Lyphomas

Lymphoma is when cancer invades the lymphoid cells.  They are usually seen as a solid tumor in the lyphoid cells.

The two main categories for lymphoma are Hodgkin's lymphoma and non-Hodgkin's lymphoma.  Since there was so many lymphomas that have nothing in common they developed a new classification called WHO.  There are four major categories and 70 different lymphomas divided under the four categories. The four major categories are as follows.

Follicular lymphoma in the Bone Marrow

A.  Mature T cell and natural killer (NK) cell neoplasms

B.  Mature B cell neoplasms

C. Hodgkin lymphoma

E. Immunodeficiency-associated lymphoproliferative disorders

 

The Symptoms of Lymphoma are the following:

*weight loss

*abnormal amount of white cells in urine

*lymphdenopathy 

* fever of no indicated reason

What lab tests are ordered in diagnosing Lymphoma?

Other laboratory tests that may be useful include:

• Complete Blood Count (CBC) – may be ordered to rule out non-lymphoma conditions (such as leukemia) and/or to see if anemia is present. A CBC can determine if the platelet count and/or white blood cell count are low, which may indicate that lymphoma is present in the bone marrow.
• Bone marrow biopsy and examination – used to evaluate the cells present in the bone marrow. The presence of abnormal lymphoid cells and/or lymphoid aggregates may be seen with lymphoma.
• Blood smear – used to evaluate the quality of red and white blood cells and platelets as well as abnormal cells (lymphocytes), if present. 
• Immunophenotyping can identify the cells involved by testing for the presence or absence of certain markers on the membrane of the cells or inside the cells. These commonly used markers are called clusters of differentiation (CD) and are listed numerically. By developing a list of the CDs present on the cells, it is possible to classify the cells. This test can be done by several different methods, including flow cytometry and immunohistochemistry.
• Cytogenetics – an evaluation of the chromosomes in the nucleus of cancer cells to determine if pieces of the chromosomes have moved (translocation). This is rarely used for lymphomas. 
• Molecular genetic analysis – evaluating the cancer cell's DNA for genetic changes, particularly to determine whether all of the cells belong to a single clone.
• If it is thought that lymphoma has spread (metastasized) to other areas of the body, analysis of cerebrospinal fluid or other body fluids may be performed. 
• Beta-2 microglobulin – this test may be used to help predict the prognosis. I there are increased levels of the B2 microglobulin it is indicator of a problem, but not used as a diagnostic tool

Non-laboratory tests
Primarily used to help stage and monitor lymphoma. They include:

• Physical examination
• Computed tomography (CT) scans
• Positron emission tomography (PET) scan
• Chest X-ray
• Exploratory surgery (occasionally necessary)
• Magnetic Resonance Imaging (MRI)

You can read more at labsonline.org

Four types of Treatment for Lyphoma 

They are Chemotherapy and treated with the drug Rituxan.

RITUXAN^® (Rituximab) is indicated for the treatment of patients with:

• Previously untreated follicular, CD20-positive, B-cell NHL in combination with first-line chemotherapy and, in patients achieving a complete or partial response to RITUXAN in combination with chemotherapy, as single-agent maintenance therapy
• Non-progressing (including stable disease), low-grade, CD20-positive, B-cell NHL, as a single agent, after first-line CVP chemotherapy
• Previously untreated diffuse large B-cell, CD20-positive NHL in combination with CHOP or other anthracycline-based chemotherapy regimens
• Relapsed or refractory, low-grade or follicular, CD20-positive, B-cell NHL as a single agent

People with serious infections should not receive RITUXAN.

Important Safety Information

• RITUXAN can cause serious side effects that can lead to death, including infusion reactions, tumor lysis syndrome (TLS; kidney failure due to fast breakdown of cancer cells), severe skin and mouth reactions, and progressive multifocal leukoencephalopathy (PML; a rare, serious brain infection).
• RITUXAN has also been associated with serious and life-threatening side effects, including the return of active hepatitis B virus infection with sudden and serious liver problems including liver failure, and death, other serious infections that can lead to death, heart problems, kidney problems, and stomach and serious bowel problems including blockage and tears in the bowel that can sometimes lead to death.
• The most common side effects of RITUXAN seen in patients with non-Hodgkin's lymphoma were infusion reactions, fever, chills, low white blood cells, infections, body aches, and tiredness. Before starting treatment with RITUXAN it is important to talk to your doctor about your medical history.
• Tell your doctor about any side effect that bothers you or that does not go away. These are not all of the possible side effects with RITUXAN. For more information, ask your doctor.

Please see full Prescribing Information, including Medication Guide.

CVP=cyclophosphamide, vincristine, and prednisone or prednisolone; CHOP=cyclophosphamide, doxorubicin, vincristine, and prednisone. Got to website:   http//:www.rituxan.com

When a person is in treatment with Chemotherapy they will have to have blood drawn for a complete blood counts.  Chemo can cause the white cell count and platelet to decrease.  Your white has to be at least 2000 to receive chemo.  If it is not then you have to wait another day to be treated.

