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January 19, 2012
The leukosis (other names — a blood cancer, leukemia, a leukemia) is a group of diseases of blood cells which are malignant. Initially the leukosis is shown at the person in marrow. This body is responsible for development of leukocytes (white blood cells), erythrocytes (red blood cells) and thrombocytes. The leukosis arises if one of cells in marrow mutates. So, in development this cell becomes not a mature leukocyte, but a cancer cell.
After education the white blood cell does not carry out the usual functions any more, but at the same time there is very fast and uncontrolled process of its division. As a result owing to formation of a large number of abnormal cancer cells they force out normal blood cells. Anemia, infections, display of bleedings becomes result of such process. Further leukemic cells get into lymph nodes and other bodies, provoke manifestation of pathological changes.
Most often the leukosis affects people of advanced age and children. The leukosis arises with a frequency about 5 cases at 100 000 children. The leukosis is diagnosed for children more often than other cancer diseases. Most often this disease arises at children at the age of 2-4 years.
Till today there are no precisely certain reasons which provoke development of a leukosis. However there are exact data on risk factors which promote developing of a blood cancer. Those is radiation by radiation, influence of cancerogenic chemicals, smoking, a heredity factor. However many people who have a leukosis did not face before one of the specified risk factors.
Types of a leukosis
The leukosis of blood can be divided into several different types. If to take character of a course of an illness into account, then allocate an acute leukosis and a chronic leukosis. If in case of an acute leukosis symptoms of an illness are shown at the patient sharply and promptly, then at a chronic leukosis the illness progresses gradually, for several years. At an acute leukosis the patient has rapid uncontrollable growth of unripe blood cells. At patients with a chronic leukosis the quantity of cells which are more mature quickly grows. Symptoms of a leukosis of acute type much heavier therefore this form of an illness demands the immediate correctly picked up therapy.
If to consider types of a leukosis from the point of view of defeat like cells, then distinguish a number of forms of a leukosis: a lymphoid leukosis (a form of an illness at which defect of lymphocytes is observed); a myeloleukemia (process at which normal maturing of granulotsitarny leukocytes is broken). In turn, these types of a leukosis subdivide into certain subspecies which are distinguished on various properties, and also on selection like treatment. Therefore, it is very important to establish the expanded diagnosis precisely.
First of all, it is necessary to consider that leukosis symptoms directly depend on what form of an illness takes place at the person. The main general symptoms of a leukosis are headaches, the increased temperature, manifestation of the expressed tendency to developing of bruises and hemorrhages. At the patient painful feelings in joints and bones, increase in a spleen, liver, swelling of lymph nodes, manifestations of feeling of weakness, tendency to infections, loss of appetite and, as a result, weight are also shown.
It is important that the person paid attention to manifestation of similar symptoms in time and defined emergence of changes in health. Also complications of infectious character can join development of a leukosis: necrotic quinsy, stomatitis.
At a chronic leukosis symptoms are shown gradually. The patient quickly gets tired, feels weakness, at him the desire to eat and work vanishes.
At late stages of a leukosis at the patient also expressed tendency to fibrinferments is shown.
If at the patient with a leukosis of blood innidiation process begins, then leukemic infiltrates are shown in various bodies. They often arise in lymph nodes, a liver, a spleen. In view of obturation of vessels by tumor cells in bodies heart attacks, complications of ulcer and necrotic character can be also shown.
There is a number of the moments which are defined as possible origins of mutations in chromosomes of usual cells. Impact of ionizing radiation on the person is the reason of a leukosis. This feature was proved after the atomic explosions which occurred in Japan. After a while after them the number of patients with an acute leukosis increased several times. Directly influences development of a leukosis and effect of carcinogens. These are some medicines (levomycetinum, Butadionum, cytostatics) and chemicals (benzene, pesticides, oil refining products). The heredity factor in this case belongs first of all to a chronic form of a disease. But in those families which members were ill an acute form of a leukosis the risk of developing of a disease also increased several times. It is considered to be that tendency to a mutation of normal cells devolves.
There is also a theory that the reason of development of a leukosis in the person can become special viruses which can be built in DNA of the person and afterwards provoke transformation of usual cells in malignant. Somewhat display of leukoses depends on in what geographical zone the person and what representative of race he is will live.
Diagnosis of a leukosis
Diagnosis of an illness is carried out by the specialist oncologist performing preliminary inspection of the patient. For statement of the diagnosis first of all the general blood test and biochemical blood analyses is carried out. For ensuring accuracy of diagnosis conduct also research of marrow.
For research the marrow sample from the patient is taken from a breast or an ileal bone. If at the patient the acute leukosis develops, then in the course of research replacement of normal cells with unripe tumor cells comes to light (they are called blasts). Also in the course of diagnosis can immunophenotyping (inspection of immunological character) is carried out. The method of a flowing tsitometriya is for this purpose used. This research allows to obtain information on what subspecies of a blood cancer take place at the patient. These data allow to pick up the most effective technique of treatment.
