Text B. Acute Myeloid Leukemia.

Acute myeloid (myelocytic, myelogenous, myeloblastic, myelomonocytic) leukemia is a life-threatening disease in which myelocytes (the cells that normally develop into granulocytes) become cancerous and rapidly replace normal cells in the bone marrow.

This type of leukemia affects people of all ages but mostly adults. Exposure to large doses of ra­diation and use of some cancer chemotherapy drugs increase the likelihood of developing acute myeloid leukemia.

The leukemic cells accumulate in the bone mar­row, destroying and replacing cells that produce normal blood cells. Theyre released into the bloodstream and transported to other organs where they continue to grow and divide. They can form small tumors (chloromas) in or just under the skin and can cause meningitis, anemia, liver and kidney failure, and other organ damage.

Symptoms and Diagnosis

The first symptoms usually occur because the bone marrow fails to produce enough normal blood cells. These symptoms include weakness, shortness of breath, infection, fever, and bleed­ing. Other symptoms may include headaches, vomiting, irritability, and bone and joint pain.

A complete blood cell count can provide the first evidence that a person has leukemia. Very immature white blood cells (blasts) are seen in blood samples examined under a microscope. Also, a bone marrow biopsy is almost always per­formed to confirm the diagnosis and determine the type of leukemia.

Prognosis and Treatment

Between 50 and 85 percent of people who have acute myeloid leukemia respond to treatment. Between 20 and 40 percent of people show no signs of the disease 5 years after treatment; bone marrow transplantation has increased that success rate to between 40 and 50 percent. People over age 50 and those who develop acute myeloid leukemia after undergoing chemotherapy and radiation therapy for other diseases have the poorest prognosis.

Treatment is aimed at bringing about prompt remission – the destruction of all leukemic cells. However, acute myeloid leukemia responds to fewer drugs than other types of leukemia do, and treatment often makes patients sicker before they get better. Patients get sicker because the treatment suppresses bone marrow activity, resulting in fewer white blood cells (particularly granulocytes), and having too few granulocytes makes infection likely. The hospital staff takes meticulous care to prevent infections and promptly treats any that occur with antibiotics. Red blood cell transfusions and platelet transfusions may also be needed.

The first course of chemotherapy generally includes cytarabine for 7 days and daunorubicin for 3 days. Sometimes, additional drugs such as thioguanine or vincristine and prednisone are given, but their role is limited.

People whose disease is in remission usually receive additional chemotherapy (consolidation chemotherapy) a few weeks or months after the initial treatment to help ensure that as many leukemic cells as possible are destroyed.

Treatment to the brain usually isn't needed, and long-term treatment hasn't been shown to improve survival. Bone marrow transplantation may be performed in people who haven't re­sponded to treatment and in younger people who have responded to a first course of treatment, to eradicate any remaining leukemic cells.

 

Notes:

myeloid occur evidence determine respond consolidation chemotherapy

относящийся к спинному или костному мозгу происходить, случаться ясность, наглядность, очевидность определять, устанавливать отвечать консолидированная (объединенная) химиотерапия

Lymphomas

 

Lymphomas are cancers (malignancies) of the lymphatic system.

The lymphatic system carries a specialized type of white blood cells called lymphocytes through a network of tubular channels (lymph vessels) to all parts of the body, including the bone marrow. Scattered throughout this network are collections of lymphocytes in lymphnodes (commonly but incorrectly called lymph glands). Cancerous lymphocytes (lymphoma cells) can be confined to a single lymph node or can spread throughout the body to almost any organ.

The two major types of lymphoma are Hodgkin's lymphoma, more commonly known as Hodgkin's disease, and non-Hodgkin's lymphoma Non-Hodgkin's lymphoma has several subtypes that include Burkitt's lymphoma and mycosis fungoides.

 

Text A. Hodgkin's Disease.

Hodgkin's disease (Hodgkin's lymphoma) is a type of lymphoma distinguished by a particular kind of cancer cell called a Reed-Stemberg cell that has a distinctive appearance under a microscope.

Reed-Sternberg cells are large cancerous lymphocytes that have more than one nucleus. They can be seen when a biopsy specimen of lymph node tissue is examined under a microscope.

Hodgkin's disease is classified into four types on the basis of characteristics of tissue seen under a microscope.

Cause

The disease is more common in males than in females—about three men are affected for every two women. Peo­ple can develop Hodgkin's disease at any age, but it rarely occurs before age 10. It's most common in people between ages 15 and 34 and in those over 60. The cause is unknown, although some authorities suspect a virus, such as the Epstein-Barr virus. However, the disease doesn't appear to be contagious.

Symptoms

Hodgkin's disease usually is discovered when a person has an enlarged lymph node, most often in the neck but sometimes in the armpit or groin. Although usually painless, the enlarged node may be painful for a few hours after a person drinks large amounts of alcohol. Sometimes enlarged lymph nodes deep within the chest or abdomen, which are usually painless, are found unexpect­edly on a chest x-ray or computed tomography (CT) scan performed for other reasons. Along with enlarged lymph nodes, Hodgkin's disease sometimes produces additional symptoms such as fever, night sweats, and weight loss. For reasons not known, the skin may itch in­tensely. Some people have Pel-Ebstein fever, an unusual pattern of high temperature for several days alternating with normal or below-normal temperature for days or weeks. Other symptoms may develop, depending on where the lymphoma cells are growing. A person may have no symp­toms or only a few of these symptoms.

Diagnosis

In Hodgkin's disease, lymph nodes usually en­large slowly and painlessly, with no apparent in­fection. A rapid enlargement of lymph nodes— which may occur when a person has a cold or infection—isn't typical of Hodgkin's disease. If the lymph nodes remain enlarged for more than a week, a doctor may suspect Hodgkin's disease, especially when a person also has a fever, night sweats, and weight loss.

Abnormalities in blood cell counts and other blood tests may provide supportive evidence, but to make the diagnosis, a doctor must perform a biopsy of the affected lymph node to see if Reed-Sternberg cells are present. The type of biopsy depends on which node is enlarged and how much tissue is needed to be certain of the diag­nosis. A doctor must remove enough tissue to be able to distinguish Hodgkin's disease from other diseases that can cause lymph node enlarge­ment—including non-Hodgkin's lymphoma, other cancers with similar symptoms, infectious mononucleosis, toxoplasmosis, cytomegalovirus disease, leukemia, sarcoidosis, tuberculosis, and AIDS.

When the enlarged node is near the surface of the neck, a needle biopsy may be performed. In this procedure, an area of skin is anesthetized and a small piece of the node is removed with a needle and syringe. If this type of biopsy doesn't provide enough tissue to diagnose and classify Hodgkin's disease, a small incision must be made and a larger piece of the lymph node is removed. When the enlarged lymph node is not near the surface— for example, when it is deep within the chest— surgery may be more complex.