What You Need To Know About Lung Cancer, Treatments, tips and cure

The Lungs

Your lungs are a pair of large organs in your chest. They are part of your respiratory system. Air enters your body through your nose or mouth. It passes through your windpipe (trachea) and through each bronchus, and goes into your lungs. When you breathe in, your lungs expand with air.
This is how your body gets oxygen. When you breathe out, air goes out of your lungs. This is how your body gets rid of carbon dioxide. Your right lung has three parts (lobes). Your left lung is smaller and has two lobes. A thin tissue (the pleura) covers the lungs and lines the inside of the chest. Between the two layers of the pleura is a very small amount of fluid (pleural fluid). Normally, this fluid does not build up.
Cancer Cells
Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body. Normal, healthy cells grow and divide to form new cells as the body needs them. When normal cells grow old or become damaged, 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 or damaged cells do not die as they should. The build-up of extra cells often forms a mass of tissue called a growth or tumor.

Tumor cells can be benign (not cancer) or malignant (cancer). Benign tumor cells are usually not as harmful as malignant tumor cells:
Benign lung tumors :-
*are rarely a threat to life
*usually do not need to be removed
* do not invade the tissues around them
* do not spread to other parts of the body
Malignant lung tumors:-
*may be a threat to life
*may grow back after being removed
*can invade nearby tissues and organs
*can spread to other parts of the body Cancer cells spread by breaking away from the original tumor. They enter blood vessels or lymph vessels, which branch into all the tissues of the body. The cancer cells attach to other organs and form new tumors that may damage those organs. The spread of cancer is called metastasis.
Risk Factors
Doctors cannot always explain why one person develops lung cancer and another does not. However, we do know that a person with certain risk factors may be more likely than others to develop lung cancer. A risk factor is something that may increase the chance of developing a disease. Studies have found the following risk factors for lung cancer:
* Tobacco smoke:
Tobacco smoke causes most cases of lung cancer. It's by far the most important risk factor for lung cancer. Harmful substances in smoke damage lung cells. That's why smoking cigarettes, pipes, or cigars can cause lung cancer and why secondhand smoke can cause lung cancer in nonsmokers. The more a person is exposed to smoke, the greater the risk of lung cancer.
* Radon:
Radon is a radioactive gas that you cannot see, smell, or taste. It forms in soil and rocks. People who work in mines may be exposed to radon. In some parts of the country, radon is found in houses. Radon damages lung cells, and people exposed to radon are at increased risk of lung cancer. The risk of lung cancer from radon is even higher for smokers.
* Asbestos and other substances:
People who have certain jobs (such as those who work in the construction and chemical industries) have an increased risk of lung cancer. Exposure to asbestos, arsenic, chromium, nickel, soot, tar, and other substances can cause lung cancer. The risk is highest for those with years of exposure. The risk of lung cancer from these substances is even higher for smokers.
* Air pollution:
Air pollution may slightly increase the risk of lung cancer. The risk from air pollution is higher for smokers.
* Family history of lung cancer:
People with a father, mother, brother, or sister who had lung cancer may be at slightly increased risk of the disease, even if they don't smoke.

* Personal history of lung cancer:

People who have had lung cancer are at increased risk of developing a second lung tumor.

* Age over 65:

Most people are older than 65 years when diagnosed with lung cancer. Researchers have studied other possible risk factors. For example, having certain lung diseases (such as tuberculosis or bronchitis) for many years may increase the risk of lung cancer. It's not yet clear whether having certain lung diseases is a risk factor for lung cancer. People who think they may be at risk for developing lung cancer should talk to their doctor. The doctor may be able to suggest ways to reduce their risk and can plan an appropriate schedule for checkups. For people who have been treated for lung cancer, it's important to have checkups after treatment. The lung tumor may come back after treatment, or another lung tumor may develop.
Screening
Screening tests may help doctors find and treat cancer early. They have been shown to be very helpful in some cancers such as breast cancer. Currently, there is no generally accepted screening test for lung cancer. Several methods of detecting lung cancer have been studied as possible screening tests. The methods under study include tests of sputum (mucus brought up from the lungs by coughing), chest x-rays, or spiral (helical) CT scans. You can read more about these tests in the Diagnosis section. However, screening tests have risks. For example, an abnormal x-ray result could lead to other procedures (such as surgery to check for cancer cells), but a person with an abnormal test result might not have lung cancer. Studies so far have not shown that screening tests lower the number of deaths from lung cancer. You may want to talk with your doctor about your own risk factors and the possible benefits and harms of being screened for lung cancer. Like many other medical decisions, the decision to be screened is a personal one. Your decision may be easier after learning the pros and cons of screening.
Symptoms
Early lung cancer often does not cause symptoms. But as the cancer grows, common symptoms may include:
* a cough that gets worse or does not go away
* breathing trouble, such as shortness of breath
* constant chest pain
* coughing up blood
* a hoarse voice
* frequent lung infections, such as pneumonia
* feeling very tired all the time
* weight loss with no known cause Most often these symptoms are not due to cancer. Other health problems can cause some of these symptoms. Anyone with such symptoms should see a doctor to be diagnosed and treated as early as possible.
Diagnosis
If you have a symptom that suggests lung cancer, your doctor must find out whether it's from cancer or something else. Your doctor may ask about your personal and family medical history. Your doctor may order blood tests, and you may have one or more of the following tests:
* Physical exam:
Your doctor checks for general signs of health, listens to your breathing, and checks for fluid in the lungs. Your doctor may feel for swollen lymph nodes and a swollen liver.
* Chest x-ray:
X-ray pictures of your chest may show tumors or abnormal fluid.
* CT scan:
Doctors often use CT scans to take pictures of tissue inside the chest. An x-ray machine linked to a computer takes several pictures. For a spiral CT scan, the CT scanner rotates around you as you lie on a table. The table passes through the center of the scanner. The pictures may show a tumor, abnormal fluid, or swollen lymph nodes. Finding Lung Cancer Cells The only sure way to know if lung cancer is present is for a pathologist to check samples of cells or tissue. The pathologist studies the sample under a microscope and performs other tests. There are many ways to collect samples. Your doctor may order one or more of the following tests to collect samples

: * Sputum cytology:

Thick fluid (sputum) is coughed up from the lungs. The lab checks samples of sputum for cancer cells.
* Thoracentesis:
The doctor uses a long needle to remove fluid (pleural fluid) from the chest. The lab checks the fluid for cancer cells.
* Bronchoscopy:
The doctor inserts a thin, lighted tube (a bronchoscope) through the nose or mouth into the lung. This allows an exam of the lungs and the air passages that lead to them. The doctor may take a sample of cells with a needle, brush, or other tool. The doctor also may wash the area with water to collect cells in the water.
* Fine-needle aspiration:
The doctor uses a thin needle to remove tissue or fluid from the lung or lymph node. Sometimes the doctor uses a CT scan or other imaging method to guide the needle to a lung tumor or lymph node.
* Thoracoscopy:
The surgeon makes several small incisions in your chest and back. The surgeon looks at the lungs and nearby tissues with a thin, lighted tube. If an abnormal area is seen, a biopsy to check for cancer cells may be needed.
* Thoracotomy:
The surgeon opens the chest with a long incision. Lymph nodes and other tissue may be removed.
* Mediastinoscopy:
The surgeon makes an incision at the top of the breastbone. A thin, lighted tube is used to see inside the chest. The surgeon may take tissue and lymph node samples.
You may want to ask these questions before the doctor takes a sample of tissue:
* Which procedure do you recommend? How will the tissue be removed?
* Will I have to stay in the hospital? If so, for how long?
* Will I have to do anything to prepare for it?
* How long will it take? Will I be awake? Will it hurt?
* Are there any risks? What is the chance that the procedure will make my lung collapse? What are the chances of infection or bleeding after the procedure?
* How long will it take me to recover? * How soon will I know the results? Who will explain them to me?
* If I do have cancer, who will talk to me about next steps? When?
Types of Lung Cancer
The pathologist checks the sputum, pleural fluid, tissue, or other samples for cancer cells. If cancer is found, the pathologist reports the type. The types of lung cancer are treated differently. The most common types are named for how the lung cancer cells look under a microscope:
* Small cell lung cancer:
About 13 percent of lung cancers are small cell lung cancers. This type tends to spread quickly.
* Non-small cell lung cancer:
Most lung cancers (about 87 percent) are non-small cell lung cancers. This type spreads more slowly than small cell lung cancer.
Staging To plan the best treatment, your doctor needs to know the type of lung cancer and the extent (stage) of the disease. Staging is a careful attempt to find out whether the cancer has spread, and if so, to what parts of the body. Lung cancer spreads most often to the lymph nodes, brain, bones, liver, and adrenal glands. When cancer spreads from its original place to another part of the body, the new tumor has the same kind of cancer cells and the same name as the original cancer. For example, if lung cancer spreads to the liver, the cancer cells in the liver are actually lung cancer cells. The disease is metastatic lung cancer, not liver cancer. For that reason, it's treated as lung cancer, not liver cancer. Doctors call the new tumor "distant" or metastatic disease.
Staging may involve blood tests and other tests:
* CT scan:
CT scans may show cancer that has spread to your liver, adrenal glands, brain, or other organs. You may receive contrast material by mouth and by injection into your arm or hand. The contrast material helps these tissues show up more clearly. If a tumor shows up on the CT scan, your doctor may order a biopsy to look for lung cancer cells.
* Bone scan:
A bone scan may show cancer that has spread to your bones. You receive an injection of a small amount of a radioactive substance. It travels through your blood and collects in your bones. A machine called a scanner detects and measures the radiation. The scanner makes pictures of your bones on a computer screen or on film.
* MRI:
Your doctor may order MRI pictures of your brain, bones, or other tissues. MRI uses a powerful magnet linked to a computer. It makes detailed pictures of tissue on a computer screen or film.
* PET scan:
Your doctor uses a PET scan to find cancer that has spread. You receive an injection of a small amount of radioactive sugar. A machine makes computerized pictures of the sugar being used by cells in the body. Cancer cells use sugar faster than normal cells, and areas with cancer look brighter on the pictures. Stages of Small Cell Lung Cancer Doctors describe small cell lung cancer using two stages:
* Limited stage:
Cancer is found only in one lung and its nearby tissues.

