Chronic Lymphocytic Leukemia

What is leukemia?

Leukemia is a term for cancers of the blood cells. Leukemia starts in blood-forming tissues such as the bone marrow. Your bone marrow makes the cells which will develop into white blood cells, red blood cells, and platelets. Each type of cell has a different job:

• White blood cells help your body fight infection
• Red blood cells deliver oxygen from your lungs to your tissues and organs
• Platelets help form clots to stop bleeding

When you have leukemia, your bone marrow makes large numbers of abnormal cells. This problem most often happens with white blood cells. These abnormal cells build up in your bone marrow and blood. They crowd out the healthy blood cells and make it hard for your cells and blood to do their work.

Chronic lymphocytic leukemia (CLL) is a type of chronic leukemia. "Chronic" means that the leukemia usually gets worse slowly. In CLL, the bone marrow makes abnormal lymphocytes (a type of white blood cell). When the abnormal cells crowd out the healthy cells, it can lead to infection, anemia, and easy bleeding. The abnormal cells can also spread outside the blood to other parts of the body. CLL is one of the most common types of leukemia in adults. It often occurs during or after middle age. It is rare in children.

CLL happens when there are changes in the genetic material (DNA) in bone marrow cells. The cause of these genetic changes is unknown, so it's hard to predict who might get CLL. There are a few factors that might raise your risk.

It is hard to predict who will get CLL. There are a few factors that could raise your risk:

• Age - your risk goes up as you get older. Most people who are diagnosed with CLL are over 50.
• Family history of CLL and other blood and bone marrow diseases
• Racial/ethnic group - CLL is more common in whites than in people from other racial or ethnic groups
• Exposure to certain chemicals, including Agent Orange, a chemical that was used in the Vietnam War

In the beginning, CLL does not cause any symptoms. Later, you can have symptoms such as:

• Swollen lymph nodes - you may notice them as painless lumps in the neck, underarm, stomach, or groin
• Weakness or feeling tired
• Pain or a feeling of fullness below the ribs
• Fever and infection
• Easy bruising or bleeding
• Petechiae, which are tiny red dots under the skin. They are caused by bleeding.
• Weight loss for no known reason
• Drenching night sweats

Your health care provider may use many tools to diagnose CLL:

• A physical exam
• A medical history
• Blood tests, such as a complete blood count (CBC) with differential and blood chemistry tests. Blood chemistry tests measure different substances in the blood, including electrolytes, fats, proteins, glucose (sugar), and enzymes. Specific blood chemistry tests include a basic metabolic panel (BMP), a comprehensive metabolic panel (CMP), kidney function tests, liver function tests, and an electrolyte panel.
• Flow cytometry tests, which check for leukemia cells and identify which type of leukemia it is. The tests can be done on blood, bone marrow, or other tissue.
• Genetic tests to look for gene and chromosome changes

If you are diagnosed with CLL, you may have additional tests to see whether the cancer has spread. These include imaging tests and bone marrow tests.

Treatments for CLL include:

• Watchful waiting, which means that you don't get treatment right away. Your health care provider regularly checks to see if your signs or symptoms appear or change.
• Targeted therapy, which uses drugs or other substances that attack specific cancer cells with less harm to normal cells.
• Chemotherapy
• Radiation therapy
• Immunotherapy
• Chemotherapy with bone marrow or stem cell transplant

The goals of treatment are to slow the growth of the leukemia cells and to give you long periods of remission. Remission means that the signs and symptoms of cancer are reduced or have disappeared. The CLL may come back after remission, and you may need more treatment.

NIH: National Cancer Institute

Chronic Myeloid Leukemia

What is leukemia?

Leukemia is a term for cancers of the blood cells. Leukemia starts in blood-forming tissues such as the bone marrow. Your bone marrow makes the cells which will develop into white blood cells, red blood cells, and platelets. Each type of cell has a different job:

• White blood cells help your body fight infection
• Red blood cells deliver oxygen from your lungs to your tissues and organs
• Platelets help form clots to stop bleeding

When you have leukemia, your bone marrow makes large numbers of abnormal cells. This problem most often happens with white blood cells. These abnormal cells build up in your bone marrow and blood. They crowd out the healthy blood cells and make it hard for your cells and blood to do their work.

Chronic myeloid leukemia (CML) is a type of chronic leukemia. "Chronic" means that the leukemia usually gets worse slowly. In CML, the bone marrow makes abnormal granulocytes (a type of white blood cell). These abnormal cells are also called blasts. When the abnormal cells crowd out the healthy cells, it can lead to infection, anemia, and easy bleeding. The abnormal cells can also spread outside the blood to other parts of the body.

