Hematologic Cancers
Blood cancers (leukemias), bone marrow (myeloma, waldenstrom), or lymph nodes (lymphomas) now account for about 5% of all cancers. The causes of these diseases have been clarified. There are three possible origins to their occurrence: a viral origin (such as the HILV1 virus for some acute leukemias, or the EB virus for certain lymphomas).
A physical origin, related to irradiation, (some myeloid leukemias, some lymphomas)
A chemical origin (benzene, hydrocarbons, pesticides etc...) Probably for a greater number of them (some leukemias, some lymphomas, myeloma etc...).
Progress on hematologic cancers recorded over the past few years has been the sharpest. Hematology, the study of blood diseases, is an older medical discipline than cancer. Hematologic cancers are "liquid tumors", i.e. tumors whose cells circulate in a liquid: blood or lymph. These tumors are therefore easy to access for different molecular biology tests (blood samples or ganglion swabs), and especially they are particularly susceptible to chemotherapy and radiation therapy.
Thus, in the case of leukemia, lymphoma or other hematologic diseases, is it necessary for you to be taken care of in a competent hematology service, as exists in many Hospitalo University centres (CHU).
There are two types of acute leukemias, depending on the nature of the blood cells involved: acute lymphoblastic leukemia (LAL) particularly frequent in children (see childhood cancers), and
Acute Myeloblastiques leukemia (LAM), which is particularly common in adults.
The work of Prof. Dominique Belpomme on this type of leukemia led to propose for the first time an international prognostic classification, based on immunological tests, allowing to distinguish Lal of type T, Lal type B or type "No t No B ". However, given recent progress in the treatment of these leukemias, this classification is now less useful in setting the prognosis, although it retains its interest in deciding on the type of therapeutic protocol to be used. In fact, the basic treatment consists in the realization of a chemotherapy of which one distinguishes two periods: a first period of induction, consisting in obtaining in a rapid way a complete regression of the disease (normalization of blood and marrow)
A second period of maintaining and above all consolidating the previously obtained complete regression.
A This general chemotherapy is added during this second phase, a specific local chemotherapy, instilled using a lumbar puncture, in order to avoid the occurrence of leptomeningeal relapses.
The current progress is mainly related to this second period of maintenance and consolidation. Today about 80% of children with LAL are permanently cured of their disease.
Acute Myeloblastiques leukemias mainly concern adults. As with the LAL, the basic treatment is based on chemotherapy, of which two periods are distinguished: the first is to obtain a complete regression of the disease (normalization of blood and marrow) and the second, to maintain and Consolidate this regression.
Given the slightest susceptibility of myeloblastiques cells to chemotherapy, induction (first period) is often more intense, and consolidation (second period) heavier. This is why it is often used in the second period, in the aseptic sector, of heavy chemotherapy protocols, which are sought to alleviate certain effects by their association with bone marrow autografts. In this case the "normal" marrow is taken from the patient as soon as the complete regression is obtained, to reinject it at the time of the administration of the heavy chemotherapy protocols during the second period of consolidation.
It is therefore clear that such treatments can only be carried out in highly specialized haematological services.
3.1. Chronic Leukemias
Chronic leukemia is mainly about the adult. There are two types of chronic leukemia, depending on the nature of the blood cells involved:
Chronic lymphoid leukemias (LLC) and
Chronic myeloid leukemia (CML).
3.2. Chronic lymphoid Leukemias (LLC) Chronic lymphoid leukemias (CLL) are characterized by the presence of abnormal lymphocytes in the blood. They occur mainly in the elderly. As long as leukemia is characterized by a low number of lymphocytes in the blood and is well tolerated clinically, no special treatment is to be considered. Conversely, when leukemia progresses and becomes more important, i.e. when the number of lymphocytes increases and the disease appears to be less well tolerated clinically, it is important to treat it early enough, before a stage of medullary deficiency (anemia, neutropenia, thrombocytopenia) that are difficult to reducible.
A particular form of LLC, hairy leukemia has recently benefited from the contribution of a particularly effective drug, cladribine, since it allows to obtain the cure of the patients in a few months. Comparable progress today concerns chronic myeloid leukemias.
Chronic myeloid leukemias are characterized by the presence of myeloid cells in the blood and by a fundamental chromosomal anomaly: the presence of a particular supernumerary chromosome, called the Philadelphia chromosome. These leukemias occur mainly in subjects after fifty years. Until recent years, the chemotherapy used, although allowing to control the disease for several years, did not prevent the transformation of this chronic leukemia into acute leukemia, most often fatal.