* Extensive stage:

Cancer is found in tissues of the chest outside of the lung in which it began. Or cancer is found in distant organs. The treatment options are different for limited and extensive stage small cell lung cancer. See the Treatment section for information about treatment choices. Stages of Non-Small Cell Lung Cancer Doctors describe non-small cell lung cancer based on the size of the lung tumor and whether cancer has spread to the lymph nodes or other tissues:
* Occult stage:
Lung cancer cells are found in sputum or in a sample of water collected during bronchoscopy, but a tumor cannot be seen in the lung.
* Stage 0:
Cancer cells are found only in the innermost lining of the lung. The tumor has not grown through this lining. A Stage 0 tumor is also called carcinoma in situ. The tumor is not an invasive cancer.
* Stage IA:
The lung tumor is an invasive cancer. It has grown through the innermost lining of the lung into deeper lung tissue. The tumor is no more than 3 centimeters across (less than 1 ¼ inches). It is surrounded by normal tissue and the tumor does not invade the bronchus. Cancer cells are not found in nearby lymph nodes.
* Stage IB:
The tumor is larger or has grown deeper, but cancer cells are not found in nearby lymph nodes. The lung tumor is one of the following (see the picture of the main bronchus and pleura): -The tumor is more than 3 centimeters across. - It has grown into the main bronchus. - It has grown through the lung into the pleura.
* Stage IIA:
The lung tumor is no more than 3 centimeters across. Cancer cells are found in nearby lymph nodes.
* Stage IIB:
The tumor is one of the following:
-Cancer cells are not found in nearby lymph nodes, but the tumor has invaded the chest wall, diaphragm, pleura, main bronchus, or tissue that surrounds the heart
- Cancer cells are found in nearby lymph nodes, and one of the following:
*The tumor is more than 3 centimeters across
. * It has grown into the main bronchus.
* It has grown through the lung into the pleura.
* Stage IIIA:
The tumor may be any size. Cancer cells are found in the lymph nodes near the lungs and bronchi, and in the lymph nodes between the lungs but on the same side of the chest as the lung tumor.
* Stage IIIB:
The tumor may be any size. Cancer cells are found on the opposite side of the chest from the lung tumor or in the neck. The tumor may have invaded nearby organs, such as the heart, esophagus, or trachea. More than one malignant growth may be found within the same lobe of the lung. The doctor may find cancer cells in the pleural fluid.

* Stage IV:

Malignant growths may be found in more than one lobe of the same lung or in the other lung. Or cancer cells may be found in other parts of the body, such as the brain, adrenal gland, liver, or bone.

Treatment:

* Local therapy:
Surgery and radiation therapy are local therapies. They remove or destroy cancer in the chest. When lung cancer has spread to other parts of the body, local therapy may be used to control the disease in those specific areas. For example, lung cancer that spreads to the brain may be controlled with radiation therapy to the head.

*Systemic therapy:

Chemotherapy and targeted therapy are systemic therapies. The drugs enter the bloodstream and destroy or control cancer throughout the body.
Second Opinion
Before starting treatment, you might want a second opinion about your diagnosis and treatment plan. Many insurance companies cover a second opinion if you or your doctor requests it. It may take some time and effort to gather your medical records and see another doctor. In most cases, a brief delay in starting treatment will not make treatment less effective. To make sure, you should discuss this delay with your doctor. Sometimes people with lung cancer need treatment right away. For example, a doctor may advise a person with small cell lung cancer not to delay treatment more than a week or two. There are many ways to find a doctor for a second opinion. You can ask your doctor, a local or state medical society, a nearby hospital, or a medical school for names of specialists. Also, your nearest cancer center can tell you about doctors who work there.
Comfort Care
Lung cancer and its treatment can lead to other health problems. You may need comfort care to prevent or control these problems. Comfort care is available both during and after treatment. It can improve your quality of life. Your health care team can tell you more about the following problems and how to control them:
* Pain:
Your doctor or a pain control specialist can suggest ways to relieve or reduce pain.
* Shortness of breath or trouble breathing:
People with lung cancer often have trouble breathing. Your doctor may refer you to a lung specialist or respiratory therapist. Some people are helped by oxygen therapy, photodynamic therapy, laser surgery, cryotherapy, or stents.
* Fluid in or around lungs:
Advanced cancer can cause fluid to collect in or around the lungs. The fluid can make it hard to breathe. Your health care team can remove fluid when it builds up. In some cases, a procedure can be done that may prevent fluid from building up again. Some people may need chest tubes to drain the fluid.
* Pneumonia:
You may have chest x-rays to check for lung infections. Your doctor can treat infections.
* Cancer that spreads to the brain:
Lung cancer can spread to the brain. The symptoms may include headache, seizures, trouble walking, and problems with balance. Medicine to relieve swelling, radiation therapy, or sometimes surgery can help. People with small cell lung cancer may receive radiation therapy to the brain to try to prevent brain tumors from forming. This is called prophylactic cranial irradiation
. * Cancer that spreads to the bone:
Lung cancer that spreads to the bone can be painful and can weaken bones. You can ask for pain medicine, and the doctor may suggest external radiation therapy. Your doctor also may give you drugs to help lower your risk of breaking a bone.
* Sadness and other feelings:
It's normal to feel sad, anxious, or confused after a diagnosis of a serious illness. Some people find it helpful to talk about their feelings.

Nutrition

It's important for you to take care of yourself by eating well. You need the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy. Sometimes, especially during or soon after treatment, you may not feel like eating. You may be uncomfortable or tired. You may find that foods don't taste as good as they used to. In addition, the side effects of treatment (such as poor appetite, nausea, vomiting, or mouth sores) can make it hard to eat well. Your doctor, a registered dietitian, or another health care provider can suggest ways to deal with these problems.


Sources of Support
Learning you have lung cancer can change your life and the lives of those close to you. These changes can be hard to handle. It's normal for you, your family, and your friends to have many different and sometimes confusing feelings. You may worry about caring for your family, keeping your job, or continuing daily activities. Concerns about treatments and managing side effects, hospital stays, and medical bills are also common. Because most people who get lung cancer were smokers, you may feel like doctors and other people assume that you are or were a smoker (even if you weren't). You may feel as though you're responsible for getting cancer (or that others blame you). It's normal for anyone coping with a serious illness to feel fear, guilt, anger, or sadness. It may help to share your feelings with family, friends, a member of your health care team, or another person with cancer. Here's where you can go for support:
* Doctors, nurses, and other members of your health care team can answer many of your questions.
* Social workers, counselors, or members of the clergy can be helpful if you want to talk about your feelings or concerns. Often, social workers can suggest resources for financial aid, transportation, home care, or emotional support.
* Support groups also can help. In these groups, patients or their family members meet with other patients or their families to share what they have learned about coping with the disease and the effects of treatment. Groups may offer support in person, over the telephone, or on the Internet. You may want to talk with a member of your health care team about finding a support group.

