Hyperesthesia

• An abnormal or pathological increase in sensitivity to sensory stimuli, as

of the skin to touch or the ear to sound.

Hematenic

• an agent that tends to stimulate blood cell formation or to increase the

hemoglobin in the blood

at is a colposcopy?
LPOSCOPY is a test in which the doctor uses an instrument called a Colposcope to look at the cervix
magnification (The Colposcope is not inserted into your vagina.) The Colposcope looks like a pair of
ulars mounted on a pedestal with a light attached. This instrument magnifies the cervix, vagina and
rnal genital area when the doctor looks through the lenses into the vagina where a speculum has been
d. Different colored filters, similar to those used for cameras are used to block out colors.
ification helps to see abnormal areas clearly so that biopsies (pieces of tissue) can be done precisely.
pieces of tissue are looked at in the laboratory under a microscope. After all the biopsies are taken, a
ing is done inside the cervical canal to make sure there are no abnormal cells past where the doctor can
These scrapings are also sent to the lab to be looked at under the microscope. A Colposcopy is done
abnormal cells are seen on a Pap Smear.

w to Prepare for Your Colposcopy

- Relax, it will not be as bad as you think it will be.

Take 600-800 mg of Aleve or Advil one hour before leaving for your doctor's office. If you are
allergic to ibuprofen, take two Extra-Strength Tylenol.
Make sure you have not started nor will start your period for about two weeks.
Do not use anything in the vagina for 24-48 hours before the procedure. This includes spermicides,
 vaginal medications, douching products or tampons. These all interfere with the accuracy of the test.

Do not have vaginal sex 24 - 48 hours before the procedure because this can also interfere with teh
test's accuracy.

w is it done?
will lie on the examining table just as in a regular pelvic exam. The
colposcope is placed at the vaginal opening in order to examine the genital
area, vagina and cervix. The doctor will use a speculum, the same as used
during your regular examination, to separate the walls of the vagina as in a
smear. The speculum will be moistened with warm water and stays in the
a throughout the procedure. Upon insertion of the speculum, inspection of the vaginal walls will be done.
speculum will be gently rotated so that the entire vagina can be seen. Next, the speculum is placed so
the cervix is completely visible. While looking through the colposcope, your doctor will do a Pap Smear
will be sent to the lab with any other tissue samples, called biopsies, that may be taken dung your
ination. The Pap Smear is done as usual, making sure that cells from the Transformation Zone are
ded in the smear. The doctor will then look at your cervix under 2 - 3 different magnifications.
excess mucus or other secretions will be cleaned from the cervix using a large cotton swab. After this, a
sensation will be felt. This is the application of acetic acid, a vinegar solution, that will enable abnormal
to be more visible. This may sting a bit. Acetic acid dissolves mucous and accentuates atypical areas
e epithelium, punctation, mosaic and atypical vessels) by causing cellular dehydration and coagulation of
ar protein.
he effect of the acetic acid peaks in approximately 2 minutes and fades in approximately 5 minutes.
use of this, your doctor may need to re-apply the acetic acid solution several times. Areas of the cervix
turn white after the acetic acid has been applied. These areas are called White (or aceto-white)
elium. White epithelium is sometimes associated with dysplasia. These areas will be biopsied by your
r near the end of the procedure.
e the acetic acid is used, she will also look at your cervix using different colored filters to be able to see
blood vessel patterns that can't be seen using regular light. The green filter absorbs the red color so
the pattern of the cervical blood vessels can be seen. There are three abnormal blood vessel patterns
may be found during this part of the examination: mosaic, puntate, and atypical. If any blood vessel
rns are found, these areas will also be biopsied near the end of the procedure.
After looking through the red-free filter, your doctor will paint the cervix
vagina with an iodine solution called Lugol's Solution. This stains the
gen, a component of cells. Mature, normal cells will stain a dark-brown color. Immature cells, cervicitis,
dyspasia cells will not stain. This is called a Schiller Test. Non-staining areas will biopsied.

