There are two types of cancer classified as solid cancer and haematological malignancies.The most common types of cancer are given below with a brief explanation of each type.

• Breast Cancer
• Cancer of the Prostate
• Mouth(Oral cancer and adjacent areas)
• OESOPHAGUS
• Bowel(Colon and Return)
• Pancreas
• Cervical Cancer
• Hematological Malignancies Leukemias

1- Breast Cancer

Breast Cancer

Predominant cell types-Duct-Cell carcinoma and lobular carcinoma.

Risk factors

• Lifestyle related
• Obesity,lack of exercise
• Excessive alcohol consumption
• Family Medical History

Breast cancer-Breast-ovarian cancer syndrome in which patients develop ovarian cancer and breast at an unusually early age and a high incidence of tumours in both breasts.

Personal Medical or Health History
Previous cancer in the other breast
Labular carcinoma insitu

Moderate or a typical hyperplasia begining condition in which normal breast tissue cells proliferate at an  abnormally high rate.Pappilloma-a non malignant tumour of the milk ducts or skin of the breast.Any medical condition that required large doses of radiation to the chest.
Early menarche or late menopause.
Never having given birth or first giving birth after age 30.

Warning Signs and symptoms

• Persistent lump or thickening in the breast or armpit.
• Change in the breast's size or contour.
• Change  in the colour of the breast or areola.
• Dimpling,puckering scaling or similar change in the skin texture,skin looking somewhat like the peel of an orange.
• Discharge from the nipple that appears milky,bloody,green,clear and sticky.
• Retraction of the nipples.

If  not controlled breast cancer may spread to ,
Lymph nodes
Bone
Lung
Liver
Skin
Central nervious system
Thyroid

Typese of Breast Cancer

About three in four breast cancers are ductal carcinomas.They originate in milk ducts whereas lobular carcinomas arise in either the lobes or the lobules.

A third type,the rare inflammatory breast cancer materialize in the lymph vessels in the skin of the breast.If  symptoms are markedly different from the other two. "Inflammatory breast cancer resembles an infection " explains Dr.Norton,the skin  becomes thick,raised and red.Instead of a discrete lump,it usually involves the whole breast.A fast growing disease, inflammatory breast cancer is prone to metastasis of the three types,lobular carcinoma is the one most likely to occur in both breast or unilateral.

Diagnosis

Physical examination,Clinical breast examination.
Imaging studies:- Ultra sound often shows whether a lump is a solid mass or a begin cyst filled with fluid Mammogram.
Biopsy:-Needle biopsy mammographic localization with biopsy.Incisional surgical biopsy.Excisional surgical biopsy.
Any number of these staging procedures may be performed.
Next,Laboratory test,blood tests
Imaging studies(Typically of the liver,lungs,bones)Chest X-ray,CT scan MRI scan.
Biopsy:- Excisional surgical biopsy of lymph nodes under the  arm, performed as part of the operation to treat the cancer.

Self Examination of Breast

Stand  Front of a mirror
1)Rasie your hands
2)Put down your hands
3)Hold the hips

Look for the following Changes

*Dimpling of the breast
*Change in outline
*Appearance of an orange peel change of colour and texture of skin
*A change in the nipple direction of reaction

While bathing examine your breast Thickening of skin or a hardness beneath a small lump is a very important finding.
Use the right hand to examine the left breast and left hand to examine the right breast Use the following procedure to examine the entire breast.Palmer surface of the fingers should be used.gradually approach the nipple in circular movements.Press the nipple between the fingers and look for discharge.Same way you could examine the breast lying down.Remove the pillow and place it under the shoulder blade of the examining side.The hand of that to examine side to kept behind to support the head.With left hand to examine the left breast. Position of pillow changed accordingly.Develop the habit of self examination of breast.Once a month.Choose a fixed day in relation to menstruation every month ,5th,6th and 7th day after menstruation every month.

2- Prostate Cancer

Prostate cancer

Predominat cell type-Adenocarcinoma

Risk factors

• Life style related
• Fatty dist-Obesity
• Lack of exrcise

Family medical history,Family history of Prostate cancer No Personal Medical, Health, Environmental,Occupational carcinogens Identified.

