Leukemia: Bone Marrow and Blood Formation

     Bones are not solid, but instead are made up of two distinct regions. The outter, weight bearing area, is hard, compact and calcium based. It surrounds a lattice work of fiberous bone known as cancellous tissue.
The inner region, or marrow, is one of the largest organs of the body, is located within the bones. It fills the shaft of the long bones, the trabeculae ( spaces within cancellous tissue ), and extends into the boney canals.
     Bone marrow may contain fat cells, fluid, fibrous tissue, blood vessels and blood formimg (hematopoietic) cells. Marrow appears yellow in color when it holds many fat cells and red when it has more blood forming material. The marrow is the principle site for blood formation (hematopoiesis), which occurs primarily within the bones of the legs, arms, ribs, breastbone, and spine.

Stem Cells

Many of the blood cells that comprise the bloodstream within the arteries and veins are born and mature within the marrow. They are derived from hematopoietic cells that are called stem cells. Stem cells within the bone marrow continously divide to form new cells.

     Some of the new cells remain unchanged as stem cells and have a lifelong capacity for self renewal. These cells are called pluripotential cells. Other unipotential stem cells have a limited capacity for self-renewal also known as progenitor cells. Unipotential cells become committed to forming only one type of blood cell line, eythrocytes (red blood cells), leukocytes (white blood cells) and platelets.

     Colonies of progenitor cells provide offspring of increasing differentiation (maturity). They react to specific compounds known as protein. Proteins stimulate the progenitor cells until they transform into the appropriate young blood cell known as a " Blast Cell".

Getting ready for spring

Bone Cancer Symptoms

Understanding Bone Pain


As cancer grows within the cartilage or bone tissue, a painful sensation may develop in the bones. Sometimes it is described as a "deep" pain that doesn't go away. As the cancer develops, the pain may grow to become constant throughout the day and may be accompanied by swelling. Occasionally, the tumor may cause the bone to weaken and fracture. Any unusual bone pain, the most common symptom of bone cancer, is a signal to talk to your doctor.



Other injuries or conditions, however, may have similar symptoms. Arthritis or osteoporosis are far more common ailments causing bone or joint pain in adults. Talk with your doctor if you are experiencing any bone pain. Your medical history and knowledge of previous accidents or injuries can help you doctor evaluate your condition.



Potential Bone Cancer Symptoms

Experiencing one or more of these symptoms does not mean you have bone cancer. However, you may be exhibiting symptoms of another condition or injury that may still require medical attention, so you should not ignore them.



The following are some potential symptoms of bone cancer:



•Bone Pain: Pain in the bones is usually noticeable as the tumor begins to grow. Early on, the pain may only occur at certain times of the day. As the cancer develops, the pain may become more persistent. Other conditions, like osteoporosis or arthritis, may also cause bone or joint pain.



•Swelling: The area where the pain is localized may begin to show signs of swelling.



•Fractures: Cancerous cells may weaken the bone. Sometimes this may result in fractures.



•Decreased Mobility: In some cases, if the location of the tumor is near a joint, it may make normal movements difficult or painful.



•Other Symptoms: Unintended weight loss and fatigue may accompany the bone pain. Other symptoms may develop if the cancer has spread to other organs.



NOTE: These symptoms may be attributed to a number of conditions other than cancer, such as an infection or other illness. It is important to consult with a medical professional for an accurate diagnosis.



Paget's Disease and Related Symptoms

Paget's disease is a rare condition resulting in abnormal bone growth. The breakdown of cartilage may lead to arthritis. Although the disease is non-cancerous, it does increase a person's likelihood of developing bone cancer.



Similar to the feeling of a pinched nerve, the pressure of the increased bone mass on the nerves may cause tingling and numbness in extremities. There may be a hereditary factor involved and certain tests are available for anyone who believes they may be at risk for Paget's disease.(Note: Paget’s disease of the breast, a rare form of breast cancer, is medically unrelated to Paget’s disease of the bone.)



Bone and joint pain can be extremely painful or inhibit mobility. These symptoms may be indicative of another injury or condition other than bone cancer. However, it is important to receive treatment for these symptoms as they arise. Let your doctor know if you have any of the bone cancer risk factors, such as Paget's disease or a history of radiation therapy.

