Leukemia

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1 角聲癌症關懷電話癌症教育講座白血病和淋巴瘤的治療新知時間 : 5/18/2009 星期一加州時間下午 7 點到 8 點講員 : 沈育民醫生血液腫瘤科主任醫生, Parkland Memorial Hospital 美西南醫學院內科助理教授, U. T. Southwestern 211 Topaz Street, Milpitas, CA Tel: (408) x102 Fax: (408) Website: cancer.cchc.org

2 Leukemia 白血病 / 血癌

3 Introduction Cancer of blood-forming tissues 造血組織的癌症 Bone marrow 骨髓 Lymphatic system 淋巴系統 Bone marrow produces a large number of abnormal white blood cells that don t function properly 骨髓裡產生不正常的白血球 Affects children and adults 小孩大人都可能有 Treatment can be complex and intensive; may involve stem cell transplant 治療過程很複雜

don t function properly 骨髓裡產生不正常的白血球 Affects children and adults 小孩大人都可

4 Signs and Symptoms Common symptoms 常見的徵狀 Fevers or chills 發燒發冷 Persistent fatigue, weakness 疲倦 Frequent infections 慣性發炎 Loss of appetite or weight 沒胃口, 體重下降 Swollen lymph nodes, enlarged liver or spleen 淋巴腺, 肝臟, 脾臟腫大 Easy bleeding or bruising 流血, 瘀血 Shortness of breath when you are physically active 喘氣 Tiny red spots on the skin 皮下小出血點 Excessive sweating, especially at night 夜裡盜汗 Bone pain or tenderness 骨頭疼痛 May resemble flu or other common illnesses 與流感徵狀類似 Severity depends on number of abnormal blood cells and where they collect

of breath when you are physically active 喘氣 Tiny red spots on the skin 皮下小出血點 Excessive sweating, especially at night 夜裡盜汗 Bone pain or

5 Classification 分類 Speed of progression Acute leukemia 急性白血病 Abnormal blood cells are immature (blasts, 裂殖胞 ) Can t carry out normal function Multiply rapidly Chronic leukemia 慢性白血病 Abnormal blood cells are more mature 比較成熟的細胞 Can function normally for some time Multiply slowly Type of cells affected Lymphocytic leukemia: 淋巴性白血病 Abnormal cells are lymphoid cells (lymphocytes) which form the lymphatic system (lymph nodes, spleen, tonsils) Myelogenous leukemia: 骨髓細胞性白血病 Abnormal cells are myeloid cells, which develop into red blood cells, white blood cells and platelets

Type of cells affected Lymphocytic leukemia: 淋巴性白血病 Abnormal cells are lymphoid cells (lymphocytes) which form the lymphatic system (lymph nodes,

6 淋巴系統骨髓細胞

7 Major Types 白血病的種類 Acute myelogenous leukemia (AML) 急性骨髓細胞性白血病 Most common Affects both children and adults Acute lymphocytic leukemia (ALL) 急性淋巴性白血病 Most common type young children; 75% of all childhood leukemias Chronic myelogenous leukemia (CML) 慢性骨髓細胞性白血病 Mainly affects adults Associated with Philadelphia chromosome t(9;22) (BCR-ABL) Slow growing phase followed by a rapid growth phase Chronic lymphocytic leukemia (CLL) 慢性淋巴性白血病 Common in adults; almost never occurs in children More common in Jewish of Russian or Eastern European descent May have no symptoms for years without treatment Others

Associated with Philadelphia chromosome t(9;22) (BCR-ABL) Slow growing phase followed by a rapid growth phase Chronic lymphocytic leukemia (CLL) 慢性淋巴性白血

8 Causes 原因 Unclear 不明. 基因和環境因素導致不正常細胞的發展 Combination of genetic and environmental factors that lead to abnormal development and growth Results in shortage of normal blood cells 正常細胞缺乏導致 Infection 感染 Bleeding 流血 Anemia 貧血 Abnormal cells may infiltrate organs 不正常細胞侵襲 Liver 肝臟 Spleen 脾臟 Brain 腦部 Skin 皮膚 GI tract 腸胃系統

lead to abnormal development and growth Results in shortage of normal blood cells 正常細

9 Risk Factors 危險因素 Prior cancer therapy Chemotherapy 化療 Radiation therapy 電療 Usually occurs many years after therapy Genetics Down syndrome increases risk 唐氏症 Fanconi s anemia 范康尼貧血 Exposure to radiation and certain chemicals Survivors of atomic bomb or nuclear accidents 核能 Benzene 苯 Many people get leukemia without risk factors, many with risk factors do not get leukemia

Exposure to radiation and certain chemicals Survivors of atomic bomb or nuclear accidents 核能

10 When to Seek Medical Advice 何時就醫 Persistent fatigue, weight loss, easy bruising, bleeding, swollen lymph nodes or fever 持續的疲倦, 體重下降, 青腫, 流血, 淋巴腺腫大, 發燒.