Warning signs/Symptoms

• Weak or interrupted urine flow
• Unusally frequent urination
• Difficulty in holding back urine or starting urination
• Pain or burning sensation upon urinating
• Blood in the urine or semen
• Inability to urinate
• Painful ejaculation

If not controlled prostate cancer may spread to,
*Lymphnodes
*Bone
*Liver
*Lung
*Bladder
*Rectum

Prostate cancer is what's called an indolent cancer.That's good news because it means that the tumor grows extremely  slowly,sometimes taking as long as two to four years to double in size because the median age at diagnosis is seventy two.
Cancer of the prostate is very common,Even if it spread to other parts of the body it may be controlled by hormone treatment for long periods of time.
The most important features of the tumors,The prostate gland's location close to the rectum, allows it to be easily examined and assessed by the doctor.Prostate cancer is relatively easy to cure.If it's detected and treated before it has spread.
If the cancer is small and remains inside the prostate,the prostate gland can be removed by an operation(Prostectomy)

Diagnosis

Biopsy -This procedure is done with a thin needle often using ultrasound guidance and is virtually painless.The biopsy produces a small piece of Prostate

Blood Test

Prostate Specific Antigen(PSA)and the acid phosphatase(An enzyme that seems to be produces almost exclusively by malignant prostate cells)

Other Test

CT scan of the abdomen pelvis or an ultrasound scan quite often a bone scan may also be reccommended t oshow up any areas bone to which the cancer have spread.

Treatment

Two types,
1)Treatment required when the cancer is limited to the prostate itself and has not spread elsewhere.
2)Treatment that may be used if the cancer has spread.
*Surgery
*Radiotherapy
*Chemotherapy

Screening and Early Diagnosis

A screening test should be so good at detecting a disease  that it is effective with every body who is at risk(every  man over the age of 50 or even 40)even if the person has no symptoms.
The purpose of screening test it to detect and treat the cancer at an early age.At present ,the best candidate for  a screening test for prostate cancer is the blood test (Prostate specific Antigen- PSA)

3- Mouth (Oral Cancer and Adjacent areas)

oral/mouth cancer

Oral Cancer is the term given to cancers arising  in any of  the components of the mouth and the oral cavity,including  the lip,the tongue,the floor of the mouth,the lining of the cheeks,the tonsils and the gums.
Oral cancers are mostly caused by tobacco(smoking cigarettes or chewing tobacco)or a combination of tobacco and alcohol.If treated in the early stages ,oral cancers may be cured in the majority of cases by surgery,radiotherapy or a combination of both.

Age and Incidence

Oral cancers are predominantly condiyins that devleop in the fifties and sizties.They affect men mor ethan women .

causes

Tobacoo:-tobacco contains a large number of chemicals  of which the most important ones that damage the tissue are known.Some of these chemicals are found in the tars and the tar-like components of tobacco. These can contribute to the development of oral whether the tobacco is smoked or chewed.
Betel Chewing

Alcohol:- Although alcohol causes many medical problems.it is associated with only one  two areas of cancer -cancer of the liver  and cancer of the mouth ,and oesophagus (including cancer of the larynx,pharynx and other adjacent areas)
Sunlight:-the lips can be  damaged by sunlight.The component  of sunlight that causes the problem is the ultra violet part of  sunlight ,which is at the right wave length t o damage living  tissues.Heavy and prolonged exposure to sunlight over many  tears causes cumulative damage to the covering of the lips and may contributor to cancer
Chronic irritation:- people who have particularly bad teeth or very ill fitting dentures have an increased chance of developing oral cancer.
Other factors :-In a very small proportion of cases ,a chemical factor may contribute to the development of the world..
How the  cancer tends t o spread pre-cancerous changes in  the  lining of the mouth cavity may be important.Early warnings signs of cancer.These usually begin as white patches(called leukoplakia) or red patches(called erythroplakia).
Invasive cancer- If a true ,invasive cancer develops,it  usually spreads in two directions, along the surface of the mouth lining ,and also more deeply into the tissues underneath lining.
If untreated ,it can spread deeper and into such bony area as the jaw bone.It can also apread to lymph nodes in the neck.

Symptoms

Two points need to be emphasized.First,oral cancer often causes the same sort of problems that occur in the mouth anyway -sores or ulcers-but with cancer they do not heal or disappear after two weeks or so.
Second-these areas are very often painless.It is important to make sure that any  lesions in the mouth that do not heal are assessed by the doctor.Sometimes oral cancer can also cause such symptoms as difficulty in swallowing,difficulty in speaking clearly,pain in the cheek or side of the face.
Pain in the ear or side of the head or lump that can be felt in the neck episodes of choking or episodes of bleeding .Any symptoms like these should be assessed by a doctor.

