New York

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Waldenstrım's Macroglobulinemia Cancer

This disease is due to overproduction of cells that are like Plasma cells from the bone marrow. Under normal circumstances, these cells are in charge of producing immune globulins, the immune proteins that our body needs to fight infections. In case of Waldenström's Disease, the abnormal plasma cells produce abnormal and dysfunctional immune globulins. The kind of immune globulin that is produced in this disease can cause thickening of the blood and lead to a Hyperviscosity syndrome. This disease is basically diagnosed by detecting these abnormal immune globulins in the blood, or alternatively, by observing the abnormal cells in the bone marrow. This is a very rare and low grade cancer and is more commonly seen after age of 65.


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Causes:

The cause of this illness is unknown. The disease is named after Professor Jan Waldenström, a Swedish physician who described this illness.




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Signs and Symptoms

Patients may not show any signs for quite sometime. This illness can present itself in many different fashions. Most patients, however, present with Hyperviscosity syndrome. As the disease progresses, it can cause any of the following problems:

Anemia

Low platelet count

Frequent infections

Fever

Weight loss

Enlargement of lymph glands

Enlargement of Liver and spleen.


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Diagnosis

The diagnosis is established by certain blood tests and also taking a biopsy of the bone marrow.


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Treatment

Waldenström's Disease involves almost all of the bone marrow space in the body. As a result, the disease can only be treated with chemotherapy. Any patient who is under the age of 60, and otherwise in good health, should be considered for a bone marrow transplantation. For individuals who are older or can not tolerate the transplant, chemotherapy is most appropriate. If the disease causes a local problem in bones, like bone pain, or fractures, etc., radiation can be used to alleviate that problem.

The most commonly used chemotherapy regimens for treatment of Waldenström's Disease is Cladribine (Leustatin). This drug can induce a very good remission in great majority of patients.

Other drugs that might be used are : Melphalan , Prednisone, Cytoxan, Interferon


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Remission:

Refers to the response of any cancer to the treatment.

Complete remission refers to the situation where the disease disappears completely with the treatment

Partial remission refers to the situation where the disease shrinks but does not disappears completely with the treatment

The remission status is determined by measuring the immune globulin levels in the blood, as well as repeating the bone marrow tests.


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Prognosis:

Waldenström's Disease may remain silent for years. It may, however, gradually transition into more aggressive stage, or even transform into a Lymphoma. Prognosis of Waldenström's Disease depends on the response to chemotherapy.


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Follow up

After completion of treatment, and in any combination that might have taken place, patients need to remain under surveillance for possibility of recurrence of cancer. Follow up shall be scheduled on a regular basis and initially every 1-3 months for 1-2 years. The frequency of follow up will depend on the condition of the patient and their disease. In each follow up visits, patients are examined and normally a blood test and evaluation of immune globulins should be done.

Treatment of recurrent disease will depend on the stage and extent of the reoccurred disease. Most patients are then treated with chemotherapy with same agents as mentioned above. Radiation therapy may be helpful in managing painful or symptomatic areas, where the cancer has spread to.

Multiple Myeloma

Roughly 16,000 Americans develop this illness each year. It is more frequent in men than in women and is more commonly seen after age 60. This disease is due to an overproduction of plasma cells from the bone marrow. Under normal circumstances, these cells are in charge of producing immune globulins, the immune proteins that our body needs to fight infection. In the case of multiple Myeloma, the abnormal plasma cells produce abnormal and dysfunctional immune globulins.

One indicator of the disease is a blood test known as Beta 2 microglobulin. This disease is basically diagnosed by detecting these abnormal immune globulins in the blood or, alternatively, by observing the abnormal plasma cells in the bone marrow.


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Causes:

The cause of this illness is unknown.


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Signs and Symptoms

Patients may not show any signs for quite sometime and Myeloma can present itself in many different ways. Approximately 20 percent of patients are diagnosed incidentally and during workup on an unrelated problem. As the disease progresses, it can cause any of the following problems:

Bone pain

High calcium levels

Kidney failure

Anemia

Low platelet count

Hyperviscosity Syndrome

Frequent infections

Fever

Weight loss


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Diagnosis

The diagnosis is established by certain blood tests and also taking a biopsy of the bone marrow.


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Staging

Staging refers to determination of the extent of the disease and is a very good guideline as to the treatment plans and outcome of Multiple Myeloma. The extent of the disease depends on the presence or absence of any of the following:

Bone Disease

High calcium levels

Kidney failure

Anemia

Low platelet count

Lower stages of the illness are indicated by very minimal problems, and higher stages with the presence of most of the above problems.


