justify;"><a href="http://benign-mesothelioma-shear.blogspot.com/search/label/Symptoms%20or%20Signs"><u style="color: red;"><b>Signs and Symptoms </b></u></a></div><div style="text-align: justify;">Most people are diagnosed without symptoms as the result of a routine blood test that returns a high white blood cell count. Less commonly, CLL may present with enlarged lymph nodes without a high white blood cell count or no evidence of the disease in the blood. This is referred to as <i>small lymphocytic lymphoma</i>. In some individuals the disease comes to light only after the neoplastic cells overwhelm the bone marrow resulting in anemia producing tiredness or weakness. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b><span style="font-size: x-large;">Wikipedia</span></b></u></div></div>Shearhttp://www.blogger.com/profile/06260451169164951546noreply@blogger.com0tag:blogger.com,1999:blog-7270379911839193875.post-81548186732470419332011-05-04T17:36:00.000-07:002011-05-04T17:38:52.342-07:00Chronic Myelogenous Leukemia Classification (Chronic Phase, Accelerated Phase, Blast Crisis)<div dir="ltr" style="text-align: left;" trbidi="on"><div style="text-align: justify;">CML is often divided into three phases based on clinical characteristics and laboratory findings. In the absence of intervention, CML typically begins in the <i>chronic</i> phase, and over the course of several years progresses to an <i>accelerated</i> phase and ultimately to a <i>blast crisis</i>. Blast crisis is the terminal phase of CML and clinically behaves like an acute leukemia. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Drug treatment will usually stop this progression if started early. One of the drivers of the progression from chronic phase through acceleration and blast crisis is the acquisition of new chromosomal abnormalities (in addition to the Philadelphia chromosome). Some patients may already be in the accelerated phase or blast crisis by the time they are diagnosed.<span class="mw-headline" id="Chronic_phase"> <a name='more'></a></span><u><b><span class="mw-headline" id="Chronic_phase"> </span></b></u><br />
<u><b><span class="mw-headline" id="Chronic_phase">Chronic phase</span></b></u></div><div></div><div style="text-align: justify;">Approximately 85% of patients with CML are in the chronic phase at the time of diagnosis. During this phase, patients are usually asymptomatic or have only mild symptoms of fatigue, left side pain, joint and/or hip pain, or abdominal fullness. The duration of chronic phase is variable and depends on how early the disease was diagnosed as well as the therapies used. In the absence of treatment, the disease progresses to an accelerated phase<span class="mw-headline" id="Accelerated_phase"> </span></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b><span class="mw-headline" id="Accelerated_phase">Accelerated phase</span></b></u></div><div style="text-align: justify;"></div><div style="text-align: justify;">Criteria for diagnosing transition into the accelerated phase are somewhat variable; the most widely used criteria are those put forward by investigators at M.D. Anderson Cancer Center,<sup class="reference" id="cite_ref-6"></sup> by Sokal et al.,<sup class="reference" id="cite_ref-7"></sup> and the World Health Organization.<sup class="reference" id="cite_ref-WHO_3-1"></sup><sup class="reference" id="cite_ref-8"></sup> The WHO criteria are perhaps most widely used, and define the accelerated phase by any of the following:</div><div style="text-align: justify;"></div><ul style="text-align: justify;"><li>10–19% myeloblasts in the blood or bone marrow</li>
<li>>20% basophils in the blood or bone marrow</li>
<li>Platelet count <100,000, unrelated to therapy</li>
<li>Platelet count >1,000,000, unresponsive to therapy</li>
<li>Cytogenetic evolution with new abnormalities in addition to the Philadelphia chromosome</li>
<li>Increasing splenomegaly or white blood cell count, unresponsive to therapy</li>
</ul><div style="text-align: justify;"></div><div style="text-align: justify;">The patient is considered to be in the accelerated phase if any of the above are present. The accelerated phase is significant because it signals that the disease is progressing and transformation to blast crisis is imminent. Drug treatment often becomes less effective in the advanced stages.<span class="mw-headline" id="Blast_crisis"> </span></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b><span class="mw-headline" id="Blast_crisis">Blast crisis</span></b></u></div><div style="text-align: justify;"></div><div style="text-align: justify;">Blast crisis is the final phase in the evolution of CML, and behaves like an acute leukemia, with rapid progression and short survival.<sup class="reference" id="cite_ref-Tefferi_1-4"></sup> Blast crisis is diagnosed if any of the following are present in a patient with CML:<sup class="reference" id="cite_ref-9"></sup></div><div style="text-align: justify;"></div><ul style="text-align: justify;"><li>>20% myeloblasts or lymphoblasts in the blood or bone marrow</li>
<li>Large clusters of blasts in the bone marrow on biopsy</li>
<li>Development of a chloroma (solid focus of leukemia outside the bone marrow)</li>
</ul><div style="text-align: justify;"><u><span style="font-size: x-large;"><b>Wikipedia</b></span></u></div></div>Shearhttp://www.blogger.com/profile/06260451169164951546noreply@blogger.com0tag:blogger.com,1999:blog-7270379911839193875.post-49407382506748268732011-05-04T17:28:00.000-07:002011-05-04T17:28:25.016-07:00Chronic Myelogenous Leukemia (Signs and Symptoms, Diagnosis, Treatment)<div dir="ltr" style="text-align: left;" trbidi="on"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNQj28AcNcIxFGksmtFeD_gsGtVXWYWi3EGwQwe155fHfpC9_ARzK35U9VGEgsmvIjvVt1uUKSNj3jf1KL6ZmaWUciN8dXv2_6HzsLgZVUyJCgCIZzWxQ9583euUYVZBZiDWg7Wby4SEM/s1600/Bcrablmet.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNQj28AcNcIxFGksmtFeD_gsGtVXWYWi3EGwQwe155fHfpC9_ARzK35U9VGEgsmvIjvVt1uUKSNj3jf1KL6ZmaWUciN8dXv2_6HzsLgZVUyJCgCIZzWxQ9583euUYVZBZiDWg7Wby4SEM/s1600/Bcrablmet.jpg" /></a></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><b>Chronic myelogenous (or myeloid) leukemia</b> (<b>CML</b>), also known as <b>chronic granulocytic leukemia (CGL)</b>, is a cancer of the white blood cells. It is a form of leukemia characterized by the increased and unregulated growth of predominantly myeloid cells in the bone marrow and the accumulation of these cells in the blood. CML is a clonal bone marrow stem cell disorder in which proliferation of mature granulocytes (neutrophils, eosinophils, and basophils) and their precursors is the main finding. </div><a name='more'></a><br />
<div style="text-align: justify;">It is a type of myeloproliferative disease associated with a characteristic chromosomal translocation called the Philadelphia chromosome. It is now treated with one of several targeted therapies including imatinib, dasatinib, and nilotinib, which have dramatically improved survival to nearly 90% due to the advent of these targeted therapies.<span class="mw-headline" id="Signs_and_symptoms"> </span></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b><span class="mw-headline" id="Signs_and_symptoms">Signs and symptoms</span></b></u></div><div> </div><div style="text-align: justify;">Patients are often asymptomatic at diagnosis, presenting incidentally with an elevated white blood cell count on a routine laboratory test. In this setting, CML must be distinguished from a leukemoid reaction, which can have a similar appearance on a blood smear. Symptoms of CML may include: enlarged spleen causing pain on the left side, malaise, joint and/or hip pain, low-grade fever, increased susceptibility to infections, anemia, and thrombocytopenia with easy bruising (although an <i>increased</i> platelet count (thrombocytosis) may also occur in CML)</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b>Diagnosis </b></u></div><div style="text-align: justify;">CML is often suspected on the basis on the complete blood count, which shows increased granulocytes of all types, typically including mature myeloid cells. Basophils and eosinophils are almost universally increased; this feature may help differentiate CML from a leukemoid reaction. A bone marrow biopsy is often performed as part of the evaluation for CML, and CML is diagnosed by detecting the Philadelphia chromosome. This characteristic chromosomal abnormality can be detected by routine cytogenetics, by fluorescent in situ hybridization, or by PCR for the bcr-abl fusion gene.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-Tefferi_1-1"><span></span><span></span></sup></div><div style="text-align: justify;"> Controversy exists over so-called <i>Ph-negative</i> CML, or cases of suspected CML in which the Philadelphia chromosome cannot be detected. Many such patients in fact have complex chromosomal abnormalities which mask the (9;22) translocation, or have evidence of the translocation by FISH or RT-PCR in spite of normal routine karyotyping.<sup class="reference" id="cite_ref-2"><span></span><span></span></sup> The small subset of patients without detectable molecular evidence of bcr-abl fusion may be better classified as having an undifferentiated myelodysplastic/myeloproliferative disorder, as their clinical course tends to be different from patients with CML.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b>Treatment</b></u></div><div style="text-align: justify;">Chronic phase CML is treated with inhibitors of tyrosine kinase, the first of which was imatinib mesylate (marketed as Gleevec or Glivec; previously known as STI-571) approved by the United States FDA in 2001. To overcome imatinib resistance and to increase responsiveness of TK inhibitors, two novel agents were later developed. The first, dasatinib, is a TK inhibitor that blocks several oncogenic proteins and was initially approved by the US FDA in 2007 to treat CML patients who were either resistant to or intolerant of imatinib. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Another TK inhibitor, nilotinib, was also approved by the US FDA for the same indication. Nilotinib and dasatanib were approved for first-line therapy in 2010, so there are now three drugs available for first-line treatment of CML. In the past, antimetabolites (e.g. cytarabine, hydroxyurea), alkylating agents, interferon alfa 2b, and steroids were used, but these drugs have been replaced by TK inhibitor drugs. The TK inhibitor drugs specifically target BCR/abl, the constitutively activated tyrosine kinase fusion protein caused by the Philadelphia chromosome translocation. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">The IRIS study is an international study that compared interferon/cytarabine combination with imatinib. Long term follow up demonstrating the superiority of imatinib regimens is clear cut. Bone marrow transplantation was also used as initial treatment for CML before the advent of imatinib, but is now rarely used, primarily for those who fail drug treatment. While transplantation can often be curative, there remains a high rate of transplant-related mortality.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"> </div><div style="text-align: justify;">Dasatanib and nilotinib failed to overcome the imatinib resistance caused by the T315I mutation. All current treatments for this mutation are experimental. In October 2010, ponatinib, a small molecule, oral drug developed by Ariad Pharmaceuticals, was entered into evaluation in a pivotal Phase 2 trial. Ponatinib, a pan-BCR-ABL inhibitor, has shown ongoing strong efficacy in its continuing Phase 1 trial in treatment of the T315I mutation CML, as well as all other known mutations. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">This drug has also been granted orphan status. Recently Chemgenex released results of their open-label Phase 2/3 study (CGX-635-CML-202) which investigated the use of their non-targeted agent omacetaxine, administered subcutaneously in CML patients who had failed imatinib and who have the highly drug-resistant T315I kinase domain mutation. Stem cell transplantation remains an option for those patients who rarely develop the T315I mutation.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"> In 2005 encouraging but mixed results of vaccination were reported with the <i>BCR/abl</i> p210 fusion protein in patients with stable disease, with GM-CSF as an adjuvant.</div><div style="text-align: justify;"> </div><div style="text-align: justify;"><u><b><span style="font-size: x-large;">Wikipedia </span></b></u></div><div style="text-align: justify;"></div></div>Shearhttp://www.blogger.com/profile/06260451169164951546noreply@blogger.com0tag:blogger.com,1999:blog-7270379911839193875.post-33447925338016476632011-05-03T18:39:00.000-07:002011-05-03T18:39:07.307-07:00Other Form of Leukemia - Acute Lymphoblastic Leukemias (ALL)<div dir="ltr" style="text-align: left;" trbidi="on"><div style="text-align: justify;"><b>Acute lymphoblastic leukemias</b> (<b>ALL</b>), is a form of <a href="http://benign-mesothelioma-shear.blogspot.com/search/label/Leukemia"><u style="color: red;"><i><b>leukemia</b></i></u></a>, or cancer of the white blood cells characterized by excess lymphoblasts.</div><div style="text-align: justify;"><br />