The Prostate Cancer, Risk Factors, Treatments And Support.

The prostate Cancer

The prostate is part of a man's reproductive system. It's an organ located in front of the rectum and under the bladder. The prostate surrounds the urethra, the tube through which urine flows.

A healthy prostate is about the size of a walnut. If the prostate grows too large, it squeezes the urethra. This may slow or stop the flow of urine from the bladder to the penis.

The prostate is a gland. It makes part of the seminal fluid. During ejaculation, the seminal fluid helps carry sperm out of the man's body as part of semen.

Male hormones (androgens) make the prostate grow. The testicles are the main source of male hormones, including testosterone. The adrenal gland also makes testosterone, but in small amounts.


Prostate Cancer Cells

Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.

Normal cells grow and divide to form new cells as the body needs them. When normal cells grow old or get damaged, they die, and new cells take their place.

Sometimes, this process goes wrong. New cells form when the body doesn't need them, and old or damaged cells don't die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor.

Prostate growths can be benign (not cancer) or malignant (cancer).

Benign growths are not as harmful as malignant growths:

-Benign growths (such as BPH):
- are rarely a threat to life
-can be removed and probably won't grow back
-don't invade the tissues around them
- don't spread to other parts of the body


Risk Factors

When you're told you have prostate cancer, it's natural to wonder what may have caused the disease. But no one knows the exact causes of prostate cancer. Doctors seldom know why one man develops prostate cancer and another doesn't.

However, research has shown that men with certain risk factors are more likely than others to develop prostate cancer. A risk factor is something that may increase the chance of getting a disease.

Studies have found the following risk factors for prostate cancer:

* Age over 65: Age is the main risk factor for prostate cancer. The chance of getting prostate cancer increases as you get older. In the United States, most men with prostate cancer are over 65. This disease is rare in men under 45.

* Family history: Your risk is higher if your father, brother, or son had prostate cancer.

* Race: Prostate cancer is more common among black men than white or Hispanic/Latino men. It's less common among Asian/Pacific Islander and American Indian/Alaska Native men.

* Certain prostate changes: Men with cells called high-grade prostatic intraepithelial neoplasia (PIN) may be at increased risk of prostate cancer. These prostate cells look abnormal under a microscope.

* Certain genome changes: Researchers have found specific regions on certain chromosomes that are linked to the risk of prostate cancer. According to recent studies, if a man has a genetic change in one or more of these regions, the risk of prostate cancer may be increased. The risk increases with the number of genetic changes that are found. Also, other studies have shown an elevated risk of prostate cancer among men with changes in certain genes, such as BRCA1 and BRCA2.

Having a risk factor doesn't mean that a man will develop prostate cancer. Most men who have risk factors never develop the disease.

Many other possible risk factors are under study. For example, researchers have studied whether vasectomy (surgery to cut or tie off the tubes that carry sperm out of the testicles) may pose a risk, but most studies have found no increased risk. Also, most studies have shown that the chance of getting prostate cancer is not increased by tobacco or alcohol use, BPH, a sexually transmitted disease, obesity, a lack of exercise, or a diet high in animal fat or meat. Researchers continue to study these and other possible risk factors.

Researchers are also studying how prostate cancer may be prevented. For example, they are studying the possible benefits of certain drugs, vitamin E, selenium, green tea extract, and other substances. These studies are with men who have not yet developed prostate cancer.
* Malignant tumors:
-may be a threat to life
- often can be removed, but sometimes grow back
- can invade and damage nearby tissues and organs
- can spread to other parts of the body

Cancer cells can spread by breaking away from the prostate tumor. They enter blood vessels or lymph vessels, which branch into all the tissues of the body. The cancer cells can attach to other tissues and grow to form new tumors that may damage those tissues. The spread of cancer is called metastasis. See the Staging section for information about prostate cancer that has spread.

Symptoms

A man with prostate cancer may not have any symptoms. For men who do have symptoms, the common symptoms include:

* Urinary problems
- Not being able to pass urine
- Having a hard time starting or stopping the urine flow
- Needing to urinate often, especially at night
- Weak flow of urine
- Urine flow that starts and stops
-Pain or burning during urination

* Difficulty having an erection

* Blood in the urine or semen

* Frequent pain in the lower back, hips, or upper thighs

Most often, these symptoms are not due to cancer. BPH, an infection, or another health problem may cause them. If you have any of these symptoms, you should tell your doctor so that problems can be diagnosed and treated.



Detection and Diagnosis

If Cancer Is Not Found
If Cancer Is Found

Your doctor can check for prostate cancer before you have any symptoms. During an office visit, your doctor will ask about your personal and family medical history. You'll have a physical exam. You may also have one or both of the following tests:

* Digital rectal exam: Your doctor inserts a lubricated, gloved finger into the rectum and feels your prostate through the rectal wall. Your prostate is checked for hard or lumpy areas.

* Blood test for prostate-specific antigen (PSA): A lab checks the level of PSA in your blood sample. The prostate makes PSA. A high PSA level is commonly caused by BPH or prostatitis (inflammation of the prostate). Prostate cancer may also cause a high PSA level.

The digital rectal exam and PSA test are being studied in clinical trials to learn whether finding prostate cancer early can lower the number of deaths from this disease.

The digital rectal exam and PSA test can detect a problem in the prostate. However, they can't show whether the problem is cancer or a less serious condition. If you have abnormal test results, your doctor may suggest other tests to make a diagnosis. For example, your visit may include other lab tests, such as a urine test to check for blood or infection. Your doctor may order other procedures:

* Transrectal ultrasound: The doctor inserts a probe into the rectum to check your prostate for abnormal areas. The probe sends out sound waves that people cannot hear (ultrasound). The waves bounce off the prostate. A computer uses the echoes to create a picture called a sonogram.

* Transrectal biopsy: A biopsy is the removal of tissue to look for cancer cells. It's the only sure way to diagnose prostate cancer. The doctor inserts needles through the rectum into the prostate. The doctor removes small tissue samples (called cores) from many areas of the prostate. Transrectal ultrasound is usually used to guide the insertion of the needles. A pathologist checks the tissue samples for cancer cells.

If cancer cells are found, the pathologist studies tissue samples from the prostate under a microscope to report the grade of the tumor. The grade tells how much the tumor tissue differs from normal prostate tissue. It suggests how fast the tumor is likely to grow.

Tumors with higher grades tend to grow faster than those with lower grades. They are also more likely to spread. Doctors use tumor grade along with your age and other factors to suggest treatment options.

One system of grading is with the Gleason score. Gleason scores range from 2 to 10. To come up with the Gleason score, the pathologist uses a microscope to look at the patterns of cells in the prostate tissue. The most common pattern is given a grade of 1 (most like normal cells) to 5 (most abnormal). If there is a second most common pattern, the pathologist gives it a grade of 1 to 5, and adds the two most common grades together to make the Gleason score. If only one pattern is seen, the pathologist counts it twice. For example, 5 + 5 = 10. A high Gleason score (such as 10) means a high-grade prostate tumor. High-grade tumors are more likely than low-grade tumors to grow quickly and spread.

Another system of grading prostate cancer uses grades 1 through 4 (G1 to G4). G4 is more likely than G1, G2, or G3 to grow quickly and spread.



Staging

If the biopsy shows that you have cancer, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. Staging is a careful attempt to find out whether the tumor has invaded nearby tissues, whether the cancer has spread and, if so, to what parts of the body.

Some men may need tests that make pictures of the body:

* Bone scan: The doctor injects a small amount of a radioactive substance into a blood vessel. It travels through the bloodstream and collects in the bones. A machine called a scanner detects and measures the radiation. The scanner makes pictures of the bones on a computer screen or on film. The pictures may show cancer that has spread to the bones.

* CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your pelvis or other parts of the body. Doctors use CT scans to look for prostate cancer that has spread to lymph nodes and other areas. You may receive contrast material by injection into a blood vessel in your arm or hand, or by enema. The contrast material makes abnormal areas easier to see.