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Treatment

Multiple Myeloma involves almost all of the bone marrow space in the body. As a result, the disease can only be treated with systemic therapies. Any patient, who is under the age of 70, and in otherwise good health, should be considered and offered a bone marrow transplantation.

Following are the two of the most commonly used regimens for treatment of multiple Myeloma:

Thalidomide, Dexamethasone known as ThalDex regimen which is treatment of choice for previously untreated patients.

Velcade

Melphalan, Prednisone, known as MP regimen: The two drugs are given orally for 4-7 days and are repeated every month

Vincristine, Adriamycin, Decadron, known as VAD regimen. This is an intravenous treatment, whereby Vincristine and Adriamycin are given intravenously by way of continuous infusion over a period of four days. The infusion is repeated every month. Decadron is given orally. This is a more aggressive regimen with more side effects, as opposed to MP.

If the disease causes a local problem in the bones, like bone pain or fractures, etc., radiation can be used to alleviate the problem. Other drugs that can also be used are: Cytoxan, VP-16, Interferon, BiCNU


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Remission:

Refers to the response of any cancer to treatment.

Complete remission refers to the situation where the disease disappears completely with the treatment.

Partial remission refers to the situation where the disease shrinks but does not disappear completely with the treatment

Measuring the immune globulin levels in the blood, as well as repeating the bone marrow tests determine the remission status. When and if patients enter a remission, they are best maintained on a treatment regimen with Interferon.


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Prognosis:

Patients with lower stages have a better prognosis. Low Stage Multiple Myeloma may remain silent for years. It may, however, gradually progress into higher stages. Prognosis of High Stage Multiple Myeloma depends on the response to chemotherapy.


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Special Situations

Patients with advanced Multiple Myeloma may develop any of the following complications.

Spinal cord compression

Bone destruction and metastasis

High Calcium level

Pain

High Uric acid


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Survival

Survival of patients with Multiple Myeloma, in whom a cure is not possible, may vary from months to years, depending on the extent of the cancer, overall condition of the patient, as well as his/her response to treatment and the duration of the response. Those treated with bone marrow transplant have a 30% chance of cure.


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Follow-up

After completion of treatment, in any combination that might have taken place, patients need to remain under surveillance for the possibility of a recurrence of cancer. Follow-up should be scheduled on a regular basis, initially every one to three months for one to two years. The frequency of follow-up will depend on the condition of the patient and his/her disease. In each follow-up visit, patients are examined and normally a blood test and evaluation of immune globulins and Beta 2 microglobulin is done.

Treatment of recurrent disease will depend on the stage and extent of the reoccurred disease. Most patients are then treated with chemotherapy using the same agents mentioned above. Radiation therapy may be helpful in managing painful or symptomatic areas to which the cancer has spread. If patients experience pain, various pain medications can be used to alleviate pain. For patients with advanced disease,

Lymphomas

Lymphomas are cancers of the organs and cells of the body's immune (lymphoid) system. They are categorized into two primary groups:

Hodgkin's Lymphoma or Hodgkin's Disease

Non-Hodgkin's Lymphoma

The signs and symptoms, as well as the treatment of these diseases, may vary.

Leukemias

Leukemia is a cancerous disorder of the blood cells. There are a variety of Leukemias, each with its own peculiar signs, symptoms, prognosis and behavior. roughly 30,000 Americans develop some sort of leukemia every year.

There are four major types of leukemia:

Acute Myeloid Leukemia

Acute Lymphoid Leukemia

Chronic Myeloid Leukemia

Chronic Lymphoid Leukemia

Acute Leukemia refers to Leukemia which, if left untreated, can cause fatal complications in a very short period of time.

Chronic Leukemias, on the other hand, if left untreated in some cases may not cause any problems at all even for years.

Hairy Cell Leukemia is an entity of its own that will be discussed separately.

When Leukemias progress, they can cause a rise or decline in the number of blood cells. Even though the total number of blood cells may be elevated, in most instances, the count of normal blood cells is reduced. This is due to overproduction of the leukemic cells that result in overpopulation of the bone marrow and suppression of normal blood cell production.

In most instances, the underlying problem is an abnormality in maturation and growth of normal blood cells which leads to accumulation of abnormal, immature and dysfunctional cells in the blood, the leukemia cells.