</div><div> </div><div style="text-align: justify;">Malignant, immature white blood cells continuously multiply and are overproduced in the bone marrow. ALL causes damage and death by crowding out normal cells in the bone marrow, and by spreading (infiltrating) to other organs. ALL is most common in childhood with a peak incidence at 2–5 years of age, and another peak in old age. The overall cure rate in children is about 80%, and about 45%-60% of adults have long-term disease-free survival.</div><a name='more'></a><br />
<div style="text-align: justify;"> </div><div style="text-align: justify;"><i>Acute</i> refers to the relatively short time course of the disease (being fatal in as little as a few weeks if left untreated) to differentiate it from the very different disease of Chronic Lymphocytic Leukemia which has a potential time course of many years. It is interchangeably referred to as Lymphocytic or Lymphoblastic. This refers to the cells that are involved, which if they were normal would be referred to as lymphocytes but are seen in this disease in a relatively immature (also termed 'blast') state.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"> </div><div style="text-align: justify;"><b>Symptoms</b> The <a href="http://benign-mesothelioma-shear.blogspot.com/search/label/Symptoms%20or%20Signs"><u style="color: red;"><i><b>signs and symptoms</b></i></u></a> of ALL are variable but follow from bone marrow replacement and/or organ infiltration.</div><div style="text-align: justify;"> </div><ul style="text-align: justify;"><li>Generalized weakness and fatigue</li>
<li>Anemia</li>
<li>Frequent or unexplained [fever] and [infection]</li>
<li>Weight loss and/or loss of appetite</li>
<li>Excessive and unexplained bruising</li>
<li>Bone pain, joint pain (caused by the spread of "blast" cells to the surface of the bone or into the joint from the marrow cavity)</li>
<li>Breathlessness</li>
<li>Enlarged lymph nodes,liver and/or spleen</li>
<li>Pitting edema (swelling) in the lower limbs and/or abdomen</li>
<li>Petechia, which are tiny red spots or lines in the skin due to low platelet levels</li>
</ul><div style="text-align: justify;"> </div><div style="text-align: justify;">The signs and symptoms of ALL result from the lack of normal and healthy blood cells because they are crowded out by malignant and immature leukocytes (white blood cells). Therefore, people with ALL experience symptoms from malfunctioning of their erythrocytes (red blood cells), leukocytes, and platelets. Laboratory tests which might show abnormalities include blood count tests, renal function tests, electrolyte tests and liver enzyme tests.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><span style="font-size: x-large;"><b>Wikipedia </b></span></u></div></div>Shearhttp://www.blogger.com/profile/06260451169164951546noreply@blogger.com0tag:blogger.com,1999:blog-7270379911839193875.post-77972339351282737772011-05-03T18:31:00.000-07:002011-05-03T18:31:07.705-07:00Leukemia (cancer of the Blood) Diagnosis<div dir="ltr" style="text-align: left;" trbidi="on"><div style="text-align: justify;">Diagnosis is usually based on repeated complete blood counts and a bone marrow examination following observations of the <a href="http://benign-mesothelioma-shear.blogspot.com/search/label/Symptoms%20or%20Signs"><u style="color: red;"><i><b>symptoms</b></i></u></a>, however, in rare cases blood tests may not show if a patient has leukemia, usually this is because the leukemia is in the early stages or has entered remission. A lymph node biopsy can be performed as well in order to diagnose certain types of leukemia in certain situations.</div><div style="text-align: justify;"><br />
</div><div> </div><div style="text-align: justify;">Following diagnosis, blood chemistry tests can be used to determine the degree of liver and kidney damage or the effects of chemotherapy on the patient. When concerns arise about visible damage due to <a href="http://benign-mesothelioma-shear.blogspot.com/search/label/Leukemia"><u style="color: red;"><i><b>leukemia</b></i></u></a>, doctors may use an X-ray, MRI, or ultrasound. These can potentially view leukemia's effects on such body parts as bones (X-ray), the brain (MRI), or the kidneys, spleen, and liver (ultrasound). Finally, CT scans are rarely used to check lymph nodes in the chest.</div><a name='more'></a><br />
<div style="text-align: justify;">Despite the use of these methods to diagnose whether or not a patient has leukemia, many people have not been diagnosed because many of the symptoms are vague, unspecific, and can refer to other diseases. For this reason, the American Cancer Society predicts that at least one-fifth of the people with leukemia have not yet been diagnosed.</div><div style="text-align: justify;"> </div><div style="text-align: justify;"><u><span style="font-size: x-large;"><b>Wikipedia </b></span></u></div><div style="text-align: justify;"><a href="http://en.wikipedia.org/wiki/Leukemia#cite_note-ACS1-14"><span></span></a></div></div>Shearhttp://www.blogger.com/profile/06260451169164951546noreply@blogger.com0tag:blogger.com,1999:blog-7270379911839193875.post-87057776159491761532011-05-03T07:29:00.000-07:002011-05-03T07:29:35.964-07:00Causes for Leukemia<div dir="ltr" style="text-align: left;" trbidi="on"><div style="text-align: justify;">No single known cause for all of the different types of leukemia exists. The known causes, which are not generally factors within the control of the average person, account for relatively few cases.<sup class="reference" id="cite_ref-pmid12163333_15-0"><span></span><span></span></sup> The different leukemias likely have different causes.</div><div style="text-align: justify;"><br />
</div><div> </div><div style="text-align: justify;">Leukemia, like other <a href="http://benign-mesothelioma-shear.blogspot.com/search/label/Cancer"><u style="color: red;"><i><b>cancers</b></i></u></a>, results from somatic mutations in the DNA. Certain mutations produce leukemia by activating oncogenes or deactivating tumor suppressor genes, and thereby disrupting the regulation of cell death, differentiation or division. These mutations may occur spontaneously or as a result of exposure to radiation or carcinogenic substances, and are likely to be influenced by genetic factors.</div><a name='more'></a><br />
<div style="text-align: justify;"> </div><div style="text-align: justify;">Among adults, the known causes are natural and artificial ionizing radiation, a few viruses such as Human T-lymphotropic virus, and some chemicals, notably benzene and alkylating chemotherapy agents for previous malignancies.<sup class="reference" id="cite_ref-isbn1-55009-111-5_17-0"><span></span><span></span></sup><sup class="reference" id="cite_ref-isbn1-893441-36-9_18-0"><span></span><span></span></sup><sup class="reference" id="cite_ref-isbn0-8247-0170-4_19-0"><span></span><span></span></sup> Use of tobacco is associated with a small increase in the risk of developing acute myeloid leukemia in adults.<sup class="reference" id="cite_ref-isbn1-55009-111-5_17-1"><span></span><span></span></sup> </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Cohort and case-control studies have linked exposure to some petrochemicals and hair dyes to the development of some forms of leukemia. A few cases of maternal-fetal transmission have been reported.<sup class="reference" id="cite_ref-isbn1-55009-111-5_17-2"><span></span><span></span></sup> Diet has very limited or no effect, although eating more vegetables may confer a small protective benefit.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-pmid12163333_15-1"><span></span><span></span></sup></div><div style="text-align: justify;"> </div><div style="text-align: justify;">Viruses have also been linked to some forms of leukemia. Experiments on mice and other mammals have demonstrated the relevance of retroviruses in leukemia, and human retroviruses have also been identified. The first human retrovirus identified was Human T-lymphotropic virus, or HTLV-1, is known to cause adult T-cell leukemia.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-20"><span></span><span></span></sup></div><div style="text-align: justify;"> </div><div style="text-align: justify;">Some people have a genetic predisposition towards developing leukemia. This predisposition is demonstrated by family histories and twin studies.<sup class="reference" id="cite_ref-isbn1-55009-111-5_17-3"><span></span><span></span></sup> The affected people may have a single gene or multiple genes in common. In some cases, families tend to develop the same kind of leukemia as other members; in other families, affected people may develop different forms of leukemia or related blood cancers.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-isbn1-55009-111-5_17-4"><span></span><span></span></sup></div><div style="text-align: justify;"> </div><div style="text-align: justify;">In addition to these genetic issues, people with chromosomal abnormalities or certain other genetic conditions have a greater risk of leukemia.<sup class="reference" id="cite_ref-isbn1-893441-36-9_18-1"><span></span><span></span></sup> For example, people with Down syndrome have a significantly increased risk of developing forms of acute leukemia (especially acute myeloid leukemia), and Fanconi anemia is a risk factor for developing acute myeloid leukemia.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-isbn1-55009-111-5_17-5"><span></span><span></span></sup></div><div style="text-align: justify;"> Whether non-ionizing radiation causes <a href="http://benign-mesothelioma-shear.blogspot.com/search/label/Leukemia"><u style="color: red;"><i><b>leukemia</b></i></u></a> has been studied for several decades. The International Agency for Research on Cancer expert working group undertook a detailed review of all data on static and extremely low frequency electromagnetic energy, which occurs naturally and in association with the generation, transmission, and use of electrical power.<sup class="reference" id="cite_ref-isbn92-832-1280-0_21-0"><span></span><span></span></sup> </div><div style="text-align: justify;"> </div><div style="text-align: justify;">They concluded that there is limited evidence that high levels of ELF magnetic (but not electric) fields might cause childhood leukemia. Exposure to significant ELF magnetic fields might result in twofold excess risk for leukemia for children exposed to these high levels of magnetic fields.<sup class="reference" id="cite_ref-isbn92-832-1280-0_21-1"><span></span><span></span></sup> However, the report also says that methodological weaknesses and biases in these studies have likely caused the risk to be overstated.<sup class="reference" id="cite_ref-isbn92-832-1280-0_21-2"><span></span><span></span></sup> No evidence for a relationship to leukemia or another form of malignancy in adults has been demonstrated.<sup class="reference" id="cite_ref-isbn92-832-1280-0_21-3"><span></span><span></span></sup> </div><div style="text-align: justify;"> </div><div style="text-align: justify;">Since exposure to such levels of ELFs is relatively uncommon, the World Health Organization concludes that ELF exposure, if later proven to be causative, would account for just 100 to 2400 cases worldwide each year, representing 0.2 to 4.9% of the total incidence of childhood leukemia for that year (about 0.03 to 0.9% of all leukemias).</div><div style="text-align: justify;"> </div><div style="text-align: justify;"><u><b><span style="font-size: x-large;">Wikipedia </span></b></u></div></div>Shearhttp://www.blogger.com/profile/06260451169164951546noreply@blogger.com0tag:blogger.com,1999:blog-7270379911839193875.post-9318160743217150542011-05-03T07:18:00.000-07:002011-05-03T07:18:00.619-07:00Signs and Symptoms for Leukemia<div dir="ltr" style="text-align: left;" trbidi="on"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjStvD4s_FMFGwRV0WDPmb7L5mxfoHxfO5-wHJRrqUGG6WH6Yk5nASCzMXH5a4XjKz4v88eeY4pdHZaWVDDI14C9VcoWMeh2B5wftYV_zRmZR8939X7SYnJmdScpIq0qfq8UKQp9toyAwk/s1600/Symptoms+of+leukemia.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="259" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjStvD4s_FMFGwRV0WDPmb7L5mxfoHxfO5-wHJRrqUGG6WH6Yk5nASCzMXH5a4XjKz4v88eeY4pdHZaWVDDI14C9VcoWMeh2B5wftYV_zRmZR8939X7SYnJmdScpIq0qfq8UKQp9toyAwk/s320/Symptoms+of+leukemia.png" width="320" /></a></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Damage to the bone marrow, by way of displacing the normal bone marrow cells with higher numbers of immature white blood cells, results in a lack of blood platelets, which are important in the blood clotting process. This means people with leukemia may easily become bruised, bleed excessively, or develop pinprick bleeds (petechiae).</div><a name='more'></a><br />