Primary Risk Factors

Understanding Primary Bone Cancer


Cancers are named for the site of origin. The naming of bone cancer depends on the type of tissue where the cancerous cells first arise. Primary bone cancer tumors, or sarcomas, originate in the bone tissue or cartilage and are relatively rare. Cancer that has spread (metastasized) from a different part of the body, such as the lung, is called secondary bone cancer.



This is an important distinction for understanding risk factors, diagnosis, and treatment because secondary bone cancer may behave differently. For example, cancer cells from the lung are different than those originating in the bladder, or the bone, and will respond differently to treatments.



Understanding Risk Factors for Bone Cancer

Scientists have not yet identified a cause for primary bone cancers, or sarcomas. Certain diseases and the treatment of other diseases may increase a person's likelihood for developing bone cancer.



Knowledge of risk factors may help with the diagnosis and treatment of the disease, but having one or more risk factors does not mean you will get bone cancer. Many factors are beyond our control. However, some risk factors, like exposure to high doses of radiation, can be managed to promote better overall health.



Note: Myeloma is cancer of the white blood cells. Sometimes these cells will collect within the bone marrow or on the outer part of the bone. Although the bones are involved, myeloma is not a bone cancer. You can learn more about multiple myeloma by visiting our Multiple Myeloma Center.



Bone Cancer Risk Factors

Primary bone cancer affects only about 2,500 people a year. Chondrosarcomas (originating in the cartilage) are the most common form, and are more likely to effect people over age 40. Osteosarcomas (originating in bone cells) are more common in younger adults. Ewing's sarcomas (found either in the bone or soft tissue) are rather rare, and occur more often in children.



Although there is not a clear cause of bone cancer, the factors that may affect a person's risk of developing the disease are as follows:



•Genetic Syndromes: Certain inherited conditions have been associated with an increased likelihood of developing the disease:

•Li-Fraumeni syndrome

•Rothmund-Thompson syndrome

•Inherited Retinoblastoma

•Multiple exostoses (multiple osteochondromas)

•Paget's Disease: Typically affecting adults over age 40, Paget's disease (or osteitis deformans) is a non-cancerous condition that deforms and weakens the bones and may increase the risk of developing osteosarcomas. (Note: Paget’s disease of the breast, a rare form of breast cancer, is medically unrelated to Paget’s disease of the bone.)

•Radiation Treatment: People who have undergone radiation therapy or chemotherapy for other conditions may be at an increased risk for developing bone cancer, particularly younger adults treated with high doses of radiation. Small sources of radiation, like a typical X-ray, do not pose a risk.

NOTE: Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer. Not having risk factors does not mean that you won't get cancer. If you think you may be at risk, you should discuss it with your doctor.



Assessing the Risk Factors of Bone Cancer

There is not a single identifiable cause of primary bone cancer. Having one or more of the risk factors only means that the probability of developing bone cancer may have increased.



For example, if you have received radiation therapy to treat another cancer, you may want to discuss what this means for your individual risk of developing bone cancer with your doctor. Or, if you have been diagnosed with Paget's disease, you and your doctor can work together to manage the risk factors associated with this condition. With knowledge and awareness, you can take charge of your risk factors.

What Is Bone Cancer?

Bone cancer is a rare cancer that forms in the cells of bones. As the supporting framework of the body, the bones provide structure and shape to the body, act as braces for muscles to produce movement, and protect internal organs.



Most bones are hollow and consist of a hard outer portion (onto which calcium salts are deposited), a spongy inner tissue that contains bone marrow (which makes and stores blood cells), and cartilage at each end of the bone (which acts as a cushion between bones). The bone itself contains three types of cells: osteoblasts (which form new bone), osteocytes (which help maintain bone), and osteoclasts (which break down bone).



Cancer that begins in the bone (known as primary bone cancer) is not the same disease as cancer that starts in another part of the body and spreads (or metastasizes) to the bone (called secondary bone cancer). While it can occur in any of the bones of the body, primary bone cancer most often occurs in the long bones of the arms and legs.



According to the American Cancer Society, primary bone cancers account for less than 0.2 percent of all cancers, only about 2,300 new cases per year in the United States. More commonly, bones are the site of tumors that spread to the bone from another part of the body (bone metastases), such as the breasts, lungs, and prostate.



Types of Bone Cancer

Bone cancers can be primary (sarcomas), where the cancer forms in the cells of the bone. Or they can be secondary (bone metastasis) where the cancer has spread from another part of the body to the bone.