Lung cancer

Lung cancer is the second most common malignancy affecting both sexes. Roughly 170,000 Americans are diagnosed with this illness ever year. It is considered the most rapidly increasing cause of death from cancer. Since 1987, lung cancer has been the leading cause of cancer death in women, surpassing breast cancer. And while lung cancer incidence has leveled off among men, it continues to rise steadily among women. The average age of patients with lung cancer is 60 years. It is more common in African-Americans and Hawaiians.


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Causes

Cigarette smoking is the number one cause of this disease. Even passive inhalation of the smoke increases the chance of developing this illness. Radon exposure is another cause of lung cancer, killing 14,000 Americans every year. Asbestos exposure also increases Lung cancer risk. The risk becomes astronomical in exposed individuals who also smoke.


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Signs and Symptoms

Patients do not manifest any signs in the very early stages. Cough, shortness of breath, chest pain or blood in the sputum are among the early warning signs. Other signs of this illness could be a change of voice, hoarseness, weakness, fatigue, and weight loss.


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Establishing Diagnosis

When the diagnosis is suspected, patients must be examined carefully by a qualified physician. A chest x-ray along with studying a sample of sputum are the very first steps in establishing a diagnosis. If the study sputum does not confirm the diagnosis, then Bronchoscopy and biopsy are the next steps. In certain patients, cancer may have already spread to lymph glands in the neck. In such cases, a Fine needle aspiration of the lymph gland should be performed. This is a fairly easy procedure. Unfortunately, most doctors avoid the simple test of sputum study. There is no reason not to perform this test, since it establishes the diagnosis in about 30% of patients. In a small percentage of patients, none of the above tests will lead into a diagnosis and there will be a need to proceed with more invasive procedures, and perhaps surgery.


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Different Types of Lung cancer

There are two basic kinds of lung cancer:

Small cell or oat cell, that occurs in one-third of all patients with lung cancer

Non-small cell in two-thirds of patients.

This distinction is rather important, because the treatment for the two kinds is very different. Small cell cancers are primarily treated with Chemotherapy. Surgery does not play a role in this type of lung cancer. On the other hand, Non-small cell lung cancer is treated primarily with surgery.

Another type of cancer that can develop in the lungs is Carcinoid Tumor.


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Staging Work-Up

Once a diagnosis of the lung cancer is established, a thorough examination of the patient should be performed to disclose crucial information. CT scan of the chest and abdomen and a bone scan should be performed to determine the extent of cancer spread. Additional tests for Small Cell Lung Cancer include CT scan of the brain and a bone marrow test. The purpose of these tests is to study the areas where cancer has a tendency to spread.

Small cell cancers have two stages,

Limited stage, when the cancer is confined to a defined area in the chest

Extensive stage, when the cancer may have spread to a wider area in the chest or to areas outside the chest


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Patterns of Spread

Lung cancer can either spread locally and involve nearby tissues, such as the cavity outside the lungs (pleural space), layers around the heart, or may travel to distant sites such as local lymph glands or the liver, bones, brain or the opposite lung. Other organs where lung cancer has a tendency to spread are the adrenal glands, which are the glands located above the kidneys and which produce special hormones. Another area where cancer may spread is the area near the spinal cord and vertebrae.


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Treatment of Small Cell Lung Cancer

Limited stage small cell lung cancers are usually treated with a combination radiation to the chest and Chemotherapy. There is no role for surgery. There are many different ways to combine these two modalities. There is a small chance to completely cure this condition in up to five percent of patients. Age of the patients and their overall health status determine the intensity of treatment. A general rule is that younger patients are treated with more aggressive regimens. The most effective chemotherapy drugs used to treat this condition are VP-16, Carboplatinum, and Cisplatinum. If the disease does not respond to these drugs, there are other drugs that could be used. Radiation therapy may also be administered at the same time as Chemotherapy, or after completion of Chemotherapy. Chemotherapy is normally given every three to four weeks for a period of at least six months.

Extensive stage small cell lung cancer is normally treated with the same chemotherapy drugs as mentioned above. There is no rule for using radiation therapy to the chest. However, if cancer has spread to brain or bones, those areas could be treated with radiation therapy. Unfortunately, a cure is not possible for this condition. However, the illness is quite manageable for a period of time, varying form months to even years.

Recently a number of new active drugs have been identified for treating patients with small cell lung cancer. These agents include Taxol, Taxotere, Irinotecan, Topotecan and Gemcitabine.


