Myeloproliferative Dimyeloproliferative disorders

Myeloproliferative disease or MPD deals with  a group of diseases of the bone marrow in which excess cells are produced.

Myeloproliferative disorders is the name for a group of conditions that cause blood cells -- platelets, white blood cells, and red blood cells -- to grow abnormally in the bone marrow. Though myeloproliferative disorders are serious, and may pose certain health risks, people with these conditions often live for many years after diagnosis. The prognosis largely depends on the type of disorder.

Myeloproliferative disorders include:

• Polycythemia vera -- occurs when the bone marrow produces too many blood cells, especially red blood cells. More than 95% of people with polycythemia vera carry the blood mutation JAK2V617F.
• Essential thrombocytosis -- occurs when the body produces too many platelet cells, which help blood to clot. Clots can block blood vessels leading to heart attack or stroke.
• Primary or idiopathic myelofibrosis, also known as myelosclerosis -- occurs when the bone marrow produces too much collagen or fibrous tissue in the bone marrow. This reduces bone marrow's ability to produce blood cells.
• Chronic myelogenous leukemia (CML) -- cancer of the bone marrow that produces abnormal granulocytes, a type of white blood cell, in the bone marrow.

Signs and Symptoms:

Many people with myeloproliferative disorders have no symptoms when their doctors first make the diagnosis. One symptom shared by all myeloproliferative disorders, with the exception of essential thrombocytosis, is an enlarged spleen. An enlarged spleen can cause abdominal pain and a feeling of fullness.

Many times, especially in the early stages, myeloproliferative disease does not have symptoms. When it does have signs, they vary from person to person. If you have symptoms, they may include:

• Headache
• Fatigue
• Shortness of breath
• Easy bruising or bleeding
• Petechiae (tiny red spots under the skin)
• Unexplained weight loss
• Night sweats
• Fever

Specific disorders in which the bone marrow produces too many cells have similar and yet different symptoms.

Some signs and symptoms of the different types of myeloproliferative disorders include:

Polycythemia vera

• Fatigue, general malaise
• Trouble breathing
• Intense itching after bathing in warm water
• Stomachaches
• Purple spots or patches on the skin
• Nosebleeds, gum or stomach bleeding, or blood in the urine
• Throbbing and burning pain in the skin, often with darkened, blotchy areas
• Headache and problems with vision
• High blood pressure
• Blockage of blood vessels. This may cause heart disease, stroke, or gangrene (tissue death) of the arms and legs.

Essential thrombocytosis

• Heart attack or stoke
• Headache
• Burning or throbbing pain, redness, and swelling of the hands and feet
• Bruising
• Gastrointestinal bleeding or blood in the urine

Primary myelofibrosis

• Fatigue, general malaise
• Trouble breathing
• Anemia
• Weight loss
• Fever and night sweats
• Abnormal bleeding

Chronic myelogenous leukemia (CML)

• Fatigue, general malaise
• Weight loss or loss of appetite
• Fever and night sweats
• Bone or joint pain
• Heart attack or stroke
• Trouble breathing
• Gastrointestinal bleeding
• Infection

Laboratory Tests

Complete blood count (CBC) and differential CBCs and differentials are the most frequently ordered tests used to help diagnose and monitor MPDs. Often ordered as part of a yearly physical exam, they are routine tests that count the number and relative proportion of each of the different types of cells in your blood stream. They give your doctor information about the size, shape, and relative maturity of the blood cells present in your blood at that moment.
CBCs and differentials can be used to detect WBC, RBC, and platelet increases, decreases, and abnormalities. They can help determine their severity, diagnose their cause, monitor the course of a disease, and monitor the response to treatment.
With polycythemia vera, increased RBCs, platelets, and sometimes WBCs, may be seen. With myelofibrosis, immature granulocytes and misshapen immature teardrop-shaped red blood cells are often seen, and WBC and RBC numbers are often decreased. With thrombocythemia, greatly increased numbers of platelets are seen along with abnormally large platelets, platelet clumps, and fragments of megakaryocytes.
Irregularities in cell counts may be due to MPDs, but they may also be due to a variety of other temporary or chronic conditions. Other testing is usually done to confirm or rule out the diagnosis of an MPD.
Bone marrow aspiration/biopsyIf a doctor suspects a bone marrow disorder, he may order a bone marrow aspiration or biopsy to collect a small sample of marrow. When a specialist (a pathologist, oncologist, or hematologist) examines the bone and fluid from the bone marrow sample under the microscope, he can see the number, size, and shape of precursor cells (blasts), red and white blood cells, and megakaryocytes (platelet precursors). He can determine the proportions of mature and immature cells, see any overgrowth of fibrous tissue, and detect any cancer cells from cancers that may have spread to the marrow. Most bone marrow disorders can be diagnosed during this examination.

