Acute Myelocytic Leukemia

Back in February of 2006, my father was diagnosed with Acute Myelocytic Leukemia.

Acute myeloid leukemia (AML), also known as acute myelogenous leukemia, is a cancer of the myeloid line of blood cells, characterized by the rapid growth of abnormal white blood cells that accumulate in the bone marrow and interfere with the production of normal blood cells. AML is the most common acute leukemia affecting adults, and its incidence increases with age. The symptoms of AML are caused by replacement of normal bone marrow with leukemic cells, which causes a drop in red blood cells, platelets, and normal white blood cells. These symptoms include fatigue, shortness of breath, easy bruising and bleeding, and increased risk of infection. (reference: wikipedia.com)

We never saw it coming. We never expected it and so it was no surprise that we were so shocked with the news. We never took note of the symptoms because we never considered AML as a possibility for any member of the family. Initially, he was only supposed to have the polyps in his sinuses removed but then his laboratory result showed he had very low blood counts (RBC,WBC, Platelet count).

Complete Blood Count ( CBC) - used as a broad screening test to check for such disorders as anemia, infection, and many other diseases. It is actually a panel of tests that examines different parts of the blood and includes the following:

• White blood cell (WBC) count is a count of the actual number of white blood cells per volume of blood. Both increases and decreases can be significant.
• White blood cell differential looks at the types of white blood cells present. There are five different types of white blood cells, each with its own function in protecting us from infection. The differential classifies a person's white blood cells into each type: neutrophils (also known as segs, PMNs, granulocytes, grans), lymphocytes, monocytes, eosinophils, and basophils.
• Red blood cell (RBC) count is a count of the actual number of red blood cells per volume of blood. Both increases and decreases can point to abnormal conditions.
• Hemoglobin measures the amount of oxygen-carrying protein in the blood.
• Hematocrit measures the percentage of red blood cells in a given volume of whole blood.
• The platelet count is the number of platelets in a given volume of blood. Both increases and decreases can point to abnormal conditions of excess bleeding or clotting. Mean platelet volume (MPV) is a machine-calculated measurement of the average size of your platelets. New platelets are larger, and an increased MPV occurs when increased numbers of platelets are being produced. MPV gives your doctor information about platelet production in your bone marrow.
• Mean corpuscular volume (MCV) is a measurement of the average size of your RBCs. The MCV is elevated when your RBCs are larger than normal (macrocytic), for example in anemia caused by vitamin B12 deficiency. When the MCV is decreased, your RBCs are smaller than normal (microcytic) as is seen in iron deficiency anemia or thalassemias.
• Mean corpuscular hemoglobin (MCH) is a calculation of the average amount of oxygen-carrying hemoglobin inside a red blood cell. Macrocytic RBCs are large so tend to have a higher MCH, while microcytic red cells would have a lower value.
• Mean corpuscular hemoglobin concentration (MCHC) is a calculation of the average concentration of hemoglobin inside a red cell. Decreased MCHC values (hypochromia) are seen in conditions where the hemoglobin is abnormally diluted inside the red cells, such as in iron deficiency anemia and in thalassemia. Increased MCHC values (hyperchromia) are seen in conditions where the hemoglobin is abnormally concentrated inside the red cells, such as in burn patients and hereditary spherocytosis, a relatively rare congenital disorder.
• Red cell distribution width (RDW) is a calculation of the variation in the size of your RBCs. In some anemias, such as pernicious anemia, the amount of variation (anisocytosis) in RBC size (along with variation in shape – poikilocytosis) causes an increase in the RDW. (reference: http://www.labtestsonline.org )

My father's Surgeon found the result of his CBC to be highly unusual and so advised for the surgery to be cancelled. He was referred instead to another doctor, this time a Hematologist.

Hematology - the branch of internal medicine, physiology, pathology, clinical laboratory work, and pediatrics that is concerned with the study of blood, the blood-forming organs, and blood diseases. Hematology includes the study of etiology, diagnosis, treatment, prognosis, and prevention of blood diseases. (reference: wikipedia.com)

Hematologist - A doctor who specializes in the field of Hematology.

His new doctor did a Bone Marrow Aspiration on him and I gotta say that just by watching the entire procedure I could tell that it was very painful.