 

 

 

Recent News Update For Breast Cancer Survivors

I know that many survivors of Breast Cancer are concerned about recurrence. I have seen it happen in the Cancer center where I was employed.  I found an article on New Way to Predict Cancer Returning.
http://www.nhs.uk/news/2011/10October/Pages/new-test-for-breast-cancer-return.aspx

Breast and Ovarian Cancer Risk Testing

Women have the option of BRCA 1 and BRCA 2 testing to see if they have inherited the gene mutation.

Key Points

• BRCA1 and BRCA2 are human genes that belong to a class of genes known as tumor suppressors. Mutation of these genes has been linked to hereditary breast and ovarian cancer (see Question 1).
• A woman's risk of developing breast and/or ovarian cancer is greatly increased if she inherits a deleterious (harmful) BRCA1 or BRCA2 mutation. Men with these mutations also have an increased risk of breast cancer. Both men and women who have harmful BRCA1 or BRCA2 mutations may be at increased risk of other cancers (see Question 2).
• Genetic tests are available to check for BRCA1 and BRCA2 mutations. A blood sample is required for these tests, and genetic counseling is recommended before and after the tests (see Question 5).
• If a harmful BRCA1 or BRCA2 mutation is found, several options are available to help a person manage their cancer risk (see Question 11).
• Federal and state laws help ensure the privacy of a person’s genetic information and provide protection against discrimination in health insurance and employment practices (see Questions 14 and 15).
• Many research studies are being conducted to find newer and better ways of detecting, treating, and preventing cancer in BRCA1 and BRCA2 mutation carriers. Additional studies are focused on improving genetic counseling methods and outcomes. Our knowledge in these areas is evolving rapidly 

1. How do BRCA1 and BRCA2 gene mutations affect a person's risk of cancer? Not all gene changes, or mutations, are deleterious (harmful). Some mutations may be beneficial, whereas others may have no obvious effect (neutral). Harmful mutations can increase a person’s risk of developing a disease, such as cancer.
   A woman’s lifetime risk of developing breast and/or ovarian cancer is greatly increased if she inherits a harmful mutation in BRCA1 or BRCA2. Such a woman has an increased risk of developing breast and/or ovarian cancer at an early age (before menopause) and often has multiple, close family members who have been diagnosed with these diseases. Harmful BRCA1 mutations may also increase a woman’s risk of developing cervical, uterine, pancreatic, and colon cancer (1, 2). Harmful BRCA2 mutations may additionally increase the risk of pancreatic cancer, stomach cancer, gallbladder and bile duct cancer, and melanoma (3).
   Men with harmful BRCA1 mutations also have an increased risk of breast cancer and, possibly, of pancreatic cancer, testicular cancer, and early-onset prostate cancer. However, male breast cancer, pancreatic cancer, and prostate cancer appear to be more strongly associated with BRCA2 gene mutations (2–4).
   The likelihood that a breast and/or ovarian cancer is associated with a harmful mutation in BRCA1 or BRCA2 is highest in families with a history of multiple cases of breast cancer, cases of both breast and ovarian cancer, one or more family members with two primary cancers (original tumors that develop at different sites in the body), or an Ashkenazi (Central and Eastern European) Jewish background (see Question 6). However, not every woman in such families carries a harmful BRCA1 or BRCA2 mutation, and not every cancer in such families is linked to a harmful mutation in one of these genes. Furthermore, not every woman who has a harmful BRCA1 or BRCA2 mutation will develop breast and/or ovarian cancer.
   According to estimates of lifetime risk, about 12.0 percent of women (120 out of 1,000) in the general population will develop breast cancer sometime during their lives compared with about 60 percent of women (600 out of 1,000) who have inherited a harmful mutation in BRCA1 or BRCA2 (4, 5). In other words, a woman who has inherited a harmful mutation in BRCA1 or BRCA2 is about five times more likely to develop breast cancer than a woman who does not have such a mutation.
   Lifetime risk estimates for ovarian cancer among women in the general population indicate that 1.4 percent (14 out of 1,000) will be diagnosed with ovarian cancer compared with 15 to 40 percent of women (150–400 out of 1,000) who have a harmful BRCA1 or BRCA2 mutation (4, 5).
   It is important to note, however, that most research related to BRCA1 and BRCA2 has been done on large families with many individuals affected by cancer. Estimates of breast and ovarian cancer risk associated with BRCA1 and BRCA2 mutations have been calculated from studies of these families. Because family members share a proportion of their genes and, often, their environment, it is possible that the large number of cancer cases seen in these families may be due in part to other genetic or environmental factors. Therefore, risk estimates that are based on families with many affected members may not accurately reflect the levels of risk for BRCA1 and BRCA2 mutation carriers in the general population. In addition, no data are available from long-term studies of the general population comparing cancer risk in women who have harmful BRCA1 or BRCA2 mutations with women who do not have such mutations. Therefore, the percentages given above are estimates that may change as more data become available.  Go to www.cancer.gov/pics/factssheet/Risk/BRCA   for more information.

