Symptoms of Hodgkin's Disease

Symptoms	Cause
Decreased number of red blood cells (resulting in anemia), white blood cells, and platelets; possibly bone pain	Lymphoma is invading bone marrow
Loss of muscle strength; hoarseness	Enlarged lymph nodes are compressing nerves in the spinal cord or nerves to the vocal cords
Jaundice	Lymphoma is blocking flow of bile from the liver
Swelling of the face, neck, and upper extremities (superior vena cava syndrome)	Enlarged lymph, nodes are blocking flow of blood from the head to the heart
Swellling of legs and feet	Lymphoma is blocking lymphatic flow from the legs
Illness similar to pneumonia	Lymphoma is invading the lungs
Decreased ability to fight infection and increased susceptibility to fungal and viral infections	Disease is continuing to spread

 

Staging Hodgkin's Disease

Before treatment is started, doctors must determine how extensively the lymphoma has spread—the stage of the disease. A superficial examination may detect only a single enlarged lymph node, but staging procedures may detect considerably more disease that's hidden (occult). The disease is classified into four stages based on the extent of its spread and symptoms. Choice of treatment and the prognosis are based on the stage. The chance that treatment will completely cure the disease is excellent for people who have stage I, II, or III disease and better than 50 percent for people who have stage IV disease.

The four stages are subdivided, based on the absence (A) or presence (B) of one or more of the following symptoms: unexplained fever, night sweats, and unexplained loss of more than 10 percent of sweats body weight in the preceding 6 months. For example, a stage may be described as IIA or IIB.

Several procedures are used to stage or evaluate Hodgkin's disease. A chest x-ray helps detect enlarged nodes near the heart. Lymphangiograms are x-rays taken after a small dose of dye that can be seen on x-rays (radiopaque dye) is injected into lymph vessels in the foot. The dye travels to and outlines lymph nodes deep in the abdomen and pelvis. This procedure has largely been replaced by CT scanning of the abdomen and pelvis. Faster and more comfortable than lymphangioraphy, CT is quite accurate in detecting enlarged lymph nodes or spread of the lymphoma to the liver and other organs.

Gallium scanning is another procedure that can be used for staging and following the effects of treatment. A small dose of radioactive gallium is injected into the bloodstream, and 2 to 4 days later, a body scan is performed with a device that detects the radioactivity and then produces an image of the internal organs.

Sometimes surgery to examine the abdomen (laparotomy) is needed to determine whether the lymphoma has spread there. During this procedure, surgeons often remove the spleen (splenectomy) and perform a liver biopsy to determine whether the lymphoma has spread to these organs. A laparotomy is performed only when its results are likely to affect the choice of treatment – for example, when a doctor needs to know whether to use radiation therapy or chemotherapy or both.

Treatment

Two effective treatments are radiation therapy and chemotherapy. With one or both of these treatments, most people who have Hodgkln's disease can be cured.

Radiation therapy alone cures about 90 percent of people who have stage I or II disease. Treat­ments are usually given on an outpatient basis over the course of about 4 or 5 weeks. Radiation is beamed at the affected areas and at the sur­rounding lymph nodes. Greatly enlarged lymph nodes in the chest are treated with radiation ther­apy that is usually preceded or followed by che­motherapy. With this dual approach, 85 percent of the people are cured. Treatment for stage III disease varies with the situation. When a person has no symptoms, sometimes radiation therapy alone is sufficient. However, only 65 to 75 percent of such people are cured. The addition of chemotherapy increases the likelihood of cure to 75 to 80 percent. When a person has symptoms in addition to enlarged lymph nodes, chemotherapy is used with or with­out radiation therapy. For such people, cure rates range from 70 to 80 percent.

In stage IV disease, a combination of chemo­therapy drugs is used. Two common (traditional) combination chemotherapy regimens are MOPP (mechlorethamine, vincristine, procarbazine, and prednisone) and ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine). Each cycle of chemotherapy lasts for 1 month, with total treatment time being 6 or more months. Alternative treatments include other combinations of chemotherapy drugs. Even at this advanced stage of the disease, treatment cures more than 50 percent of the people.

The decision to use chemotherapy in treating Hodgkin's disease is difficult for both patients and doctors. Although chemotherapy greatly im­proves a person's chances for a cure, side effects can be serious. The drugs may cause temporary or permanent sterility, an increased risk of infec­tion, and reversible hair loss. Leukemia and other cancers develop in some people in 5 to 10 years or even longer after treatment with either che­motherapy or radiation therapy and in even more people who have been treated with both.