your doctor will biopsy, cut small pieces of tissue, from all the
areas that were noted during the examination. There are
several different kinds of instruments made to do this. This
give you an example of them.
The biopsies are then done by your doctor. She will make a
notation on your chart of all the areas that have been
ied. These are noted using the hands of the clock, i.e.. 10:00, 1:00, etc. You may experience a pinch
en cramping when the biopsies are done. Each piece of tissue is placed in a separate jar and labeled
the clock method.
raping if the endocervical canal (ECC) will be done by a thin instrument called an endocervical curette.
may cause some cramping.
y, your doctor will apply pressure to the cervix using a large cotton swab to stop any bleeding from the
y areas. If this doesn't work, a solution called Monsel's Solution or silver nitrate will be applied to the
x. This will stop any bleeding that is happening.
r the procedure is finished, your doctor will explain what she found. She will also tell you to expect a
arge similar to coffee grounds. This comes from the solution used to stop the bleeding. You will also be
not to put ANYTHING into your vagina for two weeks - this includes having sex and tampons.

at are the Risks and Complications?

are very slight and are. You may have some minor bleeding from the biopsy sights.
lications that can occur are:heavy bleeding (more than one pad per hour or more bleeding than your
trual flow); fever; infection; and pelvic or abdominal pain.

at happens after a Colposcopy?

will return to see your doctor 1 - 2 weeks after your procedure to discuss what the laboratory saw on the
ies and the ECC. She will then discuss the options for treatment if anything has been found.

Schillers test
test for cancer of the cervix, in which the cervix is stained with a solution of iodine turns
dark brown in all non cancerous areas.

Prostate Cancer Treatment

Surgery Surgery is an option for many prostate cancer patients. A prostatectomy and
lymphadenectomy are both surgeries used to treat prostate cancer.

.u wave
The U wave is not always seen. It is typically small, and, by definition, follows the T
wave. U waves are thought to represent repolarization of the papillary muscles or
Purkinje fibers. Prominent U waves are most often seen in hypokalemia, but may be
present in hypercalcemia, thyrotoxicosis, or exposure to digitalis, epinephrine, and Class
1A and 3 antiarrhythmics, as well as in congenital long QT syndrome and in the setting of
intracranial hemorrhage. An inverted U wave may represent myocardial ischemia or left
ventricular volume overload.[13]

. Cholangiogram: A radiologic procedure used to look at the gallbladder and

bile

cholecystogram is an x-ray procedure used to look for gallstones in the

gallbladder or bile duct.
Overview

Benign prostatic hyperplasia (BPH) is not simply a case of too many prostate cells.
Prostate growth involves hormones, occurs in different types of tissue (e.g., muscular,
glandular), and affects men differently. As a result of these differences, treatment varies
in each case. There is no cure for BPH and once prostate growth starts, it often continues,
unless medical therapy is started.

The prostate grows in two different ways. In one type of growth, cells multiply around
the urethra and squeeze it, much like you can squeeze a straw. The second type of growth
is middle-lobe prostate growth in which cells grow into the urethra and the bladder outlet
area. This type of growth typically requires surgery.

The prostate is a walnut-sized gland located beneath the bladder and in front of the
rectum. It is surrounded by a capsule of fibrous tissue called the prostate capsule. The
urethra (tube that transports urine and sperm out of the body) passes through the prostate
to the bladder neck. Prostate tissue produces prostate specific antigen and prostatic acid
phosphatase, an enzyme found in seminal fluid (the milky substance that combines with
sperm to form semen).

Incidence and Prevalence

It is difficult to establish incidence and prevalence of BPH because research groups often
use different criteria to define the condition. According to the National Institutes of
Health (NIH), BPH affects more than 50% of men over age 60 and as many as 90% of
men over the age of 70.

The cause of benign prostatic hyperplasia is unknown. It is possible that the

condition is associated with hormonal changes that occur as men age. The testes
produce the hormone testosterone, which is converted to dihydrotestosterone (DHT)
and estradiol (estrogen) in certain tissues. High levels of dihydrotestosterone, a
testosterone derivative involved in prostate growth, may accumulate and cause
hyperplasia. How and why levels of DHT increase remains a subject of research.