CML usually occurs in adults during or after middle age. It is rare in children.

Most people with CML have a genetic change called the Philadelphia chromosome. It's called that because researchers in Philadelphia discovered it. People normally have 23 pairs of chromosomes in each cell. These chromosomes contain your DNA (genetic material). In CML, part of the DNA from one chromosome moves to another chromosome. It combines with some DNA there, which creates a new gene called BCR-ABL. This gene causes your bone marrow to make an abnormal protein. This protein allows the leukemia cells to grow out of control.

The Philadelphia chromosome isn't passed from parent to child. It happens during your lifetime. The cause is unknown.

It is hard to predict who will get CML. There are a few factors that could raise your risk:

• Age - your risk goes up as you get older
• CML is slightly more common in men
• Exposure to high-dose radiation

Sometimes CML does not cause symptoms. If you do have symptoms, they can include:

• Feeling very tired
• Weight loss for no known reason
• Drenching night sweats
• Fever
• Pain or a feeling of fullness below the ribs on the left side

Your health care provider may use many tools to diagnose CML:

• A physical exam
• A medical history
• Blood tests, such as a complete blood count (CBC) with differential and blood chemistry tests. Blood chemistry tests measure different substances in the blood, including electrolytes, fats, proteins, glucose (sugar), and enzymes. Specific blood chemistry tests include a basic metabolic panel (BMP), a comprehensive metabolic panel (CMP), kidney function tests, liver function tests, and an electrolyte panel.
• Bone marrow tests. There are two main types - bone marrow aspiration and bone marrow biopsy. Both tests involve removing a sample of bone marrow and bone. The samples are sent to a lab for testing.
• Genetic tests to look for gene and chromosome changes, including tests to look for the Philadelphia chromosome

If you are diagnosed with CML, you may have additional tests such as imaging tests to see whether the cancer has spread.

CML has three phases. The phases are based on how much the CML has grown or spread:

• Chronic phase, where less than 10% of cells in the blood and bone marrow are blast cells (leukemia cells). Most people are diagnosed in this phase, and many do not have symptoms. Standard treatment usually helps in this phase.
• Accelerated phase, 10% to 19% of the cells in the blood and bone marrow are blast cells. In this phase, people often have symptoms and standard treatment may not be as effective as in the chronic phase.
• Blastic phase, where 20% or more of the cells in the blood or bone marrow are blast cells. The blast cells have spread to other tissues and organs. If you have tiredness, fever, and an enlarged spleen during the blastic phase, it is called a blast crisis. This phase is harder to treat.

There are several different treatments for CML:

• Targeted therapy, which uses drugs or other substances that attack specific cancer cells with less harm to normal cells. For CML, the drugs are tyrosine kinase inhibitors (TKIs). They block tyrosine kinase, which is an enzyme that causes your bone marrow to make too many blasts.
• Chemotherapy
• Immunotherapy
• High-dose chemotherapy with stem cell transplant
• Donor lymphocyte infusion (DLI). DLI is a treatment that may be used after a stem cell transplant. It involves giving you an infusion (into your bloodstream) of healthy lymphocytes from the stem cell transplant donor. Lymphocytes are a type of white blood cell. These donor lymphocytes may kill the remaining cancer cells.
• Surgery to remove the spleen (splenectomy)

Which treatments you get will depend on which phase you are in, your age, your overall health, and other factors. When the signs and symptoms of CML are reduced or have disappeared, it is called remission. The CML may come back after remission, and you may need more treatment.

NIH: National Cancer Institute

Colonoscopy

What are colonoscopy and flexible sigmoidoscopy?

Colonoscopy and flexible sigmoidoscopy are procedures that let your doctor look inside your rectum and colon (large intestine). They use instruments called scopes. Scopes have a light and a tiny camera attached to a long, thin tube. These procedures let your doctor see problems such as inflamed tissue, ulcers, polyps, and cancer.

Colonoscopy checks your entire colon and rectum. Flexible sigmoidoscopy checks the rectum and the lower colon (sigmoid colon) only.

A virtual colonoscopy also looks inside your rectum and part of your colon. But it does not use a scope. Instead, it is an x-ray test. Another name for this test is CT colonography.

You may need a colonoscopy, virtual colonoscopy, or flexible sigmoidoscopy to find the cause of unexplained symptoms such as:

• Bleeding from your anus (the opening of the rectum through which stool passes out of your body)
• Changes in your bowel activity, such as diarrhea
• Pain in your abdomen (belly)
• Unexplained weight loss

Doctors also use these procedures to screen for colon polyps and cancer. Screening is testing for diseases when you have no symptoms. It may find diseases at an early stage, when they are easier to treat. If aren't at higher risk for colorectal cancer, your health care provider will likely recommend you start getting screenings at age 45. If you are at higher risk, you may need to start getting screened for colorectal cancer earlier.