A person who doesn't improve after radiation therapy or chemotherapy or who improves but then relapses within 6 to 9 months has less of a chance for long-term survival than a person who relapses 1 year or more after the initial treatment. Further chemotherapy combined with large doses of radiation therapy and bone marrow or blood stem-cell transplantation may still be helpful in certain people. Large doses of chemo­therapy combined with bone marrow transplan­tation has a high risk of overwhelming infection, which may be fatal; however, about 20 to 40 per­cent of people who undergo bone marrow trans­plantation remain free of Hodgkin's disease for 3 years or more and may be cured. The best results are achieved in people who are under 55 years old and in otherwise good health.

 

Notes:

tubular channels mycosis Epstein-Barr virus contagious computed tomography night sweats lymph node radiopaque dye dual approach

трубчатые канальцы (лимфатические) микоз вирус Эпштейна-Барра заразный, контагиозный компьютерная томография ночная потливость лимфатический узел рентгенконтрастный двустороннее сближение

Text B. Burkitt's Lymphoma.

Burkitt's lymphoma is a very high grade non-Hodgkin's lymphoma that originates from a B lym­phocyte and tends to spread to areas outside the lymphatic system, such as the bone marrow, blood, central nervous system, and spinal fluid.

Although Burkitt's lymphoma can develop at any age, it's most common in children and young adults, particularly males. It may develop in peo­ple who have AIDS.

Unlike other lymphomas, Burkitt's lymphoma has a specific geographic distribution: it's most common in central Africa and rare in the United States. It's caused by the Epstein-Barr virus, which causes infectious mononucleosis; however, people who have Burkitt's lymphoma can't spread the disease to others.

Symptoms

Large numbers of lymphoma cells may accumulate in the lymph nodes and organs of the abdomen, causing it to swell. Lymphoma cells may invade the small intestine, resulting in blockage or bleeding. The neck and jaw may swell, sometimes painfully.

Diagnosis and Treatment

To make the diagnosis, a doctor performs a bi­opsy of the abnormal tissue and orders proce­dures to determine how far the disease has spread (staging). Rarely is the disease confined to one area (localized). If the lymphoma has spread to the bone marrow, blood, or central nervous system at the time of diagnosis, the prog­nosis is poor.

Without treatment, Burkitt's lymphoma progresses rapidly and is fatal. Surgery may be needed to remove affected parts of the intestine, which otherwise may bleed, become blocked, or rupture. Chemotherapy is intensive. Drugs include combinations of cyclophosphamide, rnethotrexate, vincristine, doxorubicin, and cytarabine. Chemotherapy can cure about 80 percent of those who have localized disease and 70 percent of those who have moderately advanced disease. For disease that has spread widely (dissemi­nated), the usual cure rate is 50 to 60 percent, but it decreases to 20 to 40 percent if the lymphoma has invaded the central nervous system or bone marrow.

 

Notes:

perform moderately istribution

исполнять, выполнять умеренно, сдержанно распределение, распространение

Plasma Cell Disorders

Text A. Introduction.

Plasma cell disorders (plasma cell dyscrasias, monoclonal gammopathies) are conditions in which one group (clone) of plasma cells multiplies excessively and produces a large quantity of abnor­mal antibodies.

Plasma cells develop from lymphocytes, a type of white blood cell, and normally produce anti­bodies to help the body fight infection. There are thousands of different types of plasma cells, found mainly in bone marrow and lymph nodes. Each plasma cell divides and multiplies to form a clone, composed of many identical cells. The cells of a clone produce only one specific type of anti­body (immunoglobulin).

In plasma cell disorders, one clone of plasma cells grows excessively and overproduces one type of antibody-like molecule. Because these cells and the antibodies they produce aren't normal, they don't help protect the body against infections. In addition, normal antibody production often decreases, making a person more susceptible to infections. The ever-increasing number of abnormal plasma cells invades and damages various tissues and organs.

In monoclonal gammopathies of undetermined significance, plasma cells are abnormal but not can­cerous. They produce a large quantity of abnormal antibodies but usually don't cause significant problems. These disorders often remain stable for years—as long as 25 years in some people— and don't require treatment. They're more common in older people. For unknown reasons, these disorders progress to multiple myeloma, a plasma cell cancer, in 20 to 30 percent of people. Mul­tiple myeloma may appear abruptly and usually requires treatment. Macroglobulinemia, another plasma cell disorder, also can develop in people who have monoclonal gammopathies of undetermined significance.