11 Diagnosis 診斷 Few patients have elevated white blood cell count on routine blood tests without symptoms Diagnostic procedures Blood smear examination to look for abnormal cells 血塗抹檢查 Immunophenotype to determine the cell type 血球計數 Cytogenetic analysis to look for changes in chromosomes 染色體檢查 Bone marrow aspiration and biopsy 骨髓穿刺

cells 血塗抹檢查 Immunophenotype to determine the cell type 血球計數 Cytogenetic

12 Treatment 治療 Chemotherapy 化學治療 Main stay of therapy for leukemia Single or combination of drugs Pills or infusion into veins or cerebrospinal fluid Biological therapy or immunotherapy 生物或免疫治療 Substances that bolster your immune system s response to cancer Kinase inhibitors 摧化酶抑制劑 For leukemias with abnormal tyrosine kinases (CML, some ALL and AML) Gleevec, Sprycel, Tasigna Other drug therapy ATRA 視黃醇類 Arsenic 砷 Radiation therapy 電療 Stem cell (bone marrow) transplant 幹細胞移植 Clinical trials

to cancer Kinase inhibitors 摧化酶抑制劑 For leukemias with abnormal tyrosine kinases (CML, some ALL and AML) Gleevec, Sprycel,

13 Hodgkin s & Non-Hodgkin s Lymphoma 淋巴癌

14 Introduction Cancer of the lymphatic system 淋巴系統的腫瘤 Abnormal cells in the lymphatic system grows and may spread beyond the lymphatic system Body s ability to fight infection is compromised 抵抗力衰弱 Hodgkin s is named after Thomas Hodgkin, a British physician who first described the disease in 1832 Both Hodgkin s and non-hodgkin s are highly treatable cancer 淋巴癌是很容易治療的癌 Non-Hodgkin s is 5x more common than Hodgkin s

is named after Thomas Hodgkin, a British physician who first described the disease in 1832 Both Hodgkin s

15 Signs & Symptoms Many initial signs & symptoms are similar to those of the flu 早期徵兆和流感很相近 Fever 發燒 Fatigue 疲倦 Night sweats 夜裡盜汗 Common symptoms Painless swelling of lymph nodes in neck, armpits or groin 淋巴腺腫大 Unexplained weight loss, >10% of body weight 體重下降 Loss of appetite 失去食慾 Itching 癢 Abdominal pain or swelling 肚子腫脹 Chest pain, coughing or difficulty breathing 胸部疼痛, 咳嗽, 呼吸困難

armpits or groin 淋巴腺腫大 Unexplained weight loss, >10% of body weight 體重下降 Loss of appetite 失去食

16 Normal and Swollen Lymph Nodes 正常與腫大的淋巴腺

17 Normal Lymph Node

18 Causes 原因 Exact cause is unknown 不明 Hodgkin s lymphoma Abnormal B cells in the lymphatic system called Reed-Sternberg cells 不正常的 B 淋巴球 Commonly begins in the upper body and spread contiguously from one lymph node to the next, and eventually any part of the body 傳遞式的擴散 Non-Hodgkin s lymphoma Abnormal B or T cells due to activation of certain genes; 85% B cells, 15% T cells 不正常的 B 或 T 淋巴球 Generally spreads throughout the body 全身的擴散

node to the next, and eventually any part of the body 傳遞式的擴散 Non-Hodgkin s lymphoma Abnormal B or T cells

19 Reed-Sternberg Cell in Hodgkin s Lymphoma

20 Lymphoma in Various Places

21 Risk Factors 危險因素 Age 年齡 >55 Family history 家庭史 Males slightly more likely (Hodgkin s) Infection 某些感染 Epstein-Barr virus (Hodgkin s) Helicobacter pylori (non-hodgkin s) Hepatitis C (non-hodgkin s) Chemicals Pesticides 殺蟲劑 Herbicides 殺草劑 Compromised immune system 免疫系統衰弱

22 Diagnosis 診斷 Disease can be difficult to diagnose as early signs are similar to those of other disorders 早期徵狀和其它疾病相似 Biopsy of enlarged lymph node is needed to make diagnosis 淋巴腺切片 Other tests X-ray CT/MRI 斷層掃瞄 Gallium or PET scans Bone marrow biopsy 骨髓穿刺 Blood tests

23 Staging

24 Treatment 治療 Factor to consider when deciding on treatment 治療前須要考慮的因素 Your age 年齡 Your symptoms 徵狀 Whether you are pregnant 懷孕 Your overall health status 健康狀況 Radiation for early stage (I or II) 電療 Chemotherapy 化療 Immunotherapy and radioimmunotherapy 免疫治療 Stem cell (bone marrow) transplant 幹細胞移植

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