Bones Cancer

What Is Bone Cancer?

Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR

Cancers can be discovered in bones in a number of different circumstances. When canceris located in the bones, it is important to differentiate whether this cancer has spread from another site to the bones or whether the cancer originated in the bone tissue itself. This distinction is important not only for the sake of correct terminology, but also to accurately determine which treatment options are appropriate.

There are more than 100 types of cancer, and each cancer type is named for the organ or tissue in which it begins. When cancer cells spread, they may travel via the lymphatic channels to lymph nodes, or they may enter the bloodstream and travel to other organs or locations in the body that are distant from the site of the original, or primary, tumor. It is not unusual for cancers that originate in other parts of the body to spread to the bones and begin growing there. Certain types of cancers are particularly likely to spread to the bones. Cancers that commonly metastasize, or spread, to the bones include breast cancer, lung cancer, thyroid cancer, prostate cancer, and cancers of the kidney.

It is important to note that when these other types of cancer spread to the bone, they are still named for the tissue or organ where they arose and are not termed "bone" cancer. For example, breast cancer that has spread to the bones is referred to as metastatic breast cancer and not bone cancer.

In contrast to cancers which have spread to the bone, true bone cancers are tumors that arise from the tissues of the bones. These cancers, called primary bone cancers, are quite rare in comparison to cancers that have spread to the bones.

True bone cancer affects over 2,000 people in the United States each year. It is found most often in the bones of the arms and legs, but it can occur in any bone. Children and young people are more likely than adults to develop bone cancer. The symptoms of bone cancer tend to develop slowly and depend on the type, location, and size of the tumor. Pain is the most frequent symptom of bone cancer, but sometimes a lump on the bone can be felt through the skin.

Get the facts on the types, treatment, and prognosis of bone cancer »

Bone cancer facts

• The majority of cancer involving the bones is metastatic disease from other remote cancers. Primary bone cancer is much rarer.
• Not all bone tumors are cancerous.
• The most common symptom of bone cancer is pain. The pain is usually mild initially and gradually becomes more intense.
• Treatment of bone cancer includes a combination of surgery,chemotherapy, and radiation therapy.
• Treatment is based on the size and location of the cancer and whether or not the cancer has spread from the bone to surrounding tissues.

What are bones for?

Your body has 206 bones. These bones serve many different functions. First, your bones provide structure to your body and help provide its shape. Muscles attach to the bones and allow you to move. Without the bones, your body would be an unstructured pile of soft tissues and you would be unable to stand, walk, or move. Second, the bones help to protect the more fragile organs of the body. For example, the bones of the skull protect the brain, the vertebrae of the spine protect the spinal cord, and the ribs protect the heart and lungs. Third, the bones contain bone marrow, which produces and stores new blood cells. Finally, the bones help control your body's collection of various proteins and nutrients including calcium and phosphorus.

What is cancer?

Your body is made up of many small structures called cells. There are many different types of cells that grow to form the different parts of your body. During normal growth and development, these cells continuously grow, divide, and make new cells. This process continues throughout life even after you are no longer growing. The cells continue to divide and make new cells to replace old and damaged cells. In a healthy person, the body is able to control the growth and division of cells according to the needs of the body. Cancer is when this normal control of cells is lost and the cells begin to grow and divide in an uncontrolled manner. The cells also become abnormal and have altered functions in patients with cancer. The cancer cells can become very destructive to the surrounding cells and can invade normal organs and tissues, disrupting their function.

There are many different type of cancer. The cancer is usually named based on the type of cell from which the cancer initially grows. For example,lung cancer is caused by uncontrolled cells that form the lungs and breast cancer by cells that form the breast. A tumor is a collection of abnormal cells grouped together. However, not all tumors are cancerous. A tumor can be benign (not cancerous) or malignant (cancerous). Benign tumors are usually less dangerous and are not able to spread to other parts of the body. Benign tumors can still be dangerous. They can continue to grow and expand locally. This can lead to compression and damage to the surrounding structures. Malignant tumors are usually more serious and can spread to other areas in the body. The ability of cancer cells to leave their initial location and move to another location in the body is called metastasis. Metastasis can occur by the cancer cells entering the body's bloodstream or lymphatic system to travel to other sites in the body. When cancer cells metastasize to other parts of the body, they are still named by the original type of abnormal cell. For example, if a group of breast cells becomes cancerous and metastasizes to the bones or liver, it is called metastatic breast cancer instead of bone cancer or liver cancer. Many different types of cancer are able to metastasize to the bones. The most common types of cancer that spread to the bones are cancers of the lung, breast, prostate, thyroid, and kidney. Cancers arising from lymphatic or blood cells, includinglymphoma and multiple myeloma, can also frequently affect the bones.