ABGs (Arterial blood gases) - This test measures the amount of gases in your arterial blood and may be done when polycythemia vera is suspected. Low levels of oxygen are associated with secondary polycythemia.
Erythropoietin is a hormone that stimulates the bone marrow to produce RBCs. With primary polycythemia, erythropoietin levels will be very low or absent, but with secondary polycythemia they will be normal or high.
Genetic testing is sometimes used in suspected chronic myelogenous leukemia to check for the presence or absence of a Philadelphia (Ph') chromosome or a bcr-abl translocation (see BCR ABL) and in suspected polycythemia vera, myelofibrosis, and essential thrombocythemia for the presence or absence of JAK2 mutations, a gene associated with marrow cell production.

                                        Video of Bone Marrow Biopsy

              This video is a lecture about a very common MPD  which is polycythemia vera.  It is seen frequently in persons who live in high altitudes.

For more information then check the following websites:

http://www.umm.edu/altmed/articles/myeloproliferative-disorders-000114.htm or

http://labtestsonline.org/understanding/conditions/myelopro-disorders?start=2
                                      

Melanoma Of The Eye

When melanoma is discussed we immediately think of cancer of the skin , but it also can be present in our eyes. This type of cancer is called Intraocular Melanoma.

                                                               Melanoma in the iris of the eye.

                                                            Melanoma in the retina of the eye


Intraocular melanoma begins in the middle of 3 layers of the wall of the eye. The outer layer includes the white sclera (the "white of the eye") and the clear cornea at the front of the eye. The inner layer has a lining of nerve tissue, called the retina, which senses light and sends images along the optic nerve to the brain.

This type of cancer most often occurs in people who are middle aged. In most cases of intraocular melanoma, doctors detect the cancer during a routine eye examination. The chance of recovery (prognosis) will depend on factors such as the size and cell type of the cancer. This type of melanoma is rare.

Most people with intraocular melanoma experience no symptoms of the cancer in its early stages. Melanoma that starts in the iris may appear as a dark spot on the iris. Intraocular melanoma that is in the ciliary body or choroid may cause blurry vision.

Age and sun exposure may increase the risk of developing intraocular melanoma.
Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for intraocular melanoma include the following:

• Older age
• Being white
• Having a fair complexion (light skin) or green or blue eyes.
• Being able to tan

Possible signs of intraocular melanoma include a dark spot on the iris or blurred vision.
Intraocular melanoma may not cause any early symptoms. It is sometimes found during a routine eye exam when the doctor dilates the pupil and looks into the eye. The following symptoms may be caused by intraocular melanoma or by other conditions. A doctor should be consulted if any of these problems occur:

• A dark spot on the iris
• Blurred vision
• A change in the shape of the pupil
• A change in vision

Glaucoma may develop if the tumor causes the retina to separate from the eye. If this happens, there may be no symptoms, or symptoms may include the following:

• Eye pain
• Blurred vision
• Eye redness
• Nausea

 

Doctors stage intraocular melanoma based on the area of the eye where the tumor is found and the size of the tumor. The stages of intraocular melanoma include:

 

• Iris melanoma
• Ciliary body melanoma
• Small choroidal melanoma
• Medium and large choroidal melanoma
• Extraocular extension and metastatic intraocular melanoma
• Recurrent intraocular melanoma. 
•  

Iris Melanoma

Intraocular melanoma of the iris occurs in the front colored part of the eye. Iris melanomas usually grow slowly and do not spread to other parts of the body.

 

Ciliary Body Melanoma

Intraocular melanoma of the ciliary body occurs in the back part of the eye.

 

Small Choroidal Melanoma

Intraocular melanoma of the choroid occurs in the back part of the eye. This type of tumor is classified by the size of the tumor. A small choroidal melanoma is 3 millimeters or less in thickness.

 

Medium and Large Choroidal Melanoma

Intraocular melanomas of the choroid occur in the back part of the eye. This type of tumor is classified by the size of the tumor. Medium and large choroidal melanomas are more than 3 millimeters in thickness.

 

Extraocular Extension and Metastatic Intraocular Melanoma

In extraocular extension and metastatic intraocular melanoma, the melanoma has spread outside the eye, to the nerve behind the eye (the optic nerve), to the eye socket, or to other parts of the body.

 

Recurrent

Recurrent intraocular melanoma refers to cases of the cancer that have come back (recurred) after they were treated.