4- Oesophagus Cancer

oesophageal-cancer

Cancer of the Oesophagus is not very common.It is partly caused by a combination of smoking and drinking alcohol.If the cancer is located in the lower part of the Oesophagus and has not spread,it may be cured by surgery.

Age and Incidence

In Canada-cancer of the oesophagus is predominantly disease of people over the age of sixty and particularly of people  who drink alcohol and smoke.It occurs more frequently in men than in women and in black people than in white.In other parts of the world -China,other Asian countries and Indonesia-it is more common than Canada.Due to carcinogenic substances in the diet and occurs in younger people.

Causes

Tobacco and Alcohol,long term use of Alcohol and tobacco are risk factors.
Some medical condition-Long standing Oesophagitis due to reflux,Barrett's Oesophagus,Achalasia in which the Oesophagus is unable to propel feed and drink normally.
People who often drink very hot fluids may sustain chronic damage to the Oesphagus and this may also increase the risk of cancer.
Other factors: In other areas of the world,Asia and Indonesia particularly certain substances in the diet are common contributing causes of Oesophageal cancer.These substances include - nitrosamines,nitrites dietary deficiencies-nicotinic acid,zinc and riboflavin etc...,

Oesophageal Cancinomea Symptoms

i) The most common symptom caused by cancer of the oesophagus is difficulty in swallowing or pain when food or liquid is swallowed.When we swallow food or liquid,it may feel as if the material will not go down properly and is stuck in the oesophagus some where-a very important symptom.
ii) Pain-dull-sharp and is often felt behind the breast bone(sternum)ma few minutes after food leaves the  mouth.If the tumour is in the upper part of the oesophagus ,the pain might be felt in the throat.
iii) Unplanned weight loss-because they find eating and drinking uncomfortable ,people with cancer of oesophagus often lose weight.In some  cases,the cancer can affect the nerves that go to the vocal cords and may cause hoarseness of the voice.In some cases,the tumour may bleed,causing patient to cough up blood.

Diagnosis

1.Endoscopy-Endoscopy involves using a flexible scope to look down the oesophagus and take biopsies of anything that appears suspicious.
2.CT scan -ACT scan may be used in determining the extent of a tumour,whether it involves any neighbouring structures and whether any lymph nodes are involved.
Barium X-rays -In some situations,a barium X-ray may be recommended to drink a dye that shows up white under -X-rays,allowing a tumour to be seen and also showing how the rest of the oesophagus is moving.

Types of Treatment

Surgery:-If the cancer is situated in the bottom part of the oesophagus and has not spread,it may be possible to remove it.
Radiotherapy:-If the cancer is in the upper part of the oesophagus ,particularly if it may be recommended with the intention of curing the cancer.
Chemotherapy:-In general,cancer of the oesophagus does not respond well to chemotherapy drugs,but chemotherapy may have a role as additional treatment for oesophageal cancer that has not advanced or spread.

5- Bowel(Colon and Rectum)

Bowel-cancer.jpg

Cancer of the bowel(Colon the rectum) is a very common tumor that grows and progresses fairly slowly and is a predictable way.It starts on the inner lining of the bowel wall and then grows deeper into the wall,until it spreads through the wall end to the lymph nods in the abdomen,further spread usually goes to the liver..
If removed before it has spread deeply into the bowel wall,it is cured in nearly three quarters of cases.Unfortunately it is very difficult to diagnose bowel cancer in the early stages because it may not produce and symptoms.

Age and incidence

Bowel cancer is predominantly a condition of middle age and beyond.The peak incidence of the disease occurs in the early sixties.It can occur in the thirties or slightly earlier but is very rare in that age group unless there is some specific predisposing reason or cause.It occurs in men and women equally.

Factors

General factors that contribute to Bowel cancer.

Diet-
1)Too much fat in the diet
2)Too little fiber in the diet

The saturated fats are identified by many researchers as the major contributory factor.Substances that protect against Bowel cancer.

Brassicae group of vegetables (such as broccoli )as well as beta-carotenes (found in carrots and colored vegetables)calcium,vitamin C and selenium.

Bowel habit-Cancer of the bowel seems to be more common among people who are constipated most of the time,the stool is constipated,and spends a longer time in
the bowel,particularly in the colon and rectum.The standard medical term for this is a slow transit time.Slow transit time with prolonged contact between the stool and the wall of the large bowel can produce cancer if the stool contains high amounts of residues of fat.
A good bowel habit does definitely decrease the chance that a person will develop bowel cancer.