There are also other tests to screen for colorectal cancer, including stool tests. Talk with your provider about which test is right for you and when and how often you should get it.

To prepare for a colonoscopy, virtual colonoscopy, or flexible sigmoidoscopy, you will need to:

• Talk with your doctor about any health problems you have and all of the medicines and supplements that you take. You may need to stop taking some of your medicines and/or supplements before the procedure.
• Follow the bowel prep instructions from your doctor. The bowel prep clears the stool out of your colon, so your doctor will be able to see the colon during the procedure:
  • You may need to follow a clear liquid diet, usually for about one day before the procedure. Avoid red or purple drinks or gelatin; the dye can look like blood in the colon. You probably need to stop eating and drinking the night before the exam.
  • You will need to take some laxatives. They may be pills, a powder that you dissolve in liquid, an enema, or a combination of these. The laxative will cause diarrhea, so you need to stay close to the bathroom.

For a virtual colonoscopy, you will also need to drink a contrast medium the night before. The contrast medium is a dye or other substance that is visible on x-rays. It can help your doctor tell the difference between stool and polyps.

For a colonoscopy:

• You will have the procedure at a hospital or outpatient center. It usually takes 30 to 60 minutes.
• You will get IV (intravenous) sedatives or anesthesia, usually along with pain medicine, so you won't be awake or feel pain during the procedure.
• You'll lie on a table while the doctor inserts a colonoscope through your anus and into your rectum and colon. The scope inflates your large intestine with air for a better view. The camera sends a video image to a monitor so your doctor can see your colon.
• Once the scope reaches the opening to your small intestine, the doctor will slowly remove the scope. While doing so, your doctor will examine your colon again.
• If you have polyps, your doctor may remove them and send them to a lab for testing. Most polyps aren't cancer, but removing them can prevent them from becoming cancer later on.
• If you have abnormal tissue, your doctor may do a biopsy.
• The sedative or anesthesia takes time to wear off completely. You'll stay at the hospital or outpatient center for 1 to 2 hours after the procedure. Then you will need someone to drive you home.

For a virtual colonoscopy:

• You will have the procedure at a hospital or outpatient center. It usually takes about 10 to 15 minutes.
• You do not need anesthesia.
• You'll lie on a table while a specially trained x-ray technician inserts a thin tube through your anus and into your rectum. The tube inflates your large intestine with air for a better view.
• The table slides into a tunnel-shaped device where the technician takes the x-ray images. You will turn over on your side or stomach to get more images taken.

For a flexible sigmoidoscopy:

• You will have the procedure at a hospital, medical office, or outpatient center. It usually takes about 20 minutes.
• You do not need anesthesia.
• You'll lie on a table while the doctor inserts a thin tube through your anus and into your rectum. The tube inflates your large intestine with air for a better view. The camera sends a video image to a monitor so your doctor can see your lower colon.
• Once the scope has reached the top of the lower colon, the doctor will slowly remove the scope. While doing so, your doctor will examine your lower colon again.
• If you have polyps, your doctor may remove them and send them to a lab for testing. Most polyps aren't cancer, but removing them can prevent them from becoming cancer later on.
• If you have abnormal tissue, your doctor may do a biopsy.

You may feel cramping in your abdomen or bloating during the first hour after the any of these procedures. If the doctor removed polyps or performed a biopsy, you may have light bleeding from your anus. This bleeding is normal.

For a virtual colonoscopy or a flexible sigmoidoscopy, you go back to your regular activities and diet right after the test. For a colonoscopy, you can expect a full recovery and return to your normal diet by the next day.

Your doctor will give you the results of your procedure. If you had a biopsy, it can take a few days to get those results.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Hodgkin Lymphoma

What is Hodgkin lymphoma?

Hodgkin lymphoma, also called Hodgkin disease, is a type of cancer that develops in the lymph system. Your lymph system is part of your immune system. It helps protect your body from infection and disease.

The lymph system is made up of tissues and organs that produce, store, and carry white blood cells. It includes your:

• Bone marrow
• Lymph nodes
• Lymphatic vessels
• Spleen
• Thymus
• Tonsils

Hodgkin lymphoma is one of the main types of lymphoma. The other is non-Hodgkin lymphoma. Each type starts in different types of white blood cells.

The cause of Hodgkin lymphoma is unknown. But there are certain people who are at higher risk of developing it.

