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Bladder Cancer Information

Taken from: http://www.nlm.nih.gov/medlineplus/ency/article/000486.htm

Alternative names
Transitional cell carcinoma of the bladder


Definition
Bladder cancer is a malignant tumor within the bladder. In the United States, bladder cancers usually start from the cells lining the bladder (transitional cells).

These tumors may be classified based on their growth pattern:

- Papillary tumors have a wart-like appearance and are attached to a stalk.
- Nonpapillary tumors are much less common, but they are more invasive and have a poorer prognosis.


Causes, incidence, and risk factors
As with most other cancers, the exact cause is uncertain. However, several factors may contribute to the development of bladder cancer.

Cigarette smoking increases the risk of developing bladder cancer by a factor of nearly five, compared to non-smokers. As many as 50% of all bladder cancers in men and 30% in women may be attributable to cigarette smoke. This risk does show a gradual decline in people who quit smoking.

About one in four cases of bladder cancer can be attributed to workplace exposure to carcinogens (cancer-causing chemicals). Arylamines are the chemicals most responsible. Dye workers, rubber workers, aluminum workers, leather workers, truck drivers, and pesticide applicators are at the highest risk, although arylamines have been reduced or eliminated in many workplaces.

The association between artificial sweeteners and bladder cancer has been studied and is weak or non-existent.

Women who received radiation therapy for the treatment of cervical cancer have an increased risk of developing transitional cell bladder cancer, as do some people who received the chemotherapy drug cyclophosphamide (Cytoxan).

A chronic (long term) bladder infection or irritation may lead to the development of squamous cell bladder cancer. However, this cancer is very slow growing. Bladder infections do not increase the risk of transitional cell cancers.

In third world countries, infection with a parasite (schistosomiasis) has been linked to the development of bladder cancer.

Bladder cancers are classified or staged based on their aggressiveness and the degree that they are different from the surrounding bladder tissue. There are several different ways to stage tumors. Recently, the TNM staging system has become common. This staging system contains several substages, but it basically categorizes tumors using the following scale:

- Stage 0 -- Non-invasive tumors limited to the bladder lining
- Stage I -- Tumor extends through the lining, but does not extend into the muscle layer
- Stage II -- Tumor invades the muscle layer
- Stage III -- Tumor extends past the muscle layer into tissue surrounding the bladder
- Stage IV -- Cancer has spread to regional lymph nodes or to distant sites (metastatic disease)

Bladder cancer spreads by extending into the nearby organs, including the prostate, uterus, v****a, ureters, and rectum. It can also spread to the pelvic lymph nodes or to other parts of the body, such as the liver, lungs and bones.


Symptoms
While most of the symptoms listed below can be associated with bladder cancer, they can also be associated with non-cancerous conditions. Nevertheless, medical evaluation is critical.

- Blood in the urine
- Urinary frequency
- Painful urination
- Urinary urgency

Additional symptoms that may be associated with this disease:

- Urinary incontinence
- Bone pain or tenderness
- Abdominal pain
- Anemia
- Weight loss
- Lethargy (tiredness)


Signs and tests
A physical examination will be performed, including a rectal and pelvic exam.

Diagnostic tests that may be performed include:

- Urinalysis
- Urine cytology (microscopic exam of urine to look for cancerous cells)
- Cystoscopy (use of lighted instrument to view inside of bladder)
- B- ladder biopsy (usually performed during cystoscopy)
- Intravenous pyelogram - IVP (to evaluate upper urinary tract for tumors or blockage)


Treatment
The choice of an appropriate treatment is based on the stage of the tumor, the severity of the symptoms, and the presence of other medical conditions.

Generally, stage 0 and I tumors are treated by removing the tumor without removing the rest of the bladder. They sometimes may also be treated by administering chemotherapy or immunotherapy (see below) directly into the bladder. Because the risk of the cancer returning is so high, people with bladder cancer require constant follow-up for the rest of their lives.

The treatment for patients with stage II and stage III disease is changing. While the accepted treatment has been removing the entire bladder (in a surgery called radical cystectomy), there is growing interest in keeping as much of the bladder as possible. Some patients may be treated by removing only part of the bladder, and that procedure is followed by radiation and chemotherapy. Some patients may be treated with chemotherapy before surgery, to try and shrink their tumor down, so that they might be able to avoid having the entire bladder removed. However, many people with stage II and stage III tumors still require bladder removal. In some patients with stage III tumors who choose not to have surgery, or who cannot tolerate surgery, a combination of chemotherapy and radiation may be used.

Most patients with stage IV tumors cannot be cured and surgery is not indicated. In these patients, chemotherapy is often considered.

CHEMOTHERAPY
Chemotherapy for bladder cancer can be administered through a vein or into the bladder. For early disease (stages 0 and I), it is usually given directly into the bladder. For more advanced stages (II-IV), treatment is usually given by vein.

Chemotherapy may be given to patients with stage II and III disease either before or after surgery in an attempt to prevent the tumor from returning.

Chemotherapy may be given as a single drug or in different combinations of drugs. These drugs include:

- Methotrexate
- Vinblastine
- Doxorubicin
- Cyclophosphamide
- Paclitaxel
- Docetaxel
- Carboplatin
- Cisplatin
- Ifosfamide
- Gemcitabine

The combination of two of these drugs, gemcitabine and cisplatin, has been shown to be as effective with less side effects as an older regimen known as MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin). Many centers have replaced MVAC with this new combination. Paclitaxel and carboplatin is another effective combination that is frequently used.

A Foley catheter can be used to instill the medication directly into the bladder of patients with stage I disease. The catheter is removed immediately after the medication has been instilled. You are instructed to try to hold the medication in your bladder for at least two hours after treatment. Additionally, you may be asked to rotate from side to side every 15-30 minutes to completely expose the entire bladder wall to the medication.

Several different types of chemotherapy medications may be delivered directly into the bladder. They include:

- Thiotepa (Thioplex)
- Mitomycin-C (Mutamycin)
- Doxorubicin (Adriamycin)

Common side effects include bladder wall irritation and pain when urinating. Choice of a specific drug is usually based on the stage of the tumor.

IMMUNOTHERAPY
Bladder cancers are often treated by immunotherapy, in which a medication causes your own immune system to attack and kill the tumor cells. Immunotherapy for bladder cancer is usually performed using Bacille Calmette-Guerin (commonly known as BCG), which is a solution of genetically changed tuberculosis bacteria. Because they were genetically modified, these bacteria are not able to produce infection. BCG is administered through a Foley catheter directly into the bladder. Since BCG is a biological agent, special precautions must be taken during its handling and administration.