Chronic Myelogenous Leukemia

Chronic Myelogenous Leukemia may also be referred as chronic myeloid leukemia and CML.  CML is one of the four most common types of leukemia.  All leukemias are cancers of the bone marrow and blood.

Bone Marrow

The bone marrow is where blood cells are produced.  In the marrow immature cell are produced and begin to mature through stages and as they mature the size of the cell becomes smaller.

Maturation stages of the 5 types of White Cells

When a lab tech reviews a slide of a patient they are looking at the cells in the peripheral blood that has been drawn from your vein.  Under the microscope in a normal patient all the cells will be small ,but an abnormal patient the white cells when viewed under the microscope will be large and small because immature cells will also be seen.

Myelogenous Leukemia in Peripheral Blood Smear

In order to be diagnosed a bone marrow biopsy will have to be performed.  Please view the posted on bone marrow aspiration on this blog site.  The oncologist will perform the biopsy and will be sent to the lab for analysis. They bone marrow will be sent to pathology, special hematolgy and cytogenetics for testing .  For pathology the bone marrow will be stained and the pathologist will review the cells under the microscope and evaluate the bone marrow production.  In CML there will be a abnormal , increased production of granulocytes in the bone marrow.  The reason that they are termed granulocytes is because when viewed under the microscope that appear to have granules in the cell.  This includes neutrophils, basophils and eosinophils.

In Special Hematology they will perform a flow cytometry.  This procedure is where cells are suspended in stream of fluid and the cells and and chromosomes by passing them by an electronic apparatus to identify the cells.
In the genetic testing they will need to find out if there is a chromosomal translocation in the Philadelphia chromosome which is a characteristic of CML.

Symptoms of CML are the following:

1. weight loss
2. malaise
3. hip and joint pain
4. susceptible to infections
5. low grade fever
6. abnormal platelet count

If you are experiencing any of these symptoms you need to see a healthcare professional.
CML is treated with inhibitors of tyrosine kinase such as Gleevec.

The prognosis for CML is good if the patient is pro-active in taking medications and regular visits to the their oncologist.

Recent News Update !

Discussion of the AMAS test which can detect malignancy earlier in most cancer.  Read the info and express your opinion.  Here is the link:

http://www.prweb.com/releases/2011/10/prweb8864167.htm

Acute Myelogenous Leukemia

AML is a very serious cancer of the bone marrow and the blood.  The bone marrow is rapidly producing immature blast cells of the granular type of white cell.  The immature cells grow so rapidly that they push out other blood cells such as platelet, lymphocytes and red cells. The blast cell ,being very immature, cannot perform the function of the mature cell in immunity protection.

Acute Myelogenous Leukemia

 In the picture above you will notice how large the cells are and the nucleus( purple center) of the cell is light and not condensed.  This means that the cell  is immature .  Below is a chart to see how white cells mature.

Add caption

The two charts show the maturation of the different white cells. In the healthy blood specimen there should be no immature cells.  When the blood analyzer detects and immature cells , a smear of the abnormal blood must be prepared and stain stained to be viewed by a tech and ultimately a pathologist.

If the oncologist and pathologist detect an acute leukemia they will do a bone marrow aspirate to be stained and analyzed by the pathologist.  The other genetic testing and other diagnostic testing make take longer to receive than the bone marrow results.  Genzyme , Mayo and other lab testing facilities perform genetic testing to help greatly with diagnosing AML.  Acute myelogenous leukemia is also known as acute myeloid leukemia, acute myeloblastic leukemia, acute granulocytic leukemia and acute nonlymphocytic leukemia.


In general, leukemia occurs when some blood cells acquire mutations in their DNA — the instructions inside each cell that guide its action. The mutations cause the cell to grow and divide more rapidly and to continue living when normal cells would die. Over time, these abnormal cells can crowd out healthy blood cells, causing the signs and symptoms of leukemia.
Symptoms of AML are the following:

• Fever or chills
• Persistent fatigue, weakness
• Frequent infections
• Losing weight without trying
• Swollen lymph nodes, enlarged liver or spleen
• Easy bleeding or bruising
• Tiny red spots in your skin (petechiae)
• Excessive sweating, especially at night
• Bone pain or tenderness

Please see a medical professional immediately if these symptoms occur.

Go To Mayo Clinic website for more information.

Cancer Research news!

This is a great new update! "How to Stop Killer Cells from Growing" 

http://www.dailytelegraph.com.au/news/national/aussies-crack-cancer-secret/story-e6freuzr-1225758516909