<div> </div><div style="text-align: justify;"> </div><div style="text-align: justify;">White blood cells, which are involved in fighting pathogens, may be suppressed or dysfunctional. This could cause the patient's immune system to be unable to fight off a simple infection or to start attacking other body cells. Because <a href="http://benign-mesothelioma-shear.blogspot.com/2011/05/leukemia-cancer-of-blood-classification.html"><u style="color: red;"><i><b>leukemia</b></i></u></a> prevents the immune system from working normally, some patients experience frequent infection, ranging from infected tonsils, sores in the mouth, or diarrhea to life-threatening pneumonia or opportunistic infections. Finally, the red blood cell deficiency leads to anemia, which may cause dyspnea and pallor.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"> </div><div style="text-align: justify;">Some patients experience other symptoms, such as feeling sick, having fevers, chills, night sweats and other flu-like symptoms, or feeling fatigued. Some patients experience nausea or a feeling of fullness due to an enlarged liver and spleen; this can result in unintentional weight loss. If the leukemic cells invade the central nervous system, then neurological symptoms (notably headaches) can occur. All symptoms associated with leukemia can be attributed to other diseases. Consequently, leukemia is always diagnosed through medical tests.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"> </div><div style="text-align: justify;">The word <i>leukemia</i>, which means 'white blood', is derived from the disease's namesake high white blood cell counts that most leukemia patients have before <a href="http://benign-mesothelioma-shear.blogspot.com/search/label/Treatments"><u style="color: red;"><i><b>treatment</b></i></u></a>. The high number of white blood cells are apparent when a blood sample is viewed under a microscope. Frequently, these extra white blood cells are immature or dysfunctional. The excessive number of cells can also interfere with the level of other cells, causing a harmful imbalance in the blood count.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"> Some leukemia patients do not have high white blood cell counts visible during a regular blood count. This less-common condition is called <i>aleukemia</i>. The bone marrow still contains cancerous white blood cells which disrupt the normal production of blood cells, but they remain in the marrow instead of entering the bloodstream, where they would be visible in a blood test. For an aleukemic patient, the white blood cell counts in the bloodstream can be normal or low. Aleukemia can occur in any of the four major types of leukemia, and is particularly common in hairy cell leukemia.</div><div style="text-align: justify;"> </div><div style="text-align: justify;"><u><b><span style="font-size: x-large;">Wikipedia </span></b></u></div><div style="text-align: justify;"></div><div style="text-align: justify;"><a href="http://en.wikipedia.org/wiki/Leukemia#cite_note-ACS1-14"><span></span></a></div></div>Shearhttp://www.blogger.com/profile/06260451169164951546noreply@blogger.com0tag:blogger.com,1999:blog-7270379911839193875.post-23388612161315834732011-05-03T06:56:00.000-07:002011-05-03T06:56:04.944-07:00Leukemia (Cancer of the Blood) Classification<div dir="ltr" style="text-align: left;" trbidi="on"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDP40xGf5aavO8XOQrbUTENeNpDqyhPOZzuLtyn10E7aBBuuNnld7gSNKAXqKpeSJzp1tknoMhUIylUdXSYNUs49ILI7Vf5824ngkHXGzAUxqA2IX9F-LXu6uU8WEN5MU-TVILBkXrwN8/s1600/Acute+leukemia-ALL.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDP40xGf5aavO8XOQrbUTENeNpDqyhPOZzuLtyn10E7aBBuuNnld7gSNKAXqKpeSJzp1tknoMhUIylUdXSYNUs49ILI7Vf5824ngkHXGzAUxqA2IX9F-LXu6uU8WEN5MU-TVILBkXrwN8/s320/Acute+leukemia-ALL.jpg" width="281" /></a></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><b>Leukemia</b> is a type of <a href="http://benign-mesothelioma-shear.blogspot.com/search/label/Cancer"><u style="color: red;"><i><b>cancer</b></i></u></a> of the blood or bone marrow characterized by an abnormal increase of white blood cells. Leukemia is a broad term covering a spectrum of diseases. In turn, it is part of the even broader group of diseases called hematological neoplasms. In 2000, approximately 256,000 children and adults around the world developed some form of leukemia, and 209,000 died from it.<sup class="reference" id="cite_ref-Numbers_1-0"><span></span><span></span></sup> About 90% of all leukemias are diagnosed in adults.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b>Classification </b></u></div><div style="text-align: justify;">Clinically and pathologically, leukemia is subdivided into a variety of large groups. The first division is between its <i>acute</i> and <i>chronic</i> forms:</div><a name='more'></a><br />
<div> </div><ul style="text-align: justify;"><li><b>Acute leukemia</b> is characterized by a rapid increase in the numbers of immature blood cells. Crowding due to such cells makes the bone marrow unable to produce healthy blood cells. Immediate treatment is required in acute leukemia due to the rapid progression and accumulation of the <a href="http://benign-mesothelioma-shear.blogspot.com/search/label/Malignant%20Mesothelioma"><u style="color: red;"><i><b>malignant</b></i></u></a> cells, which then spill over into the bloodstream and spread to other organs of the body. Acute forms of leukemia are the most common forms of leukemia in children.</li>
<li><b>Chronic leukemia</b> is characterized by the excessive build up of relatively mature, but still abnormal, white blood cells. Typically taking months or years to progress, the cells are produced at a much higher rate than normal cells, resulting in many abnormal white blood cells in the blood. Whereas acute leukemia must be treated immediately, chronic forms are sometimes monitored for some time before treatment to ensure maximum effectiveness of therapy. Chronic leukemia mostly occurs in older people, but can theoretically occur in any age group.</li>
</ul><div style="text-align: justify;"> </div><div style="text-align: justify;">Additionally, the diseases are subdivided according to which kind of blood cell is affected. This split divides leukemias into lymphoblastic or <i>lymphocytic leukemias</i> and myeloid or <i>myelogenous leukemias</i>:</div><div style="text-align: justify;"> </div><ul style="text-align: justify;"><li>In lymphoblastic or <b>lymphocytic leukemias</b>, the cancerous change takes place in a type of marrow cell that normally goes on to form lymphocytes, which are infection-fighting immune system cells. Most lymphocytic leukemias involve a specific subtype of lymphocyte, the B cell.</li>
<li>In myeloid or <b>myelogenous leukemias</b>, the cancerous change takes place in a type of marrow cell that normally goes on to form red blood cells, some other types of white cells, and platelets.</li>
</ul><div style="text-align: justify;"> </div><div style="text-align: justify;">Combining these two classifications provides a total of four main categories. Within these main categories, there are typically several subcategories. Finally, some rarer types are usually considered to be outside of this classification scheme.</div><div style="text-align: justify;"> </div><ul style="text-align: justify;"><li><b>Acute lymphoblastic leukemia</b> (ALL) is the most common type of leukemia in young children. This disease also affects adults, especially those age 65 and older. Standard treatments involve chemotherapy and radiation. The survival rates vary by age: 85% in children and 50% in adults.<sup class="reference" id="cite_ref-isbn0-07-140235-7_3-0"><span></span><span></span></sup> Subtypes include precursor B acute lymphoblastic leukemia, precursor T acute lymphoblastic leukemia, Burkitt's leukemia, and acute biphenotypic leukemia.</li>
<li><b>Chronic lymphocytic leukemia</b> (CLL) most often affects adults over the age of 55. It sometimes occurs in younger adults, but it almost never affects children. Two-thirds of affected people are men. The five-year survival rate is 75%.<sup class="reference" id="cite_ref-4"><span></span><span></span></sup> It is incurable, but there are many effective treatments. One subtype is B-cell prolymphocytic leukemia, a more aggressive disease.</li>
<li><b>Acute myelogenous leukemia</b> (AML) occurs more commonly in adults than in children, and more commonly in men than women. AML is treated with chemotherapy. The five-year survival rate is 40%.<sup class="reference" id="cite_ref-5"><span></span><span></span></sup> Subtypes of AML include acute promyelocytic leukemia, acute myeloblastic leukemia, and acute megakaryoblastic leukemia.</li>
<li><b>Chronic myelogenous leukemia</b> (CML) occurs mainly in adults. A very small number of children also develop this disease. Treatment is with imatinib (Gleevec in US, Glivec in Europe) <sup class="reference" id="cite_ref-6"><span></span><span></span></sup> or other drugs. The five-year survival rate is 90%.<sup class="reference" id="cite_ref-7"><span></span><span></span></sup><sup class="reference" id="cite_ref-8"><span></span><span></span></sup> One subtype is chronic monocytic leukemia.</li>
<li><b>Hairy cell leukemia</b> (HCL) is sometimes considered a subset of CLL, but does not fit neatly into this pattern. About 80% of affected people are adult men. There are no reported cases in young children. HCL is incurable, but easily treatable. Survival is 96% to 100% at ten years.<sup class="reference" id="cite_ref-pmid16245328_9-0"><span></span><span></span></sup></li>
<li><b>T-cell prolymphocytic leukemia</b> (T-PLL) is a very rare and aggressive leukemia affecting adults; somewhat more men than women are diagnosed with this disease.<sup class="reference" id="cite_ref-10"><span></span><span></span></sup> Despite its overall rarity, it is also the most common type of mature T cell leukemia;<sup class="reference" id="cite_ref-pmid15716243_11-0"><span></span><span></span></sup> nearly all other leukemias involve B cells. It is difficult to treat, and the median survival is measured in months.</li>
<li><b>Large granular lymphocytic leukemia</b> may involve either T-cells or NK cells; like hairy cell leukemia, which involves solely B cells, it is a rare and indolent (not aggressive) leukemia.<sup class="reference" id="cite_ref-who1_12-0"><span></span><span></span></sup></li>
<li><b>Adult T-cell leukemia</b> is caused by human T-lymphotropic virus (HTLV), a virus similar to HIV. Like HIV, HTLV infects CD4+ T-cells and replicates within them; however, unlike HIV, it does not destroy them. Instead, HTLV "immortalizes" the infected T-cells, giving them the ability to proliferate abnormally.</li>
</ul><div style="text-align: justify;"><u><b><span style="font-size: x-large;">Wikipedia.</span></b></u></div><div style="text-align: justify;"><a href="http://en.wikipedia.org/wiki/Leukemia#cite_note-LLS-2"><span></span></a></div></div>Shearhttp://www.blogger.com/profile/06260451169164951546noreply@blogger.com0tag:blogger.com,1999:blog-7270379911839193875.post-90913032560267479612011-05-02T19:17:00.000-07:002011-05-02T19:17:02.091-07:00Radiotheraphy for Lung Cancer (Lung Cancer Treatments)<div dir="ltr" style="text-align: left;" trbidi="on"><div style="text-align: justify;">Radiotherapy is often given together with chemotherapy, and may be used with curative intent in patients with non-small-cell lung carcinoma who are not eligible for surgery. This form of high intensity radiotherapy is called <i>radical radiotherapy</i>.<sup class="reference" id="cite_ref-OTO_95-0"><span></span><span></span></sup> A refinement of this technique is continuous hyperfractionated accelerated radiotherapy (CHART), in which a high dose of radiotherapy is given in a short time period.<sup class="reference" id="cite_ref-Saunders_96-0"><span></span><span></span></sup> </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">For <a href="http://benign-mesothelioma-shear.blogspot.com/2011/05/lung-cancer-small-cell-lung-carcinoma.html"><u style="color: red;"><i><b>small-cell lung</b></i></u></a> carcinoma cases that are potentially curable, chest radiation is often recommended in addition to chemotherapy.<sup class="reference" id="cite_ref-Wagner_97-0"><span></span><span></span></sup> The use of adjuvant thoracic radiotherapy following curative intent surgery for non-small-cell lung carcinoma is not well established and is controversial. Benefits, if any, may only be limited to those in whom the tumor has spread to the mediastinal lymph nodes.</div><a name='more'></a><br />