Common symptoms of benign prostatic hyperplasia include the following:

Blood in the urine (i.e., hematuria), caused by straining to void

• Dribbling after voiding

• Feeling that the bladder has not emptied completely after urination
• Frequent urination, particularly at night (i.e., nocturia)
• Hesitant, interrupted, or weak urine stream caused by decreased force
• Leakage of urine (i.e., overflow incontinence)
• Pushing or straining to begin urination
• Recurrent, sudden, urgent need to urinate

In severe cases of BPH, another symptom, acute urinary retention (the inability to
urinate), can result from holding urine for a long time, alcohol consumption, long period
of inactivity, cold temperatures, allergy or cold medications containing decongestants or
antihistamines, and some prescription drugs (e.g., ipratropium bromide, albuterol,
epinephrine). Any of these factors can prevent the urinary sphincter from relaxing and
allowing urine to flow out of the bladder. Acute urinary retention causes severe pain and
discomfort. Catheterization may be necessary to drain urine from the bladder and obtain

• Surgical treatments
o Transurethral resection of the prostate (TURP)
o Holmium laser enucleation of the prostate (HoLEP)
o Prostatectomy
o Transurethral incision of the prostate (TUIP)

Fluorouracil
(flure oh yoor' a sill)Transurethral ultrasound-guided laser incision of the This medication
is used to treat:

• colon cancer
• rectal cancer
• breast cancer
• stomach cancer
 • pancreatic cancer

This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more
information.

Fluorouracil belongs to a group of drugs known as antimetabolites. It resembles a normal cell

nutrient needed by cancer cells to grow. The cancer cells take up fluorouracil, which then
interferes with their growth.

Precautions Return to top

Before taking fluorouracil,

• tell your doctor and pharmacist if you are allergic to fluorouracil or any other drugs.
• tell your doctor and pharmacist what prescription and nonprescription medications you
are taking, especially aspirin, leucovorin, and vitamins.
• you should know that fluorouracil may interfere with the normal menstrual cycle (period)
in women and may stop sperm production in men. However, you should not assume that
you cannot get pregnant or that you cannot get someone else pregnant. Women who are
pregnant or breast-feeding should tell their doctors before they begin taking this drug.
You should not plan to have children while receiving chemotherapy or for a while after
treatments. (Talk to your doctor for further details). Use a reliable method of birth control
to prevent pregnancy. Fluorouracil may harm the fetus.
• do not have any vaccinations (e.g., measles or flu shots) without talking to your doctor.

Side effects from fluorouracil are common and include:

• thinned or brittle hair

• headache
• weakness or achiness
• drying or darkening of the skin or nails
• sensitivity of skin to sunlight
• blistering skin or acne
• loss of appetite or weight
• tingling in the hands or feet

Tell your doctor if either of these symptoms is severe or lasts for several hours:

• mouth blistering
• fatigue

If you experience any of the following symptoms, call your doctor immediately:

• painful urination or red urine

• black, tarry stools
• diarrhea
 • stomach pain
• unusual bruising or bleeding
• swelling of the feet or legs
• cough
• fever
• sore throat
• nausea and vomiting
• rash
• yellowing of the skin or eyes

joint painAcute
lymphocytic leukemia (ALL) is a type of cancer in which
the bone marrow makes too many lymphocytes, which is a type of
white blood cell. Acute lymphocytic leukemia, which is also called
acute lymphoblastic leukemia, accounts for about 3,800 new cases of
leukemia each year. Although acute lymphocytic leukemia is the most
common type of leukemia in young children, it can also affect adults.

This eMedTV article discusses acute lymphocytic leukemia for both

children and adults. You can click Childhood Acute Lymphoblastic
Leukemia for more information on childhood ALL or Adult Acute
Lymphoblastic Leukemia for more information on adult ALL. You can
also click Types of Leukemia to learn about other leukemia types.

Acute Lymphocytic Leukemia and Blood Cells

Normally, the body produces bone marrow stem cells (immature cells)
that develop into mature blood cells.

The three types of mature blood cells include:

• Red blood cells that carry oxygen and other materials to all
tissues of the body
• White blood cells that fight infection and disease
• Platelets that help prevent bleeding by causing blood clots to
form.

In acute lymphocytic leukemia, too many stem cells develop into a

type of white blood cell called lymphocytes. These lymphocytes may
also be called lymphoblasts or leukemia cells.

The three types of lymphocytes include:

 • B lymphocytes that make antibodies to help fight infection
• T lymphocytes that help B lymphocytes make the antibodies that
help fight infection
• Natural killer cells that attack cancer cells and viruses.

In acute lymphocytic leukemia:

• The lymphocytes are not able to fight infection very well

• The number of lymphocytes increases in the blood and bone
marrow
• There is less room for healthy white blood cells, red blood cells,
and platelets.