In the course of diagnosis conduct also cytogenetic and molecular and genetic research. In the first research it is possible to find specific chromosomal damages. It allows specialists to find out what subspecies of a leukosis are observed at the patient, and to understand, disease is how aggressive. Existence of genetic disorders at molecular level comes to light in the course of molecular and genetic diagnosis.
At suspicion on some forms of an illness can studying of cerebrospinal fluid regarding existence in it of tumor cells is carried out. The obtained data also help to pick up the correct program of therapy of an illness.
In the course of statement of the diagnosis differential diagnosis is especially important. So, the leukosis at children and adults has a number of the symptoms characteristic of HIV infection, and also other signs (increase in bodies, a pancytopenia, leukemoid tests) which can testify also to other diseases.
Treatment of a leukosis
Treatments of a leukosis of an acute form consists in use of several drugs with antineoplastic action at once. They are combined with rather high doses of glucocorticoid hormones. After careful inspection of patients doctors define whether there is a sense of carrying out to the patient of operation on a bone marrow transplantation. In the course of therapy carrying out the supporting actions is of very great importance. So, to the patient carry out transfusion of components of blood, and also take measures for operational treatment of the joined infection.
In the course of treatment of a chronic leukosis antimetabolites — the drugs suppressing development of malignant cells are actively applied today. Also treatment with use of radiation therapy, and also introduction to the patient of radioactive materials is applied.
The specialist defines a technique of treatment of a leukosis, being guided by what form of a disease develops at the patient. In the course of carrying out treatment control of a condition of the patient by means of regular carrying out blood tests and research of marrow is provided.
Treatment of a leukosis is carried out regularly, throughout all life. It is important to consider that without treatment the fast lethal outcome is possible.
The most important point which should be considered that for whom the acute leukosis is diagnosed is that treatment of a leukosis of this form should be begun immediately. Without appropriate treatment the illness progresses extraordinary quickly.
Distinguish three stages of an acute leukosis. At the first stage there is a disease debut: initial clinical manifestations. The period comes to an end with receiving effect of the taken measures for treatment of a leukosis. The second stage of an illness – its remission. It is accepted to distinguish remission full and incomplete. If full kliniko-hematologic remission which lasts not less than one month takes place, then clinical manifestations are absent, in a miyelogramma no more than 5% of blast cells and no more than 30% of lymphocytes are defined. At incomplete kliniko-hematologic remission clinical indicators return to normal, in punctate of red marrow available there is no more than 20% of blast cells. At the third stage of an illness there is its recurrence. Process can begin with emergence of the extramedullary centers of a leukemic infiltration in different bodies, at the same time indicators of a hemogenesis will be normal. The patient can not state complaints, however at research of red marrow reveal recurrence signs.
It is necessary to treat an acute leukosis at children and adults only in specialized institution of a hematologic profile. In the course of therapy the main method is the chemotherapy which purpose – to destroy all leukemic cells in a human body. Also auxiliary actions which are appointed are carried out, being guided by the general a condition of the patient. So, the transfusion of components of blood, actions directed to decrease in level of intoxication and prevention of infections can be carried out.
Treatment of an acute leukosis consists of two important stages. First, induction therapy is carried out. It is chemotherapy at which malignant cells are destroyed and to be set the purpose to reach full remission. Secondly, carrying out chemotherapy after achievement of remission. This method is directed to warning a palindromia. In this case approach to treatment is defined already in an individual order. Carrying out chemotherapy with consolidation approach use is possible. Thus after remission the program of chemotherapy similar to that which was applied earlier is used. Approach of an intensification consists in use of more active chemotherapy, than in the course of treatment. Use of a maintenance therapy consists in use of smaller doses of drugs. However process of chemotherapy longer.
Treatment by means of other methods is also possible. So, a leukosis of blood it is possible to treat by high-dose chemotherapy after which to the patient transplantation of stem hemopoietic cells is made. New medicines from which it is possible to distinguish nukleozidny analogs, monoclones differentiating means are applied to treatment of an acute leukosis.
Prevention of a leukosis
As prevention of leukoses it is regularly very important to pass routine inspections at specialists, and also to carry out all necessary preventive laboratory analyses. In the presence of the symptoms described above it is necessary to address the specialist immediately. At the moment accurate measures for primary prevention of an acute leukosis are not developed. After achievement of a stage of remission it is very important to patient to carry out the high-quality supporting and antirecurrent therapy. The constant control and supervision at an onkogematolog and the pediatrician is necessary (in case of a leukosis at children). Constant careful control over indicators of blood of the patient is important. After treatment of a leukosis patients are not recommended to move to other climatic conditions, and also to subject the patient to physiotherapeutic procedures. To children who had a leukosis carry out preventive inoculations according to individually developed calendar of inoculations.