<div> </div><div style="text-align: justify;">For both non-small-cell lung carcinoma and small-cell lung carcinoma patients, smaller doses of radiation to the chest may be used for symptom control (palliative radiotherapy). Unlike other treatments, it is possible to deliver palliative radiotherapy without confirming the histological diagnosis of lung cancer.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"> </div><div style="text-align: justify;">Brachytherapy (localized radiotherapy) may be given directly inside the airway when cancer affects a short section of bronchus.<sup class="reference" id="cite_ref-Raben_100-0"><span></span><span></span></sup> It is used when inoperable lung cancer causes blockage of a large airway.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-Celebioglu_101-0"><span></span><span></span></sup></div><div style="text-align: justify;"> </div><div style="text-align: justify;">Patients with limited-stage small-cell lung carcinoma are usually given prophylactic cranial irradiation (PCI). This is a type of radiotherapy to the brain, used to reduce the risk of metastasis.<sup class="reference" id="cite_ref-Ng_102-0"><span></span><span></span></sup> More recently, PCI has also been shown to be beneficial in those with extensive small-cell lung cancer. In patients whose cancer has improved following a course of chemotherapy, PCI has been shown to reduce the cumulative risk of brain metastases within one year from 40.4% to 14.6%.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-Slotman_103-0"><span></span><span></span></sup></div><div style="text-align: justify;"> Recent improvements in targeting and imaging have led to the development of extracranial stereotactic radiation in the treatment of early-stage lung cancer. In this form of radiation therapy, very high doses are delivered in a small number of sessions using stereotactic targeting techniques. Its use is primarily in patients who are not surgical candidates due to medical comorbidities.</div></div>Shearhttp://www.blogger.com/profile/06260451169164951546noreply@blogger.com0tag:blogger.com,1999:blog-7270379911839193875.post-83199530818373831752011-05-02T19:11:00.000-07:002011-05-02T19:11:48.510-07:00Lung Cancer Surgery (Lung Cancer Treatments)<div dir="ltr" style="text-align: left;" trbidi="on"><div style="text-align: justify;">If investigations confirm lung cancer, CT scan and often positron emission tomography (PET) are used to determine whether the disease is localized and amenable to surgery or whether it has spread to the point where it cannot be cured surgically.</div><div style="text-align: justify;"><br />
</div><div> </div><div style="text-align: justify;">Blood tests and spirometry (lung function testing) are also necessary to assess whether the patient is well enough to be operated on. If spirometry reveals poor respiratory reserve (often due to chronic obstructive pulmonary disease), surgery may be contraindicated.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"> </div><div style="text-align: justify;">Surgery for lung cancer has an operative death rate of about 4.4%, depending on the patient's lung function and other risk factors.<sup class="reference" id="cite_ref-Strand_86-0"><span></span><span></span></sup> In non-small-cell lung carcinoma, surgery is usually only an option if the cancer is limited to one lung, up to stage IIIA. This is assessed with medical imaging (computed tomography, positron emission tomography). A sufficient preoperative respiratory reserve must be present to allow adequate lung function after the tissue is removed.</div><a name='more'></a><br />
<div style="text-align: justify;"> </div><div style="text-align: justify;">Procedures include wedge resection (removal of part of a lobe), segmentectomy (removal of an anatomic division of a particular lobe of the lung), lobectomy (one lobe), bilobectomy (two lobes), or pneumonectomy (whole lung). In patients with adequate respiratory reserve, lobectomy is the preferred option, as this minimizes the chance of local recurrence. If the patient does not have enough functional lung for this, wedge resection may be performed.<sup class="reference" id="cite_ref-El-Sherif_87-0"><span></span><span></span></sup> Radioactive iodine brachytherapy at the margins of wedge excision may reduce recurrence to that of lobectomy.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-Fernando_88-0"><span></span><span></span></sup></div><div style="text-align: justify;"> </div><div style="text-align: justify;">Video-assisted thoracoscopic surgery and VATS lobectomy have allowed for minimally invasive approaches to lung cancer surgery that may have the advantages of quicker recovery, shorter hospital stay and diminished hospital costs.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-AUTOREF11_89-0"><span></span><span></span></sup></div><div style="text-align: justify;"> Early studies suggested that small-cell lung carcinoma (SCLC) fared better when treated with chemotherapy and/or radiation than when treated surgically.<sup class="reference" id="cite_ref-LennoxFlavell_90-0"><span></span><span></span></sup><sup class="reference" id="cite_ref-FoxScadding_91-0"><span></span><span></span></sup> While this approach to treating SCLC remains the current standard of care,<sup class="reference" id="cite_ref-SimonTurrisi_92-0"><span></span><span></span></sup> the role of surgery in SCLC is being reconsidered, recent reviews indicating that surgery might improve outcomes when added to chemotherapy and radiation in early stage SCLC<sup class="reference" id="cite_ref-pmid21155455_93-0"><span></span><span></span></sup> and combined forms of SCLC and NSCLC.<a href="http://en.wikipedia.org/wiki/Lung_cancer#cite_note-HageElbers-94"><span></span></a></div></div>Shearhttp://www.blogger.com/profile/06260451169164951546noreply@blogger.com0tag:blogger.com,1999:blog-7270379911839193875.post-65662426484018649522011-05-01T23:32:00.000-07:002011-05-01T23:33:32.710-07:00Lung Cancer (Small-Cell Lung Carcinoma, Metastasis)<div dir="ltr" style="text-align: left;" trbidi="on"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrixZ6CZdjsgMt9BkhnKG-qNWnzVVg2bIn5JAJJVW99rEy09apMG5-BFfd52EvHMUMO7JS5oA_vfmDtm5xdMA-sCa5Q7LOD6Ipjw6Ux_a8g5A_4DLmD7e_YlGoe9GncH2qlDPoyeU73kc/s1600/Lung+small+cell+carcinoma+%25281%2529+by+core+needle+biopsy.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="241" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrixZ6CZdjsgMt9BkhnKG-qNWnzVVg2bIn5JAJJVW99rEy09apMG5-BFfd52EvHMUMO7JS5oA_vfmDtm5xdMA-sCa5Q7LOD6Ipjw6Ux_a8g5A_4DLmD7e_YlGoe9GncH2qlDPoyeU73kc/s320/Lung+small+cell+carcinoma+%25281%2529+by+core+needle+biopsy.jpg" width="320" /></a></div><br />
<div style="text-align: justify;"><u><b>Small-Cell Lung Carcinoma </b></u></div><br />
<div style="text-align: justify;">Small-cell lung carcinoma (SCLC) is less common. It was formerly referred to as "oat-cell" carcinoma.<sup class="reference" id="cite_ref-68"></sup> Most cases arise in the larger airways (primary and secondary bronchi) and grow rapidly, becoming quite large.<sup class="reference" id="cite_ref-Collins_69-0"></sup> The small cells contain dense neurosecretory granules (vesicles containing neuroendocrine hormones), which give this tumor an endocrine/paraneoplastic syndrome association.<sup class="reference" id="cite_ref-Rosti_70-0"></sup> </div><a name='more'></a><br />
<div style="text-align: justify;">While initially more sensitive to chemotherapy and radiation, it is often metastatic at presentation, and ultimately carries a worse prognosis. Small-cell lung cancers have long been dichotomously staged into limited and extensive stage disease. This type of lung cancer is strongly associated with smoking.<span class="mw-headline" id="Others"> </span></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b><span class="mw-headline" id="Others">Others</span></b></u></div><div></div><div style="text-align: justify;"></div><div style="text-align: justify;">Lung cancers are highly heterogeneous malignancies, with tumors containing more than one subtype being very common.<sup class="reference" id="cite_ref-RoggliVollmer_72-0"></sup> Currently, the most widely recognized and utilized lung cancer classification system is the 4th revision of the Histological Typing of Lung and Pleural Tumours, published in 2004 as a cooperative effort by the World Health Organization and the International Association for the Study of Lung Cancer. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"></div><div style="text-align: justify;">It recognizes numerous other distinct histopathological entities of non-small-cell lung carcinoma, organized into several additional subtypes, including sarcomatoid carcinoma, salivary gland tumors, carcinoid tumor, and adenosquamous carcinoma. The latter subtype includes tumors containing at least 10% each of adenocarcinoma and squamous cell carcinoma. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">When a tumor is found to contain a mixture of both small-cell carcinoma and non-small-cell carcinoma, it is classified as a variant of small-cell carcinoma and called a combined small-cell carcinoma. Combined small-cell carcinoma is the only currently recognized variant of small-cell carcinoma. In infants and children, the most common primary lung cancers are pleuropulmonary blastoma and carcinoid tumor.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b>Metastasis </b></u></div><div style="text-align: justify;"></div><div style="text-align: justify;">The lung is a common place for metastasis of tumors from other parts of the body. Secondary cancers are classified by the site of origin; e.g., breast cancer that has spread to the lung is called <i>breast cancer</i>. Metastases often have a characteristic round appearance on chest radiograph.<sup class="reference" id="cite_ref-Seo_74-0"></sup> </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Solitary round lung nodules are not infrequently of an uncertain etiology and may prompt a lung biopsy. In children, the majority of lung cancers are secondary.<sup class="reference" id="cite_ref-pmid18605764_73-1"></sup> Primary lung cancers themselves most commonly metastasize to the adrenal glands, liver, brain, and bone.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b><span style="font-size: x-large;">Wikipedia </span></b></u></div></div>Shearhttp://www.blogger.com/profile/06260451169164951546noreply@blogger.com0tag:blogger.com,1999:blog-7270379911839193875.post-20375388218026535682011-05-01T23:21:00.000-07:002011-05-01T23:21:20.197-07:00Lung Cancer (Classification, Non-Small-Cell Lung Carcinoma)<div dir="ltr" style="text-align: left;" trbidi="on"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvWYG6OoM6GW92A39T_sffGhZ4ITR0stnxEf0fpPG-PLvW8wUFds57zqUQVzFEd3j2GyXnD8nvfrwgKUoI8aH2NFFL3-kAL6P5HUJrTBh8m7wvQnU-sQzuM_yjLhAu0pO7BKSJLedpzsE/s1600/Squamous+carcinoma+lung+2+cytology.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvWYG6OoM6GW92A39T_sffGhZ4ITR0stnxEf0fpPG-PLvW8wUFds57zqUQVzFEd3j2GyXnD8nvfrwgKUoI8aH2NFFL3-kAL6P5HUJrTBh8m7wvQnU-sQzuM_yjLhAu0pO7BKSJLedpzsE/s320/Squamous+carcinoma+lung+2+cytology.jpg" width="320" /></a></div><div style="text-align: justify;"><u><b>Classification</b></u></div><div style="text-align: justify;">Lung cancers are classified according to histological type. This classification has important implications for clinical management and prognosis of the disease. The vast majority of lung cancers are carcinomas—malignancies that arise from epithelial cells. The two most prevalent histological types of lung carcinoma, categorized by the size and appearance of the malignant cells seen by a histopathologist under a microscope: <i>non-small-cell</i> and <i>small-cell</i> lung carcinoma.<sup class="reference" id="cite_ref-Travis_59-0"><span></span><span></span></sup> The non-small-cell type is the most prevalent by far (see accompanying table).</div><a name='more'></a><br />
<div style="text-align: justify;">Cancer found outside of the lung may be determined to have arisen within the lung, as lung cancers that metastasize, i.e. spread, often retain a cell marker profile that allow a pathologist to say, with a good deal of certainty, that the tumor arose from the lung, i.e. is a <i>primary lung cancer</i>. Primary lung cancers of adenocarcinoma histology typically have nuclear immunostaining with TTF-1.</div><br />
<br />
<table class="wikitable floatright" style="font-size: 90%; margin-left: auto; margin-right: auto; text-align: left; width: 45%;"><caption style="background: none repeat scroll 0% 0% rgb(229, 175, 170);"><b>Frequency of histological types of lung cancer</b><sup class="reference" id="cite_ref-Travis_59-1"><span></span><span></span></sup></caption> <tbody align="center">
<tr style="background: none repeat scroll 0% 0% rgb(229, 175, 170); font-size: 90%;"> <th abbr="Type">Histological type</th> <th abbr="Frequency">Frequency (%)</th> </tr>
<tr> <td>Non-small-cell lung carcinoma</td> <td>80.4</td> </tr>
<tr> <td>Small-cell lung carcinoma</td> <td>16.8</td> </tr>
<tr> <td>Carcinoid<sup class="reference" id="cite_ref-AUTOREF2_60-0"><span></span><span></span></sup></td> <td>0.8</td> </tr>
<tr> <td>Sarcoma<sup class="reference" id="cite_ref-AUTOREF3_61-0"><span></span><span></span></sup></td> <td>0.1</td> </tr>
<tr> <td>Unspecified lung cancer</td> <td>1.9</td></tr>
</tbody></table><div style="text-align: center;"><br />