This may cause infection, anemia, and easy bleeding. Acute

lymphocytic leukemia can also spread to the central nervous system
(brain and spinal cord).

Chr onic lymphocytic leukemia (CLL) is a disorder of

morphologically mature but immunologically less mature lymphocytes and is manifested
by progressive accumulation of these cells in the blood, bone marrow, and lymphatic
tissues. Lymphocyte counts in the blood are usually equal to or higher than 10,000 per
cubic millimeter.[1] There is no curative therapy. The overall 5-year survival is
approximately 60%, but depends on stage of disease. Antileukemic therapy is frequently
unnecessary in uncomplicated early disease.[2]

CLL occurs primarily in middle-aged and elderly individuals, with increasing frequency
in successive decades of life.[3] The clinical course of this disease progresses from an
indolent lymphocytosis without other evident disease to one of generalized lymphatic
enlargement with concomitant pancytopenia. Complications of pancytopenia, including
hemorrhage and infection, represent a major cause of death in these patients.[4]
Immunological aberrations, including Coombs-positive hemolytic anemia, immune
thrombocytopenia, and depressed immunoglobulin levels may all complicate the
management of CLL.[5]

Chronic lymphocytic leukemia (CLL) has no standard staging system. The Rai staging
system and the Binet classification are presented below.[1,2] An NCI-sponsored working
group has formulated standardized guidelines for eligibility, response, and toxic effects
criteria to be used in future clinical trials in CLL.[3]
Rai Staging System

Stage 0

Stage 0 chronic lymphocytic leukemia: absolute lymphocytosis (>15,000 per cubic

millimeter) without adenopathy, hepatosplenomegaly, anemia, or thrombocytopenia.

Stage I

Stage I chronic lymphocytic leukemia: absolute lymphocytosis with lymphadenopathy

without hepatosplenomegaly, anemia, or thrombocytopenia.

Stage II

Stage II chronic lymphocytic leukemia: absolute lymphocytosis with either hepatomegaly

or splenomegaly, with or without lymphadenopathy.

Stage III

Stage III chronic lymphocytic leukemia: absolute lymphocytosis and anemia

(hemoglobin <11 g/dL) with or without lymphadenopathy, hepatomegaly, or
splenomegaly.

Stage IV

Stage IV chronic lymphocytic leukemia: absolute lymphocytosis and thrombocytopenia

(<100,000 per cubic millimeter) with or without lymphadenopathy, hepatomegaly,
splenomegaly, or anemia.

Binet classification

Clinical stage A: no anemia or thrombocytopenia and fewer than three areas of lymphoid
involvement (Rai stages 0, I, and II)*

Clinical stage B: no anemia or thrombocytopenia with three or more areas of lymphoid

involvement (Rai stages I and II)*

Clinical stage C: anemia and/or thrombocytopenia regardless of the number of areas of

lymphoid enlargement (Rai stages III and IV)

*Lymphoid areas include cervical, axillary, inguinal, and spleen.

Leukemia is a form of cancer that affects the body's blood-making system, including the
lymphatic system and bone marrow. Leukemia is either acute (coming on suddenly) or
chronic (lasting a long time). Chronic leukemia rarely affects children, whereas acute
leukemia affects both adults and children.
Leukemia accounts for about 2% of all cancers. It strikes 9 out of every 100,000 people in
the United States every year. Men are more likely to develop leukemia than women, and
white people get the disease more than other racial or ethnic groups. Adults are 10 times
more likely to develop leukemia than children. Leukemia occurs most often in the elderly.
When leukemia occurs in children, it happens most often before age 4.

Acute Leukemia
With acute leukemia, immature blood cells reproduce quickly in the bone marrow, where
they eventually crowd out healthy cells. When present in high numbers, these immature,
abnormal cells sometimes can spread to other organs, causing damage, especially in a type
of leukemia called acute myeloid leukemia. The two main types of acute leukemia involve
different types of blood cells:

• Acute lymphoid leukemia is the most common type of leukemia that affects children,
mainly those younger than 10. Adults sometimes develop acute lymphoid leukemia,
but it is rare in people older than 50. It occurs when primitive blood-forming cells
called lymphoblasts reproduce without developing into normal blood cells. These
abnormal cells crowd out healthy blood cells. They can collect in the lymph nodes
and cause swelling.