Primary bone cancers:

•Osteosarcoma - Also known as osteogenic sarcoma, osteosarcoma is the most common bone cancer and typically starts in the bones of the arms, legs, or pelvis of people between the ages of 10 and 30.

•Chondrosarcoma - This type of bone cancer forms in cartilage cells and is the second most common form of the disease. It rarely occurs in people under the age of 20, and the chances of developing it increases with age.

•Ewing tumor - Also known as Ewing sarcoma, this cancer starts in the bones, but can also start in other tissues and muscles. It is the third most common and typically forms in children and teenagers.

•Fibrosarcoma and malignant fibrous histiocytoma - Both of these bone cancers develop in the soft tissue around the bones and tend to occur in older adults. They most commonly affect the arms, legs or jaw.

•Giant cell tumor of bone - This type of bone cancer can have both benign and malignant forms, benign being the most common. It usually affects the arm or leg bones among young and middle aged adults without spreading. They commonly return after surgical removal and tend to spread to other parts of the body.

•Chordoma - Often found in adults 30 or older, this bone cancer affects the spine and the base of the skull. It is about twice as common for men than women and tends to grow more slowly without spreading. However after surgery, this bone cancer can return and usually spreads to the lungs, liver or lymph nodes.

Secondary bone cancer:

•Bone metastasis - Bone metastasis is a form of bone cancer that develops in another part of the body and spreads to the bones through the blood stream or lymph system. While this type of cancer can form in any part of the body it is most commonly found in the bones near the center, like the pelvis or spine.

Back to Basics for Children's Health

Nutrition and fitness are the cornerstones of children's health.




To give your child a head start on lifelong fitness, consider children's sports and other kid-friendly physical activities. With your encouragement, chances are a few sports will spark your child's interest. And consider other classic tips from children's health experts, such as promoting activity — not exercise — and setting a good example yourself.



You can also promote children's health by encouraging your child to eat a variety of healthy foods and control portion sizes. Learn which nutrients are necessary, in what amounts, and how the guidelines change as a child grows older.



Of course, other children's health issues matter, too — such as vaccines, child safety and preventing child abuse. Share any concerns you may have about children's health with your child's doctor.

Staging

Staging




Once the physician has diagnosed lymphoma, he or she will want to perform studies to establish the patient's stage—that is, to find out how far the patient's cancer has spread. Staging helps the physician to select appropriate treatment options and helps him/her to arrive at a prognosis, or estimate of disease outlook and survival. Clinical information is reviewed, including findings from the physical examination, blood tests, and imaging studies. The imaging studies most often employed are chest X-ray and computed tomographic (CT) scan of the chest, abdomen, and pelvis.



One of the hallmarks of HD is that it tends to spread from one lymph node set to the next, without "skipping" an area unless the disease has progressed very far. HD rarely invades single, nonlymphatic organs or sites, and it does not tend to spread to nearby organs. Because of these characteristics, HD is "staged" according to sites of involvement in relation to the diaphragm, the major muscle of the abdomen that is used for breathing.



If the patient has Hodgkin's Disease (HD), the physician may order additional tests such as a gallium scan and lymphangiography. In addition, a bone marrow biopsy may be obtained.



Tests

Gallium scanning—Gallium scanning is a nuclear medicine procedure. Radioactive gallium is injected into the patient's vein, and it is taken up by malignant lymphoma cells. A specialized camera then is used to produce a picture of the pooled gallium, which will identify the size and sites of cancerous areas. Gallium scanning is particularly useful when HD is located in the patient's chest; however, this procedure is used more often to help predict recurrence in patients with radiologic abnormalities that remain after therapy.

Chemotherapy Side Effects

Not only feeling tired and depressed from Cancer,many people fear chemotherapy because they have heard that it can have uncomfortable side effects. But side-effect management has come a long way over the last few decades. Today, many side effects once associated with chemotherapy can be prevented or controlled. With some types of chemotherapy, you may experience only minimal side effects. And chemotherapy may be your best option for a successful outcome. You can help achieve a successful outcome by understanding how side effects can impact your treatment. Learn how best to manage chemotherapy side effects.
Chemotherapy is the general term for any treatment involving the use of chemical agents to stop cancer cells from growing. Chemotherapy can eliminate cancer cells at sites great distances from the original cancer. As a result, chemotherapy is considered a systemic treatment.
More than half of all people diagnosed with cancer receive chemotherapy. For millions of people, chemotherapy helps treat their cancer effectively, enabling them to enjoy full, productive lives.
A chemotherapy regimen (a treatment plan and schedule) usually includes drugs to fight cancer plus drugs to help support completion of the cancer treatment.2-8 To get the most from chemotherapy, it's important to stick to a schedule of treatment.
How Chemotherapy Works :

Chemotherapy is designed to kill cancer cells. Chemotherapy can be administered through a vein, injected into a body cavity, or delivered orally in the form of a pill, depending on which drug is used.