A Bone marrow aspiration removes a small amount of bone marrow fluid and cells through a needle put into a bone. The bone marrow fluid and cells are checked for problems with any of the blood cells made in the bone marrow. Cells can be checked for chromosome problems. Cultures can also be done to look for infection.

A bone marrow biopsy removes bone with the marrow inside to look at under a microscope. The aspiration (taking fluid) is usually done first, and then the biopsy.

A bone marrow aspiration, biopsy, or both are done to:

• Look for the cause of problems with red blood cells, white blood cells, or plateletsin people who have conditions such as thrombocytopenia, anemia, or an abnormal white blood cell count.
• Find blood disorders, such as leukemia, certain anemias, or problems that affect the bone marrow, such as multiple myeloma or polycythemia vera.
• Check to see if a known cancer, such as Hodgkin's lymphoma or non-Hodgkin's lymphoma, has spread to the bone marrow. This is part of what is called staging. It is done to find out if the cancer has spread and how much it has spread. This helps plan cancer treatment. Staging can be done for other cancers, such asprostate, breast, or lung cancer that may have spread to the bone marrow.
• Find infections or tumors that may start in or spread to the bone marrow. If you have an infection, a culture and sensitivity test of the bone marrow sample may be used to find out which antibiotics will work best to treat the infection.
• Find the best treatment for a bone marrow problem. Once treatment has been started, a bone marrow aspiration and biopsy may be done to see if the leukemia cells are gone, which means the treatment is working.
• Collect a sample of bone marrow for medical procedures, such as stem cell transplantation or chromosomal analysis. (reference: http://www.webmd.com)

After the doctor delivered the news to us (first to me, then to my father), we were left with a feeling of hopelessness. That was a dark part in our lives. My father, although he never did break down, hinted of giving up. He told us that he might as well wait for his time to come instead of go through treatments when he would not be assured of recovery.

Treatment Options for AML:

Induction

All FAB subtypes except M3 are usually given induction chemotherapy with cytarabine (ara-C) and an anthracycline (such as daunorubicin or idarubicin).^[32] This induction chemotherapy regimen is known as "7+3" (or "3+7"), because the cytarabine is given as a continuous IV infusion for seven consecutive days while the anthracycline is given for three consecutive days as an IV push. Up to 70% of patients will achieve a remission with this protocol.^[33] Other alternative induction regimens, including high-dose cytarabine alone or investigational agents, may also be used.^[34][35] Because of the toxic effects of therapy, including myelosuppression and an increased risk of infection, induction chemotherapy may not be offered to the very elderly, and the options may include less intense chemotherapy or palliative care.

The M3 subtype of AML, also known as acute promyelocytic leukemia, is almost universally treated with the drug ATRA (all-trans-retinoic acid) in addition to induction chemotherapy.^[36][37][38] Care must be taken to prevent disseminated intravascular coagulation (DIC), complicating the treatment of APL when the promyelocytes release the contents of their granules into the peripheral circulation. APL is eminently curable with well-documented treatment protocols.

The goal of the induction phase is to reach a complete remission. Complete remission does not mean that the disease has been cured; rather, it signifies that no disease can be detected with available diagnostic methods.^[32] Complete remission is obtained in about 50%–75% of newly diagnosed adults, although this may vary based on the prognostic factors described above.^[39] The length of remission depends on the prognostic features of the original leukemia. In general, all remissions will fail without additionalconsolidation therapy.^[40]

Consolidation

Even after complete remission is achieved, leukemic cells likely remain in numbers too small to be detected with current diagnostic techniques. If no further postremission or consolidation therapy is given, almost all patients will eventually relapse.^[41] Therefore, more therapy is necessary to eliminate non-detectable disease and prevent relapse — that is, to achieve a cure.

The specific type of postremission therapy is individualized based on a patient's prognostic factors (see above) and general health. For good-prognosis leukemias (i.e. inv(16), t(8;21), and t(15;17)), patients will typically undergo an additional 3–5 courses of intensive chemotherapy, known as consolidation chemotherapy.^[42][43] For patients at high risk of relapse (e.g. those with high-risk cytogenetics, underlying MDS, or therapy-related AML), allogeneic stem cell transplantation is usually recommended if the patient is able to tolerate a transplant and has a suitable donor. The best postremission therapy for intermediate-risk AML (normal cytogenetics or cytogenetic changes not falling into good-risk or high-risk groups) is less clear and depends on the specific situation, including the age and overall health of the patient, the patient's personal values, and whether a suitablestem cell donor is available.^[43]