Family histroy-If a first degree relative(parent,sibling,child)has had bowel cancer,then our chance of developing bowel cancer is increased,compared to the
general population

Ulcerative colitis-Ulcerative colitis in which the colon becomes inflamed for no known reason.If the condition involes much or most of the colon,the evidence suggests that after many years(ten or more)the chance of cancer is increased.For this reason people with ulcerative colitis are usually recommended to have a colonoscopy regularly(once a year)and many require surgery to remove the colon if there are signs that cancer may be developing.

Familial polyposis coli
This is a very rare condition in which the bowel is studded with polyps.The polyps themselves are not unusual,but there are so many of them and they grow so
larger that the chance that a cancer will develop becomes extremely high,.

Symptoms

It may affect the bowel habit.
It may irritate the wall of the bowel causing it to produce too much mucus.
It may cause bleeding
It may block the bowel,making it difficult for stool to pass

The early stages of cancer of the bowel often causes no symptoms at all.One of the most common symptoms is bleeding.This will be seen as a read streak of blood
on the surface of the stool.
Another possible symptoms-change in bowel habit.This is not an easy problem to define.Since every body's bowel habit varies from time to time.A person may
notice constipation or diarrhoea.
Sometimes alternating diarrhoea and constipation or mucus mixed with the stool or on the surface.So that it becomes somewhat slimy in appearance.Depending on the position the shape and size of the cancer,it may also cause blockage to the bowel and interface with the passage of bowel contents.That may cause colicky pain in the abdomen(pain that comes and goes in waves)and sudden or marked swelling or distention of the abdomen.If it is very severe,there may be vomiting and the patient may be pass stool or wind.

Diagnosis and Test

1)Occult /blood Testing-Testing for occult blood simply means testing the stool to find out if thesr is blood in ti that is not visible.

2)Sigmodoscopy and or colonoscopy:
Depending on the circumstances return must be examined(sigmoidoscopy) or the whole colon(colonoscopy)

3)Barium enema- Depending on the particualr case,a special X-ray of the large bowel may be needed.In this procedure,a liquid containing barium which shows up
white on X-rays,is given into the bowel in the form of an enema and X-ray pictures are taken.

4)CT scan or Liver Ultrasound-If a cancer of the bowel is detected,further tests will almost certainly be recommended t osee if there is any evidence that the
tumor has spread in the bowel.

Other Tests-Blood test called the CEA(Carcino Embryonic Antigen)is a substance produced by many types if cancer,including most cancers of the bowel.CEA can be used as marker.That is a test that can be repeated to show whether the tumor is getting bigger or it is used after the tumor has been removed to alert the possibility of an occurrence

Decreasing the risk of getting Bowel Cancer
Avoid constipation:
Have enough fibre in our diet so what we pass a soft bowel motion once (or twice) a day without needing to strain or hold our breath.
Train the bowel have a daily routine and educate bowel into acting at the same time every day.Try to get regular exercise (jog,walk)

Decrease the amount of fat in Diet
A diet in which fat contributes 25 percent or less of our total energy(calorie)intake could reduce our risk of both bowel cancer and heart disease.

Consider other dietary factors
It is important not to be deficient in calcium,/vitamin C and selenium.At present however,it appears that most people have sufficient amounts o thest in their diet.

Have regular check-ups
Over the age of forty make sure have a complete examination- including a rectal examination-at least once a year

Get a medical assessment of many potentially dangerous symptoms
These incude bleeding from the rectrum od blood on hte toilet paper,significant changes in bowel habit(eg.alternately having diarrhoea and constipation).Such problems are more likely to have non-cancerous causes such as haemorrhoids,but we must get them checked just in case.

6- Pancreas

digestive system

Who gets cancer of the pancreas? What causes cancer of the pancreas? The exact cause of pancreatic cancer is not known.Studies have shown that cigarette smoking can increase the risk of developing pancreatic cancer.
Although several dietary habits like eating high fat foods ,drinking coffee and alcohol are felt to play a role in the development of pancreatic cancer,no proof has yet been found.Some studies have suggested that the following may be related to the development of pancreatic cancer.
working with chemicals like petroleum products and solvents,history of chronic inflammation of the pancreas (chronic pancreatic)history of diabetes close family relative with pancreatic cancer.