Most of the time, when people have cancer in their bones, it is caused by cancer that has spread from elsewhere in the body to the bones. It is much less common to have a true bone cancer, a cancer that arises from cells that make up the bone. It is important to determine whether the cancer in the bone is from another site or is from a cancer of the bone cells themselves. The treatments for cancers that have metastasized to the bone are often based on the initial type of cancer.

Cataracts

What Are Cataracts? What Causes Cataracts?

Cataracts are cloudy areas in the lens inside the eye - which is normally clear. Cataracts can develop in one or both eyes. If they develop in both eyes, one will be more severely affected than the other. A normally clear lens allows light to pass through to the back of the eye, so that the patient can see well-defined images. If a part of the lens becomes opaque light does not pass through easily and the patient's vision becomes blurry - like looking through cloudy water or a fogged-up window. The more opaque (cloudier) the lens becomes, the worse the person's vision will be. 

According to Medilexicon's medical dictionary, cataract is "Complete or partial opacity of the ocular lens.".

There are two types of cataracts:

• Age related cataracts - they appear later in life; the most common form.


• Congenital cataracts (childhood cataracts) - these may be present when the baby is born, or shortly after birth. Cataracts may also be diagnosed in older babies and children - these are sometimes referred to as developmental, infantile or juvenile cataracts.Researchers from the University Zurich were the first to identify the chromosomal location and exact molecular defect in the coding region of the gene responsible for a childhood cataract.

The rest of this article focuses just on age-related cataracts.

A patient with cataracts will eventually find it hard to read, or drive a car - especially during the night. Even seeing people's facial expressions becomes difficult. Cataracts are not usually painful. The patient's long-distance vision is more severely affected at first. 

Articles About Eye Diseases

What Is AMD? What Is Macular Degeneration?

What Is Glaucoma? What Causes Glaucoma?

As cataracts develop very slowly most people do not know they have them at first. However, the clouding progresses and vision will gradually get worse. Stronger lighting and eyeglasses can help improve vision. Nevertheless, eventually the vision impairment affects the patient's ability to carry out everyday tasks. At this point the individual will need surgery. Fortunately, cataract surgery is usually a very effective and safe procedure. 

Cataracts cause more vision problems globally than any other eye condition or disease - especially in developing countries, where they are much more common among poor people,according to a study carried out in Kenya, The Philippines, and Bangladesh.

Visit our specialized news section

Eye Health / Blindness News

Includes the latest news and research on vision problems and eye disorders, visual pathways in the brain, areas surrounding the eye, age related macular degeneration (AMD), glaucoma, cataracts, and much more.

Add this Eye Health rss news feed to your rss reader

Some studies indicate that cataracts are more common among elderly people further down the socioeconomic ladder in the USA - prevalence of cataracts causing significant visual problems appears high among older U.S. Hispanics who also often encounter barriers to access to care (in the USA "Hispanics" refers to Americans of Latin American origin, not people who originate from Spain). 

Both men and women are affected equally.

According to the National Health Service (NHS), UK, approximately one third of people aged 65 or over have cataracts in one or both eyes.

Factors that may increase the risk of developing cataracts

We are all at risk of developing cataracts because we will all get old one day - the greatest risk factor is age. In the USA approximately 50% of people aged 65 or more have some degree of lens clouding. 70% of Americans aged 75 or more have their vision significantly impaired by cataracts. 

Researchers at the Wilmer Eye Institute at The Johns Hopkins Medical Institutions, Baltimore predicted that the number of people in the USA affected by cataracts is estimated to rise to 30.1 million people in the next 20 years, an increase of 50 percent, because people will live longer.