For patients who are not eligible for a stem cell transplant, immunotherapy with a combination of histamine dihydrochloride (Ceplene) and interleukin-2 (Proleukin) after the completion of consolidation has been shown to reduce the absolute relapse risk by 14%, translating to a 50% increase in the likelihood of maintained remission.^[44]

Relapsed AML

For patients with relapsed AML, the only proven potentially curative therapy is a hematopoietic stem cell transplant, if one has not already been performed.^[45][46][47] In 2000, the monoclonal antibody-linked cytotoxic agent gemtuzumab ozogamicin (Mylotarg) was approved in the United States for patients aged more than 60 years with relapsed AML who are not candidates for high-dose chemotherapy.^[48]

Patients with relapsed AML who are not candidates for stem cell transplantion, or who have relapsed after a stem cell transplant, may be offered treatment in a clinical trial, as conventional treatment options are limited. Agents under investigation include cytotoxic drugs such as clofarabine as well as targeted therapies such as farnesyl transferase inhibitors, decitabine, and inhibitors of MDR1 (multidrug-resistance protein). Since treatment options for relapsed AML are so limited, another option which may be offered ispalliative care.

For relapsed acute promyelocytic leukemia (APL), arsenic trioxide has been tested in trials and approved by the Food and Drug Administration. Like ATRA, arsenic trioxide does not work with other subtypes of AML.^[49]

(reference: wikipedia.com)

It's a good thing my eldest sister was able to convince him to undergo treatment because it definitely helped. After my father agreed to have Chemotherapy, we immediately arranged for living arrangements as well as hospital accommodations (since it would be too much of a hassle and discomfort to have to travel back and forth between two cities while he was undergoing treatment).

When he was already in Chemotherapy, he would stay at the hospital for days to a week. The amount of medications he had to take and the strength of each one of those medicines took a toll on his body. Sometimes he would have hallucinations and would bruise all over. He became very thin, his hairs started to fall off (which was why he decided to shave his head off). He was very prone to infections and was always feverish. From time to time he would need blood transfusions.

Through all these, despite the emotional, mental and physical torture that my father went through, he still managed to survive and be in good health again. He has been cancer-free for almost five years and is as strong as can be at 69 years old. I and my family, including my father, have always been and will always be grateful to God for my father's second chance at life.

In serious medical conditions as my father once had, a strong support system is truly a really big morale booster. It helps keep the patient's hopes up and keeps him fighting for his life. I believe that is what happened with my father. Aside from the fact that he is a strong person (emotionally and physically), his unwavering faith in God and his family never leaving his side strengthened his resolve to overcome his sickness and continue living.

BREAST MASSES

In early 2007, as i was absently scratching my chest, my hand accidentally felt a tiny lump in my right breast. It was located just a little above the nipple of my right breast. For a moment i didn't know what to do because i was so afraid that it might be something serious.

When I couldn't keep it to myself anymore, i told my mom about it and she immediately told me to have the lump checked. I gotta say, if i had a list of my most scary moments, the first breast lump check-up will definitely be up on top of that list (second only to being in a car accident and thinking it might be my time... but that's a different story altogether).

I first went to an Obstetrician/Gynecologist who told me to get a Sonomammogram ( Ultrasound of the breast), who then referred me to a Surgeon. The Surgeon, after checking the result of my Sonomammogram and doing some routine tests, advised that I should monitor the masses (the sonomammogram revealed that I had more than 1 breast lump) after every 6 months. He didn't advise for surgery right away because he didn't think that the lumps were something of a serious nature. He believed that the lumps most probably were all fibroadenomas (small, solid, rubbery, noncancerous, harmless lumps composed of fibrous and glandular tissue).

After I went to the doctors, I googled the terms breast lumps and fibroadenomas. I read articles about them, in order to reassure myself that everything was fine and that i'm not in a life-threatening condition. Here are some facts that I learned from my research:

Breast changes are common. From the time a girl begins to develop breasts and begins menstruating and throughout life, women may experience various kinds of breast pain and other breast changes. Some of these changes normally occur during the menstrual cycle, during pregnancy, and with aging. Breast lumps, tenderness, and other changes may occur. Most breast lumps and other changes are not cancer.