Potential side effects include bladder irritability, urinary frequency, urinary urgency, and painful urination. These are reported by 90% of the people treated with BCG. However, the symptoms usually resolve within a few days after treatment. Rare side effects include blood in the urine, malaise, nausea, chills, joint pain, and itching. Rarely, a systemic tuberculosis (TB) infection can develop, requiring treatment with anti-tuberculosis medication. Systemic infection is suspected if you develop an elevated temperature that lasts for more than one day.

TRANSURETHRAL RESECTION OF THE BLADDER (TURB)
People with stage 0 or I bladder cancer are usually treated with transurethral resection of the bladder (TURB). This surgical procedure is performed under general or spinal anesthesia. A cutting instrument is then inserted through the urethra to remove the bladder tumor.

BLADDER REMOVAL
Many people with stage II or III bladder cancer may require bladder removal (radical cystectomy). Partial bladder removal may be performed in some patients. Removal of part of the bladder is usually followed by radiation therapy and chemotherapy to help decrease the chances of the cancer returning. For those patients who undergo complete bladder removal, chemotherapy is also given after surgery to decrease the risk of a recurrence.

Radical cystectomy in men usually involves removal of the bladder, prostate, and seminal vesicles. In women, the urethra, uterus, and the front wall of the v****a are removed along with the bladder. Often, the pelvic lymph nodes are also removed during the surgery for examination in the laboratory. About half of the people treated with radical cystectomy will be completely cured; the other half shows signs of metastasis at the time of the surgery. A urinary diversion surgery (a surgical procedure to create an alternate method for urine storage) is usually performed with the radical cystectomy procedure. Two common types of urinary diversion are an ileal conduit and a continent urinary reservoir.

ILEAL CONDUIT
An ileal conduit is a small urine reservoir that is surgically created from a small segment of bowel. The ureters that drain urine from the kidneys are attached to one end of the bowel segment and the other end is brought out through an opening in the skin (a stoma). The stoma allows the patient to drain the collected urine out of the reservoir.

People who have had an ileal conduit will need to wear an external urine collection appliance at all times. Possible complications associated with ileal conduit surgery include: bowel obstruction, blood clots, urinary tract infection, pneumonia, skin breakdown around the stoma, and long-term damage to the upper urinary tract.

CONTINENT URINARY RESERVOIR
A continent urinary reservoir is another method of creating a urinary diversion. In this method, a segment of colon is removed and used to create an internal pouch to store urine. This segment of bowel is specially prepared to prevent reflux of urine back up into the ureters and kidneys, and also to reduce the risk of involuntary loss of urine. Patients are able to insert a catheter periodically to drain the urine. A small stoma is placed flush to the skin. Possible complications include: bowel obstruction, blood clots, pneumonia, urinary tract infection, skin breakdown around the stoma, ureteral reflux, and ureteral obstruction.

ORTHOTOPIC NEOBLADDER
This surgery is becoming more common in patients undergoing cystectomy. A segment of bowel is folded over to make a pouch (a neobladder or "new bladder"), then attached to the urethral stump, which is the beginning of where the urine normally empties from the bladder.

This procedure allows patients to maintain some degree of normal urinary control, although there are complications, and the urination is usually not the same as before surgery. For example, this procedure can be associated with leakage of urine at night, the need to perform manual catheterization periodically, and other complications listed above for the continent urinary reservoir.

Some patients may not be good candidates for this procedure. Discuss the pros and cons of this procedure with your urologist.


Expectations (prognosis)
Patients will be closely monitored for progression of the disease regardless of the type of bladder cancer treatment received. Monitoring may include:

- Cystoscope evaluations every 3 to 6 months after initial treatment for people with stage I disease.

- Periodic urine cytology evaluations for people whose bladders have not been removed.
- Bone scan and/or CT scan to check for metastasis.

- Complete blood count (CBC) to monitor for signs and symptoms of anemia , which would indicate the disease has progressed.

- Monitor for other signs of disease progression, such as fatigue, weight loss, increased pain, decreased bowel and bladder function, and weakness.

How well a patient does depends on the specific stage of bladder cancer and the type of treatment chosen. The prognosis for stage 0 or I cancers is fairly good, although the risk of the cancer returning is high. However, most bladder cancers that return can be surgically removed and cured.

The cure rates for patients with stage III tumors are less than 50%. Patients with stage IV are rarely cured (although patients with only a few metastatic lesions can be cured in some circumstances).


Complications
Bladder cancers may spread into the nearby organs or may travel through the pelvic lymph nodes, and metastasize to the liver, lungs, and bones. Additional complications of bladder cancer include anemia, hydronephrosis (swelling of the ureters causing kidney injury), urinary incontinence, and urethral stricture.


Calling your health care provider
Call your health care provider if you have blood in your urine, or other symptoms of bladder cancer, including urinary urgency, urinary frequency, or painful urination.

Also, call your health care provider for an appointment to be examined if you are over 40 years of age, you are a smoker, or you work in an area of high industrial exposure to potential carcinogens.


Prevention
Quitting cigarette smoking and eliminating environmental hazards may reduce your risk of developing bladder cancer.

Non-Hodgkin's Lymphoma Information

Taken from: http://www.nlm.nih.gov/medlineplus/ency/article/000581.htm

Alternative names
Lymphoma - non-Hodgkin's; Lymphocytic lymphoma; Histiocytic lymphoma; Lymphoblastic lymphoma; Cancer - non-Hodgkin's lymphoma


Definition
Non-Hodgkin's lymphoma is cancer that starts in the lymphoid tissue. Such tissue makes up the lymph nodes, spleen, and other organs of the immune system.


Causes, incidence, and risk factors
White blood cells called lymphocytes are found in lymph tissues. Most lymphomas start in a type of white blood cells called B lymphocytes.

For most patients, the cause of the cancer is unknown. However, lymphomas may develop in people with weakened immune systems. For example, after an organ transplant.

Non-Hodgkin's lymphoma is grouped, or staged, according to how fast the cancer spreads. The cancer may be low grade, intermediate grade or high grade. Burkitt's tumor is an example of a high-grade lymphoma. There are many different types of non-Hodgkin's lymphoma.

According to the American Cancer Society, a person has a 1 in 50 chance of developing non-Hodgkin's lymphoma. Most of the time, this cancer affects adults. However, children can get some forms of CLL. High-risk groups include those who have received an organ transplant or who have a weakened immune system (immunosuppression). The cancer is more common in men than women.


Symptoms
Non-Hodgkin's lymphoma can cause a variety of symptoms. Symptoms depend on what area of the body is affected by the cancer. Symptoms may include:

- Swollen lymph nodes in the neck, underarms, groin, or other areas (may occur as an armpit lump)
- Fever
- Excessive sweating with night sweats
- Unintentional weight loss
- Severe itchiness

Coughing or shortness of breath may occur if the cancer affects the thymus gland or lymph nodes in the chest, which puts pressure on the windpipe.