The following factors may increase a person's chances of developing cataracts:

• Age


• Close relatives who have/had cataracts (family history)


• Diabetes


• Ionizing radiation exposure - airline pilots have an increased risk of nuclear cataracts compared with non-pilots, and that risk is associated with cumulative exposure to cosmic radiation, scientists from the University of Iceland reported.
  
  The five-year incidence of nuclear cataract was 40% lower for statin users after adjusting for several factors, compared to non-statin users, another study found.


• Long-term exposure to bright sunlight


• Long-term use of corticosteroids - many people with asthma rely on inhaled, and sometimes oral, steroids, as do people with chronic obstructive pulmonary disease. A study conducted by the Centre for Vision Research, University of Sydney, Australia, revealed that cataract risk is higher for patients taking these medications.


• Previous eye inflammation


• Previous eye injury


• Exposure to lead - lifetime lead exposure may increase the risk of developing cataracts, scientists from the National Institute of Environmental Health Sciences, USA revealed.


• Crystallins loss of function - A specific type of protein (crystallins) begins to lose function as the eye ages. As the protein loses function, small peptides, made of 10 to 15 amino acids, start forming and accelerate cataract formation in the eye, a study revealed.

What are the symptoms of age-related cataracts?

Symptoms usually creep up many years after onset - usually when the person is elderly. Progressively, more of the lens becomes cloudy. People with mild cataracts will not notice they have it for a long time. 

Cataracts often affect both eyes, but rarely equally. 

People with cataracts may have the following symptoms:

• Blurry, cloudy, or misty vision.


• Some describe it as similar to looking through frosted glass.


• Vision may be affected by small spots or dots.


• The patient sees small patches which blur parts of his/her field of vision.


• Vision gets worse when lights are dim.


• Vision is sometimes worse when light is very bright (glare).


• Some people with cataracts also comment that colors appear less clear and faded.


• Reading becomes very difficult, and eventually impossible.


• Glasses need to be changed more frequently.


• Eventually wearing glasses becomes less effective.


• In some rare cases patients can see a halo around bright objects, such as car headlights or street lights.


• Double vision in one eye (rare).

As the person's vision deteriorates, and the glare of oncoming headlights and street lights gets worse, driving becomes awkward and potentially very dangerous - research carried out by optometrists and psychologists in Australia shows that motorists suffering from cataracts are less able to spot potentially dangerous hazards on the roads. Drivers with cataracts eventually start suffering from eyestrain and find themselves blinking more frequently in an attempt to clear their vision. 

Cataracts do not usually cause any change in the appearance of the eye. Any discomforts, such as irritation, aching, itching or redness are most likely caused by some other eye disorder.

Cataracts are not hazardous to the sufferer's health, or the health of the eye. If the cataract becomes hypermature (completely white), the sufferer may experience inflammation, headacheand some pain. Hypermature cataracts need to be removed if there is inflammation or pain.

How are cataracts diagnosed?

Anybody who experiences vision problems should see a GP (general practitioner, primary care physician), an ophthalmologist, or an optometrist. The GP will most likely refer the patient to an ophthalmologist, or an optometrist.

• Ophthalmologist - a doctor who specializes in the medical and surgical care of the eye.


• Optometrist - a person practicing eye care, but does not perform surgery.

The eye specialist will carry out a number of tests. These may include:

• Visual acuity test - this tests how clearly the individual can see an object. It tests the person's sharpness of vision. The patient reads letters from across a room. The two eyes are tested separately (one is covered). By using a chart with progressively smaller letters, the specialist can determine how acute the patient's vision is. The chart is called a Snellen Eye Chart.
  
  Sometimes the chart has to be read twice - once with, and once without bright lights. This will give an indication of glare sensitivity.


• Slit-lamp examination - this is a microscope which allows the specialist to see the structures at the front of the eye. An intense line of sight (a slit) is used to illuminate the cornea, iris, lens, as well as the space between the iris and the cornea. The slit makes it possible for the specialist to see these structures in small sections, making it easier to spot any problems.