* MRI: A strong magnet linked to a computer is used to make detailed pictures of areas inside your body. The doctor can view these pictures on a monitor and can print them on film. An MRI can show whether cancer has spread to lymph nodes or other areas. Sometimes contrast material makes abnormal areas show up more clearly on the picture.

When prostate cancer spreads, it's often found in nearby lymph nodes. If cancer has reached these nodes, it also may have spread to other lymph nodes, the bones, or other organs.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if prostate cancer spreads to bones, the cancer cells in the bones are actually prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer. For that reason, it's treated as prostate cancer, not bone cancer. Doctors call the new tumor "distant" or metastatic disease.

These are the stages of prostate cancer:

* Stage I: The cancer can't be felt during a digital rectal exam, and it can't be seen on a sonogram. It's found by chance when surgery is done for another reason, usually for BPH. The cancer is only in the prostate. The grade is G1, or the Gleason score is no higher than 4.

* Stage II: The tumor is more advanced or a higher grade than Stage I, but the tumor doesn't extend beyond the prostate. It may be felt during a digital rectal exam, or it may be seen on a sonogram.

* Stage III: The tumor extends beyond the prostate. The tumor may have invaded the seminal vesicles, but cancer cells haven't spread to the lymph nodes.

* Stage IV: The tumor may have invaded the bladder, rectum, or nearby structures (beyond the seminal vesicles). It may have spread to the lymph nodes, bones, or to other parts of the body.

Treatment

- Active Surveillance
- Surgery
- Radiation Therapy
- Hormone Therapy
- Chemotherapy

Men with prostate cancer have many treatment options. The treatment that's best for one man may not be best for another. The options include active surveillance (also called watchful waiting), surgery, radiation therapy, hormone therapy, and chemotherapy. You may have a combination of treatments.

The treatment that's right for you depends mainly on your age, the grade of the tumor (the Gleason score), the number of biopsy tissue samples that contain cancer cells, the stage of the cancer, your symptoms, and your general health. Your doctor can describe your treatment choices, the expected results of each, and the possible side effects. You and your doctor can work together to develop a treatment plan that meets your medical and personal needs.

You may want to talk to your doctor about taking part in a clinical trial, a research study of new treatment methods.

Your doctor may refer you to a specialist, or you may ask for a referral. You may want to see a urologist, a surgeon who specializes in treating problems in the urinary or male sex organs. Other specialists who treat prostate cancer include urologic oncologists, medical oncologists, and radiation oncologists. Your health care team may also include an oncology nurse and a registered dietitian.

Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. For example, you may want to discuss with your doctor the possible effects on sexual activity.

At any stage of the disease, supportive care is available to relieve the side effects of treatment, to control pain and other symptoms, and to help you cope with the feelings that a diagnosis of cancer can bring.
Active Surveillance

You may choose active surveillance if the risks and possible side effects of treatment outweigh the possible benefits. Your doctor may suggest active surveillance if you're diagnosed with early stage prostate cancer that seems to be slowly growing. Your doctor may also offer this option if you are older or have other serious health problems.

Choosing active surveillance doesn't mean you're giving up. It means you're putting off the side effects of surgery or radiation therapy. Having surgery or radiation therapy is no guarantee that a man will live longer than a man who chooses to put off treatment.

If you and your doctor agree that active surveillance is a good idea, your doctor will check you regularly (such as every 3 to 6 months, at first). After about one year, your doctor may order another biopsy to check the Gleason score. You may begin treatment if your Gleason score rises, your PSA level starts to rise, or you develop symptoms. You'll receive surgery, radiation therapy, or another approach.

Active surveillance avoids or delays the side effects of surgery and radiation therapy, but this choice has risks. For some men, it may reduce the chance to control cancer before it spreads. Also, it may be harder to cope with surgery or radiation therapy when you're older.

If you choose active surveillance but grow concerned later, you should discuss your feelings with your doctor. Another approach is an option for most men.

Surgery

Surgery is an option for men with early (Stage I or II) prostate cancer. It's sometimes an option for men with Stage III or IV prostate cancer. The surgeon may remove the whole prostate or only part of it.

Before the surgeon removes the prostate, the lymph nodes in the pelvis may be removed. If prostate cancer cells are found in the lymph nodes, the disease may have spread to other parts of the body. If cancer has spread to the lymph nodes, the surgeon does not always remove the prostate and may suggest other types of treatment.

There are several types of surgery for prostate cancer. Each type has benefits and risks. You and your doctor can talk about the types of surgery and which may be right for you:

* Open surgery: The surgeon makes a large incision (cut) into your body to remove the tumor. There are two approaches:
-Through the abdomen: The surgeon removes the entire prostate through a cut in the abdomen. This is called a radical retropubic prostatectomy.
- Between the scrotum and anus: The surgeon removes the entire prostate through a cut between the scrotum and the anus. This is called a radical perineal prostatectomy.

* Laparoscopic prostatectomy: The surgeon removes the entire prostate through small cuts, rather than a single long cut in the abdomen. A thin, lighted tube (a laparoscope) helps the surgeon remove the prostate.

* Robotic laparoscopic surgery: The surgeon removes the entire prostate through small cuts. A laparoscope and a robot are used to help remove the prostate. The surgeon uses handles below a computer display to control the robot's arms.

* Cryosurgery: For some men, cryosurgery is an option. The surgeon inserts a tool through a small cut between the scrotum and anus. The tool freezes and kills prostate tissue. Cryosurgery is under study. See the section on Taking Part in Cancer Research.

* TURP: A man with advanced prostate cancer may choose TURP (transurethral resection of the prostate) to relieve symptoms. The surgeon inserts a long, thin scope through the urethra. A cutting tool at the end of the scope removes tissue from the inside of the prostate. TURP may not remove all of the cancer, but it can remove tissue that blocks the flow of urine.

You may be uncomfortable for the first few days or weeks after surgery. However, medicine can help control the pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain relief.

The time it takes to heal after surgery is different for each man and depends on the type of surgery. You may be in the hospital for one to three days.

After surgery, the urethra needs time to heal. You'll have a catheter. A catheter is a tube put through the urethra into the bladder to drain urine. You'll have the catheter for 5 days to 3 weeks. Your nurse or doctor will show you how to care for it.

After surgery, some men may lose control of the flow of urine (urinary incontinence). Most men regain at least some bladder control after a few weeks.

Surgery can damage the nerves around the prostate. Damaging these nerves can make a man impotent (unable to have an erection). In some cases, your surgeon can protect the nerves that control erection. But if you have a large tumor or a tumor that's very close to the nerves, surgery may cause impotence. Impotence can be permanent. You can talk with your doctor about medicine and other ways to help manage the sexual side effects of cancer treatment.

If your prostate is removed, you will no longer produce semen. You'll have dry orgasms. If you wish to father children, you may consider sperm banking or a sperm retrieval procedure before surgery.


Radiation Therapy

Radiation therapy is an option for men with any stage of prostate cancer. Men with early stage prostate cancer may choose radiation therapy instead of surgery. It also may be used after surgery to destroy any cancer cells that remain in the area. In later stages of prostate cancer, radiation treatment may be used to help relieve pain.

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the treated area.

Doctors use two types of radiation therapy to treat prostate cancer. Some men receive both types:

* External radiation: The radiation comes from a large machine outside the body. You will go to a hospital or clinic for treatment. Treatments are usually 5 days a week for several weeks. Many men receive 3-dimensional conformal radiation therapy or intensity-modulated radiation therapy. These types of treatment use computers to more closely target the cancer to lessen the damage to healthy tissue near the prostate.

* Internal radiation (implant radiation or brachytherapy): The radiation comes from radioactive material usually contained in very small implants called seeds. Dozens of seeds are placed inside needles, and the needles are inserted into the prostate. The needles are removed, leaving the seeds behind. The seeds give off radiation for months. They don't need to be removed once the radiation is gone.

Side effects depend mainly on the dose and type of radiation. You're likely to be very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay active, unless it leads to pain or other problems.

If you have external radiation, you may have diarrhea or frequent and uncomfortable urination. Some men have lasting bowel or urinary problems. Your skin in the treated area may become red, dry, and tender. You may lose hair in the treated area. The hair may not grow back.

Internal radiation therapy may cause incontinence. This side effect usually goes away.

Both internal and external radiation can cause impotence. You can talk with your doctor about ways to help cope with this side effect.


