Leukemia

Leukemia

What is leukemia?

Leukemia is cancer of the blood cells. Blood cells are made by your bone marrow, which is the soft tissue in the middle of most bones. In leukemia, the bone marrow starts making too many white blood cells, and sometimes these cells don’t work right. These cells keep growing when they are supposed to stop. They also grow faster than your other cells. Over time, these abnormal cells crowd out your normal white blood cells, red blood cells, and platelets.

Your white blood cells help your body fight infection. Your red blood cells make sure all your body parts have the oxygen they need. Your platelets keep you from bleeding too much. When the leukemia cells crowd out your normal cells, your blood cannot do its job. You may bleed or bruise easily, get sick more often, and feel very tired.

Are there different types of leukemia?

There are four main types of leukemia. Acute leukemia gets worse very quickly. People with acute leukemia often feel sick right away. Chronic leukemia gets worse slowly, and you may not have any symptoms until later on in the illness. Those two kinds of leukemia are divided according to which kind of white blood cells are involved, lymphocytes or myelocytes.

• Acute lymphoblastic leukemia (ALL). ALL is the most common leukemia in children. Adults also get it.
• Acute myelogenous leukemia (AML). AML affects both children and adults.
• Chronic lymphocytic leukemia (CLL). CLL is the most common leukemia in adults, especially older adults. Children almost never get it. It mostly affects people who are older than 55.
• Chronic myelogenous leukemia (CML). CML occurs mostly in adults.

What causes leukemia?

Experts do not know what causes leukemia. They do not know why some people get it and others do not. It is likely that the different types of leukemia have different causes.

Research has shown that some people may be more likely to get leukemia. A risk factor is anything that raises your chance of getting a disease. Risk factors for leukemia include chemotherapy treatment, being exposed to large amounts of radiation or some chemicals in the workplace, and smoking and tobacco use.

Most people who get leukemia do not have any risk factors.

What are the symptoms?

Symptoms may include:

• Fevers and night sweats.
• Frequent infections.
• Weakness and fatigue.
• Headaches.
• Bruising of the skin and bleeding from the gums or rectum.
• Bone pain.
• Joint pain.
• Swelling in the belly or pain on the left side of the belly or in the left shoulder from a swollen spleen.
• Swollen lymph nodes in the armpit, neck, or groin.
• Decreased appetite and weight loss because you feel full and don’t want to eat.

The chronic forms of leukemia often cause no symptoms at first.

How is leukemia diagnosed?

If your doctor thinks you might have leukemia, he or she will ask questions about your past and present symptoms, do a physical exam, and order blood tests.

If your blood tests are not normal, a test of cells from inside your bone marrow, called a bone marrow biopsy, is usually needed to diagnose leukemia.

How is it treated?

Treatment depends on what kind of leukemia you have and how far along it is. Treatment can range from watchful waiting to a stem cell transplant. Usually it includes chemotherapy and sometimes radiation treatments.

Non-Hodgkin’s Lymphoma

Non-Hodgkin’s Lymphoma

What is non-Hodgkin’s lymphoma?

Non-Hodgkin’s lymphoma (NHL) is cancer of the cells of the lymphatic system. In non-Hodgkin’s lymphoma, cells in the lymphatic system divide and grow without order or control, or old cells do not die as cells normally do. Non-Hodgkin’s lymphoma can start almost anywhere in the body. It may occur in a single lymph node, in a group of lymph nodes, or in an organ such as the spleen. Non-Hodgkin’s lymphoma can spread to almost any part of the body, including the liver, bone marrow, and spleen.

Over time, lymphoma cells replace the normal cells in the bone marrow. This causes bleeding problems and infections. As the lymphoma cells spread, the body becomes less and less able to produce blood cells that carry oxygen to other tissues or to protect itself from infection.

Non-Hodgkin’s lymphoma is different from Hodgkin’s lymphoma and occurs about eight times more often.

Are there different types of non-Hodgkin’s lymphoma?

Over the years, experts have used a variety of terms to classify the many different types of non-Hodgkin’s lymphoma. Most often, they are grouped by how the cancer cells look under a microscope and how quickly they are likely to grow and spread. Aggressive lymphomas, also known as intermediate- and high-grade lymphomas, tend to grow and spread quickly and cause severe symptoms. Nonaggressive lymphomas, also referred to as indolent or low-grade lymphomas, tend to grow quite slowly and cause fewer symptoms early in the disease course.