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Treatment of Non-Small Cell Cancer

Surgery is the only treatment to cure this disease in its earlier stages, when the disease is confined to a small area in the chest. About one-third of such patients could be cured by surgery. Since chest surgery is a major undertaking, it is extremely important to confirm the extent of the condition prior to surgery. Such patients need to have a full staging work-up and a Bronchoscopy, as well as a Mediastinoscopy, where the local lymph glands in the chest are sampled and studied. This procedure must be done in every patient about to undergo a radical surgery. Without surgery, a cure is not feasible. In such cases, chemotherapy should be considered, as well as radiation therapy.

The most effective chemotherapy drugs used to treat this condition are Carboplatinum, Cisplatinum, Taxol, Vinorelbine, Taxotere, Irinotecan and Gemcitabine. Most these drugs are used in patients with advanced stages of this disease and they are used in combination such as combinations of: Taxol and Carboplatinum or more recently Gemcitabine and Vinorelbine.

The response rate to these drugs are in neighborhood of 30-40% of treated patients with duration of response lasting anywhere from 6-12 months and rarely up to a few years.

Radiation therapy may be administered at the same time as Chemotherapy, or after completion of Chemotherapy. Chemotherapy is normally given every three to four weeks, for a period of at least six months.


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Special Situations

Patients with advanced lung cancer may develop any of the following complications.

Pleural effusion

Pericardial effusion

Superior Vena Cava obstruction

Spinal cord compression

Brain metastasis

Bone metastasis

Pancoast syndrome

Paraneoplastic syndromes

Low sodium level

High calcium level

Eaton Lambert Syndrome, which is a form of muscle weakness due to nervous system problems.

Pain


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Survival

Survival of patients with lung cancer will depend on the type and extent of the cancer at the time of initial diagnosis. One-third of patients with early stages of non-small cell lung cancer could be cured with surgery alone. This percentage is much smaller in patients with early stage small cell cancers -- less than five percent. In the majority of patients in whom cure is not possible survival may vary from months to years, depending on the extent of the cancer, the overall condition of the patient, as well as his/her response to treatment and the duration of that response.


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Follow-up

After completion of treatment, in any combination that might have taken place, patients need to remain under surveillance for possibility of a recurrence of cancer. Follow-up should be scheduled on a regular basis, initially every one to three months for one to two years. The frequency of follow-up will depend on the condition of the patient and his/her disease. In each follow-up visit, patients are examined. Normally, a chest x-ray is obtained every few months and CT scan of chest and bone scan once a year.

Treatment of recurrent disease will depend on the stage and extent of the reoccurred disease. Most patients are then treated with chemotherapy with same agents as mentioned above. Radiation therapy may be helpful in managing painful or symptomatic areas to which the cancer has spread. If patients experience pain, different pain medications may be used to alleviate pain.

Hodgkins Disease

Roughly 8,000 Americans develop this illness each year. It is slightly more frequent in men than in women, and is more commonly seen in the third decade of life, after age 50. This disease is caused by overproduction of lymphoid cells. Hodgkin's Disease is highly curable, even in advanced stages.


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Causes:

The cause of this illness is unknown in the majority of patients. Certain viruses like EBV or HIV have been linked to causation of Hodgkin's Disease..


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Signs and Symptoms

Patients may not show any signs for sometime. As the disease progresses, it can cause any of the following problems:

Enlargement of lymph glands

Enlargement of spleen

Enlargement of liver

Anemia

Low platelet count

Frequent infections

Fever

Weight loss

Night sweats

Itching


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Diagnosis

The diagnosis is made by taking a biopsy of an enlarged lymph node or involved organ of the body. Evaluation of bone marrow under microscope may also lead to this diagnosis.


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Staging

Refers to the extent of the disease and is a very good guideline as to the treatment plans and outcome of the disease. The extent of the disease can be established by physical examination, CT scan of the chest, abdomen, and pelvis and a bone marrow test.

Stage 1 is when patients develop enlargement of lymph glands in one region.

Stage 2 is when a patient has enlargement of lymph glands in two or more regions.

Stage 3 is when a patient develops enlargement of the spleen.

Stage 4 s when the disease involves the liver, lung or bone marrow.

In the past, many patients underwent surgical exploration of the abdomen. This procedure is rarely used presently, and is being abandoned.

Gallium Scan is highly sensitive in the staging of patients. A radioactive substance, Gallium, is injected intravenously into the patient and is picked up by the sites of illness. This procedure can visualize hidden sites where the disease may be located.