</div><div style="text-align: justify;"><u><b><span class="mw-headline" id="Non-small-cell_lung_carcinoma">Non-small-cell lung carcinoma</span></b></u></div><div style="text-align: justify;">The non-small-cell lung carcinomas (NSCLC) are grouped together because their prognosis and management are similar. There are three main sub-types: squamous cell lung carcinoma, adenocarcinoma, and large-cell lung carcinoma.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"> </div><div style="text-align: justify;">Accounting for 25% of lung cancers,<sup class="reference" id="cite_ref-ReferenceA_65-0"><span></span><span></span></sup> squamous cell lung carcinoma usually starts near a central bronchus. A hollow cavity and associated necrosis are commonly found at the center of the tumor. Well-differentiated squamous cell lung cancers often grow more slowly than other cancer types.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-Cancer_Medicine_2-4"><span></span><span></span></sup></div><div style="text-align: justify;"> Adenocarcinoma accounts for 40% of non-small-cell lung cancers.<sup class="reference" id="cite_ref-ReferenceA_65-1"><span></span><span></span></sup> It usually originates in peripheral lung tissue. Most cases of adenocarcinoma are associated with smoking; however, among people who have never smoked ("never-smokers"), adenocarcinoma is the most common form of lung cancer.<sup class="reference" id="cite_ref-Subramanian_66-0"><span></span><span></span></sup> A subtype of adenocarcinoma, the bronchioloalveolar carcinoma, is more common in female never-smokers, and may have different responses to treatment.</div><div style="text-align: center;"><br />
</div><div style="text-align: center;"><a href="http://en.wikipedia.org/wiki/Lung_cancer#cite_note-Raz-67"> </a></div><table class="wikitable floatright" style="margin-left: auto; margin-right: auto; text-align: left; width: 45%;"><caption style="background: none repeat scroll 0% 0% rgb(229, 175, 170); font-size: 90%;"><b>Sub-types of non-small-cell lung cancer in
smokers and never-smokers</b><sup class="reference" id="cite_ref-Bryant_64-0"><span></span><span></span></sup></caption> <tbody>
<tr style="background: none repeat scroll 0% 0% rgb(229, 175, 170); font-size: 90%; text-align: center;"> <th abbr="Sub-type" colspan="2" rowspan="2" style="text-align: center; vertical-align: bottom;">Histological sub-type</th> <th abbr="Frequency" colspan="2" style="text-align: center;">Frequency of non-small-cell lung cancers (%)</th> </tr>
<tr> <th style="text-align: center;">Smokers</th> <th style="text-align: center;">Never-smokers</th> </tr>
<tr> <td colspan="2" style="text-align: center;">Squamous cell lung carcinoma</td> <td style="text-align: center;">42</td> <td style="text-align: center;">33</td> </tr>
<tr> <td rowspan="2" style="text-align: center;">Adenocarcinoma</td> <td style="text-align: center;">Adenocarcinoma (not otherwise specified)</td> <td style="text-align: center;">39</td> <td style="text-align: center;">35</td> </tr>
<tr> <td style="text-align: center;">Bronchioloalveolar carcinoma</td> <td style="text-align: center;">4</td> <td style="text-align: center;">10</td> </tr>
<tr> <td colspan="2" style="text-align: center;">Carcinoid</td> <td style="text-align: center;">7</td> <td style="text-align: center;">16</td> </tr>
<tr> <td colspan="2" style="text-align: center;">Other</td> <td style="text-align: center;">8</td> <td style="text-align: center;">6</td><td style="text-align: center;"><br />
</td><td style="text-align: center;"> </td></tr>
</tbody></table></div>Shearhttp://www.blogger.com/profile/06260451169164951546noreply@blogger.com0tag:blogger.com,1999:blog-7270379911839193875.post-14910546517291870862011-05-01T22:52:00.000-07:002011-05-01T22:52:38.398-07:00Diagnosis of Lung Cancer<div dir="ltr" style="text-align: left;" trbidi="on"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLO6aqFA0ETHwGvT6mAe4J-kNHiugaCZwmBM-bzW2UbFEqAYDO5n_6wEglpMpsFTgTFKrYFalqoxAp7MYIaleyYv74QkfinGwGnNSyB4WAuODmDNnELanHMf2kN-epmLS-5rwjjK2R5us/s1600/Thorax+CT+peripheres+Brronchialcarcinom+li+OF.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="231" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLO6aqFA0ETHwGvT6mAe4J-kNHiugaCZwmBM-bzW2UbFEqAYDO5n_6wEglpMpsFTgTFKrYFalqoxAp7MYIaleyYv74QkfinGwGnNSyB4WAuODmDNnELanHMf2kN-epmLS-5rwjjK2R5us/s320/Thorax+CT+peripheres+Brronchialcarcinom+li+OF.jpg" width="320" /></a></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Performing a chest radiograph is the first step if a patient reports symptoms that may suggest <a href="http://benign-mesothelioma-shear.blogspot.com/search/label/Lung%20Cancer"><u><b>lung cancer</b></u></a>. This may reveal an obvious mass, widening of the mediastinum (suggestive of spread to lymph nodes there), atelectasis (collapse), consolidation (pneumonia), or pleural effusion. If there are no radiographic findings but the suspicion is high (such as a heavy smoker with blood-stained sputum), bronchoscopy and/or a CT scan may provide the necessary information. Bronchoscopy or CT-guided biopsy is often used to identify the tumor type.</div><a name='more'></a><br />
<div> </div><div style="text-align: justify;">Abnormal findings in cells ("atypia") in sputum are associated with an increased risk of <a href="http://benign-mesothelioma-shear.blogspot.com/search/label/Lung%20Cancer"><u><i><b>lung cancer</b></i></u></a>. Sputum cytologic examination combined with other screening examinations may have a role in the early detection of lung cancer.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-pmid19265088_58-0"><span></span><span></span></sup></div><div style="text-align: justify;">The differential diagnosis for patients who present with abnormalities on chest radiograph includes lung cancer as well as nonmalignant diseases. These include infectious causes such as tuberculosis or pneumonia, or inflammatory conditions such as sarcoidosis. These diseases can result in mediastinal lymphadenopathy or lung nodules, and sometimes mimic lung cancers.<sup class="reference" id="cite_ref-Cancer_Medicine_2-3"><span></span><span></span></sup> </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Lung cancer can also be an incidental finding: a solitary pulmonary nodule (also called a coin lesion) on a chest radiograph or CT scan taken for an unrelated reason. The definitive diagnosis of lung cancer and its classification (described above) is based on examination of the suspicious tissue under the microscope.<sup class="reference" id="cite_ref-pmid19265088_58-0"><span></span></sup></div><div style="text-align: justify;"><sup class="reference" id="cite_ref-pmid19265088_58-0"><span><br />
</span></sup></div><div style="text-align: justify;"><sup class="reference" id="cite_ref-pmid19265088_58-0"><span><u><b><span style="font-size: x-large;">Wikipedia</span></b></u></span></sup></div></div>Shearhttp://www.blogger.com/profile/06260451169164951546noreply@blogger.com0tag:blogger.com,1999:blog-7270379911839193875.post-18045582818583549582011-05-01T18:33:00.000-07:002011-05-01T18:33:20.528-07:00Lung Cancer Causes (Smoking, Radon Gas, Asbestos, Viruses, Particulate Matter)<div dir="ltr" style="text-align: left;" trbidi="on"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhH1naTAJVpvGqyF8qfOoU51rSVFhBPatahrZBB45OOxfFnhzovLUPVyZBLQXs1Lm7500GrI52h7YhLkGdxxdS2zqkW4gPVVLHchUNvXFypzXliDtSwRT4oD-ihSi0N5hdM-Uamf1r-GNA/s1600/Ferruginous+body.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhH1naTAJVpvGqyF8qfOoU51rSVFhBPatahrZBB45OOxfFnhzovLUPVyZBLQXs1Lm7500GrI52h7YhLkGdxxdS2zqkW4gPVVLHchUNvXFypzXliDtSwRT4oD-ihSi0N5hdM-Uamf1r-GNA/s320/Ferruginous+body.jpg" width="281" /></a></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">The main causes of any cancer include carcinogens (such as those in tobacco smoke), ionizing radiation, and viral infection. This exposure causes cumulative changes to the DNA in the tissue lining the bronchi of the lungs (the bronchial epithelium). As more tissue becomes damaged, eventually a cancer develops.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b>Smoking </b></u></div><div style="text-align: justify;">Smoking, particularly of cigarettes, is by far the main contributor to lung cancer.<sup class="reference" id="cite_ref-AUTOREF5_18-0"><span></span><span></span></sup> Cigarette smoke contains over 60 known carcinogens,<sup class="reference" id="cite_ref-Hecht_19-0"><span></span><span></span></sup> including radioisotopes from the radon decay sequence, nitrosamine, and benzopyrene. Additionally, nicotine appears to depress the immune response to malignant growths in exposed tissue.<sup class="reference" id="cite_ref-AUTOREF6_20-0"><span></span><span></span></sup> Across the developed world, 91% of lung cancer deaths in men during the year 2000 were attributed to smoking (71% for women).<sup class="reference" id="cite_ref-Peto_21-0"><span></span><span></span></sup> </div><a name='more'></a><br />
<div style="text-align: justify;">In the United States, smoking is estimated to account for 87% of lung cancer cases (90% in men and 85% in women).<sup class="reference" id="cite_ref-Samet2_22-0"><span></span><span></span></sup> Among male smokers, the lifetime risk of developing lung cancer is 17.2%; among female smokers, the risk is 11.6%. This risk is significantly lower in nonsmokers: 1.3% in men and 1.4% in women.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-Villeneuve_23-0"><span></span><span></span></sup></div><div> </div><div style="text-align: justify;">Women who smoke (former smokers and current smokers) and take hormone therapy are at a much higher risk of dying of lung cancer. In a study by Chlebowski et <i>al.</i> published in 2009, the women taking hormones were about 60% more likely to die of lung cancer than the women taking a placebo. Not surprisingly, the risk was highest for current smokers, followed by past smokers, and lowest for never smokers. Among the women who smoked (former or current smokers), 3.4% of those taking hormone therapy died of lung cancer compared to 2.3% for women taking the placebo.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-24"><span></span><span></span></sup></div><div style="text-align: justify;"> </div><div style="text-align: justify;">The time a person smokes (as well as rate of smoking) increases the person's chance of developing lung cancer. If a person stops smoking, this chance steadily decreases as damage to the lungs is repaired and contaminant particles are gradually removed.<sup class="reference" id="cite_ref-USDHHS1990_25-0"><span></span><span></span></sup> In addition, there is evidence that lung cancer in never-smokers has a better prognosis than in smokers,<sup class="reference" id="cite_ref-Nordquist_26-0"><span></span><span></span></sup> and that patients who smoke at the time of diagnosis have shorter survival times than those who have quit.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-Tammemagi_27-0"><span></span><span></span></sup></div><div style="text-align: justify;"> </div><div style="text-align: justify;">Passive smoking—the inhalation of smoke from another's smoking—is a cause of lung cancer in nonsmokers. A passive smoker can be classified as someone living or working with a smoker. Studies from the U.S.,<sup class="reference" id="cite_ref-AUTOREF7_28-0"><span></span><span></span></sup> Europe,<sup class="reference" id="cite_ref-Boffetta_29-0"><span></span><span></span></sup> the UK,<sup class="reference" id="cite_ref-Committee_30-0"><span></span><span></span></sup> and Australia<sup class="reference" id="cite_ref-NHMRC_31-0"><span></span><span></span></sup> have consistently shown a significant increase in relative risk among those exposed to passive smoke. Recent investigation of sidestream smoke suggests that it is more dangerous than direct smoke inhalation.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-Schick_32-0"><span></span><span></span></sup></div><div style="text-align: justify;"> 10–15% of lung cancer patients have never smoked.<sup class="reference" id="cite_ref-AUTOREF8_33-0"><span></span><span></span></sup> That means between 20,000 to 30,000 never-smokers are diagnosed with lung cancer in the United States each year. Because of the five-year survival rate, each year in the U.S. more never-smokers die of lung cancer than do patients of leukemia, ovarian cancer, or AIDS.<span class="mw-headline" id="Radon_gas"> </span></div><div style="text-align: justify;"><span class="mw-headline" id="Radon_gas"> </span></div><div style="text-align: justify;"><u><b><span class="mw-headline" id="Radon_gas">Radon gas</span></b></u></div><div style="text-align: justify;"> </div><div style="text-align: justify;">Radon is a colorless and odorless gas generated by the breakdown of radioactive radium, which in turn is the decay product of uranium, found in the Earth's crust. The radiation decay products ionize genetic material, causing mutations that sometimes turn cancerous. Radon exposure is the second major cause of lung cancer in the general population, after smoking<sup class="reference" id="cite_ref-Catelinois_7-1"><span></span><span></span></sup> with the risk increasing by 8% to 16% for every 100 Bq/m^3 increase in the radon concentration.<sup class="reference" id="cite_ref-35"><span></span><span></span></sup> </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Radon gas levels vary by locality and the composition of the underlying soil and rocks. For example, in areas such as Cornwall in the UK (which has granite as substrata), radon gas is a major problem, and buildings have to be force-ventilated with fans to lower radon gas concentrations. The United States Environmental Protection Agency (EPA) estimates that one in 15 homes in the U.S. has radon levels above the recommended guideline of 4 picocuries per liter (pCi/L) (148 Bq/m³).<sup class="reference" id="cite_ref-EPA_radon_36-0"><span></span><span></span></sup> Iowa has the highest average radon concentration in the United States; studies performed there have demonstrated a 50% increased lung cancer risk, with prolonged radon exposure above the EPA's action level of 4 pCi/L.