In an effort to increase the understanding of lymphoma and standardize treatment, experts in Europe and North America (Revised European-American Lymphoma [REAL] and World Health Organization [WHO]) have revised the classification of lymphoma.

What causes non-Hodgkin’s lymphoma?

The cause of non-Hodgkin’s lymphoma is unknown. The incidence of NHL has continued to increase over the years. It is probably a genetic disorder and may require a “trigger,” such as exposure to something in the environment, to develop. NHL is not contagious.

• NHL is more common in men than in women.
• The likelihood of getting NHL increases as you get older.
• NHL is most common among those who have an inherited immune deficiency, an autoimmune disease, or HIV; it also occurs among those who take medications that impair the immune system following an organ transplant.
• Viral infections, such as with human T-lymphotropic virus type I (HTLV-1) and Epstein-Barr virus, increases the risk of developing NHL.
• Exposure to pesticides, solvents, or fertilizers increases the risk of developing NHL.

What are the symptoms?

The most common symptom of non-Hodgkin’s lymphoma is a painless swelling of the lymph nodes in the neck, underarm, or groin. Other symptoms may include:

• Unexplained fever.
• Night sweats.
• Extreme fatigue.
• Unexplained weight loss.
• Itchy skin.
• Reddened patches on the skin.

How is non-Hodgkin’s lymphoma diagnosed?

Once NHL is suspected, a piece of tissue (biopsy) must be obtained to confirm the diagnosis. Occasionally this can be done by inserting a needle into a lymph node, but usually the entire lymph node must be removed. The piece of tissue is then analyzed under a microscope by a pathologist to see whether NHL is present.

How is it treated?

Treatment of non-Hodgkin’s lymphoma depends on the stage of the disease, the grade of the disease, and your age and general health. The four treatment options available are:

• Watchful waiting (surveillance).
• Radiation therapy.
• Chemotherapy.
• Biological therapy.

Pancreatic Cancer

Pancreatic Cancer

General Information About Pancreatic Cancer

Pancreatic cancer is a disease in which malignant (cancer) cells form in the tissues of the pancreas.

The pancreas is a gland about 6 inches long that is shaped like a thin pear lying on its side. The wider end of the pancreas is called the head, the middle section is called the body, and the narrow end is called the tail. The pancreas lies behind the stomach and in front of the spine.

The pancreas has two main jobs in the body:

• To produce juices that help digest (break down) food.
• To produce hormones, such as insulin and glucagon, that help control blood sugar levels. Both of these hormones help the body use and store the energy it gets from food.

The digestive juices are produced by exocrine pancreas cells and the hormones are produced by endocrine pancreas cells. About 95% of pancreatic cancers begin in exocrine cells.

This summary provides information on exocrine pancreatic cancer. Refer to the PDQ summary on Islet Cell Carcinoma (Endocrine Pancreas) Treatment for information on endocrine pancreatic cancer.

Smoking and health history can affect the risk of developing pancreatic cancer.

The following are possible risk factors for pancreatic cancer:

• Smoking.
• Long-standing diabetes.
• Chronic pancreatitis.
• Certain hereditary conditions, such as hereditary pancreatitis, multiple endocrine neoplasia type 1 syndrome, hereditary nonpolyposis colon cancer (HNPCC; Lynch syndrome), von Hippel-Lindau syndrome, ataxia-telangiectasia, and the familial atypical multiple mole melanoma syndrome (FAMMM).

Possible signs of pancreatic cancer include jaundice, pain, and weight loss.

These and other symptoms may be caused by pancreatic cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

• Jaundice (yellowing of the skin and whites of the eyes).
• Pain in the upper or middle abdomen and back.
• Unexplained weight loss.
• Loss of appetite.
• Fatigue.

Pancreatic cancer is difficult to detect (find) and diagnose early.

Pancreatic cancer is difficult to detect and diagnose for the following reasons:

• There aren’t any noticeable signs or symptoms in the early stages of pancreatic cancer.
• The signs of pancreatic cancer, when present, are like the signs of many other illnesses.
• The pancreas is hidden behind other organs such as the stomach, small intestine, liver, gallbladder, spleen, and bile ducts.