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Treatment of Hodgkin’s Disease

Patients with stages 1 and 2 are mainly treated with radiation therapy. Higher stages are normally treated with chemotherapy, with or without radiation. A cure is possible in the vast majority of patients. The standard chemotherapy regimens for Hodgkin’s Disease are MOPP and ABVD regimens.

Certain patients are treated with Bone Marrow Transplantation:

Patients who do not enter a remission

Patients who relapse soon after initial remission


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Side effects of Radiation

Dryness of the mouth

Difficulty swallowing

Heartburn

Dry cough

Skin irritation


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Remission:

Refers to the response of any cancer to treatment.

Complete remission refers to the situation where the disease disappears completely with the treatment.

Partial remission refers to the situation where the disease shrinks, but does not disappear completely with the treatment.


--------------------------------------------------------------------------------

Prognosis:

Patients with lower stages have a better prognosis. They may, however, gradually transform into higher stages. The prognosis for patients with Hodgkin's disease depends on its response to chemotherapy, but the majority of patients are cured with treatment.


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Special Situations

Patients with advanced Hodgkin's lymphoma may develop any of the following complications:

Spinal cord compression

Brain metastasis

Bone metastasis

Paraneoplastic syndromes

High calcium level

Pain

High uric acid

Pleural effusion


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Survival

Survival of patients with Hodgkin's disease is excellent. In those patients in whom a cure is not possible, survival could vary from months to years, depending on the extent of the cancer and the overall condition of the patient, as well as the response to treatment and the duration of that response.


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Follow-up

After completion of treatment, in any combination that might have taken place, patients need to remain under surveillance for the possibility of a recurrence of cancer. Follow-up shall be scheduled on a regular basis, initially every one to three months for one to two years. The frequency of follow-up will depend on the condition of the patient and his/her disease. At each follow-up visit, patients are examined. Normally, a chest x-ray, CT scan of the chest and abdomen along with a Gallium scan is obtained every few months.

Treatment of recurrent disease will depend on the stage and extent of the reoccurred disease. Most patients are then treated with chemotherapy, using the same agents as mentioned above, or bone marrow transplantation . Radiation therapy may be helpful in managing this condition. If patients experience pain, various pain medications may be used to alleviate pain

Prostate Cancer

Prostate cancer is the most common cancer in American men, with roughly 185,000 men diagnosed in 1998 and claiming 39,000 lives from it. Risk of developing this cancer increases with age and it is more common in men over ages 60-65. It is significantly more common in African-American men. Lifetime risk of developing this cancer is about 16-20% (1in 5 to 6).

It is estimated that 40% of men over age of 50 have microscopic areas of cancer in their prostate gland. However, only 8% of men will develop clinically significant disease and only 3% will die of this disease. Prostate cancer grows very slowly in older men and does not contribute to the cause of death in majority of cases.


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Cause:

The cause of this cancer is unknown. However, certain factors increase the risk of developing prostate cancer:

Increasing age

African-American men

Family history of prostate cancer

High dietary fat

Vasectomy

Genetic factors

Socioeconomic Status

Cigarette smoking

Occupational exposure to Cadmium Heavy metal

Sexual activity and sexually transmitted illnesses


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Signs and Symptoms:

Patients do not have any signs at very early stages. As the disease progresses, patients may notice any of the following:

Difficulty in urinating

Burning while passing urine

Increased frequency of urination

Difficulty in starting the urine stream

Blood in urine

Pain while urinating

Bone pain

Swelling of legs


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Diagnosis:

A cure of this cancer is possible when it is diagnosed at very early stages. Screening tests are performed on healthy individuals to detect cancers at very early stages, even before the cancer causes any signs.

PSA (prostate specific antigen) is a simple blood test. An elevated PSA blood level would hint at the possibility of prostate cancer and would be a strong indication to do a complete workup.

Digital rectal examination is very simple to perform and can detect lesions in rectum and prostate. This should be part of a routine physical exam for adults.

Establishing the diagnosis is achieved by taking a biopsy from the prostate tissue. This is done by Fine Needle Aspiration (FNA) of a trochar biopsy under ultrasound guidance. The biopsy sample is then sent to the pathologist for further study. Prostate cancer can be rendered a score based on the microscopic findings. This scoring system will determine the degree of aggressiveness of the cancer. Gleason Score is from two to ten, two being the least aggressive and ten the most aggressive kind of cancer.


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Staging:

The next step after establishing the diagnosis is staging which is done by CT scan or MRI of pelvis and abdomen and bone scan.


