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By: Dr. R V Raghunandan
25 Jul 2024
Exhaustion that lingers even after a good night's sleep, coupled with frequent infections that seem never-ending – these could be signs of something more serious than just a busy lifestyle or a run-down immune system.
Leukemia, a cancer of the blood and bone marrow, can often masquerade as these everyday ailments, delaying diagnosis and treatment. Understanding the connection between fatigue, infections, and leukemia can empower individuals to seek timely medical attention.
Unveiling the Causes of Fatigue in Leukemia
Extreme fatigue is a common foe for people battling leukemia. Let's explore the culprits behind this relentless tiredness:
Symptoms to look out for:
Fatigue is a hallmark symptom of leukemia. Cancer cells crowd out healthy blood cell production, leading to a shortage of red blood cells, the oxygen carriers in the body. This oxygen deficiency leaves people feeling constantly tired and drained, even after seemingly adequate rest. Unlike fatigue caused by everyday stressors, this exhaustion is persistent and doesn't improve with relaxation or a change in routine.
Leukemia also weakens the body's immune system. Healthy white blood cells are crucial for fighting infections. In leukemia, abnormal white blood cells may be produced, but they are dysfunctional and unable to effectively combat germs. This leaves the body vulnerable to a wider range of infections, including bacterial, viral, and fungal. These infections can manifest in various ways, such as recurrent fever, chills, mouth sores, or persistent skin infections.
The specific type of leukemia can influence the pattern of fatigue and infections. Acute leukemias, which progress rapidly, often cause severe fatigue and frequent infections early on. Chronic leukemias, on the other hand, may present with more subtle symptoms that develop gradually over time. However, regardless of the type, persistent fatigue and recurrent infections should raise a red flag and prompt a visit to the doctor.
Difference between normal fatigue and the fatigue caused by leukemia
Normal fatigue is a familiar feeling of tiredness that improves with rest or catching up on sleep. It often stems from everyday activities like physical exertion, stress, or a late night. Leukemia fatigue, however, is a different beast. Medically termed cancer-related fatigue (CRF), it's an overwhelming, persistent exhaustion that disrupts your daily life. Even after sleep, simple tasks feel draining, and concentration suffers.
This unrelenting fatigue is caused by leukemia itself or its treatment, impacting your body's ability to produce energy-carrying red blood cells. Unlike normal tiredness, leukemia fatigue can be accompanied by symptoms like shortness of breath, weakness, and difficulty fighting infections. If you experience such persistent fatigue alongside other unexplained symptoms, consulting a doctor is crucial for proper diagnosis and treatment.
How to get it diagnosed?
Early diagnosis of leukemia is crucial for successful treatment:
· A simple blood test can provide initial clues. A complete blood count (CBC) measures the levels of red blood cells, white blood cells, and platelets. Abnormalities in these counts, such as a significant decrease in healthy white blood cells or an abnormal increase in immature white blood cells, can warrant further investigation.
· A bone marrow aspiration and biopsy, where a small sample of bone marrow is extracted and examined under a microscope, can definitively diagnose leukemia by identifying the presence and type of abnormal blood cells.
What are the treatment options?
Fortunately, significant advancements have been made in leukemia treatment. Chemotherapy remains a mainstay, effectively eliminating cancerous cells. Newer targeted therapies and immunotherapies are also showing promise, offering more personalized and potentially less toxic treatment options. Bone marrow transplants can be curative in some cases, particularly for younger patients. Early diagnosis allows for a wider range of treatment options and significantly improves the chances of a successful outcome.
Normal fatigue is a familiar feeling of tiredness that improves with rest or catching up on sleep. It often stems from everyday activities like physical exertion, stress, or a late night. Leukemia fatigue, however, is a different beast. Medically termed cancer-related fatigue (CRF), it's an overwhelming, persistent exhaustion that disrupts your daily life. Even after sleep, simple tasks feel draining, and concentration suffers. This unrelenting fatigue is caused by leukemia itself or its treatment, impacting your body's ability to produce energy-carrying red blood cells. Unlike normal tiredness, leukemia fatigue can be accompanied by symptoms like shortness of breath, weakness, and difficulty fighting infections. If you experience such persistent fatigue alongside other unexplained symptoms, consulting a doctor is crucial for proper diagnosis and treatment.