• Retinal examination - eye drops are administered which dilate the pupils, providing a bigger window to the back of the eyes. The specialist examines the lens for signs of cataract with either an ophthalmoscope or a slit lamp. If signs of cataract are found, the specialist can also determine how dense the clouding is. Most specialists will check forglaucoma at the same time, and perhaps some other eye conditions/diseases.
  
  The pupils will remain dilated for a few hours after the examination before the eye drops gradually lose their effect. During this time the patient may find it harder to focus on close objects. It is advisable to wear sunglasses, especially if it is a bright day. Driving is not advisable until the pupils are back to their normal size.


• Measuring a protein related to cataract formation - A device based on a laser light technique called dynamic light scattering can safely eye test for measuring a protein related to cataract formation, according to researchers at the National Eye Institute, USA.

Although an eye test may help confirm a cataract diagnosis, it may not always reflect the patient's quality of life. Some patients who do badly in a test seem to have no problem with daily function, while others who may do well insist that their eyesight is poor and does interfere with ordinary activities.

Treatment for cataracts

If the patient is found to be only mildly affected surgical treatment may not be needed. During its early stages, stronger glasses and brighter lights may help improve vision. The following simple approaches may assist people who are not ready yet to have surgery:

• Make sure your glasses are the most accurate prescription possible.
• Use a magnifying glass for reading.
• Get brighter lamps for your house. Halogen lights may help a lot.
• Wear sunglasses to reduce glare on sunny days.
• Try to refrain from driving at night.

Surgery

However, these are only temporary measures - the cataracts will continue developing and gradually impair eyesight more. 

Patients who take alpha-blockers or are considering taking alpha-blockers should be aware that the drugs may increase the difficulty of cataract surgery. While Flomax (an alpha-blocker) is largely prescribed to men to treat prostate enlargement, some women also take the drug to treat urinary retention problems. Other alpha-blockers are used to treat hypertension. The American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery issued an advisory telling patients and GPs to inform their surgeon if they are taking alpha-blockers, or took them in the past. Once informed, the ophthalmologist can anticipate certain problems and employ different surgical techniques that help to achieve excellent outcomes. 

When the cataracts are severe the only effective treatment is surgery. The specialist will recommend surgery if the patient:

• Is having trouble looking after himself/herself.
• Is having difficulties looking after someone else.
• Cannot drive, or finds driving difficult.
• Has problems leaving the house.
• Finds it hard to see or recognize people's faces.
• Has problems doing his/her job.
• Cannot read properly.
• Can no longer watch television properly.

The cloudy lens is removed from the eye and an artificial clear plastic one is put in its place - an intraocular implant (intraocular lens). In most developed countries, and a growing number of developing countries, cataract operations are performed as keyhole surgery. The patient will be given a local anesthetic. He/she will not usually have to spend the night in hospital. The operation is commonly known as phacoemulsification or phaco extracapsular extraction. Laser surgery is not used for cataract procedures. (There are more details about the operation further down this page) 

Pre-operative assessment (assessment before surgery) 

The specialist will assess the patient's eyes and general health. During the pre-operative assessment the eye will be measured so that the replacement artificial lens can be prepared.

The day of the operation - before it begins

Eye drops that dilate (widen) the pupils will be administered just before the procedure. Sometimes the eye drops will also have anesthetic in them, or the doctor may inject the tissue around the eye for a local anesthetic. As soon as the anesthetic starts working the area will be numbed and the patient will feel nothing. During the operation he/she will be aware of a bright light, but will not be able to see what is happening. 

Various types of replacement lenses may be used:

• Monofocal lens - this is a fixed-strength lens which is set for one level of vision - usually distance vision.


• Multifocal lens - this type of lens may have two or more different strengths; near and distance vision.


• Accommodating lens - this type of lens is the most similar to the natural human lens. It allows the eye to focus on near and distant objects.

The operation

The eye surgeon makes a tiny cut in the cornea at the front. He/she then inserts a minute probe through the cut. The probe uses ultrasound and breaks up the cloudy lens into very small pieces which are sucked out. 

The artificial lens is then inserted through the cut. The lens sits in the lens capsule to keep it in place - the lens capsule is like a little pocket. When it is first inserted the lens is folded - it unfolds when in position. 