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Patterns of spread:

The disease can spread from prostate to the surrounding tissues, as well as to the pelvic lymph nodes, abdominal nodes, bone and lungs. This process may take years to decades, especially in the elderly. Most patients do not suffer from any major complications of this illness.


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Click here to go to Treatment

of prostate cancer.


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Special Situations

Patients with advanced prostate cancer may develop any of the following complications:

Spinal cord compression

Bone metastasis

Paraneoplastic syndromes

High calcium level

Pain

High uric acid

Pleural effusion

Swelling of the legs


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Survival

Survival of patients with advanced prostate cancer, in whom cure is not possible, could vary from months to years, depending on the extent of the cancer, the overall condition of the patient (as well as his response to treatment) and the duration of the response.


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Family Member issues

First degree relatives of all patients with this cancer should be monitored carefully. This cancer has a tendency to run in families and be associated with genetic abnormalities, for which they can be tested for. Family members should consider genetic counseling to determine their risk and possible work up for early detection of the cancer.


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Follow-up

After completion of treatment, in any combination that might have taken place, patients need to remain under surveillance for the possibility of recurrence of cancer. Follow-up shall be scheduled on a regular basis -- initially every one to three months for many years. The frequency of follow-up will depend on the condition of the patient and his disease. In each follow-up visit, the patient is examined and normally a PSA, and at times a CT scan of chest and abdomen and a bone scan is obtained

Treatment of the recurring disease will depend on the stage and extent of the recurring disease. Most patients are then treated with hormonal therapy, with the same agents as mentioned above. Radiation therapy may be helpful in managing painful or symptomatic areas in which the cancer has spread. If patients experience pain, various pain medications may be used to alleviate the pain. For patients with advanced disease,

Colorectal Cancer

Colorectal cancer is the third most common cancer in men and women. An estimated 131,000 Americans are diagnosed with this disease each year and some 55,000 die as a result of it. Certain genetic factors play a role in the development of this cancer. The specific cause of Colorectal cancer is unknown, however, environmental, genetic, familial factors and preexisting Ulcerative Colitis have been linked to the development of this cancer. It is more common among African-Americans.


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Risk Factors

Age: Average age at the time of diagnosis is between 60-65, and the older we get the higher our risk of colorectal cancer.

Family History of colorectal cancer increases the risk of developing this illness in first- degree relatives. Certain familial conditions, like Familial Polyposis, is associated with a much higher risk.

Genetic factors clearly play a role in the development of colorectal cancers. Several genetic and inherited illnesses carry a very high risk of colorectal cancer: Familial Polyposis, Turcot syndrome, Gardner syndrome, Peutz-Jeghers syndrome, Juvenile Polyposis, Cowden's disease, Neurofibromatosis.

Ulcerative colitis , High Dietary Fat and Low Dietary Fiber can each increase the risk of this cancer.


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Signs and Symptoms

This cancer may exhibit no signs in its early stages. Gradually, as the disease progresses, any of the following may be seen;

Blood in the stool
Diarrhea
Constipation
Bowel obstruction, causing nausea, vomiting and abdominal distention
Abdominal pain
Pelvic pain
Anemia due to blood Loss
Weight loss
Loss of appetite
Fatigue

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Screening and Diagnosis

This cancer may be detected in its very early stages by any of the following screening tests:

Stool Occult Blood Test. Annual screening for colorectal cancer with a stool occult blood test for adults over age 50 is a must. Incidence of this cancer rises with age. This test is a rather simple test. Small amounts of stool are placed on a paper card and delivered to the physician's office for testing. A positive test mandates a complete work-up, including a Colonoscopy.

Flexible Sigmoidoscopy is a simple test that has a higher accuracy in detecting lower colon and rectal cancer. A tube is inserted inside the rectum and advanced into lower part of the large bowel. The performing physician can look for any abnormalities and take a biopsy from the abnormal area. Almost 50% of colorectal cancers are detected with this procedure.

Digital Rectal Examination is very simple to perform and can detect lesions in rectum and prostate. It should be done in a routine physical exam for adults. The physician examines the area by inserting his finger inside the rectum and feeling for abnormalities.

When colon cancer is suspected, a careful workup should be done to establish the diagnosis or to rule it out. It is empirical to visualize the entire colon and rectum. This is achieved by:

Barium Enema - A radiological study wherein patients are given a barium enema followed by a series of x-rays of the abdomen.
Colonoscopy -This is by far the best method for evaluating the colorectal area. Biopsies can be taken of any abnormal areas at the same time. A diagnosis is established by laboratory examination of the cancer tissue.