Looking ahead:
If you are experiencing persistent fatigue and recurrent infections, don't hesitate to speak to your doctor. Early diagnosis of leukemia is critical for successful treatment, and with a range of treatment options available, there is hope for a positive outcome. A healthcare professional can guide you through the diagnostic process and explore the most suitable treatment plan.
By: Dr. R V Raghunandan, Senior Consultant - Radiation Oncology, HCG MNR Cancer Hospital, Ongole
By:- Dr. Prasad Kasbeka
19 Jul 2024
70-year-old female, was incidentally detected with a right hypochondriac mass approximately 15 by 12 centimetres in size, located between the liver and the kidney was successfully treated at Wockhardt Hospitals, Mumbai Central, by Dr. Prasad Kasbekar using the Retroperitoneal Resection procedure.
Adrenocortical carcinoma is a rare disease in which malignant (cancer) cells form in the outer layer of the adrenal gland. Having certain genetic conditions increases the risk of adrenocortical carcinoma. Symptoms of adrenocortical carcinoma include pain in the abdomen imaging studies and tests that examine the blood and urine are used to diagnose adrenocortical carcinoma. Certain factors affect the prognosis (chance of recovery) and treatment options.
Retroperitoneal Mass Excision with Liver Non Anatomic Resection
Retroperitoneal sarcoma resection is a surgical procedure performed to remove a malignant (cancerous) tumor, known as retroperitoneal sarcoma, located in the retroperitoneal space. The retroperitoneal space is the area behind the peritoneum, or the lining of the abdomen, which contains organs such as the kidneys, pancreas, and parts of the gastrointestinal tract. The goal of this surgery is to remove the entire tumor and any surrounding tissue that may be affected to prevent the spread of cancer.
Initial Findings: The mass appeared on scans to be attached to the liver, and an external biopsy suggested the possibility of adrenocortical cancer.
Surgical Exploration and Findings: Upon surgical exploration, the mass was found to be grossly adherent to the kidney, the inferior vena cava, and the right lobe of the liver. Despite these challenges, the surgical team successfully resected the mass while preserving the kidney. The mass was extremely adherent to the inferior vena cava, but the vessel was saved. Only a very small part of the liver was resected, preserving the majority of the right lobe.
Preliminary histopathological analysis indicated that the mass is an adrenocortical neoplasm.
The surgery, which lasted around seven hours, was highly complicated due to the mass's location and attachments.
Postoperative Course: The patient had an uneventful postoperative recovery, spending approximately one day in the ICU and around five to six days in the ward.
In summary, the successful resection of the mass with minimal organ loss and the patient's smooth postoperative recovery highlight the effectiveness of the surgical intervention.
By: Dr. Prasad Kasbekar, MBBS-General Medicine, MS-General Surgery, Mch-Onco Surgeon, Wockhardt Hospitals, Mumbai Central
By :- Team VOH
26 Jun 2024
Chimeric antigen receptor T-cell (CAR-T) therapy has emerged as a leading breakthrough in cancer treatment. The field of medical science is progressing rapidly. Cancer is one of the most important medical conditions worldwide. Cancer is the abnormal growth of cells that have gone out of control and start working like a foreign body. Our body has a well-developed defense system that can recognize anything foreign entering the body and kill it; therefore, viral and bacterial infections when they enter our body are killed by the immune system. T cells constitute a major defense force. They must be trained to locate foreign bodies. Presumably, cancer cells can also be recognized and removed from the body.