• Acute myeloid leukemia accounts for 50% of leukemia diagnosed in teenagers and in
people in their 20s. It is the most common acute leukemia in adults. It occurs when
primitive blood-forming cells called myeloblasts reproduce without developing into
normal blood cells. Immature myeloblast cells crowd the bone marrow and interfere
with the production of healthy normal blood cells. This leads to anemia (not having
enough red blood cells), bleeding and bruising (due to a lack of blood platelets,
which help the blood to clot), and frequent infections because there are not enough
protective white blood cells.

Chronic Leukemia
Chronic leukemia is when the body produces too many blood cells that have developed part
way but often cannot function like mature blood cells. Chronic leukemia usually develops
more slowly and is a less dramatic illness than acute leukemia. There are two main types of
chronic leukemia:

• Chronic lymphoid leukemia is rare in people younger than 30. It is more likely to
develop the older a person gets. The greatest number of cases occur in people
between ages 60 and 70. In this form of leukemia, the abnormal cells in the bone
marrow are a type of blood cell called lymphocytes. These abnormal cells cannot
fight infection as well as normal cells can. With chronic lymphoid leukemia,
cancerous cells live in the bone marrow, blood, spleen and lymph nodes, where they
cause swelling that appears as swollen glands.

• Chronic myeloid leukemia occurs most often in people between ages 25 and 60. In
this form of leukemia, the abnormal cells are a type of blood cell called myeloid cells.
Chronic myeloid leukemia cells usually involve an abnormality in the genetic code
called the Philadelphia chromosome. However, this disease is not an inherited defect.
Chronic myeloid leukemia sometimes can be cured with a bone marrow transplant.

The vast majority of leukemias occur in people without any family history of leukemia and
are not believed to be inherited. However, some forms of the disease, especially chronic
lymphoid leukemia, occasionally strike close relatives in the same family. Certain genetic
abnormalities (such as Down syndrome ) have been linked to the development of specific
forms of leukemia. In cases of myeloid leukemia, an increased risk of the illness has been
linked to excessive exposure to radiation and to heavy exposure to benzene, a chemical
found in unleaded gasoline.
Symptoms
Early symptoms of leukemia are like symptoms of the flu or other common diseases.
Symptoms include:

• Fever
• Fatigue
• Aches in bones or joints
• Headaches
• Skin rashes
• Swollen glands (lymph nodes)
• Frequent infections
• Unexplained weight loss
• Bleeding or swelling of gums
• An enlarged spleen or liver, or a feeling of abdominal fullness
• Slow-healing cuts, nosebleeds or frequent bruises

Diagnosis
Your doctor may not suspect leukemia based on your symptoms alone. However, during
your physical examination, your doctor may discover that you have swollen lymph nodes or
an enlarged liver or spleen. The diagnosis may become clearer when routine blood tests
(especially blood cell counts) show abnormal results. Other tests will be done, including a
bone marrow biopsy (a sample of bone marrow is removed and examined), more blood
tests to detect the presence of abnormal cells and, sometimes, tests for genetic
abnormalities, such as the Philadelphia chromosome.

Expected Duration
In general, chronic leukemia progresses more slowly than acute leukemia. Without a
relatively new drug — imatinib (Gleevec) — or a bone marrow transplant, people with
chronic myeloid leukemia typically have several years of stability before developing a
picture more like acute myeloid leukemia. Whether imatinib can delay or prevent the
transformation from a chronic leukemia to an acute leukemia remains to be seen.

Prevention
There is no way to prevent most forms of leukemia. In the future, genetic testing may play
a larger role in identifying people who are more likely to develop the illness. Until then,
close relatives of people with leukemia should undergo routine physical exams, unless
suspicious symptoms develop.

Treatment
Acute Leukemia
Unlike other cancers, the treatment of acute leukemia does not depend on how far the
disease has advanced but on the person's condition and on whether the person is newly
diagnosed, continuing treatment or in remission (the disease is controlled) or the disease
has come back after a remission.

