BONE MARROW TRANSPLANT

What is bone marrow transplant?

Bone marrow transplant is a procedure in which healthy bone marrow is transplanted into a patient whose bone marrow is not functioning properly. Problems in bone marrow are often caused by chemotherapy or radiation treatment for cancer. This procedure can also be done to correct hereditary blood diseases. The healthy bone marrow may be taken from the patient prior to chemotherapy or radiation treatment (autograft), or it may be taken from a donor (allograft).

What is bone marrow?

Bone marrow is the soft, sponge-like material found inside bones. It contains immature cells called stem cells that produce blood cells. There are three types of blood cells: white blood cells, which fight infection; red blood cells, which carry oxygen to and from organs and tissues; and platelets, which enable the blood to clot.

Why is it done?

If a patient develops a disease of the blood cells, especially cancers such as leukaemia, he may require high doses of chemotherapy to destroy the cancer. However, this also destroys normal blood cells. Alternatively, hereditary or acquired disorders may cause abnormal blood cell production. In these cases, transplantation of healthy bone marrow may save a patient's life. Transplanted bone marrow will restore production of white blood cells, red blood cells, and platelets.

What is the procedure?

Bone marrow transplant patients are usually treated in specialised centres and the patient stays in a special nursing unit (a bone marrow transplant unit) to limit exposure to infections. The hospitalisation period is from 4 to 6 weeks, during which time the patient is isolated and under strict monitoring because of the increased risk of infection and/or bleeding. Donated bone marrow must match the patient's tissue type. It can be taken from the patient, a living relative (usually a brother or a sister), or from an unrelated donor. Donors are matched through special blood tests called HLA tissue typing. Bone marrow is taken from the donor in the operating room while one is unconscious and pain-free (under general anaesthesia). Some of the donor's bone marrow is removed from the top of the hip bone. The bone marrow is filtered, treated, and transplanted immediately or frozen and stored for later use. Then, transplant material is transfused into the patient through a vein and is naturally transported back into the bone cavities where it grows to replace the old bone marrow. Alternatively, blood cell precursors, called stem cells, can be induced to move from the bone marrow to the blood stream using special medications. These stem cells can then be taken from the bloodstream through a procedure called leukapheresis. The patient is prepared for transplantation by administering high doses of chemotherapy or radiation (conditioning). This serves two purposes. First, it destroys the patient's abnormal blood cells or cancer. Second, it inhibits the patient's immune response against the donor bone marrow (graft rejection). Following conditioning, the patient is ready for bone marrow infusion. After infusion, it takes 10 to 20 days for the bone marrow to establish itself. During this time, the patient requires support with blood cell transfusions.

What are the indications?

Bone marrow transplant may be recommended for: Bone marrow deficiency disease caused by: abnormal red blood cell production, such as thalassaemia or sickle cell disease aggressive cancer treatments (chemotherapy, radiation therapy), especially for leukaemia or lymphoma lack of normal blood cell production (aplastic anaemia) Immune system disorders (immunodeficiency) such as: congenital neutropenia severe combined immunodeficiency syndrome Bone marrow transplant is not recommended for: patients with heart, kidney, lungs, or liver disorders patients with other diseases that may limit survival

What are the risks?

The risks for any anaesthesia are: reactions to medications problems breathing Chemotherapy given prior to bone marrow transplant (conditioning) can cause significant toxicity, such as mouth sores, diarrhoea, liver damage, or lung damage. While waiting for bone marrow to grow, the patient is at high risk for infection as also bleeding. The major problem with bone marrow transplants (when the marrow comes from a donor, not the patient) is graft-versus-host disease. The transplanted healthy bone marrow cells may attack the patient's cells as though they were foreign organisms. In this case, drugs to suppress the immune system must be taken, but this also decreases the body's ability to fight infections. Other significant problems with a bone marrow transplant are those of all major organ transplants - finding a donor and the cost. The donor is usually a sibling with compatible tissue. The more siblings the patient has, the more chances there are of finding a compatible donor.

What is the prognosis?

Bone marrow transplant prolongs the life of a patient who would otherwise die. Relatively normal activities can be resumed as soon as the patient feels well enough and after consulting with the doctor. The patient will require attentive follow-up care for 2 to 3 months after discharge from the hospital. It may take 6 months to a year for the immune system to fully recover from this procedure.