The whole procedure should not take more than about 30 minutes. Most patients will wear an eye pad for protection for a short while. 

Other procedures

• Manual extracapsular extraction - the lens is removed in one piece. No ultrasound is used to break it up. The surgeon will make a slightly larger cut in the eye.


• Intracapsular extraction - the lens capsule as well as the lens is removed. The artificial lens is sewn into the eye. This type of procedure is much less common.

After the operation

Most patients will experience vision improvement virtually immediately. It may take a while for the eye to settle down completely. The cut in the eye may occasionally need a stitch - in most cases, however, it is so small that it heals by itself. 

Patients should avoid vigorous activities for a while. Most individuals find they can go about their daily activities as soon as they get home. An appointment will be made to test the patient's vision. Most patients will need different glasses after their operation. The new glasses can only be determined after his/her vision has settled down - this can take several weeks. 

There is no other way to cure cataracts. Medications, dietary supplements, exercise or optical devices are not effective. As mentioned earlier, during the early stages there are some things the patient can do to help see things better - but they are only temporary.

Prevention of cataracts

To prevent suffering the complications of cataracts it is advisable to have regular eye exams, especially as you get older. The following steps are advisable to lower your risk of developing cataracts - some of them have convincing circumstantial evidence of their worth, while others (smoking, diet) are proven measures:

• Give up smoking - several studies have indicated that a higher percentage of smokers develop cataracts, compared to non-smokers. There are also indications that smokers are likely to experience cataract symptoms earlier. Smoking also increases the risk of other eye disease/conditions.


• Nutrition - eat plenty of fruits and vegetables, whole grains, unrefined carbohydrates, good quality fats (avocado, olive oil, omega oils), and either plant sourced proteins or lean animal sourced proteins.
  
  The findings by researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, USA suggest that vitamins and polyunsaturated fatty acids - two categories of nutrients believed to have health benefits - may both affect cataract development, although not necessarily in beneficial ways.
  
  Women who consume plenty of dark leafy vegetables which are rich in lutein and zeaxanthin, as well as sufficient vitamin E from supplements/foods seem to have better protection against developing cataracts, scientists from the Brigham & Women's Hospital and Harvard Medical School, Boston found.


• Sunlight - wear sunglasses that block ultraviolet B rays (UV radiation). Many people are not aware of the damage UV radiation can cause to the eyes - a study found that only 49% of Americans said UV protection was the most important factor when purchasing sunglasses.


• Sleep - make sure you get at least 7 hours of good quality, continuous sleep every night.


• Obesity - obesity significantly raises the risk of developing diabetes type 2, which in turn is an important cataract risk factor. Keeping your weight within the recommended limits will help prevent your risk from increasing.


• Diabetes - be careful to have your diabetes under control; follow your treatment plan assiduously.


• Exercise - Researchers from the U.S. Department of Energy's Lawrence Berkeley National Laboratory reported that running reduces the risk of both cataracts and age-related macular degeneration.

Complications

• Blindness - If the cataracts are left untreated, they may lead to blindness.


• Higher mortality rates - people aged 49 and older with cataract and those aged 49 to 74 years with age-related macular degeneration appear to have higher mortality rates over an 11-year period than those without such visual impairments, according to a study carried out by researchers at the University of Sydney, Australia.

What Is Leukemia? What Causes Leukemia?

Leukemia (British spelling: leukaemia ) is cancer of the blood or bone marrow (which produces blood cells). A person who has leukemia suffers from an abnormal production of blood cells, generally leukocytes (white blood cells).

The word Leukemia comes from the Greekleukos which means "white" and aima which means "blood".

The DNA of immature blood cells, mainly white cells, becomes damaged in some way. This abnormality causes the blood cells to grow and divide chaotically. Normal blood cells die after a while and are replaced by new cells which are produced in the bone marrow. The abnormal blood cells do not die so easily, and accumulate, occupying more and more space. As more and more space is occupied by these faulty blood cells there is less and less space for the normal cells - and the sufferer becomes ill. Quite simply, the bad cells crowd out the good cells in the blood. 