 

Notes:

clone клон (потомство живых организмов, являющееся полной их копией)

abruptly внезапно; неожиданно; скачкообразно

 

Text B. Multiple Myeloma

 

Multiple myeloma is a plasma cell cancer in which a clone of abnormal plasma cells multiplies, forms tumors in the bone marrow, and produces a large quantity of abnormal antibodies that accumulate in the blood or urine.

This uncommon cancer affects men and women equal­ly and usually is seen in people over 40 years old. Its cause is unknown.

Plasma cell tumors (plasmacytomas) are most common in the pelvic bones, spine, ribs, and skull. Occasionally, they develop in areas other than bones, particularly in the lungs and repro­ductive organs.

The abnormal plasma cells almost always pro­duce a large quantity of abnormal antibodies, and the production of normal antibodies is reduced. As a result, people who have multiple myeloma are especially susceptible to infections.

Pieces of the abnormal antibodies frequently end up in the kidneys, damaging them and some­times causing kidney failure. Deposits of antibody pieces in the kidneys or other organs can lead to amyloidosis, another serious disorder. Abnormal antibody pieces in the urine are called Bence Jones proteins.

Symptoms and Diagnosis

Sometimes multiple myeloma is diagnosed be­fore a person has any symptoms—for instance, when an x-ray performed for other reasons re­veals punched-out areas in the bones that are typ­ical of this disorder.

Multiple myeloma often causes bone pain, es­pecially in the spine or ribs, and weakens bones, which may fracture easily. Although bone pain is usually the first symptom, occasionally the dis­order is diagnosed only after anemia (too few red blood cells), recurring bacterial infections, or kid­ney failure develops. Anemia results when the ab­normal plasma cells crowd out the normal cells that produce red blood cells in the bone marrow. Bacterial infections result because abnormal an­tibodies are ineffective against infections. Kidney failure results when pieces of the abnormal anti­bodies (Bence Jones proteins) damage the kidneys.

In rare instances, multiple myeloma interferes with blood flow to the skin, fingers, toes, and nose because the blood thickens (hyperviscosity syndrome). Inadequate flow of blood to the brain can result in neurologic symptoms, such as confu­sion, visual problems, and headaches.

Several blood tests may help a doctor diagnose this disorder. A complete blood cell count may detect anemia and abnormal red blood cells. Usu­ally, the erythrocyte sedimentation rate, a test that measures how quickly red blood cells (erythrocytes) settle to the bottom of a test tube, is abnormally high. Calcium levels are abnormally high in one third of the people who have this disorder because changes in the bone result in calcium leaking into the bloodstream. However, the key diagnostic tests are serum protein electrophoresis and immunoelectrophoresis, blood tests that detect and identify the abnormal anti­body that's the telltale sign of multiple myeloma. This antibody is found in about 85 percent of the people who have this disorder. Also, urine electrophoresis and immunoelectrophoresis can detect Bence Jones proteins, which are found in 30 to 40 percent of the people who have multiple myeloma.

Often, x-rays show loss of bone density (osteoporosis) and punched-out areas of bone destruction. A bone marrow biopsy, in which a sample of marrow is obtained with a needle and syringe and examined under a microscope, shows a large number of plasma cells abnormally arranged in sheets and clusters; the cells also may appear abnormal.

Treatment

Treatment is aimed at preventing or relieving symptoms and complications, destroying abnor­mal plasma cells, and slowing progression of the disorder.

Strong analgesics and radiation therapy directed at the affected bones can help relieve bone pain, which can be severe. People who have multiple myeloma, especially with Bence Jones proteins in the urine, need to drink plenty of fluids to dilute the urine and help prevent dehydration, which can make kidney failure more likely. Staying active is important; prolonged bed rest tends to accelerate osteoporosis and make the bones more vulnerable to fractures. However, running and heavy lifting should be avoided because the bones are weakened.

People who have signs of infection – fever, chills, or reddened areas of the skin – should see a doctor promptly because they may need antibiotics. Those who have severe anemia may need red blood cell transfusions, although for some erythropoietin – a drug that stimulates red blood cell formation – may adequately treat the anemia. High calcium levels in the blood can be treated with prednisone and intravenous fluids and sometimes with diphosphonates, drugs that lower calcium levels. People who have high levels of uric acid in the blood may benefit from allopurinol,

Chemotherapy slows the progression of multiple myeloma by killing the abnormal plasma cells. The drugs most frequently used are melphalan and cyelophosphamide. Because chemotherapy kills normal cells as well as abnormal ones, the blood cells are monitored and the dose is adjusted if the number of normal white blood cells and platelets decreases too much. Corticosteroids such as prednisone or dexamethasone are also given as part of the chemotherapy. For those who have a good response to chemotherapy, the drug interferon may enable the response to last longer.