*reference NDTV Doctor

Moles can be Cancer

What are moles?

Moles are usually harmless collections of pigmented cells called melanocytes on the skin. They can appear alone or in multiples. Most moles are present on the torso, but they are also commonly found on the face, arms and legs. Moles can also be present in more obscure locations such as the scalp, under the nails, in the armpits and around the genitals. Moles can be cancerous in rare cases.

What are the various types of moles?

Moles vary in colour, shapes and sizes. They can be flesh-coloured, brown, blue or black spots that vary in shape from oval to round. They can be as small as a pinhead or large enough to cover an entire limb. Moles that are larger than 8 inches in diameter and are present at birth are a special problem. They may need to be removed to avoid the risk of cancer. The surface of a mole can be smooth or wrinkled, flat or raised. Moles are likely to change over a lifetime. They may darken with exposure to sun. They also may start out flat and brown in colour and later become slightly raised and lighter in colour. Some may become raised enough that they form a small stalk and are eventually rubbed off. Others may just disappear. Several types of moles have a higher than average risk of becoming cancerous. They include: Congenital moles- Large moles present at birth are called congenital moles or giant hairy moles. These moles may increase the risk of malignant melanoma, a deadly form of skin cancer. Hereditary moles- These moles are about 1/4 inch (6 mm) and irregular in shape and known as atypical (dysplastic) moles. They usually have dark brown centres and lighter, uneven borders. Dysplastic moles have a greater risk of developing malignant melanoma.

What are the causes?

Moles have no known purpose and it is not known why they develop. Women may develop numerous dark moles during pregnancy.

How to take care of moles?

Most moles are harmless and don't require special care. If a mole is irritating or unattractive, however, one can get it removed. All moles that are removed should be examined under a microscope because doctors can't always tell if moles are pre-cancerous or cancerous just by the way they look on the skin. One should monitor moles for changes in size, shape, colour, texture and sensation that may indicate a problem. To take care of moles, the following can be done: Avoid sun exposure, particularly from 10 a.m. to 4 p.m., when ultraviolet rays are most intense. Apply sunscreen with a sun protection factor (SPF) of at least 15 to minimize the risk of skin cancer. Broad-brimmed hats, long sleeves and other protective clothing also help avoiding sunrays that damage the skin. An unattractive mole can be covered up with the help of makeup designed to conceal blemishes. Hair growth on the mole can be clipped close to the skin's surface. Permanent removal of hair on a mole is also possible. Shaving repeatedly over a mole may cause irritation; therefore one should get it removed by a dermatologist. Care should be taken while cutting a mole; the area around the mole should be clean. A dermatologist should be consulted if the mole doesn’t heal properly. The doctor examines the skin from head to toe, including scalp, palms, the soles of feet and the skin between the buttocks. If the doctor suspects that a mole may be cancerous, he may take a sample of the tissue (biopsy) and submit the biopsy for microscopic examination.

What is the treatment?

If a mole is found to be cancerous, the entire mole and a margin of normal tissue around it needs to be removed. Usually a mole that has been removed does not reappear. If it does, a doctor should be consulted immediately. Treatment of most moles usually isn't necessary. For cosmetic reasons, a mole can be removed in several ways: Shave excision: In this method, the area around the mole is numbed and a small blade is used to shave off the mole close to the skin. Punch biopsy: The mole is removed with a small incision or punch biopsy technique, which uses a small cookie-cutter-like device. Excisional surgery: In this method the mole is cut off along with a surrounding margin of healthy skin.

How can moles be prevented?

The skin should be examined carefully on a regular basis. If there is a family history of melanoma, monthly check up of moles is required. Otherwise the moles should be checked every three months, to detect early skin changes that may signal melanoma, the most serious form of skin cancer. Areas that are not exposed to sunlight should also be checked, including the scalp, armpits, feet (the soles and between the toes), and genitals. Women should also examine the skin underneath the breasts

*Reference NDTV Doctor

What is a Pap smear?

A Pap smear is a test that checks for changes in the cells of the cervix. The cervix is the lower part of the uterus that opens into the vagina. Other terms for Pap smear are Papanicolaou smear, Pap test, and cervical smear. The main purpose of the Pap test is to find abnormal cell changes that may arise from cervical cancer or before cancer develops.

What is a pelvic exam?