Some patients may have stomach pain or swelling, which may lead to a loss of appetite, constipation, nausea, and vomiting.

If the cancer affects cells in the brain, the person may have a headache, concentration problems, personality changes, or seizures.


Signs and tests
The doctor will perform a physical exam and feel lymph nodes to see if they are swollen. Tests to diagnose and stage non-Hodgkin's lymphoma include:

- Lymph node biopsy
- Bone marrow biopsy
- CBC with differential
- CT scans of the chest, abdomen and pelvis
- Blood chemistry tests
- X-rays
- PET (positron emission tomography) scan


Treatment
Treatment depends on how quickly the cancer spreads, the stage of the cancer when you are first diagnosed, and symptoms.

Chemotherapy is commonly used. A drug called rituximab (Rituxan) is often used to treat non-Hodgkin's lymphoma. Rituxan is a form of immunotherapy.

Radioimmunotherapy may be used in some cases. This involves linking a radioactive substance with an antibody that helps the immune system fight infection, and injecting the substance into the body.

In select cases, a stem cell transplant may be needed.


Support Groups
The stress of illness may be eased by joining a support group whose members share common experiences and problems.


Expectations (prognosis)
Low-grade non-Hodgkin's lymphoma can not be cured with chemotherapy. However, the low-grade form of this cancer progresses slowly, and it may take more than 10 years before the disease gets worse.

Chemotherapy can help cure high-grade lymphoma. However, if the cancer does not respond to chemotherapy drugs, the disease can cause rapid death.


Complications
- Infection
- Autoimmune hemolytic anemia


Calling your health care provider
Call your health care provider if symptoms of this disorder develop.

If you have non-Hodgkin's lymphoma, call your health care provider if you experience persistent fever or other signs of infection.

Colon and Rectal Cancer Information

Taken from: http://www.nlm.nih.gov/medlineplus/colorectalcancer.html

Also called: Colon cancer, Rectal cancer

Cancer of the colon or rectum is also called colorectal cancer. In the United States, it is the fourth most common cancer in men and women. Caught early, it is often curable.

It is more common in people over 50, and the risk increases with age. You are also more likely to get it if you have:

- Polyps - growths inside the colon and rectum that may become cancerous
- A diet that is high in fat
- A family history or personal history of colorectal cancer
- Ulcerative colitis or Crohn's disease

Symptoms can include blood in the stool, narrower stools, a change in bowel habits and general stomach discomfort. However, you may not have symptoms at first, so screening is important. Everyone who is 50 or older should be screened for colorectal cancer. Treatments include surgery, chemotherapy, radiation or a combination.

~

Taken from: http://www.ucsfhealth.org/adult/medical_services/cancer/gastrointestinal/conditions/colon_and_rectal/signs.html

Cancer of the colon or rectum is a form of cancer that develops in the tissues of the large intestine. It is the third most common cancer in both men and women in the United States. Abnormal genes have been detected in patients who have some forms of colon and rectal cancer. Tests are being developed to determine who carries these genes long before cancer appears. Patients who are at a high risk of developing cancer may undergo regular screening tests to monitor their health.

Common signs and symptoms of colon cancer include:

- A change in bowel habits
- Diarrhea, constipation, or feeling that the bowel does not empty completely
- Blood, either bright red or very dark in the stool
- Stools that are narrower than usual
- General abdominal discomfort such as frequent gas pains, bloating, fullness or cramps
- Weight loss with no known reason
- Constant tiredness

Endometrial Cancer Information

Taken from: http://www.nlm.nih.gov/medlineplus/ency/article/000910.htm

Alternative names
Endometrial/uterine adenocarcinoma; Uterine cancer; Adenocarcinoma of the endometrium/uterus; Cancer - uterine; Cancer - endometrial; Uterine corpus cancer


Definition
Endometrial cancer is cancer that starts in the endometrium, the lining of the uterus (womb).


Causes, incidence, and risk factors
Endometrial cancer is the most common type of uterine cancer. Although the exact cause of endometrial cancer is unknown, increased levels of estrogen appear to have a role. Estrogen helps stimulate the buildup of the epithelial lining of the uterus. Studies have shown that high levels of estrogen in animals results in endometrial hyperplasia and cancer.

Most cases of endometrial cancer occur between the ages of 60 and 70 years, but a few cases may occur before age 40.

The following increase your risk of endometrial cancer:

- History of endometrial polyps or other benign growths of the uterine lining
- Estrogen replacement therapy
- Tamoxifen, a drug for breast cancer treatment
- Diabetes
- Never being pregnant (nulliparity)
- Starting menstruation at an early age (before age 12)
- Infertility (inability to become pregnant)
- Starting menopause after age 50

Associated conditions include the following:

- Obesity
- Hypertension
- Polycystic ovarian disease


Symptoms

- Abnormal uterine bleeding, abnormal menstrual periods
- Bleeding between normal periods before menopause
- Vaginal bleeding or spotting after menopause
- Extremely long, heavy, or frequent episodes of vaginal bleeding after age 40
- Lower abdominal pain or pelvic cramping
- Thin white or clear vaginal discharge after menopause


Signs and tests
A pelvic examination is frequently normal, especially in the early stages of disease. Changes in the size, shape, or consistency of the uterus or its surrounding, supporting structures may be seen when the disease is more advanced.

Tests used to diagnose endometrial cancer include:

- Pap smear
- Endometrial aspiration or biopsy
- Dilation and curettage (D and C)

If cancer is found, other tests may be done to determine how widespread the cancer is and whether it has spread to other parts of the body. This is called staging.

Stages of endometrial cancer:

1) The cancer is only in the uterus.
2) The cancer is in the uterus and cervix.
3)The cancer has spread outside of the uterus but not beyond the true pelvis area. Cancer may involve the lymph nodes in the pelvis or near the aorta (the major artery in the abdomen).
4) The cancer has spread to the inner surface of the bowel, bladder, abdomen, or other organs.


Treatment
Treatment options involve surgery, radiation therapy, and chemotherapy.

A hysterectomy may be performed in women with the early stage 1 disease. Removal of the tubes and ovaries (bilateral salpingo-oophorectomy) is also usually recommended.

Abdominal hysterectomy is recommended over vaginal hysterectomy. This type of hysterectomy allows the surgeon to look inside the abdominal area and remove tissue for a biopsy.

Surgery combined with radiation therapy is often used to treat women with stage 1 disease that could return and stage 2 disease. Chemotherapy may be considered in some cases, especially for those with stage 3 and 4 disease.


Support Groups
The stress of illness may be eased by joining a support group whose members share common experiences and problems. See cancer - support group.