High-dose chemotherapy combined with radiation therapy is still experimental. Because the combination is so toxic, stem cells must be collected from a person's blood or bone marrow before treatment; these cells are then returned (transplanted) to the person after treatment.

Generally, this procedure is reserved for people who are under 50 years old.

Currently, no cure is available for multiple my­eloma. However, treatment slows its progress in more than 60 percent of its victims. Those who respond to chemotherapy can expect to live for 2 to 3 years after the disorder is diagnosed, some­times much longer. Occasionally, people who sur­vive for many years after successful treatment of multiple myeloma develop leukemia or fibrous tissue (scarring) in the bone marrow. These late complications may result from chemotherapy and often lead to severe anemia and an Increased susceptibility to infections.

 

Notes:

identical cells uncommon cancer fracture erythrocyte sedimentation rate serum protein dehydration susceptibility victim

одинаковые клетки атипичный (неординарный) рак перелом, разрыв мягких тканей скорость оседания эритроцитов сывороточный белок обезвоживание восприимчивость, чувствительность жертва

EXERCISES

Exercise 1. Make up sentences of your own using the following words and phrases from the texts to the chapter “Anemias”.

 

to identify anemia, to be part of smth., to be caused by, excessive bleeding, bloodstream, eventually, encreased production, blood pressure, body’s oxygen supply, lead to a heart attack, sudden loss of blood, to be obvious, to depend on, reliable treatment, to be used again, iron deficiency, the most common causes of anemia, to be likely, to make a diagnosis, bone marrow examination, to take smth. by injection.

 

Exercise 2. Study the texts from the chapter “Bleeding Disorders” and say whether these statements are right or wrong. Correct them if they are wrong.

1. Bleeding disorders may result from abnormalities in the brain vessels.

2. Hemostasis is the body’s way of stopping injured blood vessels from bleeding.

3. Apithelial tissues are the first barrier to blood loss.

4. Allergic purpura develops just after a common cold, but it can be caused by drugs.

5. If a doctor suspects that the allergic reaction is caused by a drug, the drug is discontinued immediately.

6. Hemophilia is a bleeding disorder caused by a deficiency in one of the blood clotting factors.

7. Hemophilia is caused by the inadequate oxygen supply.

8. A child who has hemophilia bruises easily.

9. People who have hemophilia should avoid situations that might provoke bleeding.

10. The hemophiliacs should also avoid certain drugs and certain analgetics that can aggravate bleeding problems.

 

Exercise 3. Learn the definition of the following special tems.

 

blood vessels – a tube that carries blood. A large blood vessel that carries blood away from the heart is called an artery. Smaller vessels with the same function are arterioles. Veins and venules return blood to the heart. The two systems are united by tiny capillaries.

 

plasma – a clear, yellowish liquid which transports 25 trillion red blood cells (erythrocytes) and the many fewer white blood cells (leukocytes). The red cells carry the protein hemoglobin, which carries oxygen to the body cells. The white cells are important in fighting disease.

 

hemorrhage – the escape of a large amount of blood from the blood vessels in a short period. Hemorrhagic disorders include capillary abnormalities, platelet deficiencies, and blood clotting defects characterized by spontaneous and sometimes uncontrollable bleeding.

 

leukemia – usually a fatal disease of the blood-forming tissues characterized by the abnormal proliferation of leukocytes and their precursors and attended by fatique, weakness, lymphadenopathy, and a tendency toward profuse tissue hemorrhage.

 

clot – thick coagulated mass of blood. Clotting is caused by platelets and numerous special proteins found in the blood. Blood clotting prevents uncontrolled bleeding, but it can be dangerous if it blocks the circulation.

 

Exercise 4. Summarize the text “Leukemias” using the following introductory expressions.

 

The text discusses the problem (matter) of…

According to…

It’s worth pointing out that…

I’d like to mention…

It’s sufficient to add that…

Some of the topics to be discussed include…

The text is divided into…parts. In the first part…are described.

It should be stressed that…

Summing up…

It may be concluded that…

The information obtained will help my deeper insight into the subject.