Your breast is composed of several glands and ducts that lead to the nipple and the surrounding colored area called the areola. The milk-carrying ducts extend from the nipple into the underlying breast tissue like the spokes of a wheel. Under the areola are lactiferous ducts. These fill with milk during lactation after a woman has a baby. When a girl reaches puberty, changing levels of hormones cause the ducts to grow and cause fat deposits in the breast tissue to increase. The glands that produce milk (mammary glands) that are connected to the surface of the breast by the lactiferous ducts may extend to the armpit area (axilla).

There are no muscles in the breasts, but muscles lie under each breast and cover the ribs. These normal structures inside the breasts can sometimes make them feel lumpy. Such lumpiness may be especially noticeable in women who are thin or who have small breasts.

• Lumps within breast tissue are usually found unexpectedly or during a routine monthly breast self-exam. Most lumps are not cancer but represent changes within the breast tissue. As your breasts develop, changes occur. These changes are influenced by normal hormonal variations.

• Breast pain is a common breast problem mostly in younger women who are still having their periods, and happens less often in older women. Although pain is a concern, breast pain is rarely the only symptom of breast cancer. Most breast cancers involve a mass or lump.

• Cyclic mastalgia: About two-thirds of women with breast pain have a problem called cyclic mastalgia. This pain typically is worse before your menstrual cycle and usually is relieved at the time your period begins. The pain may also happen in varying degrees throughout the cycle. Because of its relationship to the menstrual cycle, it is believed to be caused by hormonal changes. This type of breast pain usually happens in younger women, although the condition has been reported in postmenopausal women who take hormone replacement therapy.

• Noncyclic mastalgia: Breast pain that is not associated with the menstrual cycle is called noncyclic mastalgia. It occurs less often than the cyclic form. It typically occurs in women older than 40 years and is not related to the menstrual cycle. It is sometimes linked to a fibrous mass (called afibroadenoma) or a cyst.

• Breast pain or tenderness may also occur in a teenage boy. The condition, called gynecomastia, is enlargement of the male breast which may occur as a normal part of development, often during puberty.

• Breast infection: The breast is made up of hundreds of tiny milk-producing sacs called alveoli. They are arranged in grapelike clusters throughout the breast. Once breastfeeding begins, milk is produced in the alveoli and secreted into tube-shaped milk ducts that empty through the nipple. Mastitisis an infection of the tissue of the breast that occurs most frequently during the time of breastfeeding. This infection causes pain, swelling, redness, and increased temperature of the breast. It can occur when bacteria, often from the baby's mouth, enter a milk duct through a crack in the nipple. This causes an infection and painful inflammation of the breast.
• fibroadenomas - Fibroadenomas of the breast are small, solid, rubbery, noncancerous, harmless lumps composed of fibrous and glandular tissue. Because breast cancer can also appear as a lump, doctors may recommend a tissue sample (biopsy) to rule out cancer in older patients. Unlike typical lumps from breast cancer, fibroadenomas are easy to move, with clearly defined edges. A fibroadenoma is usually diagnosed through clinical examination, ultrasound or mammography, and often a needle biopsy sample of the lump.

The information I pasted in this blog is just about a 10th of everything that there is to know about breast lumps. You can read more about this topic in a lot of articles discussing breast health, breast mass and in general, how to care for your breasts.

Basically, the lumps in my breasts are solid. They are smooth in texture and they have a definite shape. The doctors have diagnosed the lumps as fibroadenomas but I still need to monitor them from time to time (through sonomammograms) just to be sure that there are no negative changes.

(my first sonomammogram: mar 2007)

(my latest sonomammogram: February 2011)

My point in all of this is that breast lumps, however scary they may seem, is not something that should be a cause of paralyzing fear for us. Instead of being scared of whatever the lump may be, the best option is always to have it checked first, before drawing any conclusions. Also, being educated about whatever condition it is that is affecting you always helps. Knowledge about something that is a concern to you can be a form of reassurance. It has been for me.

reference/s: http://www.emedicinehealth.com ; http://en.wikipedia.org

take 2!

So this will be my second blog. I haven't completely disregarded the first one, it's just that i wanted to 'start fresh' (for lack of a better word).

I'm going to make this blog as informative as I can. Since I'm always warming the sofa surfing the internet most of the time i figured, why not learn about things that I can relate to and things that I've encountered before?