Certain factors can make you more likely to develop Hodgkin lymphoma:

• Age. Hodgkin lymphoma is most common in early adulthood (age 20-39 years) and in late adulthood (age 65 years and older).
• Being male. The risk of adult Hodgkin lymphoma is slightly higher in males than in females.
• Past Epstein-Barr virus (EBV) infection. Having an infection with EBV as a young child or teenager increases your risk of Hodgkin lymphoma.
• A family history of Hodgkin lymphoma. Having a parent or sibling with Hodgkin lymphoma increases your risk of developing it.

The signs and symptoms of Hodgkin lymphoma may include:

• Painless, swollen lymph nodes in the neck, underarm, or groin
• Fever for no known reason
• Drenching night sweats (very heavy sweating during sleep)
• Weight loss for no known reason in the past 6 months
• Itchy skin, especially after bathing or drinking alcohol
• Fatigue

To find out if you have Hodgkin lymphoma, your provider:

• Will ask about your symptoms and medical history. This will include checking for signs of disease, such as lumps or anything else that seems unusual.
• May order some lab tests, such as:
  • Complete blood count
  • Blood chemistry studies
  • Lactate dehydrogenase (LDH) test
  • Erythrocyte sedimentation rate (ESR) test
  • Blood tests to rule out other medical conditions
  • May do imaging tests such as a CT and PET (positron emission tomography) scans
  • May do a lymph node biopsy

Treatments for Hodgkin lymphoma include:

• Chemotherapy
• Radiation therapy
• Targeted therapy, which uses drugs or other substances that attack specific cancer cells with less harm to normal cells
• Cancer immunotherapy

Hodgkin lymphoma can usually be cured if it is found and treated early.

NIH: National Cancer Institute

HPV

What is HPV?

Human papillomavirus (HPV) is a group of more than 200 related viruses. Some of them are spread through sexual contact. Most people have been exposed to HPV. Usually, your immune system controls HPV infections, and they go away on their own and don't cause any health problems, but some need treatment.

There are two categories of sexually transmitted HPV. They are called low-risk HPV and high-risk HPV. Sometimes high-risk HPV infections can stay at the cervix (the lower part of a woman's uterus) for many years. This can lead to cell changes. If these changes are not screened for and treated, they may get worse over time and become cancer.

Low-risk HPVM can cause warts on or around your genitals, anus, mouth, or throat.

High-risk HPV can cause various cancers:

• Cervical cancer
• Anal cancer
• Oropharyngeal cancer, a type of head and neck cancer, also called throat cancer
• Vulvar cancer
• Vaginal cancer
• Penile cancer

HPV infections are very common. Nearly all sexually active people are infected with HPV soon after they become sexually active.

Some people get warts from certain low-risk HPV infections, but the other types (including the high-risk types) have no symptoms.

If a high-risk HPV infection lasts for many years and causes cell changes, you may have symptoms. You may also have symptoms if those cell changes develop into cancer. Which symptoms you have depends on which part of your body is affected.

Health care providers can usually find out if you have warts by looking at them.

Nearly all cervical cancers are caused by a long-lasting infection with a high-risk type of HPV. Screening can prevent cancer by finding out if you need treatment for changes that might happen before cancer, called precancer.

Screening tests for HPV can include:

• For women, there are cervical cancer screening tests that can find changes in the cervix that might lead to cancer. As part of the screening, women may have Pap tests (sometimes called a Pap smear), HPV tests, or both. HPV tests use a sample of cervical cells.
• Your provider may also suggest a colposcopy to check for abnormal cells.

An HPV infection itself cannot be treated. Because HPV causes cancer at other places in the body, testing for the HPV virus can be helpful to make other treatment decisions.

• HPV infection. Talk to your provider about whether you need other tests and how often you should be checked to prevent cervical cancer.
• Warts. There are medicines that you can apply to a wart. If they don't work, your provider could freeze, burn, or surgically remove them.
• Cell changes caused by infection with high-risk HPV. Treatments may include medicines you apply to the affected area or various surgical procedures.

People who have HPV-related cancers usually get the same types of treatment as people who have cancers that HPV does not cause. An exception to this is for people who have certain oral and throat cancers. They may have different treatment options.

Correct usage of latex condoms greatly reduces, but does not completely eliminate, the risk of catching or spreading HPV. If you or your partner is allergic to latex, you can use polyurethane condoms. The most reliable way to avoid infection is to not have anal, vaginal, or oral sex.

Vaccines can protect against several types of HPV, including genital warts and some that can cause cancer. The vaccines provide the most protection when people get them before exposure to the virus. This means that it is best for people to get them before they become sexually active.

Ask your child's provider about when to vaccinate your child against HPV. If you're over age 26 and haven't been vaccinated, talk with your provider about the possible benefits of vaccination.

NIH: National Cancer Institute