Hormone Therapy

A man with prostate cancer may have hormone therapy before, during, or after radiation therapy. Hormone therapy is also used alone for prostate cancer that has returned after treatment.

Male hormones (androgens) can cause prostate cancer to grow. Hormone therapy keeps prostate cancer cells from getting the male hormones they need to grow. The testicles are the body's main source of the male hormone testosterone. The adrenal gland makes other male hormones and a small amount of testosterone.

Hormone therapy uses drugs or surgery:

* Drugs: Your doctor may suggest a drug that can block natural hormones:
- Luteinizing hormone-releasing hormone (LH-RH) agonists: These drugs can prevent the testicles from making testosterone. Examples are leuprolide, goserelin, and triptorelin. The testosterone level falls slowly. Without testosterone, the tumor shrinks, or its growth slows. These drugs are also called gonadotropin-releasing hormone (GnRH) agonists.
- Antiandrogens: These drugs can block the action of male hormones. Examples are flutamide, bicalutamide, and nilutamide.
- Other drugs: Some drugs can prevent the adrenal gland from making testosterone. Examples are ketoconazole and aminoglutethimide.

* Surgery: Surgery to remove the testicles is called orchiectomy.

After orchiectomy or treatment with an LH-RH agonist, your body no longer gets testosterone from the testicles, the major source of male hormones. Because the adrenal gland makes small amounts of male hormones, you may receive an antiandrogen to block the action of the male hormones that remain. This combination of treatments is known as total androgen blockade . However, studies have shown that total androgen blockade is no more effective than surgery or an LH-RH agonist alone.

Hormone therapy causes side effects such as impotence, hot flashes, and loss of sexual desire. Also, any treatment that lowers hormone levels can weaken your bones. Your doctor can suggest medicines that may reduce your risk of bone fractures.

An LH-RH agonist may make your symptoms worse for a short time at first. This temporary problem is called "flare." To prevent flare, your doctor may give you an antiandrogen for a few weeks along with the LH-RH agonist.

An LH-RH agonist such as leuprolide can increase body fat, especially around the waist. The levels of sugar and cholesterol in your blood may increase too. Because these changes increase the risk of diabetes and heart disease, your health care team will monitor you for these side effects.

Antiandrogens (such as nilutamide) can cause nausea, diarrhea, or breast growth or tenderness. Rarely, they may cause liver problems (pain in the abdomen, yellow eyes, or dark urine). Some men who use nilutamide may have shortness of breath or develop heart failure. Some may have trouble adjusting to sudden changes in light.

If you receive total androgen blockade, you may have more side effects than if you have just one type of hormone treatment.

If used for a long time, ketoconazole may cause liver problems, and aminoglutethimide can cause skin rashes.

Doctors usually treat prostate cancer that has spread to other parts of the body with hormone therapy. For some men, the cancer will be controlled for two or three years, but others will have a much shorter response to hormone therapy. In time, most prostate cancers can grow with very little or no male hormones, and hormone therapy alone is no longer helpful. At that time, your doctor may suggest chemotherapy or other forms of treatment that are under study. In many cases, the doctor may suggest continuing with hormone therapy because it may still be effective against some of the cancer cells.


Chemotherapy

Chemotherapy may be used for prostate cancer that has spread and no longer responds to hormone therapy.

Chemotherapy uses drugs to kill cancer cells. The drugs for prostate cancer are usually given through a vein (intravenous). You may receive chemotherapy in a clinic, at the doctor's office, or at home. Some men need to stay in the hospital during treatment.

The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:

* Blood cells: When chemotherapy lowers the levels of healthy blood cells, you're more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. If your levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of drug. There are also medicines that can help your body make new blood cells.

* Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back, but it may change in color and texture.

* Cells that line the digestive tract: Chemotherapy can cause a poor appetite, nausea and vomiting, or diarrhea. Your health care team can give you medicines and suggest other ways to help with these problems.Second Opinion

Before starting treatment, you might want a second opinion about your diagnosis and treatment plan. You may even want to talk to several different doctors about all of the treatment options, their side effects, and the expected results. For example, you may want to talk to a urologist, radiation oncologist, and medical oncologist.

Some people worry that the doctor will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies will pay for a second opinion if you or your doctor requests it.

If you get a second opinion, the doctor may agree with your first doctor's diagnosis and treatment plan. Or, the second doctor may suggest another approach. Either way, you have more information and perhaps a greater sense of control. You can feel more confident about the decisions you make, knowing that you've looked at your options.

It may take some time and effort to gather your medical records and see another doctor. In most cases, it's not a problem to take several weeks to get a second opinion. The delay in starting treatment usually will not make treatment less effective. To make sure, you should discuss this delay with your doctor.

There are many ways to find a doctor for a second opinion. You can ask your doctor, a local or state medical society, a nearby hospital, or a medical school for names of specialists.

Other side effects include shortness of breath and a problem with your body holding extra water. Your health care team can give you medicine to protect against too much water building up in the body. Also, chemotherapy may cause a skin rash, tingling or numbness in your hands and feet, and watery eyes. Your health care team can suggest ways to control many of these problems. Most go away when treatment ends.

Second Opinion

Before starting treatment, you might want a second opinion about your diagnosis and treatment plan. You may even want to talk to several different doctors about all of the treatment options, their side effects, and the expected results. For example, you may want to talk to a urologist, radiation oncologist, and medical oncologist.

Some people worry that the doctor will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies will pay for a second opinion if you or your doctor requests it.

If you get a second opinion, the doctor may agree with your first doctor's diagnosis and treatment plan. Or, the second doctor may suggest another approach. Either way, you have more information and perhaps a greater sense of control. You can feel more confident about the decisions you make, knowing that you've looked at your options.

It may take some time and effort to gather your medical records and see another doctor. In most cases, it's not a problem to take several weeks to get a second opinion. The delay in starting treatment usually will not make treatment less effective. To make sure, you should discuss this delay with your doctor.

There are many ways to find a doctor for a second opinion. You can ask your doctor, a local or state medical society, a nearby hospital, or a medical school for names of specialists.

Nutrition and Physical Activity

It's important for you to take care of yourself by eating well and staying as active as you can.

You need the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy.

Your doctor, a registered dietitian, or another health care provider can suggest a healthy diet..

Research shows that people with cancer feel better when they are active. Walking, yoga, swimming, and other activities can increase your energy. Exercise may reduce pain and make treatment easier to handle. It also can help relieve stress. Whatever physical activity you choose, be sure to talk to your doctor before you start. Also, if your activity causes you pain or other problems, be sure to let your doctor or nurse know about it. You shouldn't try to exercise to the point of exhaustion.



Follow-up Care

You'll need regular checkups after treatment for prostate cancer. Checkups help ensure that any changes in your health are noted and treated if needed. If you have any health problems between checkups, you should contact your doctor.

Your doctor will check for return of cancer. Even when the cancer seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained somewhere in the body after treatment.

Checkups may include a digital rectal exam and a PSA test. A rise in PSA level can mean that cancer has returned after treatment. Your doctor may also order a biopsy, a bone scan, CT scans, an MRI, or other tests.

Sources of Support

Learning you have prostate cancer can change your life and the lives of those close to you. These changes can be hard to handle. It's normal for you, your family, and your friends to need help coping with the feelings that a diagnosis of cancer can bring.

Concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, keeping your job, or continuing daily activities.

Here's where you can go for support:

* Doctors, nurses, and other members of your health care team can answer questions about treatment, working, or other activities.

* Social workers, counselors, or members of the clergy can be helpful if you want to talk about your feelings or concerns. Often, social workers can suggest resources for financial aid, transportation, home care, or emotional support.

* Support groups also can help. In these groups, patients or their family members meet with other patients or their families to share what they have learned about coping with the disease and the effects of treatment. Groups may offer support in person, over the telephone, or on the Internet. You may want to talk with a member of your health care team about finding a support group.


* Your doctor or a sex counselor may be helpful if you and your partner are concerned about the effects of prostate cancer on your sexual relationship. Ask your doctor about possible treatment of side effects and whether these effects are likely to last. Whatever the outlook, you and your partner may find it helps to discuss your concerns.

Leukemia , Risk Factors, Treatments And Support.

What Is Leukemia?

Normal Blood Cells
Leukemia Cells

Leukemia is cancer that starts in the tissue that forms blood. To understand cancer, it helps to know how normal blood cells form.