 

Treatment for Intraocular Melanoma

Treatment options for intraocular melanoma may include:

 

• Surgery (taking out the cancer)
• Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells)
• Laser therapy (using an intensely powerful beam of light to destroy the tumor or blood vessels that feed the tumor).

 

In some cases (such as when the cancer is small and causing no symptoms), the treatment plan may involve monitoring the patient's cancer carefully and waiting to treat it until it changes or causes symptoms. This is sometimes known as watchful waiting.  

                                           Video of a cancerous tumor of eye surgically removed.

http://my.clevelandclinic.org/disorders/intraocular_melanoma/hic_intraocular_melanoma.aspx

http://skin-cancer.emedtv.com/intraocular-melanoma/intraocular-melanoma-p3.html

New Testing Kits For Lung Cancer

Diagnostic Biosystems (DBS), a specialty Immunohistochemistry company, announces its debut as an automated IHC company, introducing the Mosaic 360™ System with a product offering of novel Multiplex Immunohistochemistry kits and a complementary line of optimized IHC reagents.

Built on a history of developing distinctive chromogens to differentiate morphology on a single slide, Diagnostic BioSystems introduces a portfolio of five Mosaic Multiplex™ Lung Cancer Kits for use in tissue analysis of suspected Lung Cancer patients. Pathologists are challenged with scarce tissue availability in patients with cancer. DBS is addressing the tissue challenge with the Mosaic Multiplex ™ kits enabling testing of multiple analytes on one slide with a complete kit optimized for the DBS Mosaic 360™ System automated platform for lab to lab standardized results. 

The Mosaic System™ also includes a new line of “plug and play” reagents optimized on the Mosaic 360™ platform to provide convenience for the Histology Technologist in the Pathology laboratory.

“Diagnostic Biosystems is focused on developing clinically relevant tools for pathologists. We believe it is important to provide the most information with the limited tissue available in cancer patients today. Our standardized Mosaic Multiplex™ lung cancer kits” are focused on solving this problem,” said Dr. Bipin Gupta, PhD, President & CEO of Diagnostic BioSystems. 

During the USCAP, Diagnostic BioSystems will sponsor a Pathologist Roundtable event on Tuesday, March 20, 2012 in Vancouver BC to discuss advances in the use of Multiplex Kits in the analysis of suspected cancers. Two industry experts, Dr. Omar Hameed from Vanderbilt and Dr. Arundhati Rao from Scott & White Healthcare System, will join Marc Key Ph.D., DBS Scientific Advisor, in leading these discussions. 

http://www.businesswire.com/news/calgaryherald/20120319005615/en/Diagnostic-BioSystems-Launches-Automated-IHC-Multiplex-Platform

Endometrial Cancer

Endometrial cancer affects many women.  This is why it is so important to follow the guidelines set forth by Cancer organizations for pap smears.

                               Endometrial Cancer shown under the microscope after histology preparation.

Cancer that forms in the tissue lining the uterus (the small, hollow, pear-shaped organ in a woman's pelvis in which a fetus develops). Most endometrial cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids). 

Estimated new cases and deaths from endometrial (uterine corpus) cancer in the United States in 2012:

	New cases: 47,130
	Deaths: 8,010

Diagnosing endometrial cancer
Tests and procedures used to diagnose endometrial cancer include:

• Examining you for abnormalities. During a pelvic exam, your doctor carefully inspects the outer portion of your genitals (vulva), and then inserts two fingers of one hand into your vagina and simultaneously presses the other hand on your abdomen to feel your uterus and ovaries. He or she also inserts a device called a speculum into your vagina. The speculum opens your vagina so that your doctor can view your vagina and cervix for abnormalities.
• Using sound waves to create a picture of your uterus. Your doctor may recommend a transvaginal ultrasound to look at the thickness and texture of the endometrium and help rule out other conditions. In this procedure, a wand-like device (transducer) is inserted into your vagina. The transducer uses sound waves to create a video image of your uterus. This test helps your doctor look for abnormalities in your uterine lining.
• Using a scope to examine your endometrium. During a hysteroscopy, your doctor inserts a thin, flexible, lighted tube (hysteroscope) through your vagina and cervix into your uterus. A lens on the hysteroscope allows your doctor to examine the inside of your uterus and the endometrium.
• Removing a sample of tissue for testing. To get a sample of cells from inside your uterus, you'll likely undergo an endometrial biopsy. This involves removing tissue from your uterine lining for laboratory analysis. This may be done in your doctor's office and usually doesn't require anesthesia.
• Performing surgery to remove tissue for testing. If enough tissue can't be obtained during a biopsy or if the biopsy results are unclear, you'll likely need to undergo a procedure called dilation and curettage (D&C). During D&C, tissue is scraped from the lining of your uterus and examined under a microscope for cancer cells. D&C usually requires general anesthesia, so you won't be aware during the procedure.