Expectations (prognosis)
Endometrial cancer is usually diagnosed at an early stage. The 1-year survival rate is about 94%.

The 5-year survival rate for endometrial cancer that has not spread is 96%. If the cancer has spread to distant organs, the 5-year survival rate drops to 25%.


Complications
Complications may include anemia due to blood loss. A perforation (hole) of the uterus may occur during a D and C or endometrial biopsy.


Calling your health care provider
Call for an appointment with your health care provider if you have abnormal vaginal bleeding or any other symptoms of endometrial cancer. This is particularly important if you have any associated risk factors or if you have not had routine pelvic exams.

Any of the following symptoms should be reported immediately to the doctor:

- Bleeding or spotting after intercourse or douching
- Bleeding lasting longer than 7 days
- Periods that occur every 21 days or less
- Bleeding or spotting after 6 months or more of no bleeding at all


Prevention
All women should have regular pelvic exams and Pap smears beginning at the onset of sexual activity (or at the age of 20 if not sexually active) to help detect signs of any abnormal development.

Women with any risk factors for endometrial cancer should be followed more closely by their doctors. Frequent pelvic examinations and screening tests, including a Pap smear and endometrial biopsy, should be done.

Women who are taking estrogen replacement therapy should also take these precautions.

Kidney (Renal Cell) Cancer Information

Taken from: http://www.nlm.nih.gov/medlineplus/ency/article/000516.htm

Alternative names
Renal cancer; Kidney cancer; Hypernephroma; Adenocarcinoma of renal cells; Cancer - kidney


Definition
Renal cell carcinoma is a type of kidney cancer. The cancerous cells are found in the lining of very small tubes (tubules) in the kidney. It is the most common type of kidney cancer in adults.


Causes, incidence, and risk factors
Renal cell carcinoma affects about 3 in 10,000 people, resulting in about 32,000 new cases in the US per year. Every year, about 12,000 people in the US die from renal cell carcinoma. It occurs is most common in people between 50 and 70 years of age, and typically affects men.

The exact cause is unknown.

Risk factors include:

- Smoking
- Genetics
- Family history of the disease
- Dialysis treatment
- von Hippel-Lindau disease, a hereditary disease that affects the capillaries of the brain

The first symptom is usually blood in the urine. Sometimes both kidneys are involved. The cancer spreads easily, most often to the lungs and other organs. About one-third of patients have spreading (metastasis) at the time of diagnosis.


Symptoms

- Blood in the urine
- Abnormal urine color (dark, rusty, or brown)
- Flank pain
- Back pain
- Abdominal pain
- Unintentional weight loss of more than 5% of body weight
- Emaciated, thin, malnourished appearance
- Enlargement of one testicle
- Swelling or enlargement of the abdomen

Additional symptoms that may be associated with this disease:

- Vision abnormalities
- Paleness
- Excessive hair grown in females
- Constipation
- Cold intolerance


Signs and tests
Palpation of the abdomen may show a mass or organ enlargement, particularly of the kidney or liver. There may be a testicular varicocele in men.

- Complete blood count (CBC)
- Urine test may show red blood cells
- Serum calcium levels may be high
- SGPT and alkaline phosphatase may be high
- A urine cytology
- Liver function tests
- An ultrasound of the abdomen and kidney
- Kidney x-ray
- IVP
- Renal arteriography

The following tests may be performed to see if the cancer has spread:

- An abdominal CT scan may show a liver mass.
- Abdominal MRI can determine if the cancer has spread to any surrounding blood vessels and whether it can be surgically removed.
- A chest x-ray may show mass in the chest.
- A bone scan may show involvement of the bones.


Treatment
Surgical removal of all or part of the kidney (nephrectomy) is recommended. This may include removal of the bladder or surrounding tissues or lymph nodes.

Radiation therapy does not usually work for renal cell carcinoma and, therefore, is not often used. Hormone treatments may reduce the growth of the tumor in some cases.

Medications such as alpha-interferon and interleukin have been successful in reducing the growth of some renal cell carcinomas, including some that have spread. In December 2005, the US Food and Drug Administration approved a new type of drug called Nexavar for adults with advanced renal cell carcinoma. The drug works by blocking a tumor's blood supply.

Chemotherapy may be used in some cases, but cure is unlikely unless all the cancer is removed with surgery.


Support Groups
The stress of illness may be eased by joining a support group whose members share common experiences and problems. See cancer - support group and kidney disease - support group.


Expectations (prognosis)
The outcome varies depending on the degree of metastasis. The 5-year survival rate is around 60 - 75% if the tumor is in the early stages and has not spread outside the kidney. If it has metastasized to the lymph nodes, the 5-year survival is around 5 - 15%. If it has spread to other organs, the 5-year survival at less than 5%.


Complications

- Hypertension
- Metastasis of the cancer


Calling your health care provider
Call your health care provider any time blood in the urine develops. Also call if any other symptoms of this disorder occur.


Prevention
Stop smoking. Follow your health care provider's recommendations in the treatment of kidney disorders, especially those that may require dialysis.

Leukemia Information

Taken from: http://www.nlm.nih.gov/medlineplus/ency/article/001299.htm

Definition
Leukemia is a group of bone marrow diseases involving an uncontrolled increase in white blood cells (leukocytes).

For information about a specific type of leukemia, see the following:

- Hairy cell leukemia
- Chronic myelogenous leukemia (CML)
- Chronic lymphocytic leukemia (CLL)
- Acute lymphocytic leukemia (ALL)
- Acute myelogenous leukemia (AML)

~

Taken from: http://www.medicinenet.com/leukemia/article.htm

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

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

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

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

The bone marrow makes different types of blood cells. Each type has a special function.

Leukemia Cells
In people with leukemia, the bone marrow produces abnormal white blood cells. The abnormal cells are leukemia cells. At first, leukemia cells function almost normally. In time, they may crowd out normal white blood cells, red blood cells, and platelets. This makes it hard for blood to do its work.


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

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

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

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

There are four common types of leukemia:

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

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

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

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

Hairy cell leukemia is a rare type of chronic leukemia. This booklet does not deal with hairy cell leukemia or other rare types of leukemia. Together, these rare leukemias account for about 5,200 new cases of leukemia each year. The Cancer Information Service (1-800-4-CANCER) can provide information about these types of leukemia.


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

Studies have found the following risk factors for leukemia:

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

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

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

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

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

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

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

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

Most people who have known risk factors do not get leukemia. On the other hand, many who do get the disease have none of these risk factors. People who think they may be at risk of leukemia should discuss this concern with their doctor. The doctor may suggest ways to reduce the risk and can plan an appropriate schedule for checkups.