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b>Asbestos </b></u></div><div style="text-align: justify;">Asbestos can cause a variety of lung diseases, including lung cancer. There is a synergistic effect between tobacco smoking and asbestos in the formation of lung cancer.<sup class="reference" id="cite_ref-O.27Reilly_8-1"><span></span><span></span></sup> In the UK, asbestos accounts for 2–3% of male lung cancer deaths.<sup class="reference" id="cite_ref-Darnton_39-0"><span></span><span></span></sup> Asbestos can also cause cancer of the pleura, called mesothelioma (which is different from lung cancer).<span class="mw-headline" id="Viruses"> </span></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b><span class="mw-headline" id="Viruses">Viruses</span></b></u></div><div style="text-align: justify;"> </div><div style="text-align: justify;">Viruses are known to cause lung cancer in animals,<sup class="reference" id="cite_ref-Leroux_40-0"><span></span><span></span></sup><sup class="reference" id="cite_ref-Palmarini_41-0"><span></span><span></span></sup> and recent evidence suggests similar potential in humans. Implicated viruses include human papillomavirus,<sup class="reference" id="cite_ref-Cheng_42-0"><span></span><span></span></sup> JC virus,<sup class="reference" id="cite_ref-Zheng_43-0"><span></span><span></span></sup> simian virus 40 (SV40), BK virus, and cytomegalovirus.<sup class="reference" id="cite_ref-Giuliani_44-0"><span></span><span></span></sup> These viruses may affect the cell cycle and inhibit apoptosis, allowing uncontrolled cell division.<span class="mw-headline" id="Particulate_matter"> </span></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b><span class="mw-headline" id="Particulate_matter">Particulate matter</span></b></u></div><div style="text-align: justify;"> </div><div style="text-align: justify;">Studies of the American Cancer Society cohort directly link the exposure to particulate matter with lung cancer. For example, if the concentration of particles in the air increases by only 1%, the risk of developing a lung cancer increases by 14%.<sup class="reference" id="cite_ref-AUTOREF37_45-0"><span></span><span></span></sup><sup class="reference" id="cite_ref-46"><span></span><span></span></sup> Further, it has been established that particle size matters, as ultrafine particles penetrate further into the lungs.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b><span style="font-size: x-large;">Wikipedia </span></b></u></div></div>Shearhttp://www.blogger.com/profile/06260451169164951546noreply@blogger.com0tag:blogger.com,1999:blog-7270379911839193875.post-65865602970118969502011-05-01T17:50:00.000-07:002011-05-01T17:50:14.076-07:00Lung Cancer, Signs and Symptoms<div dir="ltr" style="text-align: left;" trbidi="on"><div style="text-align: justify;">Symptoms that suggest lung <a href="http://benign-mesothelioma-shear.blogspot.com/search/label/Cancer"><u><i><b>cancer</b></i></u></a> include:<sup class="reference" id="cite_ref-Hamilton_14-0"><span></span><span></span></sup></div><div> </div><div class="references-small" style="-moz-column-count: 3; text-align: justify;"> <ul><li>dyspnea (shortness of breath)</li>
<li>hemoptysis (coughing up blood)</li>
<li>chronic coughing or change in regular coughing pattern</li>
<li>wheezing</li>
<li>chest pain or pain in the abdomen</li>
<li>cachexia (weight loss), fatigue, and loss of appetite</li>
<li>dysphonia (hoarse voice)</li>
<li>clubbing of the fingernails (uncommon)</li>
<li>dysphagia (difficulty swallowing).</li>
</ul></div><div style="text-align: justify;"> </div><div style="text-align: justify;">If the cancer grows in the airway, it may obstruct airflow, causing breathing difficulties. The obstruction can lead to accumulation of secretions behind the blockage, and predispose to pneumonia. Many lung cancers have a rich blood supply. The surface of the cancer may be fragile, leading to bleeding from the cancer into the airway. This blood may subsequently be coughed up.</div><a name='more'></a><br />
<div style="text-align: justify;"> </div><div style="text-align: justify;">Depending on the type of tumor, so-called paraneoplastic phenomena may initially attract attention to the disease.<sup class="reference" id="cite_ref-Honnorat_15-0"><span></span><span></span></sup> In lung cancer, these phenomena may include Lambert-Eaton myasthenic syndrome (muscle weakness due to auto-antibodies), hypercalcemia, or syndrome of inappropriate antidiuretic hormone (SIADH). </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Tumors in the top (apex) of the lung, known as Pancoast tumors,<sup class="reference" id="cite_ref-Jones_16-0"><span></span><span></span></sup> may invade the local part of the sympathetic nervous system, leading to changed sweating patterns and eye muscle problems (a combination known as Horner's syndrome) as well as muscle weakness in the hands due to invasion of the brachial plexus.</div><div style="text-align: justify;"> Many of the symptoms of lung cancer (bone pain, fever, and weight loss) are nonspecific; in the elderly, these may be attributed to comorbid illness.<sup class="reference" id="cite_ref-Cancer_Medicine_2-1"><span></span><span></span></sup> </div><div style="text-align: justify;"> </div><div style="text-align: justify;">In many patients, the cancer has already spread beyond the original site by the time they have symptoms and seek medical attention. Common sites of metastasis include the brain, bone, adrenal glands, contralateral (opposite) lung, liver, pericardium, and kidneys.<sup class="reference" id="cite_ref-ajcc_17-0"><span></span><span></span></sup> About 10% of people with lung cancer do not have symptoms at diagnosis; these cancers are incidentally found on routine chest radiograph.</div><div style="text-align: justify;"> </div><div style="text-align: justify;"><span style="font-size: x-large;"><u><b>Wikipedia </b></u></span></div></div>Shearhttp://www.blogger.com/profile/06260451169164951546noreply@blogger.com0tag:blogger.com,1999:blog-7270379911839193875.post-26086804332433277372011-05-01T17:36:00.000-07:002011-05-01T17:43:05.062-07:00Lung Cancer Screening (Practice Guidelines,Studies of Efficacy,CT Scans)<div dir="ltr" style="text-align: left;" trbidi="on"><div style="text-align: justify;"><b>Lung cancer screening</b> refers to strategies used to identify early lung cancers before they cause symptoms, at a point where they are more likely to be curable. Screening refers to the use of medical tests to detect disease in asymptomatic people. Screening studies have only been done in high risk populations, such as smokers and workers with occupational exposure to certain substances. This is because radiation exposure from repeated screening studies could actually induce cancer formation in a small percentage of screened subjects, so this risk should be mitigated by a (relatively) high prevalence of lung cancer in the population being screened.<span class="mw-headline" id="Practice_guidelines"> <a name='more'></a></span></div><div style="text-align: justify;"><span class="mw-headline" id="Practice_guidelines"></span><u><b><span class="mw-headline" id="Practice_guidelines">Practice guidelines</span></b></u></div><div></div><div style="text-align: justify;"></div><div style="text-align: justify;">Clinical practice guidelines issued by the American College of Chest Physicians in 2007 recommended against routine screening for lung cancer because of a lack of evidence that such screening was effective.<sup class="reference" id="cite_ref-pmid17873156_0-0"></sup> In 2004, a clinical practice guideline by the US Preventive Services Task Force (USPSTF) gave a grade I recommendation indicating that "the evidence is insufficient to recommend for or against screening asymptomatic persons for lung cancer"<span class="mw-headline" id="Studies_of_efficacy"> </span></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b><span class="mw-headline" id="Studies_of_efficacy">Studies of efficacy</span></b></u></div><div style="text-align: justify;"></div><div style="text-align: justify;">Regular chest radiography and sputum examination programs were not effective in reducing mortality from lung cancer.<sup class="reference" id="cite_ref-pmid14973979_3-0"></sup> Previous studies (Mayo Lung Project and Czechoslovakia lung cancer screening study, combining over 17,000 smokers) had shown that early detection of lung cancer was possible with such programs, but mortality was not improved. Simply detecting a tumor at an earlier stage may not necessarily lead to improved survival. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">For example, plain chest X-ray screening resulted in increased time from diagnosis of cancer until death and those cancers being detected by screening tended to be earlier stages. However, these patients continued to die at the same rate as those who are not screened. At present, no professional or specialty organization advocates screening for lung cancer outside of clinical<span class="mw-headline" id="CT_scans"> </span></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b><span class="mw-headline" id="CT_scans">CT scans</span></b></u></div><div style="text-align: justify;"></div><div style="text-align: justify;"></div><div style="text-align: justify;">A computed tomography (CT) scan can uncover tumors not yet visible on an X-ray. This led to CT scanning being actively evaluated as a screening tool for lung cancer in high-risk patients. The International Early Lung Cancer Action Project (I-ELCAP) published the results of CT screening on over 31,000 high-risk patients in late 2006 in the <i>New England Journal of Medicine</i>.<sup class="reference" id="cite_ref-pmid17065637_4-0"></sup> In this study, 85% of the 484 detected lung cancers were stage I and thus highly treatable. Historically, such stage I patients would have an expected 10-year survival of 88%. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Critics of the I-ELCAP study point out that there was no randomization of patients (all received CT scans and there was no comparison group receiving only chest x-rays) and the patients were not actually followed out to 10 years post detection (the median followup was 40 months). Regardless of these shortcomings, it is generally recognized that the prognosis of lung cancer decreases dramatically when the disease is in late stage,<sup class="reference" id="cite_ref-mountain_5-0"></sup><sup class="reference" id="cite_ref-Inoue_6-0"></sup> and that CT screening for lung cancer allows detection of lung cancer during its earliest, most curable stage. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">CT screening for lung cancer has already been extensively compared to chest x-ray screening in Japan. Among over 6,800 subjects screened in Japan, 67% to 73% of CT-detected lung cancers were missed by chest x-ray, the same test used in the comparison group of some randomized controlled trials of lung cancer screening.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-Kaneko_7-0"></sup></div><div style="text-align: justify;"><sup class="reference" id="cite_ref-Kaneko_7-0"></sup></div><div style="text-align: justify;"><sup class="reference" id="cite_ref-Kaneko_7-0"></sup></div><div style="text-align: justify;"><sup class="reference" id="cite_ref-Kaneko_7-0"></sup><sup class="reference" id="cite_ref-Sone1998_8-0"></sup><sup class="reference" id="cite_ref-Sone2001_9-0"></sup></div><div style="text-align: justify;"></div><div style="text-align: justify;">In contrast, a March 2007 study in the <i>Journal of the American Medical Association</i> (JAMA) found no mortality benefit from CT-based lung cancer screening.<sup class="reference" id="cite_ref-pmid17341709_10-0"></sup> 3,200 current or former smokers were screened for 4 years and offered 3 or 4 CT scans. Lung cancer diagnoses were 3 times as high, and surgeries were 10 times as high, as predicted by a model, but there were no significant differences between observed and expected numbers of advanced cancers or deaths.<sup class="reference" id="cite_ref-Crestanello_2004_11-0"></sup> Additional controversy arose after a 2008 <i>New York Times</i> reported that the 2006, pro-CT scan study in the <i>New England Journal of Medicine</i> had been funded indirectly by the parent company of the Liggett Group, a tobacco company.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-nytimes_12-0"></sup></div><div style="text-align: justify;"></div><div style="text-align: justify;">The National Cancer Institute funded a $300m study, the National Lung Screening Trial (NLST), which began in 2002, to compare the effectiveness of CT scan screening versus X-ray screening.<sup class="reference" id="cite_ref-WSJresults_13-0"></sup><sup class="reference" id="cite_ref-Henschke_14-0"></sup> This study, too, raised concern in the media over potential conflicts of interest related to the tobacco company, although this time on the contra-CT scan side: on October 8, 2007, the <i>Wall Street Journal</i> reported that at least two lead investigators of the study had conflicts of interest arising from their serving as paid, expert defense witnesses for the tobacco industry – one of them had given testimony asserting that promoting CT screening was "reckless or irresponsible", and another had provided an expert report warning that CT screening "may do more harm than good."