• Tissue microarray immunohistochemical expression analysis is the newest test.  issue microarray technology allows molecular profiling of tumor samples at the DNA, RNA, and protein levels.

  .

If endometrial cancer is found, you'll likely be referred to a gynecologic oncologist — a doctor who specializes in treating cancers involving the female reproductive system.
Staging endometrial cancer
Once your cancer has been diagnosed, your doctor works to determine the extent, or stage, of your cancer. Tests used to determine your cancer's stage include a chest X-ray, a computerized tomography (CT) scan and blood tests. The final determination of your cancer's stage may not be made until after you undergo surgery to treat your cancer.
Stages of endometrial cancer include:

• Stage I cancer is found only in your uterus.
• Stage II cancer is present in both the uterus and cervix.
• Stage III cancer has spread beyond the uterus, but hasn't reached the rectum and bladder. The pelvic area lymph nodes may be involved.
• Stage IV cancer has spread past the pelvic region and can affect the bladder, rectum and more distant parts of your body. 

                                        Risks for Endometrial Cancer by Dr. David Holtz

http://www.mayoclinic.com/health/endometrial-cancer/DS00306/DSECTION=tests-and-diagnosis

http://www.ncbi.nlm.nih.gov/pubmed/14614055
    

New Guidelines For Cervical Cancer Screening

The American Cancer Society today released new screening recommendations for the prevention and early detection of cervical cancer. Screenings are tests for women who have no symptoms of cervical cancer. Among the changes: the American Cancer Society no longer recommends that women get a Pap test every year.
During the past few decades, screening has reduced deaths from cervical cancer, as doctors have been able to find cancer early and treat it, or prevent it from ever developing. Researchers continue to find out more about what causes cervical cancer, and the best ways to screen for it.
There are 2 types of tests used for cervical cancer screening.

• The Pap test can find early cell changes and treat them before they become cancer. The Pap test can also find cervical cancer early, when it's easier to treat.
• The HPV (human papilloma virus) test finds certain infections that can lead to cell changes and cancer. HPV infections are very common, and most go away by themselves and don't cause these problems. The HPV test may be used along with a Pap test, or to help doctors decide how to treat women who have an abnormal Pap test.

The American Cancer Society regularly reviews the science and updates screening recommendations when new evidence suggests that a change may be needed. The latest recommendations are:

• All women should begin cervical cancer screening at age 21.
• Women between the ages of 21 and 29 should have a Pap test every 3 years. They should not be tested for HPV unless it is needed after an abnormal Pap test result.
• Women between the ages of 30 and 65 should have both a Pap test and an HPV test every 5 years. This is the preferred approach, but it is also OK to have a Pap test alone every 3 years.
• Women over age 65 who have had regular screenings with normal results should not be screened for cervical cancer. Women who have been diagnosed with cervical pre-cancer should continue to be screened.
• Women who have had their uterus and cervix removed in a hysterectomy and have no history of cervical cancer or pre-cancer should not be screened.
• Women who have had the HPV vaccine should still follow the screening recommendations for their age group.
• Women who are at high risk for cervical cancer may need to be screened more often. Women at high risk might include those with HIV infection, organ transplant, or exposure to the drug DES. They should talk with their doctor or nurse. 

http://www.sciencedaily.com/releases/2012/03/120314183348.htm

Circumcision and Prostate Cancer

According to a new article published Bradenton Herald recently , support the Jews are right in promoting circumcision on male infants.

 

 NEW YORK, March 13, 2012 — /PRNewswire/ -- It's never too early to fight prostate cancer, according to new research linking male circumcision at birth and a reduced risk of prostate cancer. A recent study published in the Cancer journal shows circumcised men could be 15 percent less likely to develop prostate cancer as an adult. As New York's leading robotic prostate cancer surgeon, Dr. David Samadi, welcomes this close-to-home news in the battle against prostate cancer.