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

Common symptoms of leukemia:

- Fevers or night sweats
- Frequent infections
- Feeling weak or tired
- Headache
- Bleeding and bruising easily (bleeding gums, purplish patches in the skin, or tiny red spots under the skin)
- Pain in the bones or joints
- Swelling or discomfort in the abdomen (from an enlarged spleen)
- Swollen lymph nodes, especially in the neck or armpit
- Weight loss

Such symptoms are not sure signs of leukemia. An infection or another problem also could cause these symptoms. Anyone with these symptoms should see a doctor as soon as possible. Only a doctor can diagnose and treat the problem.

In the early stages of chronic leukemia, the leukemia cells function almost normally. Symptoms may not appear for a long time. Doctors often find chronic leukemia during a routine checkup—before there are any symptoms. When symptoms do appear, they generally are mild at first and get worse gradually.

In acute leukemia, symptoms appear and get worse quickly. People with this disease go to their doctor because they feel sick. Other symptoms of acute leukemia are vomiting, confusion, loss of muscle control, and seizures. Leukemia cells also can collect in the testicles and cause swelling. Also, some patients develop sores in the eyes or on the skin. Leukemia also can affect the digestive tract, kidneys, lungs, or other parts of the body.


How is leukemia diagnosed?
If a person has symptoms that suggest leukemia, the doctor may do a physical exam and ask about the patient's personal and family medical history. The doctor also may order laboratory tests, especially blood tests.

The exams and tests may include the following:

- Physical exam — The doctor checks for swelling of the lymph nodes, spleen, and liver.

- Blood tests — The lab checks the level of blood cells. Leukemia causes a very high level of white blood cells. It also causes low levels of platelets and hemoglobin, which is found inside red blood cells. The lab also may check the blood for signs that leukemia has affected the liver and kidneys.

- Biopsy — The doctor removes some bone marrow from the hipbone or another large bone. A pathologist examines the sample under a microscope. The removal of tissue to look for cancer cells is called a biopsy. A biopsy is the only sure way to know whether leukemia cells are in the bone marrow.

There are two ways the doctor can obtain bone marrow. Some patients will have both procedures:

- Bone marrow aspiration: The doctor uses a needle to remove samples of bone marrow.
- Bone marrow biopsy: The doctor uses a very thick needle to remove a small piece of bone and bone marrow.

Local anesthesia helps to make the patient more comfortable.

- Cytogenetics — The lab looks at the chromosomes of cells from samples of peripheral blood, bone marrow, or lymph nodes.

- Spinal tap — The doctor removes some of the cerebrospinal fluid (the fluid that fills the spaces in and around the brain and spinal cord). The doctor uses a long, thin needle to remove fluid from the spinal column. The procedure takes about 30 minutes and is performed with local anesthesia. The patient must lie flat for several hours afterward to keep from getting a headache. The lab checks the fluid for leukemia cells or other signs of problems.

- Chest x-ray — The x-ray can reveal signs of disease in the chest.

A person who needs a bone marrow aspiration or bone marrow biopsy may want to ask the doctor the following questions:

1) Will you remove the sample of bone marrow from the hip or from another bone?
2) How long will the procedure take? Will I be awake? Will it hurt?
3) How soon will you have the results? Who will explain them to me?
4) If I do have leukemia, who will talk to me about treatment? When?


How is leukemia treated?
Many people with leukemia want to take an active part in making decisions about their medical care. They want to learn all they can about their disease and their treatment choices. However, the shock and stress after a diagnosis of cancer can make it hard to think of everything to ask the doctor. Often it helps to make a list of questions before an appointment. To help remember what the doctor says, patients may take notes or ask whether they may use a tape recorder. Some also want to have a family member or friend with them when they talk to the doctor—to take part in the discussion, to take notes, or just to listen.

The doctor may refer patients to doctors who specialize in treating leukemia, or patients may ask for a referral. Specialists who treat leukemia include hematologists, medical oncologists, and radiation oncologists. Pediatric oncologists and hematologists treat childhood leukemia.

Whenever possible, patients should be treated at a medical center that has doctors experienced in treating leukemia. If this is not possible, the patient’s doctor may discuss the treatment plan with a specialist at such a center.

Getting a second opinion
Sometimes it is helpful to have a second opinion about the diagnosis and the treatment plan. Some insurance companies require a second opinion; others may cover a second opinion if the patient or doctor requests it. There are a number of ways to find a doctor for a second opinion:

- The patient’s doctor may be able to suggest a doctor who specializes in adult or childhood leukemia. At cancer centers, several specialists often work together as a team.

- The Cancer Information Service, at 1-800-4-CANCER, can tell callers about nearby treatment centers.

- A local or state medical society, a nearby hospital, or a medical school can usually provide the names of specialists.

The American Board of Medical Specialties (ABMS) has a list of doctors who have met certain education and training requirements and have passed specialty examinations. The Official ABMS Directory of Board Certified Medical Specialists lists doctors' names along with their specialty and their educational background. The directory is available in most public libraries. Also, ABMS offers this information on the Internet at http://www.abms.org. (Click on "Who's Certified.")
Preparing for treatment

The doctor can describe treatment choices and discuss the results expected with each treatment option. The doctor and patient can work together to develop a treatment plan that fits the patient’s needs.

Treatment depends on a number of factors, including the type of leukemia, the patient’s age, whether leukemia cells are present in the cerebrospinal fluid, and whether the leukemia has been treated before. It also may depend on certain features of the leukemia cells. The doctor also takes into consideration the patient’s symptoms and general health.

These are some questions a person may want to ask the doctor before treatment begins:

- What type of leukemia do I have?
- What are my treatment choices? Which do you recommend for me? Why?
- What are the benefits of each kind of treatment?
-What are the risks and possible side effects of each treatment?
- If I have pain, how will you help me?
- What is the treatment likely to cost?
- How will treatment affect my normal activities?
- Would a clinical trial (research study) be appropriate for me? Can you help me find one?

People do not need to ask all of their questions or understand all of the answers at one time. They will have other chances to ask the doctor to explain things that are not clear and to ask for more information.

Methods of Treatment
The doctor is the best person to describe the treatment choices and discuss the expected results. Depending on the type and extent of the disease, patients may have chemotherapy, biological therapy, radiation therapy, or bone marrow transplantation. If the patient’s spleen is enlarged, the doctor may suggest surgery to remove it. Some patients receive a combination of treatments.

People with acute leukemia need to be treated right away. The goal of treatment is to bring about a remission. Then, when signs and symptoms disappear, more therapy may be given to prevent a relapse. This type of therapy is called maintenance therapy. Many people with acute leukemia can be cured.