As a first step, attempts at medullary Autografts to regraft the patient's own cells, taken in chronic periods, seemed to make some progress. In fact, two discoveries are currently to be considered in a paramount way:
The first, already ancient, using the interferon alpha, allows to obtain complete regressions and even sometimes definitive cures,
The second, more recent, using Gleevec, is even more effective, since this drug provides an even higher definitive cure rate. Thus, CML have now become potentially curable diseases in many cases, provided that they are properly treated in specialized service.
Hodgkin's disease is a tumour of the lymph nodes (lymphoma), characterized by the presence of specific lymphoid and myeloid cells, constituting the so-called Hodgkin's granuloma, and by a large cell, peculiar Called Steinberg's cell.
This disease mainly affects the young adult, although it may also occur in the child and the elderly person. The basic treatment is based on radiotherapy and chemotherapy, which should be administered under standardized conditions. It is for this disease that the progress of cancer has been most remarkable: at present, all stages included, the cure rate reaches 75%, i.e. almost 100% for stages I and II and more than 50% for stages III and IV. The frequency of Hodgkin's disease is now lower compared to what it was 20 years ago and this lower frequency appears to be currently compensated by an increasing frequency of non-Hodgkin lymphomas.
Non-Hodgkin lymphomas are like Hodgkin's disease of ganglion tumors. But these tumors, instead of being characterized by the presence of a granuloma and Steinberg cells, are in fact characterized by the presence of abnormal lymphoid cells directly from lymph nodes.
They have been the subject of numerous international classifications, the most widely used being that of Prof. Henri Rappoport. It distinguishes from the Anatomo-pathological point of view, the modular and diffuse forms and from the cellular point of view, the forms lymphoblastic, Prolymphocytaires and lymphocyte. But alongside the classical cellular forms, immunoblastiques lymphomas must also be individualized, described for the first time by Prof. G. Mathee and D. Belpomme. In addition, Prof. D. Belpomme, in close relationship with Prof. Rappoport, proposed an immunological classification of these tumours with prognostic value.
Non-Hodgkin lymphomas are of various origin. Their increasing frequency would be mainly related to the chemical pollution of our environment, in particular the carcinogenic role of certain pesticides. But a viral etiology is also invoked, particularly in the case of immunoblastiques lymphomas that occur particularly in patients with renal transplantation or with AIDS. Indeed, in these cases, the responsibility of the EB virus would be implicated.
Non-Hodgkin lymphomas have certainly benefited from the progress of chemotherapy, and the appropriate combination to radiation therapy. Thus, stages I and II are almost always an excellent prognosis, while stages III or IV still require further progress.
Multiple myeloma (or Kahler disease) and waldenstrom (or macroglobulinemia disease) are two rare diseases of the elderly, characterized by the proliferation of plasma and/or lymphocytes in the bone marrow and their ability to invade and To Lyse the bone.
Multiple myeloma or Kahler disease is characterized by the appearance of bone deficiencies, particularly in the skull and the presence in the blood, of an increased amount of the same type of immunoglobulin: Ig G, ig A, or IG M.
It's the plasma that secretes the immunoglobulins. The presence of an abnormally increased amount of the same type of immunoglobulin thus translates the monoclonal origin of the myelomatous proliferation and constitutes the biological signature of the cancer. The classification of the disease consists of 3 stages, depending on its importance.
At these three stages, there is also the possibility of renal failure, linked to the precipitation of immunoglobulin in abnormal amounts in the kidney. Resuming American work, Prof. D. Belpomme confirmed the prognostic value of this classification. In addition, he was able to show that the treatment of the disease had to be modulated according to the stage of the disease. Classically such treatment is mainly based on corticosteroids and chemotherapy, which should be supplemented by radiotherapy in case of painful bone locations.
But two recent discoveries seem to have profoundly altered the prognosis of the disease: the first, already ancient, is to use, in case of resistance to classical chemotherapy, the administration in aseptic sector, of protocols of Heavier chemotherapy, under the guise of a bone marrow autograft (the patient's own marrow is taken from the unreached bone Zone, and is reinjected after heavy Protocol administration).
The second, more recent, is to use, thalidomide, in case of resistance to classical chemotherapy. The use of such a non-cytotoxic treatment meets the current research objectives of the ARTAC. An English team demonstrated for the first time the effectiveness of the Thalidomide, which was confirmed today the ARTAC. Indeed, thalidomide, although not cytotoxic, proves to be able to lower the level of abnormal immunoglobulin in the blood and to significantly increase the life expectancy of the patients, even when the disease has become resistant to treatment Classic.
Waldenstrom or macroglobulinemia disease is a condition close to Kähler's disease. It is nevertheless distinguished by its lesser frequency, by the fact that the immunoglobulin in abnormally increased quantity is still an IGM and by the fact that the cell proliferation does not concern as for myeloma, mainly the plasma, But lymphocytes.