With acute lymphoid leukemia, treatment generally occurs in phases, although not all
phases are used for all people with the disease:
 • Phase 1 (called induction therapy) uses chemotherapy in the hospital to try to control
the disease.
• Phase 2 (called consolidation) continues chemotherapy, but on an outpatient basis
(returning to the hospital for treatment, but not staying overnight) to keep the
person in remission.
• Phase 3 (called prophylaxis) uses different chemotherapy drugs, sometimes
combined with radiation therapy, to prevent the leukemia from entering the brain
and central nervous system.
• Phase 4 (called maintenance) involves regular physical exams and laboratory tests
after the leukemia has been treated to be sure that it has not returned.
• Recurrent leukemia uses different doses of various chemotherapy drugs to combat a
disease that has returned. People may need several years of chemotherapy to keep
the leukemia in remission. Some people may receive a bone marrow transplant.

With acute myeloid leukemia, treatment generally depends on the type of the disease, as
well as the person's age and overall health. Usually people receive induction therapy in an
effort to send the leukemia into remission. Consolidation therapy also is used. For all types
of acute leukemia, a bone marrow transplant is an option when chemotherapy alone has
been less successful.

Chronic Leukemia
For chronic lymphoid leukemia, the next step after diagnosis is to determine the extent of
the cancer. This is called staging. There are four stages of chronic lymphoid leukemia:

• Stage 0 — There are too many lymphocytes in the blood. Generally, there are no
other symptoms of leukemia.
• Stage I — Lymph nodes are swollen because of too many lymphocytes in the blood.
• Stage II — Lymph nodes, spleen and liver are swollen as a result of an
overabundance of lymphocytes.
• Stage III — Anemia has developed because there are too few red blood cells in the
blood.
• Stage IV — There are too few platelets in the blood. Lymph nodes, spleen and liver
may be swollen. Anemia may be present.

Treatment of chronic lymphoid leukemia depends on the stage of the disease, as well as on
the person's age and overall health. In the earliest stage, treatment may not be needed,
although the person's health will be monitored closely. In Stage I or II, observation or
chemotherapy is the usual treatment. In Stage III or IV, intensive chemotherapy or
multiple-drug chemotherapy may be used. Some people also may be treated with a bone
marrow transplant.

For chronic myelogenous leukemia, a drug called imatinib has become standard therapy,
especially for those in the early stage of this disease. Whether a bone marrow transplant
also is done depends on the stage of the disease, the health of the patient, and whether a
suitable bone marrow donor is available.

When To Call A Professional

Call your doctor if you have frequent infections, abnormal bruising or bleeding, swollen
glands, unexplained weight loss, persistent fatigue or any other symptoms of leukemia.

Prognosis
Overall, about 42% of people with leukemia live for at least five years after they are
diagnosed. However, the survival rate varies a lot among the different types of leukemia:

• Acute lymphoid leukemia — In general, children with this cancer have a 90% chance
of complete remission, with an 80% five-year survival rate. The adult prognosis is
not as good, with only 25% to 35% of adults surviving for five years.

• Acute myeloid leukemia — With proper treatment, 70% to 75% of people with this
cancer can expect to go into remission. About 80% who go into remission will do so
within one month of induction therapy. In some people, however, the disease will
return, lowering the cure rate to no more than 40%.

• Chronic lymphoid leukemia — On average, people with this cancer survive 9 years,
although some have survived as long as 35 years. In Stage I or II, remission occurs
in about 70% of people treated with chemotherapy, although the cancer always
comes back eventually.

• Chronic myeloid leukemia — How long people with chronic myeloid leukemia survive
depends on the age of the person, the extent of the disease and the treatments
used. For example, 60% of people younger than 40 with mild symptoms survive
three years after treatment if they have a bone marrow transplant. Only 15% to
25% of those without a transplant live longer than five years. A few people have
lived as long as 20 years. Even the few years of experience with imatinib suggest
that the drug will improve survival rates. However, how much the drug helps won't
be known for some time.

Leukemia is a form of cancer that affects the body's blood-making system, including the
lymphatic system and bone marrow. Leukemia is either acute (coming on suddenly) or
chronic (lasting a long time). Chronic leukemia rarely affects children, whereas acute
leukemia affects both adults and children.

Leukemia accounts for about 2% of all cancers. It strikes 9 out of every 100,000 people in
the United States every year. Men are more likely to develop leukemia than women, and
white people get the disease more than other racial or ethnic groups. Adults are 10 times
more likely to develop leukemia than children. Leukemia occurs most often in the elderly.
When leukemia occurs in children, it happens most often before age 4.