Signs and symptoms of pancreatic cancer.

Indigestion-like pain
loss of appetite
weight loss
jaundice
Other sysmptoms
nausa
vommiting
diarrhoea
feeling tired
changes in emotions

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Making diagnosis

In addition to a complete physical examination,many teats can be done to diagnose pancreatic cancer.
ERCP(Endoscopic Rectrograde Cholangio Pancreatography)
Ultrasound
CT scan
Other tests- scans of the liver bones
MRI
Biopsy

Multiple Myelomea

Multiple Myeloma (also known as myeloma or plasma cell myeloma)is a haemotologic cancer.It is a cancer of the plasma cell,an important part of the immune system.Normal plasma cells help the body fight bacteria and other causes of infection.Multiple myeloma is a type of cancer that causes the body to keep producing more and more plasma cells.The unneeded plasma cells,all abnormal and exactly alike,are called myeloma cells.Myeloma cells tend to collect in the bone marro and in the hard,outer part of bones.
Plasma cell functions in the immune system.Plasma cells develop from B cells(also called B lymphocytes).When foreign substances such as bacteria enter the body plasma cells produce proteins called immunoglobulin(lg)also known an antibodies,they fight disease and infection.Each plasma cell develops in response to a particular foreign substance within the body and it produces immunoglobulin specific to that substance. Thus,there are many developments of malignant plasma cells.

Myeloma Cells

B cells develop in the lymph nodes and plasma cells grow off the B cells when they are needed to fight disease or infection.When B cells are damaged ,the resulting plasma cells become malignant.These cells travel through the blood stream and collect in the bone marrow,when they damage tissue.
Normally ,plasma cells make up a very small portion(less than 5%)of cells in the bone marrow,malignant plasma cells(called myeloma cells)Lower have adhesion molecules on the surface allowing them t otarget bone marrow.After they enter the bone marrow,these adhesion molecules allow them to attach to structural cells called stromal cells.Once myeloma cells attach to bone marrow stromal cells,several interactions cause myeloma cells to grow.

• Chamical messengers called cytokines are produces by both myeloma cells and stromal cells.These sytokines such as interlekin 7(IL-6)stimulate the growth of myeloma cells and inhibit natural cell death (apoptosis)
• Myeloma cells also produce growth factors that promote angiogenesis the creation of new blood vessels.These new blood vessels provide the oxygen and nutrients necessary for tumour growth.A growth factor called Vascular Endothelial Growth Factor(VFGF) plays a key role in angiogenesis.Angiogenesis helps the myeloma  cells increase in number and begin to infiltrate  the bone marrow,eventually comprising greater than 10% of the  cells present.

Malignant plsma cells ,called myeloma cells are  identical and produce the same immunoglobulin protein  called monoclonal (M)Protein or Para protein in large quantities.A patient's myeloma is often referred to by the type of immunoglobulin or light chain protein (kappa or lambda type )produced b ythe cancerous plasma cells.The most common myeloma types are lg G and lg A.Although a high level of M protein in the blood is a hallmark of myeloid disease.
Multiple myeloma is much more common after the age of 50.The median age at diagnosis is about 70 years.

Causes

No cause for myeloma has been identified.Research suggests possible associations with a decline in the immune system,genetic factors,certain occupations,exposure to certain chemicals,and exposure to radiation

 Symptoms

There are often no symptoms in the early stages of myeloma.
1)Pain-Pain in the lower back or in the ribs,This is the result of tiny fractures in the bones caused by weakend bone structure.
2)Reduced blood cells-Anaemia
3)Hypercalcemia(increased calcium in the blood) Hypercalcemia can cause a variety of symptoms including loss of appetite,fatigue,muscle,weakness,restlessness,difficulty in thinking or confusion,constipation,increased thirst,increased urine production and nausea or vomiting.
4)Kidney problems=Excess protien in the blood which is filtered through the kidneys,can cause kidney damage and lead to renal failure.

Diagnosis and Test

1)Complete Blood count
2)Chemistry profile checks the levels of Blood Urea Nitrogen(BUN and blood levels of calcium,creatinine and lactate dehydrogenance(LDH))
3)Electrophoresis measures the levels of various proteins in the  blood(serum protein electrophoresis of SPEP).
4)X rays -magnetic resonance imaging(MRI).Computerized axial temography
5)Bone marrow biopsy.