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Staging:

What is the extent of cancer? How advanced is the cancer? What areas of the body are involved? Has the cancer spread to lymph glands, bones, liver, etc.? This step is referred to as staging. These important questions must be answered prior to treatment. The answers to these questions should be obtained by utilizing a minimal number of tests and least invasive methods.

Once the diagnosis is established, the next step is to determine the extent of the disease and to implement an appropriate treatment plan. A cancer specialist should be involved for proper planning of testing and studies. A chest x-ray is always a routine aspect of this workup. Further testing will rely on the findings of the physician and his intuition. Other x-rays, CT scans, Bone scan, MRI study , etc., will determine the extent of the cancer. CEA is a blood test which indicates the presence of the cancer.

Prognosis and treatment plans for colorectal cancer depend on the extent and pattern of spread of the cancer at the time of diagnosis. Staging workup is incomplete until the removed cancer is studied by a pathologist.

Stage 1 or Duke A: When the cancer is limited to the inside of bowel
Stage 2 or Duke B: When the cancer is larger and penetrates through the wall of the bowel to the outside layers
Stage 3 or Duke C: When cancer has spread to the lymph glands in the abdomen
Stage 4 or Duke D: When the cancer has spread to other organs -- liver, lungs, etc.

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Treatment of Colon and Rectal Cancer

These topics are discussed separately and you can access them by clicking on here on Colon or Rectal Cancer.


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Patterns of spread

Colon cancer, if left untreated, or if it fails to respond to treatment, can spread and cause metastasis to the following organs:

Liver
Abdomen
Lungs
Bones
Pleural space
Brain

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Prognosis

The survival rate in colorectal cancer is determined by the stage of the disease at the time of diagnosis and, to some degree, to the response to treatment Following is a current survival table for patients at various stages of this illness. The statisticians have taken into consideration the impact of proper treatment.

Stage
5 year survival

Duke A
85-90 %

Duke B
60-80 %

Duke C
40-45%

Duke D
Less than 5 %



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Special Situations

Patients with advanced colorectal cancer may develop any of the following complications:

Spinal cord compression
Brain metastasis
Bone metastasis
Paraneoplastic syndromes
High Calcium level
Pain
High Uric acid
Pleural effusion
Fluid in the abdomen

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Survival

Survival of patients with colon cancer in whom a cure is not possible could vary from months to years, depending on the extent of the cancer, overall condition of the patient, response to treatments, and the duration of the response.


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Family Member issues

First degree relatives of all patients with this cancer should be monitored carefully. This cancer has a tendency to run in families and be associated with genetic abnormalities, for which they can be tested for. Family members should consider genetic counseling to determine their risk and possible work up for early detection of the cancer.


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Follow up

After completion of treatment, in any combination that might have taken place, patients need to remain under surveillance for possibility of recurrence of cancer. Follow-up should be scheduled on a regular basis, initially every one to three months for one to two years. The frequency of follow-up will depend on the condition of the patient and his/her disease. In each follow-up visit, patients are examined and normally a CEA, chest x-ray obtained every few months, along with a CT scan of the abdomen.

Treatment of recurrent disease will depend on the stage and extent of the reoccurred disease. Most patients are treated with the same chemotherapy drugs as mentioned in the previous treatment section. Radiation therapy may be helpful in managing painful or symptomatic areas where the cancer has spread. If patients experience pain, various pain medications may be used to alleviate pain. For patients with advanced disease, where most treatments have failed, one could

The four most common cancers

Breast cancer is the most common cancer in women, being responsible for almost 20 percent of all cancer deaths in women. It ranks second after lung cancer. Roughly 180,000 women are diagnosed with this disease each year, of which 44,000 will die. With increased awareness and increased use of routine mammograms, more women are diagnosed in the earlier stages of this disease, at which time a cure may be possible. For every 100 women, one man is diagnosed with this disease. The disease is more common in women after age 40. It is also more frequent in women of a higher social-economic class.
Causes and risk factors:

Many factors are known to increase the risk of development of breast cancer:

Genetic predisposition. A few genetic markers have been linked to development of breast cancer.