Definition of leukemia: Cancer that starts in blood-forming tissue such as the bone marrow and causes large numbers of blood cells to be produced and enter the bloodstream.

Estimated new cases and deaths from leukemia in the United States in 2008:


New cases: 44,270
Deaths: 21,710

Normal Blood Cells

Most blood cells develop from cells in the bone marrow called stem cells. Bone marrow is the soft material in the center of most bones.

Stem cells mature into different kinds of blood cells. Each kind has a special job:
White blood cells White blood cells help fight infection. There are several types of white blood cells.
Red blood cells Red blood cells carry oxygen to tissues throughout the body.
Platelets Platelets help form blood clots that control bleeding.

White blood cells, red blood cells, and platelets are made from stem cells as the body needs them. When cells grow old or get damaged, they die, and new cells take their place.

The picture below shows how stem cells can mature into different types of white blood cells. First, a stem cell matures into either a myeloid stem cell or a lymphoid stem cell:

* A myeloid stem cell matures into a myeloid blast. The blast can form a red blood cell, platelets, or one of several types of white blood cells.

* A lymphoid stem cell matures into a lymphoid blast. The blast can form one of several types of white blood cells, such as B cells or T cells.

The white blood cells that form from myeloid blasts are different from the white blood cells that form from lymphoid blasts.
Picture of blood cells maturing from stem cells.
Picture of blood cells maturing from stem cells.

Most blood cells mature in the bone marrow and then move into the blood vessels. Blood flowing through the blood vessels and heart is called the peripheral blood.

Leukemia Cells

In a person with leukemia, the bone marrow makes abnormal white blood cells. The abnormal cells are leukemia cells.

Unlike normal blood cells, leukemia cells don't die when they should. They may crowd out normal white blood cells, red blood cells, and platelets. This makes it hard for normal blood cells to do their work.

Types of Leukemia

The types of leukemia can be grouped based on how quickly the disease develops and gets worse. Leukemia is either chronic (which usually gets worse slowly) or acute (which usually gets worse quickly):

* Chronic leukemia: Early in the disease, the leukemia cells can still do some of the work of normal white blood cells. People may not have any symptoms at first. Doctors often find chronic leukemia during a routine checkup - before there are any symptoms.

Slowly, chronic leukemia gets worse. As the number of leukemia cells in the blood increases, people get symptoms, such as swollen lymph nodes or infections. When symptoms do appear, they are usually mild at first and get worse gradually.

* Acute leukemia: The leukemia cells can't do any of the work of normal white blood cells. The number of leukemia cells increases rapidly. Acute leukemia usually worsens quickly.

The types of leukemia also can be grouped based on the type of white blood cell that is affected. Leukemia can start in lymphoid cells or myeloid cells. See the picture of these cells. Leukemia that affects lymphoid cells is called lymphoid, lymphocytic, or lymphoblastic leukemia. Leukemia that affects myeloid cells is called myeloid, myelogenous, or myeloblastic leukemia.

There are four common types of leukemia:

* Chronic lymphocytic leukemia (CLL): CLL affects lymphoid cells and usually grows slowly. It accounts for more than 15,000 new cases of leukemia each year. Most often, people diagnosed with the disease are over age 55. It almost never affects children.

* Chronic myeloid leukemia (CML): CML affects myeloid cells and usually grows slowly at first. It accounts for nearly 5,000 new cases of leukemia each year. It mainly affects adults.

* Acute lymphocytic (lymphoblastic) leukemia (ALL): ALL affects lymphoid cells and grows quickly. It accounts for more than 5,000 new cases of leukemia each year. ALL is the most common type of leukemia in young children. It also affects adults.

* Acute myeloid leukemia (AML): AML affects myeloid cells and grows quickly. It accounts for more than 13,000 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 is not about hairy cell leukemia or other rare types of leukemia. Together, these rare leukemias account for fewer than 6,000 new cases of leukemia each year. The Cancer Information Service (1-800-4-CANCER) can provide information about rare types of leukemia.


Risk Factors

When you're told that you have cancer, it's natural to wonder what may have caused the disease. No one knows the exact causes of leukemia. Doctors seldom know why one person gets leukemia and another doesn't. However, research shows that certain risk factors increase the chance that a person will get this disease.

The risk factors may be different for the different types of leukemia:

* Radiation: People exposed to very high levels of radiation are much more likely than others to get acute myeloid leukemia, chronic myeloid leukemia, or acute lymphocytic leukemia.
- Atomic bomb explosions: Very high levels of radiation have been caused by atomic bomb explosions (such as those in Japan during World War II). People, especially children, who survive atomic bomb explosions are at increased risk of leukemia.
- Radiation therapy: Another source of exposure to high levels of radiation is medical treatment for cancer and other conditions. Radiation therapy can increase the risk of leukemia.
- Diagnostic x-rays: Dental x-rays and other diagnostic x-rays (such as CT scans) expose people to much lower levels of radiation. It's not known yet whether this low level of radiation to children or adults is linked to leukemia. Researchers are studying whether having many x-rays may increase the risk of leukemia. They are also studying whether CT scans during childhood are linked with increased risk of developing leukemia.

* Smoking: Smoking cigarettes increases the risk of acute myeloid leukemia.

* Benzene: Exposure to benzene in the workplace can cause acute myeloid leukemia. It may also cause chronic myeloid leukemia or acute lymphocytic leukemia. Benzene is used widely in the chemical industry. It's also found in cigarette smoke and gasoline.

* Chemotherapy: Cancer patients treated with certain types of cancer-fighting drugs sometimes later get acute myeloid leukemia or acute lymphocytic leukemia. For example, being treated with drugs known as alkylating agents or topoisomerase inhibitors is linked with a small chance of later developing acute leukemia.

* Down syndrome and certain other inherited diseases: Down syndrome and certain other inherited diseases increase the risk of developing acute leukemia.

* Myelodysplastic syndrome and certain other blood disorders: People with certain blood disorders are at increased risk of acute myeloid leukemia.

* Human T-cell leukemia virus type I (HTLV-I): People with HTLV-I infection are at increased risk of a rare type of leukemia known as adult T-cell leukemia. Although the HTLV-I virus may cause this rare disease, adult T-cell leukemia and other types of leukemia are not contagious.

* Family history of leukemia: It's rare for more than one person in a family to have leukemia. When it does happen, it's most likely to involve chronic lymphocytic leukemia. However, only a few people with chronic lymphocytic leukemia have a father, mother, brother, sister, or child who also has the disease.

Having one or more risk factors does not mean that a person will get leukemia. Most people who have risk factors never develop the disease.


Symptoms

Like all blood cells, leukemia cells travel through the body. The symptoms of leukemia depend on the number of leukemia cells and where these cells collect in the body.

People with chronic leukemia may not have symptoms. The doctor may find the disease during a routine blood test.

People with acute leukemia usually go to their doctor because they feel sick. If the brain is affected, they may have headaches, vomiting, confusion, loss of muscle control, or seizures. Leukemia also can affect other parts of the body such as the digestive tract, kidneys, lungs, heart, or testes.

Common symptoms of chronic or acute leukemia may include:

* Swollen lymph nodes that usually don't hurt (especially lymph nodes in the neck or armpit)

* Fevers or night sweats

* Frequent infections

* Feeling weak or tired

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

* Swelling or discomfort in the abdomen (from a swollen spleen or liver)

* Weight loss for no known reason

* Pain in the bones or joints

Most often, these symptoms are not due to cancer. An infection or other health problems may also cause these symptoms. Only a doctor can tell for sure.

Anyone with these symptoms should tell the doctor so that problems can be diagnosed and treated as early as possible.


Diagnosis

Other Tests

Doctors sometimes find leukemia after a routine blood test. If you have symptoms that suggest leukemia, your doctor will try to find out what's causing the problems. Your doctor may ask about your personal and family medical history.

You may have one or more of the following tests:

* Physical exam: Your doctor checks for swollen lymph nodes, spleen, or liver.

* Blood tests: The lab does a complete blood count to check the number of white blood cells, red blood cells, and platelets. Leukemia causes a very high level of white blood cells. It may also cause low levels of platelets and hemoglobin, which is found inside red blood cells.