 

Exercise 5. Write a definition of each word part below. Use a dictionary for help.

angio- ______________________________________________

athero- _____________________________________________

carcin- _____________________________________________

dia- _____________________________________________

-gram _____________________________________________

-graph _______________________________________________

graphy________________________________________________

hyper- _______________________________________________

hypo- _____________________________________________

-itis _______________________________________________

-osis ________________________________________________

-plasty_________________________________________________

-rrhea

scler- ________________________________________________

thromb-______________________________________________

-trophy _____________________________________________

Exercise 6. Write the medical meaning of each group of the letters below.

CBC

HIV

AIDS

G-CSF

GM-CSF

CT scan

HTLV-1

Exercise 7. Answer the following questions to the texts from Section “Blood Disorders”.

1. What causes anemia, and what may be the result?

2. What medication is often used to treat anemias (bleeding disorders, leukemias, lymphomas)?

3. What is the etiology of the excessive bleeding?

4. What is the medical term for the condition commonly called bleeding?

5. What is the difference between acute and chronic neutropenia?

6. What diseases is bleeding usually associated with?

7. What are the main symptoms of multiple myeloma?

8. What may be done in of vitamin deficiencies?

9. What are the most common symptoms of hemophilia?

10. Who is more susceptible to bleeding disorders?

11. What medicine is used to prevent blood clots?

12. What is allergic purpura caused by?

Exercise 8. Match the half-sentences in column A with the half-sentences in column B to make correct and complete sentences.

A

1. Red blood cells contain hemoglobin…

2. Simple blood tests can…

3. Blood pressure falls because…

4. Bleeding disorders may result from…

5. Allergic purpura affects mainly…

6. Hemophilia is a bleeding disorder caused by…

7. In acute neutropenia, a person can develop…

8. Limphocytopenia can be caused by…

9. Leukemias usually affect…

10. White blood cells develop from…

11. A complete blood cell count can provide…

12. The type of biopsy depends on…

13. Lymphoma cells may invade…

14. Plasma cells develop from…

15. The abnormal plasma cells produce…

16. Multiple myeloma often causes…

B

a) …which node is enlarged and how much tissue is needed to be certain of the diagnosis.

b) …white blood cells, and produce antibodies to help the body fight infection.

c) …bone pain, especially in the spine or ribs, and weakens bones, which may fracture easily.

d) …a variety of diseases and conditions.

e) …the small intestine, resulting in blocage or bleeding.

f) …deliver it to all parts of the body.

g) …a large quantity of abnormal antibodies.

h) …defects in the blood vessels or from abnormalities in the blood itself.

i) …fever and painful sores (ulcers) around mouth and anus.

j) …identify anemia.

k) …the amount of fluid left in the blood vessels is insufficient.

l) …young children and adults.

m) …a deficiency in one of the blood clotting factors.

n) …the white blood cells.

o) …stem cells in the bone marrow.

p) …the first evidence that a person has leukemia.

q) …which node is enlarged and how much tissue is needed to be certain of the diagnosis.

 

Exercise 9. Underline the correct word or phrase to complete each sentence.

1. Hemophilia is a bleeding disorder caused by a) an abnormal immune reaction; b) a deficiency in one of the blood clotting factors.

2. Anemia can cause a) fatigue, weakness, inability to exercise, and light-headedness; b) liver and kidney failure, and other organ damage.

3. Large numbers of lymphoma cells may accumulate in a) in the bone marrow, destroying and replacing cells that produce normal blood cells; b) the lymph nodes and organs of the abdomen, causing it to swell.

4. Plasma cell disorders are conditions in which a) the number of red blood cells or amount of hemoglobin in them is below normal; b) one group (clone) of plasma cells multiplies excessively and produces a large quantity of abnormal antibodies.

5. Plasma cells develop from a) lymphocytes; b) erythrocytes.

6. Plasma cell tumors are most common in a) the pelvic bones, spine, ribs, and skull; b) liver, spleen, lymph nodes, kidneys, and brain.

 

Exercise 10. Speak on the following:

1. Anemias. Symptoms and Treatments.

2. Bleeding Disorders. Common Causes of Bleeding.

3. Different Types of Leukemias.

4. Symptoms of Multiple Myeloma.

SECTION 5

CANCER

Causes and Risks of Cancer

A cancer is a cell that has lost its normal control mechanisms and thus has unregulated growth. Cancer can develop from any tissue within any organ. As cancer cells grow and multiply, they form a mass of cancerous tissue that invades adjacent tissues and can spread (metastasize), around the body.