</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-wsj_15-0"></sup></div><div style="text-align: justify;"></div><div style="text-align: justify;">The National Cancer Institute' National Lung Screening Trial involved over 53,000 former and current heavy smokers aged 55 to 74, who either received three CT scans or three X-rays annually.<sup class="reference" id="cite_ref-WSJresults_13-1"></sup> Deaths in either group were then logged for up to five years.<sup class="reference" id="cite_ref-WSJresults_13-2"></sup> As of October 2010, 354 people in the CT scan group had died from lung cancer, versus 442 people in the X-ray group; in other words, deaths in the CT scan group of patients were 20.3% lower than in the X-ray group.<sup class="reference" id="cite_ref-WSJresults_13-3"></sup> The study's review board concluded that this difference was statistically significant and recommended terminating the study.<sup class="reference" id="cite_ref-WSJresults_13-4"></sup> The director of the National Cancer Institute's director, Harold Varmus, said that early analysis results appeared to indicate that CT scans detected more lung cancers, at an earlier and more treatable stage, and that CT scans could therefore somewhat reduce the number of deaths in patients at high risk of lung cancer.<sup class="reference" id="cite_ref-WSJresults_13-5"></sup> </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Researchers associated with the study cautioned that the preliminary results did not constitute sufficient grounds to make the general public undergo CT scans and that further research and analysis of the data was necessary.<sup class="reference" id="cite_ref-WSJresults_13-6"></sup> The benefits of screening would have to be balanced against the risks associated with false positives – suspicious CT scan findings that in the end prove not to be cancer-related – and there is as yet no data showing how CT scan screening would benefit other sections of the population, such as people who had only smoked for shorter periods of time.<span class="mw-headline" id="Other_methods"> </span></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b><span class="mw-headline" id="Other_methods">Other methods</span></b></u></div><div style="text-align: justify;"></div><div style="text-align: justify;">An inexpensive and quick breath test involving exhaled breath condensate has shown promising results.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b><span style="font-size: x-large;">Wikipedia </span></b></u></div><div style="text-align: justify;"><sup class="reference" id="cite_ref-16"></sup></div><div style="text-align: justify;"><sup class="reference" id="cite_ref-16"><a href="http://en.wikipedia.org/wiki/Lung_cancer_screening#cite_note-16"></a></sup></div></div>Shearhttp://www.blogger.com/profile/06260451169164951546noreply@blogger.com0tag:blogger.com,1999:blog-7270379911839193875.post-20051124389307211792011-05-01T17:25:00.000-07:002011-05-01T17:25:09.524-07:00What Is Chemotherapy ??<div dir="ltr" style="text-align: left;" trbidi="on"><div style="text-align: justify;"><b>Chemotherapy</b>, in the most simple sense, is the treatment of an ailment by chemicals<sup class="reference" id="cite_ref-0"><span></span><span></span></sup> especially by killing micro-organisms or cancerous cells. In popular usage, it refers to antineoplastic drugs used to treat cancer or the combination of these drugs into a cytotoxic standardized treatment regimen. In its non-oncological use, the term may also refer to antibiotics (<i>antibacterial chemotherapy</i>). In that sense, the first modern chemotherapeutic agent was arsphenamine, an arsenic compound discovered in 1909 and used to treat syphilis. This was later followed by sulfonamides (sulfa drugs) and penicillin.</div><a name='more'></a><br />
<div> </div><div style="text-align: justify;">Most commonly, chemotherapy acts by killing cells that divide rapidly, one of the main properties of most cancer cells. This means that it also harms cells that divide rapidly under normal circumstances: cells in the bone marrow, digestive tract and hair follicles; this results in the most common side effects of chemotherapy : myelosuppression (decreased production of blood cells, hence also immunosuppression), mucositis (inflammation of the lining of the digestive tract), and alopecia (hair loss).</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"> </div><div style="text-align: justify;"> </div><div style="text-align: justify;">Other uses of cytostatic chemotherapy agents (including the ones mentioned below) are the treatment of autoimmune diseases such as multiple sclerosis, dermatomyositis, polymyositis, lupus, rheumatoid arthritis and the suppression of transplant rejections. Newer anticancer drugs act directly against abnormal proteins in cancer cells; this is termed targeted therapy.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b><span style="font-size: x-large;">Wikipedia </span></b></u></div></div>Shearhttp://www.blogger.com/profile/06260451169164951546noreply@blogger.com0tag:blogger.com,1999:blog-7270379911839193875.post-24284402405282101602011-04-30T23:35:00.000-07:002011-04-30T23:35:33.137-07:00Bladder Cancer Treatment<div dir="ltr" style="text-align: left;" trbidi="on"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEdsdN2QggVSMF4QNUD7fVsHVTvoEHiEjXkj6XGcDKPgBZLSu4SWIFk4PPDiTECPHsIjF_pm1_9juyTEh7kBZBxha-59otKWg_EPgZFtb6TuhUkSsChzR_CA5pNWR74ebc3aPKRvXCuyA/s1600/Bladder+Cancer+Treatment+Guide+v4.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="244" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEdsdN2QggVSMF4QNUD7fVsHVTvoEHiEjXkj6XGcDKPgBZLSu4SWIFk4PPDiTECPHsIjF_pm1_9juyTEh7kBZBxha-59otKWg_EPgZFtb6TuhUkSsChzR_CA5pNWR74ebc3aPKRvXCuyA/s320/Bladder+Cancer+Treatment+Guide+v4.png" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Bladder Cancer Treatment</td></tr>
</tbody></table><div style="text-align: justify;">The treatment of <a href="http://benign-mesothelioma-shear.blogspot.com/search/label/Bladder%20Cancer"><u><i><b>bladder cancer</b></i></u></a> depends on how deep the tumor invades into the bladder wall. Superficial tumors (those not entering the muscle layer) can be "shaved off" using an electrocautery device attached to a cystoscope. Immunotherapy in the form of BCG instillation is also used to treat and prevent the recurrence of superficial tumors.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-13"><span></span><span></span></sup></div><div> </div><div style="text-align: justify;">BCG immunotherapy is effective in up to 2/3 of the cases at this stage. Instillations of chemotherapy, such as valrubicin (Valstar) into the bladder can also be used to treat BCG-refractory CIS disease when cystectomy is not an option.<sup class="reference" id="cite_ref-14"><span></span><span></span></sup> Urocidin is phase III trials for this.</div><a name='more'></a><br />
<div style="text-align: justify;"> </div><div style="text-align: justify;">Patients whose tumors recurred after treatment with BCG are more difficult to treat.<sup class="reference" id="cite_ref-16"><span></span><span></span></sup> Many physicians recommend Cystectomy for these patients. This recommendation is in accordance with the official guidelines of the European Association of Urologists (EAU).<sup class="reference" id="cite_ref-17"><span></span><span></span></sup> and the American Urological Association (AUA)<sup class="reference" id="cite_ref-18"><span></span><span></span></sup> However, many patients refuse to undergo this life changing operation, and prefer to try novel conservative treatment options before opting to this last radical resort. Device assisted chemotherapy is such one group of novel technologies used to treat superficial <a href="http://benign-mesothelioma-shear.blogspot.com/search/label/Bladder%20Cancer"><u><i><b>bladder cancer</b></i></u></a>.<sup class="reference" id="cite_ref-19"><span></span><span></span></sup> </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">These technologies use different mechanisms to facilitate the absorption and action of a chemotherapy drug instilled directly into the bladder. Another technology uses an electrical current to enhance drug absorption.<sup class="reference" id="cite_ref-20"><span></span><span></span></sup> Another technology, Thermo-chemotherapy, uses radio-frequency energy to directly heat the bladder wall. The heat and chemotherapy show a synergistic effect, enhancing each other's capacity to kill tumor cells. This technology was studied by different investigators.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-21"><span></span><span></span></sup><sup class="reference" id="cite_ref-22"><a href="http://en.wikipedia.org/wiki/Bladder_cancer#cite_note-22"><span></span><span></span></a></sup><sup class="reference" id="cite_ref-23"><span></span><span></span></sup><sup class="reference" id="cite_ref-24"><span></span><span></span></sup></div><div style="text-align: justify;"> </div><div style="text-align: justify;">Untreated, superficial tumors may gradually begin to infiltrate the muscular wall of the bladder. Tumors that infiltrate the bladder require more radical surgery where part or all of the bladder is removed (a cystectomy) and the urinary stream is diverted. In some cases, skilled surgeons can create a substitute bladder (a neobladder) from a segment of intestinal tissue, but this largely depends upon patient preference, age of patient, renal function, and the site of the disease.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"> </div><div style="text-align: justify;"> </div><div style="text-align: justify;">A combination of radiation and chemotherapy can also be used to treat invasive disease. It has not yet been determined how the effectiveness of this form of treatment compares to that of radical ablative surgery. There is weak observational evidence from one very small study (84) to suggest that the concurrent use of statins is associated with failure of BCG immunotherapy.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="reference" id="cite_ref-25"><span></span><span></span></sup></div><div style="text-align: justify;"> Photodynamic diagnosis may improve surgical outcome on bladder cancer.</div><div style="text-align: justify;"> </div><div style="text-align: justify;"><u><b><span style="font-size: x-large;">Wikipedia </span></b></u></div></div>Shearhttp://www.blogger.com/profile/06260451169164951546noreply@blogger.com0tag:blogger.com,1999:blog-7270379911839193875.post-66864596687764007442011-04-30T23:25:00.000-07:002011-04-30T23:25:35.138-07:00Bladder Cancer, Diagnosis, Pathological Classification, and Staging<div dir="ltr" style="text-align: left;" trbidi="on"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpBEvT0NPeNkFzLCfkch2nNfV0iu295oOnB-kvO9B4UPH-CVu9OT2QiVnbYo0UcuDgs70xd9AeRmL5RcayDkJDA8qXIkZdGEIyVcrZ4Ua1F8gepO3SBeJ2nm2h1PC8ir-MhFvDGszQPFw/s1600/Blasentumor.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="319" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpBEvT0NPeNkFzLCfkch2nNfV0iu295oOnB-kvO9B4UPH-CVu9OT2QiVnbYo0UcuDgs70xd9AeRmL5RcayDkJDA8qXIkZdGEIyVcrZ4Ua1F8gepO3SBeJ2nm2h1PC8ir-MhFvDGszQPFw/s320/Blasentumor.jpg" width="320" /></a></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">The gold standard for diagnosing <a href="http://benign-mesothelioma-shear.blogspot.com/search/label/Bladder%20Cancer"><u><i><b>bladder cancer</b></i></u></a> is biopsy obtained during cystoscopy. Sometimes it is an incidental finding during cystoscopy.<sup class="reference" id="cite_ref-8"><span></span><span></span></sup> Urine cytology can be obtained in voided urine or at the time of the cystoscopy ("bladder washing"). Cytology is very specific (a positive result is highly indicative of bladder cancer) but suffers from low sensitivity (inability of a negative result to reliably exclude bladder cancer). There are newer urine bound markers for the diagnosis of bladder cancer. These markers are not currently used routinely in clinical practice due to absence of clear professional guidelines. They are much more expensive as well.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><sup class="Template-Fact" style="white-space: nowrap;" title="This claim needs references to reliable sources from June 2010"><i> </i></sup></div><div> </div><div style="text-align: justify;">The diagnosing of bladder cancer can also be done with a Hexvix guided fluorescence cystoscopy (Hexvix®), as an adjunct to conventional white-light cystoscopy. This procedure improves the detection of bladder cancer and reduces the rate of early tumour recurrence, compared with white-light cystoscopy alone. Hexvix cystoscopy detects more cancer and reduce recurrency. Hexvix is marketed in USA under the brand name Cysview.</div><a name='more'></a><br />