CAR-T cell therapy is a novel cellular treatment involving training a patient’s immune system to recognize cancer cells as foreign and detect and eliminate them. The patient’s T cells are manufactured to target specific antigens (proteins) present in cancer cells. This process involves removing white cells from the body using a machine through a process called leukapheresis. The blood is sent to the lab for separation of T cells. Specific viral vectors have been developed to introduce specific genes inside T cells. This gene can produce new proteins inside T cells, which increases their ability to detect cells in the body with specific markers. After the intrusion of genes into T cells, they increase in number and are re-introduced into the body of the patient. This all process happens in a laboratory. This may take a few weeks to complete. An increasing amount of research is being conducted to achieve as little time as possible. In the meantime, the patient's bodies need to be prepared to receive these cells, for this patient has to go through the process of receiving high-dose chemotherapy. This required admission and close monitoring. Once reintroduced, engineered T cells create space in the body. The introduced CAR-T cells start identifying cancerous cells with specific antigens on the surface and nullifying them.
This revolutionary method has allowed us to cure a large number of patients with hematological cancers including lymphoma, leukemia, and myeloma. Up to 85 % of the patients achieve complete disease disappearance. Science is trying to find unique markers present on the surface of cancer cells so that gene manipulations in T cells can be performed. CAR-T cell therapy uses the patient’s own immune cells, and as the cells belong to the patient’s own body, there are no other complications, as we see in bone marrow transplantation. CAR-T therapy is a short treatment that can offer long-term remission. This process may involve unique side effects. Owing to the release of special cytokines (cytokine release syndrome), patients may experience fever, nausea, chills, and sometimes life-threatening lung issues. Neurological changes may occasionally be observed. A specially designed monitoring process exists. Toxicity can occur immediately or sometimes after a few days.
Presently, CAR-T cell therapy offers a novel treatment for patients who have failed the standard treatment. This new hope has already helped many young and elderly patients. In the future, it is likely to be used for many cancers.
Dr. N Ramana Reddy, Sr. Consultant - Surgical Oncology, HCG Cancer Centre Ongole
Early detection of bladder cancer significantly enhances treatment options and outcomes, offering patients a better chance of complete recovery and improved quality of life. When diagnosed at an early stage, bladder cancer can be treated more effectively, often with less aggressive therapies, reducing the risk of recurrence and minimizing side effects. This proactive approach not only extends survival rates but also empowers patients with more choices, fostering a sense of hope and control over their health. Thus, regular screenings and awareness of early symptoms are crucial, underscoring the lifesaving potential of early diagnosis in bladder cancer.
Bladder cancer develops when cells in the bladder lining grow abnormally. This can cause several noticeable changes in urination patterns, including blood in the urine, frequent urination, and pain during urination. Early detection of bladder cancer is critical for a more favourable prognosis, and treatment often involves a combination of approaches for the best chance of success.
Cystoscopy: A Direct View Inside the Bladder
Cystoscopy, a key diagnostic procedure for bladder cancer, involves inserting a flexible tube with a camera into the bladder via the urethra. Suspicious areas, such as tumors or inflammation, are directly visualized. Biopsy can be performed during cystoscopy, confirming the diagnosis and potentially treating early-stage tumors through Transurethral Resection of Bladder Tumor (TURBT). Urine cytology, which examines urine samples under a microscope, complements cystoscopy findings by detecting shed cancer cells from the bladder lining.
Imaging Tests: Unveiling the Extent of Spread
Imaging tests play a crucial role in determining the extent of the cancer's spread. A CT urogram involves injecting a contrast dye into a vein. This dye travels through the kidneys, ureters, and bladder, allowing for detailed X-ray images of the entire urinary tract. By examining these images, doctors can assess the size, location, and depth of invasion of the tumor. In some cases, a retrograde pyelogram might be necessary. This procedure involves injecting contrast dye directly into the ureters using a catheter, followed by X-rays. This provides a clearer picture of the upper urinary tract, particularly the ureters and kidneys, which is valuable for assessing potential spread.
Staging and Grading: Understanding the Cancer
Bladder cancer is staged from I to IV based on its spread. Stage I tumors are limited to the bladder lining, while stage II involves deeper layers of the bladder wall. Stage III indicates spread to nearby tissues or lymph nodes, and stage IV signifies distant organ involvement. Grading, assessed as G1 to G3, reflects cell appearance: G1 is low-grade (normal), and G3 is high-grade (abnormal and aggressive).