History of breast cancer in a first-degree relative

History of breast cancer in the same patient, in the opposite breast

Onset of menstruation in early ages

Late onset of menopause

Radiation exposure

Heavy alcohol consumption

High fat diet

Obesity

First pregnancy after age of 30

Very tall women



Signs and Symptoms:

More women are now being diagnosed by means of a routine mammogram. Others may feel a lump in the breast or notice abnormal discharge from the nipple, or feel thickness or swelling of the skin or nipple. It is frequently diagnosed by a physician during a routine breast examination.

Any lump in the breast and any mammogram abnormality must be studied very carefully. If any degree of suspicion exists as to the nature of the lump, it should be

biopsied. This may be accomplished by Fine Needle, a Core Biopsy or Surgical Biopsy.



Staging:


What is the extent of cancer? How advanced is the cancer? What areas of the body are involved? Has the cancer spread to lymph glands, bones, liver, etc.? Resolving these questions is referred to as staging. These are the most important questions to be answered prior to an effective treatment plan being implemented. The answers to these questions should be obtained by a minimal amount of tests and by least invasive methods. Sentinel Node biopsy is a newer method of evaluating lymph node involvement.


Once the diagnosis is established, the next step is determination of the extent of the disease and appropriate treatment planning. A cancer specialist should be engaged to plan for proper testing and studies. A chest x-ray is always a routine part of workup. Further tests will depend on the findings by the physician and his intuition. Other x-rays, CT scans, Bone scan, MRI study, etc. are performed to determine the extent of the cancer.



Treatment:


Treatment of breast cancer is discussed in a different page. Please click here to go there.




Pattern of Spread, Natural History

If breast cancer is left untreated, or fails to respond to treatment, it will progress in a gradual fashion and may involve any of the following areas or cause any of the following complications:

Lymph glands

Bones

Lungs

Liver

Brain

Pleural cavity

Pericardial Effusion

High Calcium levels

Spinal Cord Compression



Pathological Types

Breast cancer's appearance under microscope is categorized into two major groups with two totally different behavior patterns:

Invasive

breast cancer refers to the most common type of breast cancer, which we have already discussed.

Infiltrating ducal carcinoma - Most breast cancers are of this type.

Infiltrating lobular carcinoma- 10% of breast cancers are of this type.

Non-Invasive

breast cancers are significantly less aggressive than regular breast cancers and there are two distinct diseases in this category:

Lobular carcinoma in situ. This condition is considered to be a marker for increased breast cancer risk. Treatment of this condition is rather controversial and any of the following may be advisable:

Follow-up only

Participation in a clinical trial

Mastectomy or removal of both breasts

Ductal carcinoma in situ. This condition is being seen more frequently with the increased use of mammograms. The average age of patients with this condition is 55-65 and patients may notice a lump in their breast. There is 30-50% chance of developing invasive breast cancer following this diagnosis. Lumpectomy may be quite adequate in small size tumors, or there might be an indication for breast radiation or using Tamoxifen.


Prognosis

The outcome of breast cancer depends on a variety of factors.

Good prognostic factors are:

Older age

Earlier stage of the disease

Node negative disease

Estrogen and progesterone receptor positive disease

Favorable laboratory study of cancer tissue

Poor prognostic factors are;

Younger age

Later stage of the disease

Distant spread of the cancer

Node positive disease

Estrogen and progesterone receptor negative disease

Unfavorable laboratory study of cancer tissue


Family Member issues

First degree relatives of all patients with this cancer should be monitored carefully. This cancer has a tendency to run in families and be associated with genetic abnormalities, for which they can be tested for. Family members should consider genetic counseling to determine their risk and possible work up for early detection of the cancer.

Cancer

What Is Cancer?

Cancer occurs when cells in a part of the body begin to grow out of control. Normal cells divide and grow in an orderly fashion, but cancer cells do not. They continue to grow and crowd out normal cells. Although there are many kinds of cancer, they all have in common this out-of-control growth of cells.

Different kinds of cancer can behave very differently. For example, lung cancer and breast cancer are very different diseases. They grow at different rates and respond to different treatments. That’s why people with cancer need treatment that is aimed at their kind of cancer.

Sometimes cancer cells break away from a tumor and spread to other parts of the body through the blood or lymph system. They can settle in new places and form new tumors. When this happens, it is called metastasis (meh-tas-tuh-sis). Cancer that has spread in this way is called metastatic cancer.

Even when cancer has spread to a new place in the body, it is still named after the part of the body where it started. For example, if prostate cancer spreads to the bones, it is still called prostate cancer. If breast cancer spreads to the lungs, it is still breast cancer. When cancer comes back in a person who appeared to be free of the disease after treatment, it is called a recurrence.