7- Cervical Cancer

Cancer of the cervix occurs almost  exclusively in women who have been sexually active at any time.The average age is in the mid fifties although the incidence is rising in younger women for Pre cancerous changes,the average age is young in the mid thirties.

causes of Pre cancerous changes and cancer
Pre cancerous changes and true invasive cancer of the  cervix are caused by a combination of factors that ate somwehow present in seminal fluid.Epidemiological research has demonstrated that connection,since cancer of the cervix rarely occurs in nuns and the chance of developing it is greater the  more sexual partners a woman has and the younger she is  when she starts sexual activity.

Viruses-Human Papiloma Virus(HPV)
Many males have these viruses which are every common.
Genital herpes(sexually transmitted disease)

Because of the  important role of voruses that are carried in sminal fluid ,the  chance of getting cervical cancer does increase the more sexual partners a woman has.That  is simply a matter of statistics,although it can also happen that a woman who has had only one sexual partner in her life may develop a cancer of the cervix,while another woman who has had many partners may not.

Starting intercourse early in teens seems to be associated with a higher risk of cervical cancer.Whether this is because the  cervix of a teenager is immature and in some way particularly  vulnerable to damage by viruses in unknown.

Socio economic factors:the chance of developong cervical cancer  is somewhat increased in the  poor socio economic groups of society and in smokers.Poor nutrition may play a part as well.
Precancerous(non invasive)changes in the cervix and screening:
Precancerous changes in the cervix are not the same as cancer itself.If left untreated, though,they may eventually turn into true,invasive cancer in the majority of cases.

Symptoms

There are no symptoms associated with pre cancerous changes in the cervix.

Diagnosis and Test

Pre-cancerous changes in the cervix can be readily detected with the pap test.The Pap smear or cervical smear test(The pap test named after its inventor,the pathologist Dr.George Papanicolaou).
The objective of the test is to obtain a sample of cells  from the cervix and in particular from the squamo columnar junction,be gently wiping a specially shaped wooden spatula over  the area and then using a cotton wool swab or a small brush to collect cells from the canal of the cervix.The sample will contain cells from the squamous lining and from the colimnar lining of the  cervix.If there are precancerous changes in the cervix or if there is a cancer developing that will be visible in the cells collected by the Pap test.
All females who have started sexual intercourse should get a pap test done at least once in every 3 t o5 years.Pap test will reveal cellular abnormalities many years before the cervical cancer develops and hence can be treats very successfully.
If the precancerous changes are moderate or severe  colposcopy  will be recommended.
Colposcopy is a techinique that allows examination of the  cervix in much greater detail than with a speculum.

Invasive cancer of the cervix

Cancer of the cervix that is truly cancerous if left  untreated grow and spread.If it is treated at an early stage,particularly before it has spread beyond the cervix itself it is curable in the majority of cases.If it has spread beyond the cervix,the enhance of cure os lower.

Symptoms

Bleeding after intercourse(post coital bleeding),after the menopause or at any time other than during  the  menstrual period.Pain during intercourse and sometimes blood stained vaginal discharge.
The main types of the cancer

There are two main sub types of cervical cancer

i)Squamous carcinoma(squamous part of the cervix)
ii)Adenocarcinoma(glandular lining of cervix)
Cervical cancer can be grouped into five groups according to the spread pf the cancer.

FIGO classification -staging

"0" - Pre cancerous  stage,only wit h cellular abnormalities diagnosed by Pap test.
"1"- Cancer confirmed to the cervix uteri
"2"-Cancer spread up to upper part of the vagina and the surrounding tissue.
"3"-Cancer spread up to lower part of the vagina and the lateral pelvic wall
"4"-Cancer spread to urinary bladder,large bowel and other parts of the body

8- Haematological Malignancies Leukaemias

blood cells

It's a disease of the parts of the blood.There are four main types of leukemia, two are called acute because they may progress rapidly and two are called chronic because they often progress slowly and intermittently.
Chronic Lymphocytic Leukaemia - (CLL)
Chronic Myeloid Leukaemia         - (CML)
Acute Lympoblastic Leukaemia   - (ALL)
Acute Myeloid Leukaemia             - (AML)