Treatment Options: Tailored to Stage and Grade
For early-stage (non-muscle-invasive) tumors, Transurethral resection of bladder tumor (TURBT) might be the sole treatment required. However, intravesical therapy—where medications (chemotherapy or immunotherapy) are directly instilled into the bladder—is often recommended to reduce recurrence risk. Chemotherapy drugs or bacillus Calmette-Guerin (BCG), an immunotherapy drug, stimulate the immune system to attack cancer cells.
In cases of advanced or muscle-invasive bladder cancer, more extensive treatments come into play. Radical cystectomy, which removes the entire bladder, is a common surgical option. Depending on the situation, additional therapies like chemotherapy (powerful drugs targeting cancer cells throughout the body) or radiation therapy (high-energy rays to destroy cancer cells) may be used before or after surgery.
Follow-Up: Monitoring for Recurrence
After successful bladder cancer treatment, regular follow-up is crucial. Scheduled cystoscopy, urine cytology, and imaging tests monitor for recurrence signs. Early detection allows prompt intervention and better management. Healthy habits (like quitting smoking, maintaining weight, and staying hydrated) reduce recurrence risk. While a bladder cancer diagnosis can be daunting, a comprehensive approach combining diagnostics, staging, and treatments offers hope. If you notice symptoms (blood in urine, changes in urination), consult your healthcare provider promptly. Early diagnosis and proactive care are vital for success.
By Dr Pradeep Mahajan, Regenerative Medicine Researcher & Founder of StemRx Hospital and Research Centre.
Amyotrophic Lateral Sclerosis (ALS) is a frightening neurodegenerative condition that has been puzzling researchers and clinicians until now. Although promising work in the field of regenerative medicine gives hope to patients and their families, it remains subjugated by the fact that ALS is the progressive degeneration of motor neurons within the brain and spinal cord, leading to muscle weakness, atrophy, and finally, respiratory failure. A leader in this research area in the field of regenerative medicine is Dr Pradeep Mahajan.
Understanding ALS and the Need for New Therapies
ALS, otherwise known as Lou Gehrig's disease, causes about 2 cases per 100,000 individuals annually. It kills most people within, on average, 3 to 5 years from the start of symptoms. Its treatment remains poor and is mainly symptomatic, trying to control related problems rather than the degeneration of neurons themselves.
Dr. Mahajan stated, "Till this point, the available traditional therapies have been found to give a minimal improvement in ALS outcomes. There is an urgent need for innovative approaches to not only stop the progression of the disease but potentially reverse its effects."
The Promise of Regenerative Medicine
Regenerative medicine, which aims to repair or replace damaged cells, tissues, and organs, leads the way in this new paradigm. It ranges across many techniques, including stem cell therapy, gene therapy, and tissue engineering.
Dr. Mahajan states, "Regenerative medicine is revolutionizing our treatment of neurodegenerative disease, harnessing the body's healing mechanisms to restore lost functions. Hopefully, this offers a better quality of life for ALS patients."
Stem Cell Therapy: A New Game Changer
Stem cell therapy is one of the most promising avenues in research on ALS. There is a possibility that these cells might be able to differentiate into any kind of cell, particularly motor neurons. Recent clinical trials have indicated that they may help to replace lost neurons and provide support factors to the remaining neurons so that the progression of the degeneration process is slowed.
"Intrathecally administered mesenchymal stem cells have shown safety and efficacy in early-phase trials," Dr. Mahajan notes. "These cells can immunomodulate and support neuronal survival, indicating their potential for multidimensional methods against ALS."
Gene Therapy: Attacking the Root of the Problem
In addition, gene therapy is a procedure that is taking place in which it tries to correct or replace causing ALS. With the breakthrough of CRISPR-Cas9 and other techniques on targeting the editing of the genetic code accurately being achieved, the work lays a foundation for a possible cure for hereditary forms of ALS caused by mutations in genes such as SOD1 and C9orf72.