In a pelvic exam, the uterus, vagina, ovaries, fallopian tubes, bladder and rectum are felt to find any abnormality in their shape or size. During a pelvic exam, an instrument called a speculum is used to widen the vagina so that the upper portion of the vagina and the cervix can be seen.

Why is a Pap smear important?

A Pap smear and pelvic exam are important parts of a woman’s routine health care because they can detect abnormalities that may lead to invasive cancer of the cervix. These abnormalities can be treated before cancer develops. Also, as with many types of cancer, cancer of the cervix is more likely to be treated successfully if it is detected early. The Pap smear tests for abnormal changes in the cervical cells. A precancerous change in the cells, called cervical dysplasia, can be detected by a Pap smear. The abnormal cells can develop into cancer if the dysplasia is not discovered and treated. The Pap smear may also detect viral infections of the cervix, such as genital warts and herpes. It may detect vaginal infections such as infections with yeast or trichomonas. Sometimes the Pap smear can give information about the hormones, especially progesterone and estrogen. Most women should get a Pap smear at least every year, especially if they are sexually active. You are at an increased risk for cervical cancer if: You have had an abnormal Pap smear. You began to have sexual intercourse in your teens or earlier. You have a history of many sexual partners. You or your sexual partner has had genital wart virus infection. You have had vulvar or vaginal cancer. Your sexual partner has or had cancer of the penis. You smoke cigarettes. Your immune system is weakened; for example, because you have had a transplant, you are taking immunosuppressive drugs, or you have AIDS. Pap smears can detect precancerous and cancerous conditions. If these conditions are discovered, there is a good chance that simple treatment will prevent the development or spread of cancer.

How to prepare for a Pap smear?

Do not use vaginal creams during the 2 days before the test. Do not have intercourse within 24 hours before the Pap smear because it can cause inaccurate test results. You should get this test done when you are not menstruating; the best time is between 10 and 20 days after the first day of the last menstrual period.

How is a Pap test done?

A Pap test is simple, quick, and painless; it can be done in a doctor’s office, a clinic, or a hospital. While a woman lies on an exam table, the clinician inserts a speculum into her vagina to widen it. A sample of cells is taken from the cervix with a wooden scraper and/or a small cervical brush. The specimen (or smear) is placed on a glass slide and preserved with a fixative, or is rinsed in a vial of fixative, and is sent to a laboratory for examination.

What happens after the procedure?

If the cells look normal, no treatment is necessary. The Pap test may show that you have an infection. The doctor may treat you for the infection and suggest that you have another Pap test in several months. If the cells look abnormal, more tests may be necessary. Discuss with the doctor when you should return for any tests or a follow-up exam. A Pap test is not 100% accurate. There are newer methods used now for Pap testing, including computer-assisted testing, which are more accurate. However, these newer methods cost more.

*Reference NDTV Doctor

Soya and lower lung cancer risk

Men who don't smoke and eat a lot of soya may have a lower risk of lung cancer.

Soya contains isoflavones, which act similarly to the hormone oestrogen, and may have anti-cancer qualities in hormone-related cancers of the breast and prostate. Cells in the lung have properties that suggest they may also respond to isoflavones.

Researchers studied more than 36,000 Japanese men and more than 40,000 Japanese women, 45 to 74 years old and free of cancer at the start of the study. They followed the women for about 11 years, after surveying their food intake, smoking status, medical history, and other lifestyle factors between 1995 and 1999. Overall rates of lung cancer were small: 481 men - or about one in 75 - and 178 women, or about one in 225 - were diagnosed during the 11 years of the study. Among the slightly more than 13,000 men who never smoked, there were 22 lung cancer cases among men who ate the least soya, and just 13 lung cancer cases among those who ate the most. Soy intake from food varied widely, from about 34 to about 162 grams per day.

After taking a number of factors into account, the risk halved in the highest versus the lowest soy intake group. There were even fewer lung cancer cases among women, so researchers could draw no conclusions about their risks. The researchers noted that in men it may not be the act of eating soya that lowered lung cancer risk in the men. Men who eat soya are maybe more likely to take part in other activities that may lower the risk, or may be more likely to eat other healthy foods. But they did take many of those factors into account.

However, the current study did not gather data on isoflavone supplement use, nor did it look at exposure second-hand smoking. That means these findings should be confirmed among Japanese and other populations. In other words, the study does not provide enough evidence to suggest a change in eating behavior.