Chronic leukemia patients who do not have symptoms may not require immediate treatment. The doctor may suggest watchful waiting for some patients with chronic lymphocytic leukemia. The health care team will monitor the patient’s health so that treatment can begin if symptoms occur or worsen. When treatment for chronic leukemia is needed, it can often control the disease and its symptoms. However, chronic leukemia can seldom be cured. Patients may receive maintenance therapy to help keep the cancer in remission.

A patient may want to talk to the doctor about taking part in a clinical trial, a research study of new treatment methods. The section on “The Promise of Cancer Research” has more information about clinical trials.

In addition to anticancer therapy, people with leukemia may have treatment to control pain and other symptoms of the cancer, to relieve the side effects of therapy, or to ease emotional problems. This kind of treatment is called symptom management, supportive care, or palliative care.

Chemotherapy
Most patients with leukemia receive chemotherapy . This type of cancer treatment uses drugs to kill leukemia cells. Depending on the type of leukemia, the patient may receive a single drug or a combination of two or more drugs.

People with leukemia may receive chemotherapy in several different ways:

- By mouth
- By injection directly into a vein (IV or intravenous)
- Through a catheter (a thin, flexible tube) placed in a large vein, often in the upper chest—A catheter that stays in place is useful for patients who need many IV treatments. The health care professional injects drugs into the catheter, rather than directly into a vein. This method avoids the need for many injections, which can cause discomfort and injure the veins and skin.
- By injection directly into the cerebrospinal fluid — If the pathologist finds leukemia cells in the fluid that fills the spaces in and around the brain and spinal cord, the doctor may order intrathecal chemotherapy. The doctor injects drugs directly into the cerebrospinal fluid. This method is used because drugs given by IV injection or taken by mouth often do not reach cells in the brain and spinal cord. (A network of blood vessels filters blood going to the brain and spinal cord. This blood-brain barrier stops drugs from reaching the brain.)

The patient may receive the drugs in two ways:

- Injection into the spine: The doctor injects the drugs into the lower part of the spinal column.
- Ommaya reservoir: Children and some adult patients receive intrathecal chemotherapy through a special catheter called an Ommaya reservoir. The doctor places the catheter under the scalp. The doctor injects the anticancer drugs into the catheter. This method avoids the discomfort of injections into the spine.

Patients receive chemotherapy in cycles: a treatment period, then a recovery period, and then another treatment period. In some cases, the patient has chemotherapy as an outpatient at the hospital, at the doctor’s office, or at home. However, depending on which drugs are given, and the patient’s general health, a hospital stay may be necessary.

Some people with chronic myeloid leukemia receive a new type of treatment called targeted therapy. Targeted therapy blocks the production of leukemia cells but does not harm normal cells. Gleevec, also called STI-571, is the first targeted therapy approved for chronic myeloid leukemia.

Biological Therapy
People with some types of leukemia have biological therapy. This type of treatment improves the body’s natural defenses against cancer. The therapy is given by injection into a vein.

For some patients with chronic lymphocytic leukemia, the type of biological therapy used is a monoclonal antibody. This substance binds to the leukemia cells. This therapy enables the immune system to kill leukemia cells in the blood and bone marrow.

For some patients with chronic myeloid leukemia, the biological therapy is a natural substance called interferon. This substance can slow the growth of leukemia cells.

Patients may want to ask these questions about chemotherapy or biological therapy:

- Why do I need this treatment?
- What drugs will I get?
- Should I see my dentist before treatment begins?
- What will the treatment do?
- Will I have to stay in the hospital?
- How will we know the drugs are working?
- How long will I be on this treatment?
- Will I have side effects during treatment? How long will they last? What can I do about them?
- Can these drugs cause side effects later on?
- How often will I need checkups?

Radiation Therapy
Radiation therapy (also called radiotherapy) uses high-energy rays to kill leukemia cells. For most patients, a large machine directs radiation at the spleen, the brain, or other parts of the body where leukemia cells have collected. Some patients receive radiation that is directed to the whole body. (Total-body irradiation usually is given before a bone marrow transplant.) Patients receive radiation therapy at a hospital or clinic.

These are some questions a person may want to ask the doctor before having radiation therapy:

- Why do I need this treatment?
- When will the treatments begin? How often will they be given? When will they end?
- How will I feel during therapy? Will there be side effects? How long will they last? What can we do about them?
- Can radiation therapy cause side effects later on?
- What can I do to take care of myself during therapy?
- How will we know if the radiation is working?
- Will I be able to continue my normal activities during treatment?
- How often will I need checkups?

Stem Cell Transplantation
Some patients with leukemia have stem cell transplantation. A stem cell transplant allows a patient to be treated with high doses of drugs, radiation, or both. The high doses destroy both leukemia cells and normal blood cells in the bone marrow. Later, the patient receives healthy stem cells through a flexible tube that is placed in a large vein in the neck or chest area. New blood cells develop from the transplanted stem cells.

There are several types of stem cell transplantation:

- Bone marrow transplantation — The stem cells come from bone marrow.
- Peripheral stem cell transplantation — The stem cells come from peripheral blood.
- Umbilical cord blood transplantation — For a child with no donor, the doctor may use stem cells from umbilical cord blood. The umbilical cord blood is from a newborn baby. Sometimes umbilical cord blood is frozen for use later.

Stem cells may come from the patient or from a donor:

- Autologous stem cell transplantation — This type of transplant uses the patient’s own stem cells. The stem cells are removed from the patient, and the cells may be treated to kill any leukemia cells present. The stem cells are frozen and stored. After the patient receives high-dose chemotherapy or radiation therapy, the stored stem cells are thawed and returned to the patient.
- Allogeneic stem cell transplantation — This type of transplant uses healthy stem cells from a donor. The patient's brother, sister, or parent may be the donor. Sometimes the stem cells come from an unrelated donor. Doctors use blood tests to be sure the donor’s cells match the patient’s cells.
- Syngeneic stem cell transplantation — This type of transplant uses stem cells from the patient’s healthy identical twin.

After a stem cell transplant, patients usually stay in the hospital for several weeks. The health care team protects patients from infection until the transplanted stem cells begin to produce enough white blood cells.

After a stem cell transplant, patients usually stay in the hospital for several weeks. The health care team protects patients from infection until the transplanted stem cells begin to produce enough white blood cells.


These are some questions a person may want to ask the doctor before having a stem cell transplant:

- What kind of stem cell transplant will I have? If I need a donor, how will we find one?
- How long will I be in the hospital? What care will I need when I leave the hospital?
- How will we know if the treatment is working?
- What are the risks and the side effects? What can we do about them?
- What changes in normal activities will be necessary?
- What is my chance of a full recovery? How long will that take?
- How often will I need checkups?