* Biopsy: Your doctor removes tissue to look for cancer cells. A biopsy is the only sure way to know whether leukemia cells are in your bone marrow. Before the sample is taken, local anesthesia is used to numb the area. This helps reduce the pain. Your doctor removes some bone marrow from your hipbone or another large bone. A pathologist uses a microscope to check the tissue for leukemia cells.

There are two ways your doctor can obtain bone marrow. Some people will have both procedures during the same visit:
- Bone marrow aspiration: The doctor uses a thick, hollow needle to remove samples of bone marrow.
- Bone marrow biopsy: The doctor uses a very thick, hollow needle to remove a small piece of bone and bone marrow.

Other Tests

The tests that your doctor orders for you depend on your symptoms and type of leukemia. You may have other tests:

* Cytogenetics: The lab looks at the chromosomes of cells from samples of blood, bone marrow, or lymph nodes. If abnormal chromosomes are found, the test can show what type of leukemia you have. For example, people with CML have an abnormal chromosome called the Philadelphia chromosome.

* Spinal tap: Your doctor may remove 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 lower spine. The procedure takes about 30 minutes and is performed with local anesthesia. You 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: An x-ray can show swollen lymph nodes or other signs of disease in your chest.

You may want to ask your doctor these questions before having a bone marrow aspiration or biopsy:

* Will you remove the sample of bone marrow from the hip or from another bone?

* Where will I go for this procedure?

* Will I have to do anything to prepare for it?

* How long will it take? Will I be awake?

* Will it hurt? What will you do to prevent or control the pain?

* Are there any risks? What are the chances of infection or bleeding after the procedure?

* How long will it take me to recover?

* How soon will I know the results? Who will explain them to me?

* If I do have leukemia, who will talk to me about next steps? When?

Treatment

Watchful Waiting
Chemotherapy
Targeted Therapy
Biological Therapy
Radiation Therapy
Stem Cell Transplant

People with leukemia have many treatment options. The options are watchful waiting, chemotherapy, targeted therapy, biological therapy, radiation therapy, and stem cell transplant. If your spleen is enlarged, your doctor may suggest surgery to remove it. Sometimes a combination of these treatments is used.

The choice of treatment depends mainly on the following:

* The type of leukemia (acute or chronic)

* Your age

* Whether leukemia cells were found in your cerebrospinal fluid

It also may depend on certain features of the leukemia cells. Your doctor also considers your symptoms and general health.

People with acute leukemia need to be treated right away. The goal of treatment is to destroy signs of leukemia in the body and make symptoms go away. This is called a remission. After people go into remission, more therapy may be given to prevent a relapse. This type of therapy is called consolidation therapy or maintenance therapy. Many people with acute leukemia can be cured.

If you have chronic leukemia without symptoms, you may not need cancer treatment right away. Your doctor will watch your health closely so that treatment can start when you begin to have symptoms. Not getting cancer treatment right away is called watchful waiting.

When treatment for chronic leukemia is needed, it can often control the disease and its symptoms. People may receive maintenance therapy to help keep the cancer in remission, but chronic leukemia can seldom be cured with chemotherapy. However, stem cell transplants offer some people with chronic leukemia the chance for cure.

Your doctor can describe your treatment choices, the expected results, and the possible side effects. You and your doctor can work together to develop a treatment plan that meets your medical and personal needs.

You may want to talk with your doctor about taking part in a clinical trial, a research study of new treatment methods.

Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat leukemia include hematologists, medical oncologists, and radiation oncologists. Pediatric oncologists and hematologists treat childhood leukemia. Your health care team may also include an oncology nurse and a registered dietitian.

Whenever possible, people should be treated at a medical center that has doctors experienced in treating leukemia. If this isn't possible, your doctor may discuss the treatment plan with a specialist at such a center.

Before treatment starts, ask your health care team to explain possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may change from one treatment session to the next.
You may want to ask your doctor these questions before you begin treatment:

* What type of leukemia do I have? How do I get a copy of the report from the pathologist?

* What are my treatment choices? Which do you recommend for me? Why?

* Will I have more than one kind of treatment? How will my treatment change over time?

* What are the expected benefits of each kind of treatment?

* What are the risks and possible side effects of each treatment? What can we do to control the side effects?

* What can I do to prepare for treatment?

* Will I need to stay in the hospital? If so, for how long?

* What is the treatment likely to cost? Will my insurance cover the cost?

* How will treatment affect my normal activities?

* Would a clinical trial be right for me? Can you help me find one?

* How often should I have checkups?

Watchful Waiting

People with chronic lymphocytic leukemia who do not have symptoms may be able to put off having cancer treatment. By delaying treatment, they can avoid the side effects of treatment until they have symptoms.

If you and your doctor agree that watchful waiting is a good idea, you'll have regular checkups (such as every 3 months). You can start treatment if symptoms occur.

Although watchful waiting avoids or delays the side effects of cancer treatment, this choice has risks. It may reduce the chance to control leukemia before it gets worse.

You may decide against watchful waiting if you don't want to live with an untreated leukemia. Some people choose to treat the cancer right away.

If you choose watchful waiting but grow concerned later, you should discuss your feelings with your doctor. A different approach is nearly always available.
You may want to ask your doctor these questions before choosing watchful waiting:

* If I choose watchful waiting, can I change my mind later on?

* Will the leukemia be harder to treat later?

* How often will I have checkups?

* Between checkups, what problems should I report?

Chemotherapy

Many people with leukemia are treated with chemotherapy. Chemotherapy uses drugs to destroy leukemia cells.

Depending on the type of leukemia, you may receive a single drug or a combination of two or more drugs.

You may receive chemotherapy in several different ways:

* By mouth: Some drugs are pills that you can swallow.

* Into a vein (IV): The drug is given through a needle or tube inserted into a vein.

* Through a catheter (a thin, flexible tube): The tube is placed in a large vein, often in the upper chest. A tube 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.

* 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. Intrathecal chemotherapy is given in two ways:
- Into the spinal fluid: The doctor injects the drugs into the spinal fluid.
- Under the scalp: Children and some adult patients receive chemotherapy through a special catheter called an Ommaya reservoir. The doctor places the catheter under the scalp. The doctor injects the drugs into the catheter. This method avoids the pain of injections into the spinal fluid.

Intrathecal chemotherapy is used because many drugs given by IV or taken by mouth can't pass through the tightly packed blood vessel walls found in the brain and spinal cord. This network of blood vessels is known as the blood-brain barrier.

Chemotherapy is usually given in cycles. Each cycle has a treatment period followed by a rest period.

You may have your treatment in a clinic, at the doctor's office, or at home. Some people may need to stay in the hospital for treatment.

The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing leukemia cells, but the drug can also harm normal cells that divide rapidly:

* Blood cells: When chemotherapy lowers the levels of healthy blood cells, you're more likely to get infections, bruise or bleed easily, and feel very weak and tired. You'll get blood tests to check for low levels of blood cells. If your levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of drug. There also are medicines that can help your body make new blood cells. Or, you may need a blood transfusion.

* Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back, but it may be somewhat different in color and texture.

* Cells that line the digestive tract: Chemotherapy can cause poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Ask your health care team about medicines and other ways to help you cope with these problems.

* Sperm or egg cells: Some types of chemotherapy can cause infertility.
-Children: 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 as adults.
-Adult men: Chemotherapy may damage sperm cells. Men may stop making sperm. Because these changes to sperm may be permanent, some men have their sperm frozen and stored before treatment (sperm banking).
-Adult women: Chemotherapy may damage the ovaries. Women may have irregular menstrual periods or periods may stop altogether. Women may have symptoms of menopause, such as hot flashes and vaginal dryness. Women who may want to get pregnant in the future should ask their health care team about ways to preserve their eggs before treatment starts

Targeted Therapy

People with chronic myeloid leukemia and some with acute lymphoblastic leukemia may receive drugs called targeted therapy. Imatinib (Gleevec) tablets were the first targeted therapy approved for chronic myeloid leukemia. Other targeted therapy drugs are now used too.

Targeted therapies use drugs that block the growth of leukemia cells. For example, a targeted therapy may block the action of an abnormal protein that stimulates the growth of leukemia cells.

Side effects include swelling, bloating, and sudden weight gain. Targeted therapy can also cause anemia, nausea, vomiting, diarrhea, muscle cramps, or a rash. Your health care team will monitor you for signs of problems.


Biological Therapy

Some people with leukemia receive drugs called biological therapy. Biological therapy for leukemia is treatment that improves the body's natural defenses against the disease.