- ndtv doctor

A quick guide, what's Lung Cancer

General symptoms of lung cancer

The symptoms of lung cancer may include

• Having a cough most of the time
• A change in a cough you have had for a long time
• Being short of breath
• Coughing up phlegm (sputum) with signs of blood in it
• An ache or pain when breathing or coughing
• Loss of appetite
• Fatigue
• Losing weight

Less common symptoms of lung cancer

Other less common symptoms of lung cancer are usually associated with more advanced lung cancer. They include

• A hoarse voice
• Difficulty swallowing
• Changes in the shape of your fingers and nails called finger clubbing
• Swelling of the face caused by a blockage of a main blood vessel (superior vena cava obstruction)
• Swelling in the neck caused by enlarged lymph nodes
• Pain or discomfort under your ribs on your right side (from the liver)
• Shortness of breath caused by fluid around the lungs (called pleural effusion

Hormone related symptoms

Some types of lung cancer cells produce hormones that get into the bloodstream. These hormones can cause symptoms that do not seem related to the lung cancer. Doctors call them 'paraneoplastic symptoms' or 'paraneoplastic syndrome'. These hormone related symptoms vary from person to person but may include

• Pins and needles or numbness in fingers or toes
• Muscle weakness
• Drowsiness, weakness, dizziness or confusion
• Breast swelling in men
• Blood clots (thrombosis)

These symptoms are uncommon with lung cancer but they can happen. So it is important to tell your doctor about any new symptoms you have noticed. If they are caused by the cancer, you can have treatment to help you feel better.

Symptoms of pancoast tumours

Lung cancer growing right at the top of the lung is called a 'pancoast tumour'. These tumours can cause very specific symptoms. The most common is severe shoulder pain. They can also cause a collection of symptoms called 'Horner's syndrome'. These are

• Drooping or weakness of one eyelid
• Small pupil in that eye
• Loss of sweating on that same side of the face

These symptoms of Horner's syndrome are caused by the tumour pressing on or damaging a nerve that runs up from the neck to that side of the face.

- Refered www.cancerhelp.org.uk

What a primary cancer is

What cancer is

Your body is made up of billions of cells that can only be seen under a microscope. The cells are grouped together to make up the tissues and organs of our bodies.

Normally cells only divide to replace old and worn out cells. Cancer develops when something inside a single cell goes wrong, causing the cell to carry on dividing until it forms a lump or tumour.

A tumour can be either benign or malignant. A benign tumour does not spread to other parts of the body. But a malignant tumour is a cancer and can spread to other parts of the body.

What a primary cancer is

The place where the cancer starts growing is called the primary site. If the cancer is not treated, cells from this primary site can break away and spread to other parts of the body. These escaped cells can then form other cancers, which are known as secondary cancers or metastases.

Cancers are named and treated according to where they started developing in the body even if they have spread to other parts of the body. For example if you have lung cancer that has spread to the liver, it is a lung cancer with liver metastases or secondaries. It is not called liver cancer. This is because the cells in the liver are actually cancerous lung cells. They are not liver cells that have become cancerous.

Why can't they find the primary cancer?

Normally it is easy to find the primary cancer. Either it will be producing symptoms or it will be seen on a scan. But sometimes secondary cancers are found in one or more parts of the body, but the doctor is unable to find the primary site. This is called cancer of unknown primary (UPC or CUP).

There are a number of reasons why the primary cancer cannot be found. It may be that

• The secondary cancer has grown very quickly, whilst the primary cancer is still very small - very small primary cancers may not be seen on scans
• Your immune system has successfully attacked the original primary cancer and it has disappeared altogether, while the secondary cancers are thriving - this is not common, but it can happen
• The primary cancer may have been ‘sloughed off’. This can happen if it was in the digestive system - a small cancer becomes detached from the wall of the bowel, for instance, and is passed out of the body with the faeces.

How doctors know you have an unknown primary cancer

The different types of cells in your body are named firstly according to the body organ they belong to, and secondly according to the job they do. When a cancer develops, it is named according to the type of cell it starts in.

So the type of cancer depends on what the cells look like under a microscope. The cells may look like breast cells that have become cancerous for instance. But sometimes cancer cells don’t look like any particular type of normal cell. The cells are too primitive. They have not become specialized enough to look like breast cells or lung cells. Cells like this are known as ‘poorly differentiated’. This can make it difficult for the doctor to tell what kind of cell the cancer started from. If this is the case, the cancer will be called a poorly differentiated cancer of unknown primary.