In order to better understand what goes on we need to have a look at what the bone marrow does.

Function of the bone marrow

The bone marrow is found in the inside of bones. The marrow in the large bones of adults produces blood cells. Approximately 4% of our total bodyweight consists of bone marrow. 

There are two types of bone marrow: 1. Red marrow, made up mainly of myeloid tissue. 2. Yellow marrow, made up mostly of fat cells. Red marrow can be found in the flat bones, such as the breast bone, skull, vertebrae, shoulder blades, hip bone and ribs. Red marrow can also be found at the ends of long bones, such as the humerus and femur. 

White blood cells (lymphocytes), red blood cells and platelets are produced in the red marrow. Red blood cells carry oxygen, white blood cells fight diseases. Platelets are essential for blood clotting. Yellow marrow can be found in the inside of the middle section of long bones. 

If a person loses a lot of blood the body can convert yellow marrow to red marrow in order to raise blood cell production. 

White blood cells, red blood cells and platelets exist in plasma - Blood plasma is the liquid component of blood, in which the blood cells are suspended.

Types of leukemia

Chronic and Acute

Experts divide leukemia into four large groups, each of which can be Acute, which is a rapidly progressing disease that results in the accumulation of immature, useless cells in the marrow and blood, or Chronic, which progresses more slowly and allows more mature, useful cells to be made. In other words, acute leukemia crowds out the good cells more quickly than chronicleukemia. 

Lymphocytic and Myelogenous

Leukemias are also subdivided into the type of affected blood cell. If the cancerous transformation occurs in the type of marrow that makes lymphocytes, the disease is calledlymphocytic leukemia. A lymphocyte is a kind of white blood cell inside your vertebrae immune system. If the cancerous change occurs in the type of marrow cells that go on to produce red blood cells, other types of white cells, and platelets, the disease is called myelogenous leukemia.

To recap, there are two groups of two groups - four main types of leukemia, as you can see in the illustration below: 

 

Acute Lymphocytic Leukemia (ALL), also known as Acute Lymphoblastic Leukemia - This is the most common type of leukemia among young children, although adults can get it as well, especially those over the age of 65. Survival rates of at least five years range from 85% among children and 50% among adults. The following are all subtypes of this leukemia: precursor Bacute lymphoblastic leukemia, precursor T acute lymphoblastic leukemia, Burkitt's leukemia, and acute biphenotypic leukemia. 

Chronic Lymphocytic Leukemia (CLL) - This is most common among adults over 55, although younger adults can get it as well. CLL hardly ever affects children. The majority of patients with CLL are men, over 60%. 75% of treated CLL patients survive for over five years. Experts say CLL is incurable. A more aggressive form of CLL is B-cell prolymphocytic leukemia.

Acute Myelogenous Leukemia (AML) - AML is more common among adults than children, and affects males significantly more often than females. Patients are treated withchemotherapy. 40% of treated patients survive for over 5 years. The following are subtypes of AMS - acute promyelocytic leukemia, acute myeloblastic leukemia, and acute megakaryoblastic leukemia.

Researchers from the Memorial Sloan-Kettering Cancer Center reported in the March 2012 issue of NEJM (New England Journal of Medicine that they identified a series of genetic mutations in people with AML. They explained that their findings may help doctors to more accurately predict patient outcomes, as well as choosing therapies they are most likely to respond to.

Chronic Myelogenous Leukemia (CML) - The vast majority of patients are adults. 90% of treated patients survive for over 5 years. Gleevec (imatinib) is commonly used to treat CML, as well as some other drugs. Chronic monocytic leukemia is a subtype of CML. 

Symptoms of leukemia

• Blood clotting is poor - As immature white blood cells crowd out blood platelets, which are crucial for blood clotting, the patient may bruise or bleed easily and heal slowly - he may also develop petechiae (a small red to purple spot on the body, caused by a minor hemorrhage).


• Affected immune system - The patient's white blood cells, which are crucial for fighting off infection, may be suppressed or not working properly. The patient may experience frequent infections, or his immune system may attack other good body cells.