Chemotherapy works by destroying cancer cells; unfortunately, it cannot tell the difference between a cancer cell and some healthy cells. So chemotherapy eliminates not only the fast-growing cancer cells but also other fast-growing cells in your body, including, hair and blood cells.

Some cancer cells grow slowly while others grow rapidly. As a result, different types of chemotherapy drugs target the growth patterns of specific types of cancer cells. Each drug has a different way of working and is effective at a specific time in the life cycle of the cell it targets. Your doctor will determine the chemotherapy drug that is right for you. To understand more about the different ways chemotherapy is given, read about how people receive chemotherapy.

Discussing the Effectiveness of Cancer Treatment :

Understand the goals and risks of each treatment option so you can work with your doctor to decide which treatment is best for you. Balance potential benefits against the risks of treatment.

Some risks of cancer treatments may include time away from family and friends, uncomfortable side effects, or long-term complications. Cancer treatment may be inconvenient, prolonged, or unavailable close to home. These are important considerations when evaluating treatment options, but they are not typically mentioned in medical journals reporting the results and benefits of new treatments.

Once you and your doctor have decided on a treatment plan, talk with your doctor about issues that could interrupt your treatment plan. You can make note of subjects to discuss and questions to ask by using Tools for Organizing Your Cancer Information.

Importance of Dose and Schedule :

Your doctor will develop a treatment plan scientifically designed for you, based on your type of cancer, its stage of advancement, and your overall health. It will consist of specific chemotherapy agents, at specific doses and intervals. These are called your scheduled cycles. Generally, treatments are given daily, weekly, or monthly. Your doctor will help you determine the most effective treatment schedule for you.

The goal is to make your chemotherapy as effective, timely, and problem-free as possible. But while your chemotherapy treatment works to fight your cancer, it also can cause side effects such as a lowered white blood cell count. A low white blood cell count means your immune system isn't as strong as it could be, which can increase your risk of infection. It also can require your doctor to change your dose or schedule of your chemotherapy.

A chemotherapy-induced low white blood cell count, caused by healthy cells lost during chemotherapy, is an expected side effect of many chemotherapy drugs. A low white blood cell count typically occurs after the administration of certain types of chemotherapy and may continue for several days. To help reduce side effects like low white blood cell count that may interfere with your treatment schedule, learn more about managing chemotherapy side effects.

Under certain circumstances, your doctor may decide your body is too weak to receive chemotherapy. A low white blood cell count can temporarily disrupt your cancer treatment or result in having your chemotherapy dose decreased.

Many doctors agree that it's important to stick to a schedule of treatment. Find out about chemotherapy cycles and schedules.

Chemotherapy Side Effects :

An undesirable consequence of chemotherapy affecting your body—not related to your cancer—is referred to as a complication of treatment, or a side effect. Some common side effects of chemotherapy are:

Low white blood cell count

Low red blood cell count

Low platelet count

Nausea

Vomiting

Hair loss

Fatigue

Some side effects may be temporary and uncomfortable. Some can cause dose reductions and treatment delays or even be life-threatening.
For example, one of the most serious potential side effects of chemotherapy is a low count of infection-fighting white blood cells—a condition called neutropenia (new-troh-PEE-nee-ah). Neutropenia can interrupt your chemotherapy schedule and put you at risk for infections that may require hospitalization and may even be life-threatening.
Fortunately, significant progress has been made in the development of "proactive" therapies that help you manage the side effects of chemotherapy—ideally, before they interrupt your treatment schedule.

Take an active role in managing side effects. Learn all you can, use your tools for organizing your cancer information to note any side effects you experience, and be sure to discuss them with your doctor. You can make note of subjects to discuss and questions to ask by using your Tools for Organizing Your Cancer Information.

Dose and Schedule:

Certain side effects may prevent doctors from delivering your full dose of chemotherapy on schedule.

Impact of Delaying Treatment or Reducing Doses:

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