In addition, given the fact that IGM is a macroglobulin (i.e. a protein of very large molecular weight), the disease essentially results in a very large increase in blood mass (blood volume). Because IGM has a very high molecular weight and is present in abnormal amounts in the blood, it retains a large amount of water. The treatment of the disease consists initially of subtracting from the blood the immunoglobulin IGM and the water it retains, by the practice of plasmapheresis (one removes large quantities of plasma) and in a second time, to treat the proliferation Lymphoid by chemotherapy. Such chemotherapy should be handled with caution, given the often-advanced age of patients with this disease. This is also to underline the need for specialised service management.
Cervical cancers
Cervical cancers are the most common of gynecological cancers. Although they can occur at any age, they mostly reach young women in times of sexual activity. The infectious cause of these cancers is linked to a carcinogenic virus, called human papillomavirus, transmissible by humans during sexual intercourse. Cervical cancer is therefore one of the venereal diseases, as was once syphilis and today AIDS is. Cervical cancers are not hereditary but they are contagious.
In addition to this viral cause, there are other factors or cofactors, particularly smoking. The determination of these causes explains that these cancers can be the subject of primary prevention. Screening for these cancers is possible through specific cytological tests: cervico-vaginal smears.
At an advanced stage, these cancers are often difficult to treat. However, although these cancers are still too frequent, the generalization of screening has led to a reduction in the mortality that they induce in our country.
In order to avoid the onset of this type of cancer, it is recommended:
Not to multiply the sexual partners (the man is as much concerned as the woman) and if that was not the case, to protect herself
To abide by the rules of vaginal hygiene
To fight smoking.
Screening consists of systematically conducting cervico-vaginal smears. Such smears consist of the use of a swab, the cells of the cervical uterine mucosa (endocervix and uterine ectocervix) and the vaginal mucosa and to colour these cells by the reaction of Papanicolaou. The results are then expressed in classes:
Classes 1 or 2: normal;
Class 3: Suspected cancer;
Class 4: Cancer.
In the case of Class 3, a smear should be done and if the class is confirmed it is necessary to carry out a coloscopique test with Lugol and to carry out a biopsy sampling where the mucous membrane appears to be reached.
In the case of Class 4, the biopsy levy must be taken from the outset.
Smears should be performed in women during periods of sexual activity, systematically every 2-3 years and must be coupled with a gynecological examination carried out by a gynecologist. When 3 successive smears are negative, the repetition of smears is not systematic, except in the case of favourable factors. After menopause, these smears must also be carried out, according to the same procedures. Hence the need here, even after menopause, to be followed by a gynecologist.
The interest of screening tests is that they not only detect precancerous or benign associated lesions (warts) or even small cancers, this means either in situ (stage 0) or microinvasive (stage 1) cancers, but also and Especially to treat these lesions or small cancers by laser or better by surgery (biopsy).
So these screening tests make it possible to obtain a definitive cure in all cases.
The answer is clearly yes, since it is the man who transmits the virus and is likely to contaminate you again. Thus, it is essential that your partner consults a doctor, so that he will examine his external genitalia and carry out samples in search of the virus.
This medical gesture is part of primary prevention, but bears the more specific name of Prophylaxié, since it is a matter of avoiding a relapse.
The call signs here are very diverse: bleeding after reports, pelvic pain, vaginal infection etc. The main thing is to consult as soon as possible a gynecologist who will carry the diagnosis as before and to consult as soon as possible a surgeon. This will make you pre-operative a Pelviabdominale ultrasound and a scanner.
The treatment is essentially based on surgery in combination with radiotherapy according to a sequence which, in its most common practical realization, consists of (1) a preoperative vaginal curithérapie then (2) in a cervico-hysterectomy , followed by post-operative radiotherapy, in case of ganglionic damage. Indeed for these cancers, chemotherapy being very low efficacy, one must trust essentially a combination of surgery and radiotherapy.
These treatments are generally well supported, but the consequence will very often be a difficulty in sexual intercourse (these may even become impossible) and this especially as the intervention has been enlarged to the upper part of the vagina. However, although your cancer has been detected later, healing is possible.
You need to be followed regularly by your gynecologist, because in some cases a recurrence is possible. The symptoms here are very diverse: pelvic pain, bleeding, cystitis pain, urinary tract infections, thigh pain, sometimes edema of a lower limb, more rarely discovered pulmonary or bony lesions. Your gynecologist, your surgeon or your radiotherapist will advise you. They will usually address you to a oncologist, which will offer you treatment. But it's better to get tested early.
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