• Anemia - As the shortage of good red blood cells grows the patient may suffer fromanemia - this may lead to difficult or labored respiration (dyspnea) and pallor (skin has a pale color caused by illness).


• Other symptoms - Patients may also experience nausea, fever, chills, night sweats, flu-like symptoms, and tiredness. If the liver or spleen becomes enlarged the patient may feel full and will eat less, resulting in weight loss. Headache is more common among patients whose cancerous cells have invaded the CNS (central nervous system).


• Precaution - As all these symptoms could be due to other illnesses. A diagnosis of leukemia can only be confirmed after medical tests are carried out.

What causes leukemia?

Experts say that different leukemias have different causes. The following are either known causes, or strongly suspected causes:

• Artificial ionizing radiation
• Viruses - HTLV-1 (human T-lymphotropic virus) and HIV (human immunodeficiency virus)
• Benzene and some petrochemicals
• Alkylating chemotherapy agents used in previous cancers
• Maternal fetal transmission (rare)
• Hair dyes
• Genetic predisposition - some studies researching family history and looking at twins have indicated that some people have a higher risk of developing leukemia because of a single gene or multiple genes.
• Down syndrome - people with Down syndrome have a significantly higher risk of developing leukemia, compared to people who do not have Down syndrome. Experts say that because of this, people with certain chromosomal abnormalities may have a higher risk.
• Electromagnetic energy - studies indicate there is not enough evidence to show that ELF magnetic (not electric) fields that exist currently might cause leukemia. The IARC (International Agency for Research on Cancer) says that studies which indicate there is a risk tend to be biased and unreliable.

Treatments for leukemia

As the various types of leukemias affect patients differently, their treatments depend on what type of leukemia they have. The type of treatment will also depend on the patient's age and his state of health. 

In order to get the most effective treatment the patient should get treatment at a center where doctors have experience and are well trained in treating leukemia patients. As treatment has improved, the aim of virtually all health care professionals should be complete remission - that the cancer goes away completely for a minimum of five years after treatment. 

Treatment for patients with acute leukemias should start as soon as possible - this usually involves induction therapy with chemotherapy, and takes place in a hospital. 

When a patient is in remission he will still need consolidation therapy or post induction therapy. This may involve chemotherapy, as well as a bone marrow transplant (allogeneic stem celltransplantation). 

If a patient has Chronic Myelogenous Leukemia (CML) his treatment should start as soon as the diagnosis is confirmed. He will be given a drug, probably Gleevec (imatinib mesylate), which blocks the BCR-ABL cancer gene. Gleevec stops the CML from getting worse, but does not cure it. There are other drugs, such as Sprycel (dasatinib) and Tarigna (nilotinb), which also block the BCR-ABL cancer gene. Patients who have not had success with Gleevec are usually given Sprycel and Tarigna. All three drugs are taken orally. A bone marrow transplant is the only current way of curing a patient with CML. The younger the patient is the more likely the transplant will be successful. 

Synribo (omacetaxine mepesuccinate) was approved by the FDA, on 26th October 2012, for the treatment of chronic myelogenous leukemia (CML) in adult patients who had been treated with at least two drugs, but whose cancer continued to progress. Resistance to medications is common in CML. Synribo is an alkaloid from Cephalotaxus harringtonia which inhibits proteins that trigger the development of cancerous cells. The drug is administered subcutaneously.

Patients with Chronic Lymphocytic Leukemia (CLL) may not receive any treatment for a long time after diagnosis. Those who do will normally be given chemotherapy or monoclonal antibody therapy. Some patients with CLL may benefit from allogeneic stem cell transplantation (bone marrow transplant). 

Rabbit antibodies help Leukemia patients - scientists from Virginia Commonwealth University reported in the journal Bone Marrow Transplantation (July 2012 issue) that rabbit antibodies can improve survival and reduce the occurrence of relapses in patients with leukemia and myelodysplasia who are receiving a stem transplant from an unrelated donor.

Leukemia patients' own T-cells achieve remission for over two years - patients who were infused with their own T-cells after they had been genetically altered to fight cancer tumors stayed in full remission for over 24 months. Researchers from the Perelman School of Medicine at the University of Pennsylvania presented their findings at the American Society of Hematology's Annual Meeting and Exposition in December 2012. All those who took part in the human study had advanced cancers - ten of them had chronic lymphocytic leukemia, and two children had acute lymphoblastic leukemia.