Acute Leukemia
With acute leukemia, immature blood cells reproduce quickly in the bone marrow, where
they eventually crowd out healthy cells. When present in high numbers, these immature,
abnormal cells sometimes can spread to other organs, causing damage, especially in a type
of leukemia called acute myeloid leukemia. The two main types of acute leukemia involve
different types of blood cells:

• Acute lymphoid leukemia is the most common type of leukemia that affects children,
mainly those younger than 10. Adults sometimes develop acute lymphoid leukemia,
but it is rare in people older than 50. It occurs when primitive blood-forming cells
called lymphoblasts reproduce without developing into normal blood cells. These
abnormal cells crowd out healthy blood cells. They can collect in the lymph nodes
and cause swelling.

• Acute myeloid leukemia accounts for 50% of leukemia diagnosed in teenagers and in
people in their 20s. It is the most common acute leukemia in adults. It occurs when
primitive blood-forming cells called myeloblasts reproduce without developing into
normal blood cells. Immature myeloblast cells crowd the bone marrow and interfere
with the production of healthy normal blood cells. This leads to anemia (not having
 enough red blood cells), bleeding and bruising (due to a lack of blood platelets,
which help the blood to clot), and frequent infections because there are not enough
protective white blood cells.

Chronic Leukemia
Chronic leukemia is when the body produces too many blood cells that have developed part
way but often cannot function like mature blood cells. Chronic leukemia usually develops
more slowly and is a less dramatic illness than acute leukemia. There are two main types of
chronic leukemia:

• Chronic lymphoid leukemia is rare in people younger than 30. It is more likely to
develop the older a person gets. The greatest number of cases occur in people
between ages 60 and 70. In this form of leukemia, the abnormal cells in the bone
marrow are a type of blood cell called lymphocytes. These abnormal cells cannot
fight infection as well as normal cells can. With chronic lymphoid leukemia,
cancerous cells live in the bone marrow, blood, spleen and lymph nodes, where they
cause swelling that appears as swollen glands.

• Chronic myeloid leukemia occurs most often in people between ages 25 and 60. In
this form of leukemia, the abnormal cells are a type of blood cell called myeloid cells.
Chronic myeloid leukemia cells usually involve an abnormality in the genetic code
called the Philadelphia chromosome. However, this disease is not an inherited defect.
Chronic myeloid leukemia sometimes can be cured with a bone marrow transplant.

The vast majority of leukemias occur in people without any family history of leukemia and
are not believed to be inherited. However, some forms of the disease, especially chronic
lymphoid leukemia, occasionally strike close relatives in the same family. Certain genetic
abnormalities (such as Down syndrome ) have been linked to the development of specific
forms of leukemia. In cases of myeloid leukemia, an increased risk of the illness has been
linked to excessive exposure to radiation and to heavy exposure to benzene, a chemical
found in unleaded gasoline.

Symptoms
Early symptoms of leukemia are like symptoms of the flu or other common diseases.
Symptoms include:

• Fever
• Fatigue
• Aches in bones or joints
• Headaches
• Skin rashes
• Swollen glands (lymph nodes)
• Frequent infections
• Unexplained weight loss
• Bleeding or swelling of gums
• An enlarged spleen or liver, or a feeling of abdominal fullness
• Slow-healing cuts, nosebleeds or frequent bruises

Diagnosis
Your doctor may not suspect leukemia based on your symptoms alone. However, during
your physical examination, your doctor may discover that you have swollen lymph nodes or
an enlarged liver or spleen. The diagnosis may become clearer when routine blood tests
(especially blood cell counts) show abnormal results. Other tests will be done, including a
bone marrow biopsy (a sample of bone marrow is removed and examined), more blood
tests to detect the presence of abnormal cells and, sometimes, tests for genetic
abnormalities, such as the Philadelphia chromosome.

Expected Duration
In general, chronic leukemia progresses more slowly than acute leukemia. Without a
relatively new drug — imatinib (Gleevec) — or a bone marrow transplant, people with
chronic myeloid leukemia typically have several years of stability before developing a
picture more like acute myeloid leukemia. Whether imatinib can delay or prevent the
transformation from a chronic leukemia to an acute leukemia remains to be seen.

Prevention
There is no way to prevent most forms of leukemia. In the future, genetic testing may play
a larger role in identifying people who are more likely to develop the illness. Until then,
close relatives of people with leukemia should undergo routine physical exams, unless
suspicious symptoms develop.