What are the side effects of treatment for leukemia?
Because cancer treatment may damage healthy cells and tissues, unwanted side effects are common. Specific side effects depend on many factors, including the type and extent of the treatment. Side effects may not be the same for each person, and they may even change from one treatment session to the next. Before treatment starts, health care providers will explain possible side effects and suggest ways to manage them. For additional information, please read the Chemotherapy and Cancer Treatment, Coping With Side Effects article.

Chemotherapy
The side effects of chemotherapy depend mainly on the specific drugs and the dose. In general, anticancer drugs affect cells that divide rapidly, especially leukemia cells. Chemotherapy can also affect other rapidly dividing cells:

- Blood cells: These cells fight infection, help the blood to clot, and carry oxygen to all parts of the body. When blood cells are affected, patients are more likely to get infections, may bruise or bleed easily, and may feel very weak and tired.

- Cells in hair roots: Chemotherapy can lead to hair loss. The hair grows back, but the new hair may be somewhat different in color and texture.

- Cells that line the digestive tract: Chemotherapy can cause mouth and lip sores, nausea and vomiting, diarrhea, and poor appetite. Many of these side effects can be controlled with drugs.

Some anticancer drugs can affect a patient’s fertility. Women may have irregular menstrual periods or periods may stop altogether. Women may have symptoms of menopause, such as hot flashes and vaginal dryness. Men may stop producing sperm. Because these changes may be permanent, some men have their sperm frozen and stored before treatment. Most children treated for leukemia appear to have normal fertility when they grow up. However, depending on the drugs and doses used and the age of the patient, some boys and girls may be infertile when they mature.

Because targeted therapy (sometimes used for chronic myeloid leukemia) affects only leukemia cells, it causes fewer side effects than most other anticancer drugs. However, Gleevec may cause patients to retain water. This may cause swelling or bloating.

Biological Therapy
The side effects of biological therapy differ with the types of substances used, and from patient to patient. Rashes or swelling where the biological therapy is injected are common. Flu-like symptoms also may occur. The health care team may monitor the blood for signs of anemia and other problems.

Radiation Therapy
Radiation therapy may cause patients to become very tired as treatment continues. Resting is important, but doctors usually advise patients to try to stay as active as they can. In addition, when patients receive radiation therapy, it is common for their skin to become red, dry, and tender in the treated area. Other side effects depend on the area of the body that is treated. If chemotherapy is given at the same time, the side effects may be worse. The doctor can suggest ways to ease these problems.

Stem Cell Transplantation
Patients who have stem cell transplantation face an increased risk of infection, bleeding, and other side effects because of the large doses of chemotherapy and radiation they receive. In addition, graft-versus-host disease(GVHD) may occur in patients who receive stem cells from a donor’s bone marrow. In GVHD, the donated stem cells react against the patient’s tissues. Most often, the liver, skin, or digestive tract is affected. GVHD can be mild or very severe. It can occur any time after the transplant, even years later. Steroids or other drugs may help.

The NCI offers a fact sheet called “Questions and Answers About Bone Marrow Transplantation and Peripheral Blood Stem Cell Transplantation.” It is available on the Internet at http://cancer.gov/publications. Also, information specialists at the NCI's Cancer Information Service at 1-800-4-CANCER can send this fact sheet and answer questions about stem cell transplantation.


What happens after treatment for leukemia?

Supportive Care
Leukemia and its treatment can lead to other health problems. Patients receive supportive care to prevent or control these problems and to improve their comfort and quality of life during treatment.

Because people with leukemia get infections very easily, they may receive antibiotics and other drugs to help protect them from infections. The health care team may advise them to stay away from crowds and from people with colds and other contagious diseases. If an infection develops, it can be serious and should be treated promptly. Patients may need to stay in the hospital for treatment.

Anemia and bleeding are other problems that often require supportive care. Patients may need transfusions of red blood cells to help them have more energy. Platelet transfusions can help reduce the risk of serious bleeding.

Dental care also is very important. Leukemia and chemotherapy can make the mouth sensitive, easily infected, and likely to bleed. Doctors often advise patients to have a complete dental exam and, if possible, undergo needed dental care before chemotherapy begins. Dentists show patients how to keep their mouth clean and healthy during treatment.

Nutrition for Cancer Patients
Patients need to eat well during cancer therapy. They need enough calories to maintain a good weight and protein to keep up strength. Good nutrition often helps people with cancer feel better and have more energy.

But eating well can be difficult. Patients may not feel like eating if they are uncomfortable or tired. Also, the side effects of treatment, such as poor appetite, nausea, or vomiting, can be a problem. Foods may taste different.

The doctor, dietitian, or other health care provider can suggest ways to maintain a healthy diet. Patients and their families may want to read the National Cancer Institute booklet Eating Hints for Cancer Patients, which contains many useful ideas and recipes. The “National Cancer Institute Booklets” section tells how to get this publication.

Followup Care
Followup care after treatment for leukemia is an important part of the overall treatment plan. Regular checkups ensure that any changes in health are noted. The doctor can find problems and treat them as soon as possible. Checkups may include a careful physical exam, blood tests, x-rays, bone marrow aspiration, or spinal tap. The doctor can explain the followup plan—how often the patient must visit the doctor and what tests are needed.

The NCI has prepared a booklet for people who have completed their treatment to help answer questions about followup care and other concerns. Facing Forward Series: Life After Cancer Treatment provides tips for getting the most out of medical visits. It describes the kinds of help people may need.


What does the future hold for patients with leukemia?
Doctors all over the country are conducting many types of clinical trials. These are research studies in which people take part voluntarily. Studies include new methods of treatment and supportive care for patients with leukemia. Research already has led to advances, and researchers continue to search for more effective approaches.

Patients who join these studies have the first chance to benefit from treatments that have shown promise in earlier research. They also make an important contribution to medical science by helping doctors learn more about the disease. Although clinical trials may pose some risks, researchers take very careful steps to protect their patients.

Researchers are testing new biological therapies and new anticancer drugs, doses, and treatment schedules. They also are working with various drugs and with combinations of drugs, biological therapy, radiation therapy, and stem cell transplantation.

Patients who are interested in being part of a clinical trial should talk with their doctor. They may want to read Taking Part in Clinical Trials: What Cancer Patients Need To Know. The NCI also offers an easy-to-read brochure called If You Have Cancer…What You Should Know About Clinical Trials. These NCI publications describe how research studies are carried out and explain their possible benefits and risks. NCI’s Web site includes a section on clinical trials at http://cancer.gov/clinical_trials. This section of the Web site provides general information about clinical trials. It also offers detailed information about ongoing studies of leukemia treatment. The Cancer Information Service at 1-800-4-CANCER can answer questions and provide information about clinical trials.