Tests that examine the pancreas are used to detect (find), diagnose, and stage pancreatic cancer.

Pancreatic cancer is usually diagnosed with tests and procedures that produce pictures of the pancreas and the area around it. The process used to find out if cancer cells have spread within and around the pancreas is called staging. Tests and procedures to detect, diagnose, and stage pancreatic cancer are usually done at the same time. In order to plan treatment, it is important to know the stage of the disease and whether or not the pancreatic cancer can be removed by surgery. The following tests and procedures may be used:

• Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. A spiral or helical CT scan makes a series of very detailed pictures of areas inside the body using an x-ray machine that scans the body in a spiral path.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radionuclide glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells.
• Endoscopic ultrasound (EUS): A procedure in which an endoscope (a thin, lighted tube) is inserted into the body. The endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography.
• Laparoscopy: A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to perform procedures such as removing organs or taking tissue samples for biopsy.
• Endoscopic retrograde cholangiopancreatography (ERCP): A procedure used to x-ray the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes pancreatic cancer causes these ducts to narrow and block or slow the flow of bile, causing jaundice. An endoscope (a thin, lighted tube) is passed through the mouth, esophagus, and stomach into the first part of the small intestine. A catheter (a smaller tube) is then inserted through the endoscope into the pancreatic ducts. A dye is injected through the catheter into the ducts and an x-ray is taken. If the ducts are blocked by a tumor, a fine tube may be inserted into the duct to unblock it. This tube (or stent) may be left in place to keep the duct open. Tissue samples may also be taken.
• Percutaneous transhepatic cholangiography (PTC): A procedure used to x-ray the liver and bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an x-ray is taken. If a blockage is found, a thin, flexible tube called a stent is sometimes left in the liver to drain bile into the small intestine or a collection bag outside the body. This test is done only if ERCP cannot be done.
• Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. There are several ways to do a biopsy for pancreatic cancer. A fine needle may be inserted into the pancreas during an x-ray or ultrasound to remove cells. Tissue may also be removed during a laparoscopy (a surgical incision made in the wall of the abdomen).

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

• Whether or not the tumor can be removed by surgery.
• The stage of the cancer (the size of the tumor and whether the cancer has spread outside the pancreas to nearby tissues or lymph nodes or to other places in the body).
• The patient’s general health.
• Whether the cancer has just been diagnosed or has recurred (come back).

Pancreatic cancer can be controlled only if it is found before it has spread, when it can be removed by surgery. If the cancer has spread, palliative treatment can improve the patient’s quality of life by controlling the symptoms and complications of this disease.

Taking part in one of the clinical trials being done to improve treatment should be considered. Information about ongoing clinical trials is available from the NCI Web site.

Thyroid cancer

Thyroid cancer

Thyroid cancer: Treatment - Patient Information [NCI PDQ] - Description

What is thyroid cancer?

Thyroid cancer is a disease in which cancer (malignant) cells are found in the tissues of the thyroid gland. The thyroid gland is at the base of the throat. It has two lobes, one on the right side and one on the left. The thyroid gland makes important hormones that help the body function normally.

Certain factors may increase the risk of developing thyroid cancer.

• Thyroid cancer occurs more often in people between the ages of 25 and 65 years.
• People who have been exposed to radiation or received radiation treatments to the head and neck during infancy or childhood have a greater chance of developing thyroid cancer. The cancer may occur as early as 5 years after exposure or may occur 20 or more years later.
• People who have had goiter (enlarged thyroid) or a family history of thyroid disease have an increased risk of developing thyroid cancer.
• Thyroid cancer is more common in women than in men.
• Asian people have an increased risk of developing thyroid cancer.

A doctor should be seen if there is a lump or swelling in the front of the neck or in other parts of the neck.

If there are symptoms, a doctor will feel the patient’s thyroid and check for lumps in the neck. The doctor may order blood tests and special scans to see whether a lump in the thyroid is making too many hormones. The doctor may want to take a small amount of tissue from the thyroid. This is called a biopsy. To do this, a small needle is inserted into the thyroid at the base of the throat and some tissue is drawn out. The tissue is then looked at under a microscope to see whether it contains cancer.