Most cancers are cancers of the epithelial cells. Epithelial cells are found in tissues throughout the body. Cancers that start in epithelial tissue are called carcinomas. More than 85% of all cancers are carcinomas. Other types of cancers develop from different types of body cell. They include

• Sarcomas, which develop from the cells muscles, fat, nerves or other soft tissues
• Leukaemias, which are cancers of white blood cells found in the bone marrow and
• Lymphomas, which are cancers of the cells of the immune system.

- Reference www.cancerhelp.org.uk

Stem cell therapy found for leukaemia

In a ray of hope for millions of leukaemia patients, American scientists have claimed to have developed a technique which multiplies the small number of stem cells in the donor blood, making it much more potent for the treatment of the fatal disease.
It also eliminates the need for a matching donor, whose bone marrow is usually transplanted to the patient, according to a study which appeared in the journal Nature Medicine. Traditionally, there was always a risk that the patient’s body may reject the new cells from a donor. The alternate path was to introduce cells extracted from umbilical cords as these cells do not have characteristics which would normally trigger immune rejection. So these cells can be used in any patient, without the need for matching. However, the only disadvantage of this process was that a single cord would not have enough cells to meet the needs of an adult patient.
Now, researchers at Fred Hutchinson Cancer Research Center in Seattle have developed a process in which using a protein they multiply the stem cells in the blood from the umbilical cord before they are transplanted to the patient. The technique has been tested on humans after successful trials on animals, the BBC reported.
leukaemia is a cancer of the blood or bone marrow and is characterized by an abnormal proliferation of blood cells, usually white blood cells — leukocytes. As part of the treatment, the infected bone marrow cells of the patient are killed off and new cells are introduced in their place.

Leukemia - Blood Cancer

Leukemia is a cancer of the blood or bone marrow and is characterized by an abnormal proliferation (production by multiplication) of blood cells, usually white blood cells (leukocytes). Leukemia is a broad term covering a spectrum of diseases. In turn, it is part of the even broader group of diseases called hematological neoplasms.
Signs and symptoms
Common symptoms of chronic or acute leukemia.Damage to the bone marrow, by way of displacing the normal bone marrow cells with higher numbers of immature white blood cells, results in a lack of blood platelets, which are important in the blood clotting process. This means people with leukemia may easily become bruised, bleed excessively, or develop pinprick bleeds (petechiae).
White blood cells, which are involved in fighting pathogens, may be suppressed or dysfunctional. This could cause the patient's immune system to be unable to fight off a simple infection or to start attacking other body cells. Because leukemia prevents the immune system from working normally, some patients experience frequent infection, ranging from infected tonsils, sores in the mouth, or diarrhea to life-threatening pneumonia or opportunistic infections.
Finally, the red blood cell deficiency leads to anemia, which may cause dyspnea and pallor.
Some patients experience other symptoms. These symptoms might include feeling sick, such as having fevers, chills, night sweats and other flu-like symptoms, or feeling fatigued. Some patients experience nausea or a feeling of fullness due to an enlarged liver and spleen; this can result in unintentional weight loss. If the leukemic cells invade the central nervous system, then neurological symptoms (notably headaches) can occur.
All symptoms associated with leukemia can be attributed to other diseases. Consequently, leukemia is always diagnosed through medical tests.
The word leukemia, which means 'white blood', is derived from the disease's namesake high white blood cell counts that most leukemia patients have before treatment. The high number of white blood cells are apparent when a blood sample is viewed under a microscope. Frequently, these extra white blood cells are immature or dysfunctional. The excessive number of cells can also interfere with the level of other cells, causing a harmful imbalance in the blood count.
Some leukemia patients do not have high white blood cell counts visible during a regular blood count. This less-common condition is called aleukemia. The bone marrow still contains cancerous white blood cells which disrupt the normal production of blood cells. However, the leukemic cells are staying in the marrow instead of entering the bloodstream, where they would be visible in a blood test. For an aleukemic patient, the white blood cell counts in the bloodstream can be normal or low. Aleukemia can occur in any of the four major types of leukemia, and is particularly common in hairy cell leukemia.