What resources are available to patients with leukemia?
Information about cancer is available from many sources, including the ones listed below. You may wish to check for additional information at your local library or bookstore and from support groups in your community.

National Cancer Institute Booklets
National Cancer Institute (NCI) publications can be ordered by writing to the address below, and some can be viewed and downloaded from http://cancer.gov/publications on the Internet.

Publications Ordering Service National Cancer Institute Suite 3036A 6116 Executive Boulevard, MSC 8322 Bethesda, MD 20892-8322

In addition, people in the United States and its territories may order these and other NCI booklets by calling the Cancer Information Service at 1-800-4-CANCER. They may also order many NCI publications on-line at http://cancer.gov/publications.

Cancer Information Service (CIS)
Provides accurate, up-to-date information on cancer to patients and their families, health professionals, and the general public. Information specialists translate the latest scientific information into understandable language and respond in English, Spanish, or on TTY equipment.

Toll-free: 1-800-4-CANCER (1-800-422-6237)
TTY (for deaf and hard of hearing callers): 1-800-332-8615

Candlelighters Childhood Cancer Foundation
Candlelighters is a national organization of parents whose children have or have had cancer. It operates a patient information service and publishes newsletters and other materials for parents and young people. Local chapters sponsor family support groups. The national office, at 1-800-366-CCCF (1-800-366-2223), can supply the telephone numbers of local chapters.

Leukemia Society of America (LSA)
The Leukemia Society of America supports cancer research and provides information and financial help to patients with leukemia. It also offers support groups for patients and their families and provides referrals to other sources of help in the community. Publications are available by calling 1-800-955-4LSA (1-800-955-4572) toll free. For information about services offered in local areas, call the number listed under Leukemia Society of America in the white pages of the telephone book.


Leukemia At A Glance

- Leukemia is a cancer of the blood cells.

- While the exact cause(s) of leukemia is not known, risk factors have been identified.

- Leukemias are grouped by how quickly the disease develops (acute or chronic) as well as by the type of blood cell that is affected.

- People with leukemia are at significantly increased risk for developing infections, anemia, and bleeding.

- Diagnosis of leukemia is supported by findings of the medical history and examination, and examining blood under a microscope. Leukemia cells can also be detected and further classified with a bone marrow aspiration and/or biopsy.

- Treatment of leukemia depends on the type of leukemia, certain features of the leukemia cells, the extent of the disease, and prior history of treatment, as well as the age and health of the patient.

- Most patients with leukemia are treated with chemotherapy. Some patients also may have radiation therapy and/or bone marrow transplantation.

Lung Cancer Information

Taken from: http://www.nlm.nih.gov/medlineplus/ency/article/000122.htm

Alternative names
Cancer - lung - small cell; Small cell lung cancer; SCLC


Definition
Small cell lung cancer (SCLC) is a fast-growing type of lung cancer. It tends to spread much more quickly than non-small cell lung cancer.

There are three different types of small cell lung cancer:

- Small cell carcinoma (oat cell cancer)
- Mixed small cell/large cell carcinoma
- Combined small cell carcinoma

Most small cell lung cancers are the oat cell type.


Causes, incidence, and risk factors
About 15% of all lung cancer cases are small cell lung cancer, according to the American Cancer Society. Small cell lung cancer is a bit more common in men than women.

Smoking almost always causes small cell lung cancer. This type of lung cancer is rare in those who have never smoked.

Small cell lung cancer usually starts in the air tubes (bronchi) in the center of the chest. Although the cancer cells are small, they grow quickly and create large masses (tumors) that can rapidly spread to other parts of the body, including the brain, liver, and bone.


Symptoms

- Cough
- Bloody sputum
- Shortness of breath
- Wheezing
- Chest pain
- Loss of appetite
- Weight loss

Additional symptoms that may be associated with this disease:

- Weakness
- Swallowing difficulty
- Nail abnormalities
- Hoarseness or changing voice
- Fever
- Facial swelling


Signs and tests
The health care provider will perform a physical exam and ask questions about your medical history. You will be asked if you smoke, and if so, how long you have smoked.

When listening to the chest with a stethoscope, the health care provider can sometimes hear fluid around the lungs, which could (but doesn't always) suggest cancer.

Small cell lung cancer has usually spread by the time it is diagnosed.

Tests that may be performed include:

- Chest x-ray
- CBC
- Sputum test
- Bone scan
- CT scan
- MRI
- Positron emission tomography (PET) scan
- Thoracentesis

In some cases, the health care provider may need to remove a piece of tissue from your lungs for examination under a microscope. This is called a biopsy. There are several ways to do this:

- Bronchoscopy combined with biopsy
- Pleural biopsy
- CT scan directed needle biopsy
- Mediastinoscopy with biopsy
- Open lung biopsy
- Endoscopic esophageal ultrasound (EUS) with biopsy

Usually, if a biopsy reveals cancer, more imaging tests are done to find out the stage of the cancer. (Stage means how big the tumor is and how far it's spread.) However, the traditional staging system, which uses numbers to tell how bad the cancer is, is usually not used for patients with SCLC. Instead, SCLC is grouped as either:

- Limited (cancer is only in the chest)
- Extensive (cancer has spread outside the chest)

Most cases are extensive.


Treatment
Because small cell lung cancer spreads quickly throughout the body, treatment must include cancer-killing drugs (chemotherapy) taken by mouth or injected into the body. Chemotherapy may be combined with high-powered x-rays (radiation therapy).

Surgery is rarely used to treat small cell lung cancer. It is only considered if it is limited small cell lung cancer with only one tumor that hasn't spread. Chemotherapy or radiation will be needed after surgery. However, because the disease has usually spread by the time it is diagnosed, very few patients with small cell lung cancer are candidates for surgery.

Combination chemotherapy and radiation treatment is given to persons with extensive small cell lung cancer. However, the treatment only helps relieve symptoms; it does not cure the disease.

Some patients with limited small cell lung cancer may receive radiation therapy to the head after they have completed treatment for the lung area. This method, called prophylactic cranial irradiation (PCI), helps prevent any lung cancer from spreading to the brain.


Expectations (prognosis)
How well a patient does depends on how much the lung cancer has spread. This type of cancer is very deadly. Only about 6% of people with this type of cancer are still alive after 5 years.


Complications

- Cancer spreads to other parts of the body
- Side effects of surgery, chemotherapy, or radiation therapy


Calling your health care provider
Call your health care provider if you have symptoms of lung cancer (particularly if you smoke).


Prevention
If you smoke, stop smoking. It's never too early to quit. Try to avoid secondhand smoke.

Routine screening for lung cancer is not recommended. Many studies have been done to look at the idea, but scientists have concluded that, at this time, screening would not help improve a person’s chance for a cure.