Leukaemias are also classified according to wheather they arise from lymphocytes (lymphocytic and lymphoblastic Leukaemias)or from  another type of white cell,granulocytes(granulocytic or myeloid leukaemia)Each type of leukaemia has a characteristic way of behaving and requires different treatment.
The most common Leukaemia in childhood is acute lymphoblastic lueukaemia which responds well to chemotherapy and is oftetn curable.
In early childhood,acute myeloid Leukaemia is more common and can sometimes be cured with intensive therapy.Chronic lymphocyte and chronic myeloid Leukaemia can both be controlled with medication for periods of time.
Two different types of white cells are particularly important the lymphocytes and the granulocytes.Each of these types ca nbecome malignant,thus giving rise to  the lymphocytic Leukaemias and  Granulocytic Leukaemias.The granulocytic ones are also often called myeloid Leukaemias.
If the Leukaemia produces extremely immature white cells (called blast cells)they will appear in the blood stream.Such a condition is called acute Leukaemia -acute lymphocytic Leukaemia and acute myeloid Leukaemia.Several years ago,before the modern era of treatment,these acute Leukaemias would usually progress very rapidly and wound often bring about the patient's death in short time.Nowadays,a good proportion of patients can actually be cured.

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Bone Marrow

The bone marrow is the soft tissue inside the hollow centre of the major bones of the body-the spine,pelvis,upper arms,legs and so on.The bone marrow is responsible for making three main types of cells that are in the bloodstream.They are,
i)The res cells which one red from the haemoglobin in them and which carry oxygen.
ii) the white cells,which are part of the body's defences against infection and include the granulocytes(also called neutrophilis)and the lymphocytes and,
iii)the platelets which are important in helping the blood clot when it needs to control bleeding or bruising after an injury.These are the three most important types of the cells made in the marrow.If the marrow is not working properly insufficient numbers of any of those three,which could cause a variety pf problems.
There are two main types of Leukemia and several varieties of each type. Lymphocytic Leukemia marked by an increased number of white blood cells called lymphocytes. These cells are made in the lymph glands and bone marrow.In lymphocytic leukemia most lymphocytes produced are abnormal or immature.
Myelogenous Leukemia-marked by an increase in white blood cells called granulocytes. These are usually madein the bone marrow but may also arise from other tissue such as in the liver or spleen.Normal granulocytes play a crucial role in the body's defence against infection,but leukaemic granulocytes lack this activity.
Leukemia can occur in either of 2 forms acute progresses rapidly and chronic progresses slowly.Acute progresses rapidly - life expectancy is short without treatment.(a few weeks to few months)This type most often seen in children though it can occur at any age.But drugs and or bone marrow transplants have extended life expectancy for children with acute  lymphocytic Leukemia and cured about 80% .(A smaller proportion) of adults with acute lymphocytic Leukemia are also cured)Chronic  progresses-with proper treatment life expectancy is three to twenty years or more from onset of illness.It occurs most often in adults but can occur at any age.

Chronic Lymphocytic Leukaemia(CLL)

It is much less alarming than almost any other form of cancer or Leukaemia.Cancer of the lymphocytes in general(and particularly CLL)are almost always responsive to chemotherapy,which may often connsists of tablets only.Thus most people with  CLL have a condition that is not only slow moving but that is also easily treatable and whose symptoms may usually be controlled.
Age and incidence -CLL is predominantly a  condition of the older age group with approximately 90 % of cases occuring after the age of 50.

Causes
The true cause of CLL in unkonwn

Symptoms
No symptoms at the time of diagnosis.Often people with CLL have no specific symptoms related to CLL at all,an the diagnosis might be made when a routine blood test is done for some other reason.
The major symptoms of CLL are of two types?
i)Problems created when lymph nodes get too big
ii)Problems created in the blood system and the immune system when the normal cells begin to be crowed out by the malignant lymphocytes.
Problems created by enlarged lymph-nodes,usually lymphonodes are small and cannot be felt unless there has been a recent infection such as a boil or a viral illness.In CLL,the lymphnodes can grow to a few centimeters in diameter and although they do not usually hurt,they can cause some local inconvenience.Ache or discomfort in the groin.neck or armpit.Spleen is enlarged,it causes some discomfort in the upper left part of the abdomen.It may give a feeling of fullness in the abdomen soon after eating a relatively small meal.
When there are a large number of lymph nodes involved in many different places.The person may have constitutional symptoms,generally unwell,tired,loss of weight,mild fever,sweating particularly at night.
Problems related to the blood and immune system.Lowered resistance to infection.This means two things first when a person gets an infection such as a cold or flu he cannot shrug off the infection in a few days as he used to.Infections are likely to take longer to deal with,and may often require treatment.Second the person gets infections more easily.The person catches things from other people more easily.