There are four main types of thyroid cancer (based on how the cancer cells look under a microscope):

1. papillary
2. follicular
3. medullary
4. anaplastic

Some types of thyroid cancer grow faster than others. The chance of recovery (prognosis) depends on the type of thyroid cancer, whether it is in the thyroid only or has spread to other parts of the body (stage), and the patient’s age and overall health. The prognosis is better for patients younger than 40 years who have cancer that has not spread beyond the thyroid.

The genes in our cells carry the hereditary information from our parents. An abnormal gene has been found in patients with some forms of thyroid cancer. If medullary thyroid cancer is found, the patient may have been born with a certain abnormal gene which may have led to the cancer. Family members may have also inherited this abnormal gene. Tests have been developed to determine who has the genetic defect long before any cancer appears. It is important that the patient and his or her family members (children, grandchildren, parents, brothers, sisters, nieces and nephews) see a doctor about tests that will show if the abnormal gene is present. These tests are confidential and can help the doctor help patients. Family members, including young children, who don’t have cancer, but do have this abnormal gene, may reduce the chance of developing medullary thyroid cancer by having surgery to safely remove the thyroid gland (thyroidectomy).

Endometrial Cancer

Endometrial Cancer - Topic Overview

Is this topic for you?

This topic provides information about the initial testing, diagnosis, and treatment of cancer of the lining of the uterus, endometrial cancer. Other types of uterine cancer are more rare and are not discussed in this topic.

If you are looking for information about cancer of the cervix, see the topic Cervical Cancer.

What is endometrial cancer?

Endometrial cancer is the rapid and uncontrolled growth of cells in the endometrium, the lining of the uterus. The uterus is the hollow, pear-shaped organ in a woman’s abdomen. Endometrial cancer usually occurs in women older than 50. Fortunately, it is highly curable if detected at an early stage when the cancer is still contained in the uterus. Most women with endometrial cancer are diagnosed in the earliest stage, and up to 93% of these women are cancer-free 5 years after treatment.¹

What causes endometrial cancer?

The cause of endometrial cancer is currently unknown. Exposure to the hormone estrogen over many years without enough of the hormone progesterone to balance it (unopposed estrogen) appears to be related to the development of endometrial cancer.²

What are the symptoms?

The most common symptom is abnormal vaginal bleeding after menopause. About 20% of women who have abnormal bleeding after menopause have endometrial cancer.³

If endometrial cancer is more advanced, additional symptoms may be present. These include difficulty urinating, a lump in the pelvic area, pain in the pelvic area, and weight loss.

What increases my risk of developing endometrial cancer?

Being exposed to estrogen for years without progesterone to balance it (unopposed estrogen) appears to be the greatest risk factor for developing endometrial cancer. Long-term exposure to unopposed estrogen may occur as a result of:

• Beginning your menstrual cycle before age 12 or starting menopause after age 55.
• Not ever being pregnant or completing a full-term pregnancy.
• Not ever breast-feeding.
• Using hormone replacement therapy without progesterone.
• Being obese. Fat cells produce estrogen. Obese women have many fat cells, which increases the rate of estrogen production.

Additional factors that increase your risk include:

• Taking tamoxifen, a breast cancer medication that acts like estrogen in the uterus.³
• Being older than 50.
• Having a history of breast, ovarian, or colon cancer.
• Having endometrial hyperplasia.
• Having a family history of endometrial cancer or hereditary nonpolyposis colon cancer (HNPCC).

How is endometrial cancer diagnosed?

Endometrial cancer is usually diagnosed with an endometrial biopsy. A biopsy removes a small sample of the lining of the uterus for examination under a microscope.

Your doctor will determine the stage of your endometrial cancer, or how far advanced it is, by gathering information from a variety of tests, including blood tests, bone scans, and X-rays. The stage of your cancer is one of the most important factors in selecting the treatment option that is right for you.

How is it treated?

Endometrial cancer in its early stages can be cured with treatment and close follow-up. The primary treatment for endometrial cancer is surgery (hysterectomy) to remove the uterus, cervix, ovaries, and fallopian tubes. Pelvic lymph nodes may also be removed. Other treatments may be used depending on the stage of cancer and whether you are at high risk of having the cancer return. These treatments include radiation therapy, hormone therapy, and chemotherapy.