These new findings in favor of an age-old tradition seem to support what our Jewish ancestors have espoused for years – circumcision is the secret to a blessed and healthy life. The covenant of circumcision takes place when a Jewish male infant is eight days old and is intended as a visible sign of a his covenant with God.
In the U.S. today, the procedure for removing a man's foreskin is widespread  for Jews and non-Jews, alike. Often pediatricians and urologists recommend circumcision for both cosmetic and health reasons. Many men prefer the physical characteristics of a circumcised penis and it has proven to offer significant hygiene benefits, particularly in reducing risk of sexually transmitted diseases (STDs).
The medical benefit of circumcision may now extend to the prostate. In the absence of the germ-trapping foreskin, the cleaner environment of a circumcised penis may reduce the risk of infection that can cause prostate inflammation that could ultimately lead to prostate cancer. So far, the findings are observational and do not show definitive cause and effect. The 15 percent reduced risk of prostate cancer was found in men who were circumcised prior to their first sexual intercourse.
Dr. Samadi, Vice Chairman, Department of Urology, and Chief of Robotics and Minimally Invasive Surgery at The Mount Sinai Medical Center, explains these findings. "This is not to say that prostate cancer is a sexually transmitted disease; however, there is substantial evidence linking infection and certain cancers. The human papillomavirus (HPV) is a prime example of one such cancer. Other cancers of the throat, cervix, and stomach have similar origins."
Dr. Samadi reminds men of other lifelong wellness factors for decreasing risk of prostate cancer, while raising awareness about risk factors and the importance of early detection.
Exercise and weight – Obesity can increase a man's risk of prostate cancer death by 33 percent. Maintaining a healthy weight through moderate exercise helps prevent prostate cancer and better positions you to fight the disease should you ever be diagnosed.
Healthy diet – In addition to supporting a healthy weight, certain diet factors are believed to aid in prostate cancer prevention. Among them are foods rich in antioxidants like tomatoes, cruciferous vegetables such as broccoli, and green tea.
Annual PSA test – A recent European study found a 38 percent reduction in prostate cancer death through routine PSA blood screening. Dr. Samadi encourages all men to discuss risk factors with their doctor and determine the right age to begin annual PSA level monitoring, no later than age 50. A qualified physician should monitor a man's PSA velocity each year, watching for any spikes indicating the need for further testing.

Read more here: http://www.bradenton.com/2012/03/13/3936425/the-rabbi-was-right-prostate-cancer.html#storylink=cpy

 http://www.bradenton.com/2012/03/13/3936425/the-rabbi-was-right-prostate-cancer.html

Read more here: http://www.bradenton.com/2012/03/13/3936425/the-rabbi-was-right-prostate-cancer.html#storylink=cpy

Bile Duct Cancer

Bile duct cancer is also know as Cholangiocarcinoma. Your bile duct is like a slender tube that moves a fluid called bile from your liver to your small intestine. Bile duct cancer (sometimes called cholangiocarcinoma) is a cancerous (malignant) growth in the duct. Cancer of the bile duct is rare and is most prevalent in people ages 50 to 70.

Cholangiocarcinoma or bile duct cancer is a cancerous (malignant) growth in one of the ducts that carries bile from the liver to the small intestine.

isks for this condition include:

• Bile duct (choledochal) cysts
• Chronic biliary irritation
• History of infection with the parasitic worm, liver flukes
• Primary sclerosing cholangitis
• Ulcerative colitis

Cholangiocarcinoma is rare. It occurs in approximately 2 out of 100,000 people.

Symptoms

• Chills
• Clay-colored stools
• Fever
• Itching
• Loss of appetite
• Pain in the upper right abdomen that may radiate to the back
• Weight loss
• Yellowing of the skin (jaundice)

Signs and tests

Your health care provider will perform a physical exam. Tests will be done to check for a tumor or blockage in the bile duct. These may include:

• Abdominal CT scan
• Abdominal ultrasound
• CT scan-directed biopsy
• Cytology -biopsy by surgeon and tissue evaluated prepared by tech and evaluated by pathologist
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Magnetic resonance cholangiopancreatography (MRCP)
• Percutaneous transhepatic cholangiogram (PTCA)

Blood tests that may be done include:

• Liver function tests (especially alkaline phosphatase or bilirubin levels) the elevation values of these tests will alert physicians to liver disfunction.
  

Treatment

The goal is to treat the cancer and the blockage it causes. When possible, surgery to remove the tumor is the treatment of choice and may result in a cure. If the tumor is large, the entire liver may need to be removed and a liver transplant will be needed. However, often the cancer has already spread by the time it is diagnosed.
Chemotherapy or radiation may be given after surgery to decrease the risk of the cancer returning. However, the benefit of this treatment is not certain.
Endoscopic therapy with stent placement can temporarily relieve blockages in the biliary ducts and relieve jaundice in patients when the tumor cannot be removed. Laser therapy combined with light-activated chemotherapy medications is another treatment option for those with blockages of the bile duct.

                                         New Treatment for Bile Duct Cancer

                                         Overall Discussion of Bile Cancer

For more information:  http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001336/

or http://www.cancer.gov/cancertopics/types/bileduct