<div style="text-align: justify;"> </div><div style="text-align: justify;">Many patients with a history, signs, and symptoms suspicious for bladder cancer are referred to a urologist or other physician trained in cystoscopy, a procedure in which a flexible tube bearing a camera and various instruments is introduced into the bladder through the urethra. Suspicious lesions may be biopsied and sent for pathologic analysis.<sup class="Template-Fact" style="white-space: nowrap;" title="This claim needs references to reliable sources from June 2010"><i><br />
</i></sup></div><div style="text-align: justify;"><span class="editsection"></span> <span class="mw-headline" id="Pathological_classification"> </span></div><div style="text-align: justify;"><u><b><span class="mw-headline" id="Pathological_classification">Pathological classification</span></b></u></div><div style="text-align: justify;"> </div><div style="text-align: justify;">90% of bladder cancers are Transitional cell carcinoma. The other 10% are squamous cell carcinoma, adenocarcinoma, sarcoma, small cell carcinoma and secondary deposits from cancers elsewhere in the body.<sup class="Template-Fact" style="white-space: nowrap;" title="This claim needs references to reliable sources from June 2010"><i> </i></sup></div><div style="text-align: justify;"> </div><div style="text-align: justify;">Carcinoma in situ (CIS) invariably consists of cytologically high grade tumour cells.<sup class="Template-Fact" style="white-space: nowrap;" title="This claim needs references to reliable sources from June 2010"><i> </i></sup></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b><span class="mw-headline" id="Staging">Staging</span></b></u></div><div style="text-align: justify;"> </div><div style="text-align: justify;">The following stages are used to classify the location, size, and spread of the cancer, according to the TNM (tumor, lymph node, and metastasis) staging system:</div><div style="text-align: justify;"> </div><ul style="text-align: justify;"><li><b>Stage 0</b>: Cancer cells are found only on the inner lining of the bladder (This stage is also often called <b>Stage Ta</b>).</li>
</ul><div style="text-align: justify;"> </div><ul style="text-align: justify;"><li><b>Stage I</b>: Cancer cells have proliferated to the layer beyond the inner lining of the urinary bladder but not to the muscles of the urinary bladder.</li>
</ul><div style="text-align: justify;"> </div><ul style="text-align: justify;"><li><b>Stage II</b>: Cancer cells have proliferated to the muscles in the bladder wall but not to the fatty tissue that surrounds the urinary bladder.</li>
</ul><div style="text-align: justify;"> </div><ul style="text-align: justify;"><li><b>Stage III</b>: Cancer cells have proliferated to the fatty tissue surrounding the urinary bladder and to the prostate gland, vagina, or uterus, but not to the lymph nodes or other organs.</li>
</ul><div style="text-align: justify;"> </div><ul style="text-align: justify;"><li><b>Stage IV</b>: Cancer cells have proliferated to the lymph nodes, pelvic or abdominal wall, and/or other organs.</li>
</ul><div style="text-align: justify;"> </div><ul style="text-align: justify;"><li><b>Recurrent</b>: Cancer has recurred in the urinary bladder or in another nearby organ after having been treated.</li>
</ul><u><span style="font-size: x-large;"><b>Wikipedia </b></span></u></div>Shearhttp://www.blogger.com/profile/06260451169164951546noreply@blogger.com0tag:blogger.com,1999:blog-7270379911839193875.post-40680540256083602762011-04-30T21:29:00.000-07:002011-04-30T21:29:05.982-07:00Bladder Cancer, Signs and Symptoms, Causes<div dir="ltr" style="text-align: left;" trbidi="on"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEje-ZmZT5us6MkXfcDAmUc_nQOAhnb9B_e_p3cImqHtZQTiH5r8ApXdnh5eYNA1zNvvxIY4IXqqmdI1Svi_XeFssRPLXzYhbW1oJRIEAXGk90qpEggYEbEGLQXI-qribj8OowLC-veD8xU/s1600/Bladder+urothelial+carcinoma.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEje-ZmZT5us6MkXfcDAmUc_nQOAhnb9B_e_p3cImqHtZQTiH5r8ApXdnh5eYNA1zNvvxIY4IXqqmdI1Svi_XeFssRPLXzYhbW1oJRIEAXGk90qpEggYEbEGLQXI-qribj8OowLC-veD8xU/s320/Bladder+urothelial+carcinoma.JPG" style="cursor: move;" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><h1 class="firstHeading" id="firstHeading"><span style="font-size: small;">Bladder urothelial carcinoma</span></h1></td></tr>
</tbody></table><div style="text-align: justify;"><b>Bladder cancer</b> is any of several types of malignant growths of the urinary bladder. It is a disease in which abnormal cells multiply without control in the bladder.<sup class="reference" id="cite_ref-0"><span></span><span></span></sup> The bladder is a hollow, muscular organ that stores urine; it is located in the pelvis. The most common type of bladder cancer begins in cells lining the inside of the bladder and is called transitional cell carcinoma (sometimes urothelial cell carcinoma).<span class="mw-headline" id="Signs_and_symptoms"> </span></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b><span class="mw-headline" id="Signs_and_symptoms">Signs and symptoms</span></b></u></div><div> </div><div style="text-align: justify;">Bladder cancer characteristically causes blood in the urine; this may be visible to the naked eye (gross hematuria) or detectable only by microscope (microscopic hematuria). Other possible symptoms include pain during urination, frequent urination (polyuria) or feeling the need to urinate without results. These signs and symptoms are not specific to bladder cancer, and are also caused by non-cancerous conditions, including prostate infections and cystitis. Kidney cancer also can cause hematuria.<span class="mw-headline" id="Causes"> <a name='more'></a></span></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b><span class="mw-headline" id="Causes">Causes</span></b></u></div><div style="text-align: justify;"> </div><div style="text-align: justify;">Tobacco smoking is the main known contributor to urinary bladder cancer: in most populations, smoking is associated with over half of bladder cancer cases in men and one-third of cases among women.<sup class="reference" id="cite_ref-1"><span></span><span></span></sup> There is a linear relationship between smoking and risk, and quitting smoking reduces the risk.<sup class="reference" id="cite_ref-2"><span></span><span></span></sup> Passive smoking has not been proven to be involved.<sup class="reference" id="cite_ref-3"><span></span><span></span></sup> In a 10-year study involving almost 48,000 men, researchers found that men who drank 1.5L of water a day had a significantly reduced incidence of bladder cancer when compared with men who drank less than 240mL (around 1 cup) per day. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">The authors proposed that bladder cancer might partly be caused by the bladder directly contacting carcinogens that are excreted in urine, although this has not yet been confirmed in other studies.<sup class="reference" id="cite_ref-Brinkman_M.2C_Zeegers_MP_2008_25.E2.80.9336_4-0"><span></span><span></span></sup> Thirty percent of bladder tumors probably result from occupational exposure in the workplace to carcinogens such as benzidine. 2-Naphthylamine, which is found in cigarette smoke, has also been shown to increase bladder cancer risk. Occupations at risk are bus drivers, rubber workers, motor mechanics, leather workers, blacksmiths, machine setters and mechanics.<sup class="reference" id="cite_ref-5"><span></span><span></span></sup> </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"> </div><div style="text-align: justify;">Hairdressers are thought to be at risk as well because of their frequent exposure to permanent hair dyes. A 2008 study commissioned by the World Health Organisation concluded that "specific fruit and vegetables may act to reduce the risk of bladder cancer."<sup class="reference" id="cite_ref-Brinkman_M.2C_Zeegers_MP_2008_25.E2.80.9336_4-1"><span></span><span></span></sup> Fruit and yellow-orange vegetables, particularly carrots and selenium,<sup class="reference" id="cite_ref-6"><span></span><span></span></sup> are probably associated with a moderately reduced risk of bladder cancer. Citrus fruits and cruciferous vegetables were also identified as having a possible protective effect. It has been suggested that mutations at HRAS, KRAS2, RB1, and FGFR3 may be associated in some cases.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><span style="font-size: x-large;"><b>Wikipedia </b></span></u></div></div>Shearhttp://www.blogger.com/profile/06260451169164951546noreply@blogger.com0tag:blogger.com,1999:blog-7270379911839193875.post-22626975571402340652011-04-28T17:36:00.000-07:002011-04-28T17:36:15.702-07:00Asbestosis, Diagnosis and Treatment<div dir="ltr" style="text-align: left;" trbidi="on"><div style="text-align: justify;">According to the American Thoracic Society (ATS),<sup class="reference" id="cite_ref-ATS_2004_2-2"><span></span><span></span></sup> the general diagnostic criteria for asbestosis are:</div><div> </div><ul style="text-align: justify;"><li>Evidence of structural pathology consistent with asbestosis, as documented by imaging or histology</li>
<li>Evidence of causation by asbestos as documented by the occupational and environmental history, markers of exposure (usually pleural plaques), recovery of asbestos bodies, or other means</li>
<li>Exclusion of alternative plausible causes for the findings</li>
</ul><div style="text-align: justify;"> </div><div style="text-align: justify;">The abnormal chest x-ray and its interpretation remain the most important factors in establishing the presence of pulmonary fibrosis.<sup class="reference" id="cite_ref-ATS_2004_2-3"><span></span><span></span></sup> The findings usually appear as small, irregular parenchymal opacities, primarily in the lung bases. Using the ILO Classification system, "s", "t", and/or "u" opacities predominate. CT or high-resolution CT (HRCT) are more sensitive than plain radiography at detecting pulmonary fibrosis (as well as any underlying pleural changes). </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">More than 50% of people affected with asbestosis develop plaques in the parietal pleura, the space between the chest wall and lungs. Once apparent, the radiographic findings in asbestosis may slowly progress or remain static, even in the absence of further asbestos exposure.<sup class="reference" id="cite_ref-9"><span></span><span></span></sup> Rapid progression suggests an alternative diagnosis.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"> </div><div style="text-align: justify;">Asbestosis resembles many other diffuse interstitial lung diseases, including other pneumoconioses. The differential diagnosis includes Idiopathic Pulmonary Fibrosis (IPF), Hypersensitivity pneumonitis, sarcoidosis, and others. The presence of pleural plaquing may provide supportive evidence of causation by asbestos. Although lung biopsy is usually not necessary, the presence of asbestos bodies in association with pulmonary fibrosis establishes the diagnosis.<sup class="reference" id="cite_ref-10"><span></span><span></span></sup> Conversely, interstitial pulmonary fibrosis in the absence of asbestos bodies is most likely not asbestosis.<sup class="reference" id="cite_ref-ATS_2004_2-4"><span></span><span></span></sup> Asbestos bodies in the absence of fibrosis indicate exposure, not disease.</div><a name='more'></a><b><span class="mw-headline" id="Treatment"> </span></b><br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDNi-iufgwaFrAwyooJJ7ihKCedhgo-d9nezu2LfgiUihSIRKLM6KJ1DXzvG77WzxzMmyzpyv2j4OvtNr6VKF1yvsfT1GEWPBWjfqDWfPrDJyXMfVwGPN3fzQ0baHTG8eGJb2Z7gcCTso/s1600/Early+Asbestosis+in+a+Retired+Pipe+Fitter.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDNi-iufgwaFrAwyooJJ7ihKCedhgo-d9nezu2LfgiUihSIRKLM6KJ1DXzvG77WzxzMmyzpyv2j4OvtNr6VKF1yvsfT1GEWPBWjfqDWfPrDJyXMfVwGPN3fzQ0baHTG8eGJb2Z7gcCTso/s400/Early+Asbestosis+in+a+Retired+Pipe+Fitter.jpg" width="328" /></a></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><b><span class="mw-headline" id="Treatment">Treatment</span></b></div><div style="text-align: justify;"> </div><div style="text-align: justify;">There is no curative treatment for asbestosis.<sup class="reference" id="cite_ref-Castleman_11-0"><span></span><span></span></sup> Oxygen therapy at home is often necessary to relieve the shortness of breath and correct underlying hypoxia. Supportive treatment of symptoms includes respiratory physiotherapy to remove secretions from the lungs by postural drainage, chest percussion, and vibration. Nebulized medications may be prescribed in order to loosen secretions or treat underlying Chronic Obstructive Pulmonary Disease. </div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;">Immunization against pneumococcal pneumonia and annual influenza vaccination is administered due to increased sensitivity to the diseases. Patients are at increased risk for certain malignancies. If the patient smokes, cessation reduces further damage. Periodic PFTs, chest x-rays, and clinical evaluations, including cancer screening/evaluations, are given to detect additional hazards.</div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><u><b><span style="font-size: x-large;">Wikipedia </span></b></u></div></div>Shearhttp://www.blogger.com/profile/06260451169164951546noreply@blogger.com0