All leukemia patients, regardless of what type they have or had, will need to be checked regularly by their doctors after the cancer has gone (in remission). They will undergo exams and blood tests. The doctors will occasionally test their bone marrow. As time passes and the patient continues to remain free of leukemia the doctor may decide to lengthen the intervals between tests.

How common is leukemia?

According to the Leukemia and Lymphoma Society, there were approximately 13,410 new cases of AML (2007), 5,200 new cases of ACL (2007), 4,570 cases of CML (2007), and 15,110 new cases of CLL (2008) diagnosed in the USA. 

What is the difference between Leukemia and Lymphoma?

Leukemia is a cancer of the blood. Lymphoma is of the lymphatic system (lymph glands).

High Blood Pressure

Causes of High Blood Pressure

What causes high blood pressure?

Blood pressure is the measure of the force of blood pushing against blood vessel walls. The heart pumps blood into the arteries (blood vessels), which carry the blood throughout the body. High blood pressure, also called hypertension, is dangerous because it makes the heart work harder to pump blood to the body and contributes to hardening of the arteries, or atherosclerosis, and to the development of heart failure.

What Is "Normal" Blood Pressure?

A blood pressure reading has a top number (systolic) and bottom number (diastolic). The ranges are:

• Normal: Less than 120 over 80 (120/80)
• Prehypertension: 120-139 over 80-89
• Stage 1 high blood pressure: 140-159 over 90-99
• Stage 2 high blood pressure: 160 and above over 100 and above

People whose blood pressure is above the normal range should consult their doctor about steps to take to lower it.

What Causes High Blood Pressure?

The exact causes of high blood pressure are not known, but several factors and conditions may play a role in its development, including:

• Smoking
• Being overweight or obese
• Lack of physical activity
• Too much salt in the diet
• Too much alcohol consumption (more than 1 to 2 drinks per day)
• Stress
• Older age
• Genetics
• Family history of high blood pressure
• Chronic kidney disease
• Adrenal and thyroid disorders

Essential Hypertension

In as many as 95% of reported high blood pressure cases in the U.S., the underlying cause cannot be determined. This type of high blood pressure is called essential hypertension.

Though essential hypertension remains somewhat mysterious, it has been linked to certain risk factors. High blood pressure tends to run in families and is more likely to affect men than women. Age and race also play a role. In the United States, blacks are twice as likely as whites to have high blood pressure, although the gap begins to narrow around age 44. After age 65, black women have the highest incidence of high blood pressure.

Essential hypertension is also greatly influenced by diet and lifestyle. The link between salt and high blood pressure is especially compelling. People living on the northern islands of Japan eat more salt per capita than anyone else in the world and have the highest incidence of essential hypertension. By contrast, people who add no salt to their food show virtually no traces of essential hypertension.

The majority of all people with high blood pressure are "salt sensitive," meaning that anything more than the minimal bodily need for salt is too much for them and increases their blood pressure. Other factors that can raise the risk of having essential hypertension include obesity; diabetes; stress; insufficient intake of potassium, calcium, and magnesium; lack of physical activity; and chronic alcohol consumption.

Secondary Hypertension

When a direct cause for high blood pressure can be identified, the condition is described as secondary hypertension. Among the known causes of secondary hypertension, kidney disease ranks highest. Hypertension can also be triggered by tumors or other abnormalities that cause the adrenal glands (small glands that sit atop the kidneys) to secrete excess amounts of the hormones that elevate blood pressure. Birth control pills -- specifically those containing estrogen -- and pregnancy can boost blood pressure, as can medications that constrict blood vessels.

Who Is More Likely to Develop High Blood Pressure?

• People with family members who have high blood pressure
• Smokers
• African-Americans
• Pregnant women
• Women who take birth control pills
• People over the age of 35
• People who are overweight or obese
• People who are not active
• People who drink alcohol excessively
• People who eat too many fatty foods or foods with too much salt
• People who have sleep apnea