Diagnosis and Test
Complete Blood Count -when there are too many lymphocytes in the bloodstream.
sample of the bone marrow.
X-rays,Scans

Chronic Myeloid Leukaemia(CML)

In general ,it progresses more steadily (and more rapidly)than CLL,so the treatment is some what different.In recent years,it has been shown that aggressive treatment only may provide long term remission or even cures in suitable patients,particularly if they are relatively young and in generally good health.

Age and Incidence
It happens in adulthood and the later years.It can occur in the thirties and forties though it is more common in the fifties and older.

Causes
In the general majority of cases,there is no known cause.It has been known for several decades. CML is associated with an abnormality of the chromosomes.An abnormal chromosome called the Philadelphia chromosome is seen within the malignant granulocytes in most cases of CML.

Symptoms
Anaemia,low platelets or low white cells resulting in tiredness,bruising or bleeding infection.
In CML cells grow rapidly,night sweats itching all over the body.

Diagnosis
Routine blood test too many granulocytes in the blood.Bone marrow biopsy.Special test for the Philadelphia chromosome test.

Acute Lympoblastic Leukaemia(ALL)

Acute Lymphoblastic leukaemia is a leukaemia that can occur in children or in adults.It is treatable and curable in children,with the great majority of children gaining remission and more than half being cured.

• ALL in childhood.

Age and Incidence:- Leukaemia is the most common type of cancer in childhood,and about four fifths of chioldhood laukaemia is of the ALL type(most of the rest is of the acute myeloid type)the peak incidence is at about three or four years of age.

Causes
Although the precise causes of ALL are not known.There are several situations in which the chance of getting AA is increased.The chromosomal disorder Down's syndrome.It is also possible that exposure to ionizing radiation.There is no evidence that viruses play any important rate in ALL.The most common cause of ALL in childhood is probably spontaneous mutation(Changes in the genetic material)of the lymphoblasts in the marrow during a phase when cell growth is very rapid.

Symptoms
In general ALL is likely to cause symptoms that happen because the normal bone marrow cells are unable to function properly.
The child may experience some or several of the following problems Anaemia,causing tiredness and lethargy,pale complexion and shortness of breath.Insufficient white cells causing prolonged or or severe infection or lack of platelets causing bruising,bleeding or petechiae.Some children have pain in one or more bones or in the abdomen. Occasionally there may be swelling of the salivary glands or of the testes in boys.
Diagnosis and Tests
Routine physical examination
Routine Blood test

• ALL in Adult hood
  It is slightly more common in male than female

Acute Myeloid Leukaemia(AML)

AML is one of the types of cancer in which the prognosis has improved dramatically over the last two decades.Before the era of modern treatment,AML was regarded as a rapidly progressing fatal condition.Now ,although it is regarded as an extremely severe condition.If the patient is in the younger gruop (the forties or under)and if bone marrow transplantation(BMT)is possible.Approximately half of the patients will have a long term remission and possible cure.
Age and Incidence
AML occurs in adulthood and gets more common with age.It is rare before the thirties and becomes steadily more common into adulthood and old age.

Causes
Actual aetiology is not known.There are ,however certain circumstances that can precipate AML,certain medical conditions:- that affect the bone marrow increase the chance that aML will develop later on.These conditions the myelodysplasia usually occur in older people.
Exposure to Nuclear Radiation :People who happen to have been exposed to nuclear accidents(at nuclear fuel-processing or power plants)or to nuclear explosions(Survivours of Hiroshima and Nagasaki)
Exposure to certain chemicals- Prolonged exposure to benzene.Certain kinds of anticancer chemotherapy drugs Melphalan drug - given continuously over a long period for the treatment of multiple myeloma.does definitely increase the risk of AML.
Certain inherited conditions- Down's syndrome.

Symptoms
Tired for several weeks due to anaemia,infections due to the reduced number of normal white cells.Bruising or Bleeding or Petechiae C little red or purple spots in the skin)
In certain rare circumstances,the early symptoms can be worsened by problems with bleeding(gum or at the other sites)

Diagnosins and Test
Routine Blood test
Bone marrow biopsy - The material obtained from the bone marrow will be examined under the microscope - myeloblaste or blast cells.
The bone marrow test may be the only test needed to confirm the diagnosis.