Treatment
Acute Leukemia
Unlike other cancers, the treatment of acute leukemia does not depend on how far the
disease has advanced but on the person's condition and on whether the person is newly
diagnosed, continuing treatment or in remission (the disease is controlled) or the disease
has come back after a remission.

With acute lymphoid leukemia, treatment generally occurs in phases, although not all
phases are used for all people with the disease:

• Phase 1 (called induction therapy) uses chemotherapy in the hospital to try to control
the disease.
• Phase 2 (called consolidation) continues chemotherapy, but on an outpatient basis
(returning to the hospital for treatment, but not staying overnight) to keep the
person in remission.
• Phase 3 (called prophylaxis) uses different chemotherapy drugs, sometimes
combined with radiation therapy, to prevent the leukemia from entering the brain
and central nervous system.
• Phase 4 (called maintenance) involves regular physical exams and laboratory tests
after the leukemia has been treated to be sure that it has not returned.
• Recurrent leukemia uses different doses of various chemotherapy drugs to combat a
disease that has returned. People may need several years of chemotherapy to keep
the leukemia in remission. Some people may receive a bone marrow transplant.

With acute myeloid leukemia, treatment generally depends on the type of the disease, as
well as the person's age and overall health. Usually people receive induction therapy in an
effort to send the leukemia into remission. Consolidation therapy also is used. For all types
of acute leukemia, a bone marrow transplant is an option when chemotherapy alone has
been less successful.
Chronic Leukemia
For chronic lymphoid leukemia, the next step after diagnosis is to determine the extent of
the cancer. This is called staging. There are four stages of chronic lymphoid leukemia:

• Stage 0 — There are too many lymphocytes in the blood. Generally, there are no
other symptoms of leukemia.
• Stage I — Lymph nodes are swollen because of too many lymphocytes in the blood.
• Stage II — Lymph nodes, spleen and liver are swollen as a result of an
overabundance of lymphocytes.
• Stage III — Anemia has developed because there are too few red blood cells in the
blood.
• Stage IV — There are too few platelets in the blood. Lymph nodes, spleen and liver
may be swollen. Anemia may be present.

Treatment of chronic lymphoid leukemia depends on the stage of the disease, as well as on
the person's age and overall health. In the earliest stage, treatment may not be needed,
although the person's health will be monitored closely. In Stage I or II, observation or
chemotherapy is the usual treatment. In Stage III or IV, intensive chemotherapy or
multiple-drug chemotherapy may be used. Some people also may be treated with a bone
marrow transplant.

For chronic myelogenous leukemia, a drug called imatinib has become standard therapy,
especially for those in the early stage of this disease. Whether a bone marrow transplant
also is done depends on the stage of the disease, the health of the patient, and whether a
suitable bone marrow donor is available.

When To Call A Professional

Call your doctor if you have frequent infections, abnormal bruising or bleeding, swollen
glands, unexplained weight loss, persistent fatigue or any other symptoms of leukemia.

Prognosis
Overall, about 42% of people with leukemia live for at least five years after they are
diagnosed. However, the survival rate varies a lot among the different types of leukemia:

• Acute lymphoid leukemia — In general, children with this cancer have a 90% chance
of complete remission, with an 80% five-year survival rate. The adult prognosis is
not as good, with only 25% to 35% of adults surviving for five years.

• Acute myeloid leukemia — With proper treatment, 70% to 75% of people with this
cancer can expect to go into remission. About 80% who go into remission will do so
within one month of induction therapy. In some people, however, the disease will
return, lowering the cure rate to no more than 40%.

• Chronic lymphoid leukemia — On average, people with this cancer survive 9 years,
although some have survived as long as 35 years. In Stage I or II, remission occurs
in about 70% of people treated with chemotherapy, although the cancer always
comes back eventually.

• Chronic myeloid leukemia — How long people with chronic myeloid leukemia survive
depends on the age of the person, the extent of the disease and the treatments
used. For example, 60% of people younger than 40 with mild symptoms survive
three years after treatment if they have a bone marrow transplant. Only 15% to
 25% of those without a transplant live longer than five years. A few people have
lived as long as 20 years. Even the few years of experience with imatinib suggest
that the drug will improve survival rates. However, how much the drug helps won't
be known for some time.