One type of biological therapy is a substance called a monoclonal antibody. It's given by IV infusion. This substance binds to the leukemia cells. One kind of monoclonal antibody carries a toxin that kills the leukemia cells. Another kind helps the immune system destroy leukemia cells.

For some people with chronic myeloid leukemia, the biological therapy is a drug called interferon. It is injected under the skin or into a muscle. It can slow the growth of leukemia cells.

You may have your treatment in a clinic, at the doctor's office, or in the hospital. Other drugs may be given at the same time to prevent side effects.

The side effects of biological therapy differ with the types of substances used, and from person to person. Biological therapies commonly cause a rash or swelling where the drug is injected. They also may cause a headache, muscle aches, a fever, or weakness. Your health care team may check your blood for signs of anemia and other problems.

You may find it helpful to read NCI's booklet Biological Therapy.
You may want to ask your doctor these questions before having chemotherapy, targeted therapy, or biological therapy:

* Which drugs will I get? What will the treatment do?

* Should I see my dentist before treatment begins?

* When will treatment start? When will it end? How often will I have treatments?

* Where will I go for treatment? Will I have to stay in the hospital?

* What can I do to take care of myself during treatment?

* How will we know the treatment is working?

* Will I have side effects during treatment? What side effects should I tell you about? Can I prevent or treat any of these side effects?

* 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. People receive radiation therapy at a hospital or clinic.

Some people receive radiation from a large machine that is aimed at the spleen, the brain, or other parts of the body where leukemia cells have collected. This type of therapy takes place 5 days a week for several weeks. Others may receive radiation that is directed to the whole body. The radiation treatments are given once or twice a day for a few days, usually before a stem cell transplant.

The side effects of radiation therapy depend mainly on the dose of radiation and the part of the body that is treated. For example, radiation to your abdomen can cause nausea, vomiting, and diarrhea. In addition, your skin in the area being treated may become red, dry, and tender. You also may lose your hair in the treated area.

You are likely to be very tired during radiation therapy, especially after several weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.

Although the side effects of radiation therapy can be distressing, they can usually be treated or controlled. You can talk with your doctor about ways to ease these problems.

It may also help to know that, in most cases, the side effects are not permanent. However, you may want to discuss with your doctor the possible long-term effects of radiation treatment.


You may want to ask your doctor these questions 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 treatment? Will I be able to continue my normal activities during treatment?

* Will there be side effects? How long will they last?

* Can radiation therapy cause side effects later on?

* What can I do to take care of myself during treatment?

* How will we know if the radiation treatment is working?

* How often will I need checkups?

Stem Cell Transplant

Some people with leukemia receive a stem cell transplant. A stem cell transplant allows you 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. After you receive highdose chemotherapy, radiation therapy, or both, you receive healthy stem cells through a large vein. (It's like getting a blood transfusion.) New blood cells develop from the transplanted stem cells. The new blood cells replace the ones that were destroyed by treatment.

Stem cell transplants take place in the hospital. Stem cells may come from you or from someone who donates their stem cells to you:

* From you: An autologous stem cell transplant uses your own stem cells. Before you get the high-dose chemotherapy or radiation therapy, your stem cells are removed. The cells may be treated to kill any leukemia cells present. Your stem cells are frozen and stored. After you receive high-dose chemotherapy or radiation therapy, the stored stem cells are thawed and returned to you.

* From a family member or other donor: An allogeneic stem cell transplant uses healthy stem cells from a donor. Your brother, sister, or parent may be the donor. Sometimes the stem cells come from a donor who isn't related. Doctors use blood tests to learn how closely a donor's cells match your cells.

* From your identical twin: If you have an identical twin, a syngeneic stem cell transplant uses stem cells from your healthy twin.

Stem cells come from a few sources. The stem cells usually come from the blood (peripheral stem cell transplant). Or they can come from the bone marrow (bone marrow transplant). Another source of stem cells is umbilical cord blood. Cord blood is taken from a newborn baby and stored in a freezer. When a person gets cord blood, it's called an umbilical cord blood transplant.

After a stem cell transplant, you may stay in the hospital for several weeks or months. You'll be at risk for infections and bleeding because of the large doses of chemotherapy or radiation you received. In time, the transplanted stem cells will begin to produce healthy blood cells.

Another problem is that graft-versus-host disease (GVHD) may occur in people who receive donated stem cells. In GVHD, the donated white blood cells in the stem cell graft react against the patient's normal 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.

You may find it helpful to read NCI's fact sheet Bone Marrow Transplantation and Peripheral Blood Stem Cell Transplantation: Questions and Answers.
You may want to ask your doctor these questions 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? Will I need special care? How will I be protected from germs? Will my visitors have to wear a mask? Will I?

* 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?


Second Opinion

Before starting treatment, you might want a second opinion about your diagnosis and treatment plan. Some people worry that the doctor will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies will pay for a second opinion if you or your doctor requests it.

If you get a second opinion, the doctor may agree with your first doctor's diagnosis and treatment plan. Or the second doctor may suggest another approach. Either way, you have more information and perhaps a greater sense of control. You can feel more confident about the decisions you make, knowing that you've looked at your options.

It may take some time and effort to gather your medical records and see another doctor. In most cases, it's not a problem to take several weeks to get a second opinion. The delay in starting treatment usually won't make treatment less effective. To make sure, you should discuss this delay with your doctor. Some people with leukemia need treatment right away.

There are many ways to find a doctor for a second opinion. You can ask your doctor, a local or state medical society, a nearby hospital, or a medical school for names of specialists.

Supportive Care

Leukemia and its treatment can lead to other health problems. You can have supportive care before, during, or after cancer treatment.

Supportive care is treatment to prevent or fight infections, to control pain and other symptoms, to relieve the side effects of therapy, and to help you cope with the feelings that a diagnosis of cancer can bring. You may receive supportive care to prevent or control these problems and to improve your comfort and quality of life during treatment.

* Infections: Because people with leukemia get infections very easily, you may receive antibiotics and other drugs. Some people receive vaccines against the flu and pneumonia. The health care team may advise you 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. You may need to stay in the hospital for treatment.

* Anemia and bleeding: Anemia and bleeding are other problems that often require supportive care. You may need a transfusion of red blood cells or platelets. Transfusions help treat anemia and reduce the risk of serious bleeding.

* Dental problems: 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 and Physical Activity

It's important for you to take care of yourself by eating well and staying as active as you can.

You need the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy.

Sometimes, especially during or soon after treatment, you may not feel like eating. You may be uncomfortable or tired. You may find that foods do not taste as good as they used to. In addition, the side effects of treatment (such as poor appetite, nausea, vomiting, or mouth sores) can make it hard to eat well. Your doctor, a registered dietitian, or another health care provider can suggest ways to deal with these problems.

Research shows that people with cancer feel better when they are active. Walking, yoga, and other activities can keep you strong and increase your energy. Exercise may reduce nausea and pain and make treatment easier to handle. It also can help relieve stress. Whatever physical activity you choose, be sure to talk to your doctor before you start. Also, if your activity causes you pain or other problems, be sure to let your doctor or nurse know about it.

Follow-up Care

You'll need regular checkups after treatment for leukemia. Checkups help ensure that any changes in your health are noted and treated if needed. If you have any health problems between checkups, you should contact your doctor.

Your doctor will check for return of the cancer. Even when the cancer seems to be completely destroyed, the disease sometimes returns because undetected leukemia cells remained somewhere in your body after treatment. Also, checkups help detect health problems that can result from cancer treatment.

Checkups may include a careful physical exam, blood tests, cytogenetics, x-rays, bone marrow aspiration, or spinal tap.

Sources of Support

Learning you have leukemia can change your life and the lives of those close to you. These changes can be hard to handle. It's normal for you, your family, and your friends to have new and confusing feelings to work through.

Concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, keeping your job, or continuing daily activities.

Here's where you can go for support:

* Doctors, nurses, and other members of your health care team can answer many of your questions about treatment, working, or other activities.

* Social workers, counselors, or members of the clergy can be helpful if you want to talk about your feelings or concerns. Often, social workers can suggest resources for financial aid, transportation, home care, or emotional support.

* Support groups can also help. In these groups, patients or their family members meet with other patients or their families to share what they have learned about coping with the disease and the effects of treatment. Groups may offer support in person, over the telephone, or on the Internet. You may want to talk with a member of your health care team about finding a support group.