Dr. Mahajan also added, "Gene therapy is focused treatment for ALS, based on its genetic point of cause. By targeting underlying genetic defects, we may stop disease progression or even prevent its onset in familial cases."
The Road Ahead: Challenges and Opportunities
Despite these promising advances, there are a few challenges. The fact that ALS is a very complex disease in its etiology and presents different symptoms in individual patients supports the use of personalized treatment strategies. In addition, it is necessary to conduct long-term safety and efficacy studies in the hope that innovative therapies will result in benefits in patients. Dr. Mahajan has been quoted as saying, "The road to a cure is still long, but the progress we've made in recent years is remarkable." "In ALS, stem cell therapy, gene therapy, and other regenerative techniques are coming together to treat all the components of the disease—both symptomatic and causative," he said.
New Hope for Those who have ALS. Such advances bring new hope to patients who are suffering from ALS. The real promise of this integration of regenerative medicine into the clinic happens with the recent ability to take ALS from a death sentence to a manageable condition. "Regenerative medicine innovation is not only about lengthening life but also improving the quality of life for those who have ALS," he said. "As we continue to explore and refine these therapies, we move closer to a future where ALS is no longer a life sentence but a condition we can effectively manage and even overcome." Inching toward these therapies, with each advancement in research, the cure for ALS is becoming a slowly shaped reality, bringing in a new ray of hope and potential to several million patients across the world
Heart failure remains a leading cause of morbidity and mortality worldwide, posing significant challenges for both patients and healthcare professionals. Recent advancements in surgery and medical technology have revolutionized the management of advanced heart failure, offering improved survival prospects for patients with end-stage cardiac diseases. Notably, Left Ventricular Assist Devices (LVADs) have emerged as a crucial advanced therapy for treating heart failure.
Understanding Heart Failure
Heart failure is a condition where patients experience symptoms and a reduced quality of life due to the heart's inability to pump blood efficiently. However, it should not be confused with a sudden cessation of the heartbeat; rather, it develops gradually over time due to various underlying causes. Factors such as coronary artery disease, hypertension, cardiomyopathy, and valve disorders often contribute to heart failure. Symptoms include breathlessness, fatigue, swollen legs, and rapid weight gain. Understanding the condition and recognizing the early signs are crucial for timely diagnosis and treatment. LVAD therapy has emerged as a revolutionary treatment option for managing heart failure.
Left Ventricular Assistance (LVADs):
Left ventricular assist devices, or LVADs are devices that help the heart's left ventricle to pump blood to the body's other organs. LVAD, is a mechanical pump that runs on batteries and assists the heart's biggest chamber in pumping blood out of it. LVADs are surgically implanted, and their mechanism of action involves withdrawing blood from the heart's left ventricle and passing it through a mechanical pump that is placed inside the chest. The blood is then pumped out to the rest of the body, bypassing the weakened heart. When heart transplantation is not suitable for a patient, LVADs can be used as a bridge to heart transplantation, as a long-term treatment for heart failure, or as a temporary measure to allow the heart to heal following surgery. After LVAD surgery, patients can have a higher quality of life and a long-term survival rate. As technology has developed over time, LVADs have become more widely available, efficient, and user-friendly.
Increased Strength and Self-Sufficiency
One of the most significant benefits of LVAD therapy is the substantial increase in exercise tolerance and functional capacity. Many patients report a marked improvement in symptoms such as dyspnea and exhaustion, enabling them to engage in activities they were previously unable to perform. Regaining physical ability enhances patients' independence, allowing them to travel, pursue hobbies, and spend more time with loved ones, leading to a happier, more fulfilling life.
Lower Hospitalization Rate and Higher Survival Rate
In patients with advanced heart failure, LVADs have been shown to improve survival rates and reduce the risk of hospitalization. By alleviating symptoms and increasing cardiac output, LVADs help stabilize patients' conditions, decreasing the need for emergency room visits and recurrent hospital stays. The support provided by LVADs also helps reverse the detrimental effects of heart failure on other vital organs, further extending patients' lives.
Cardiac Recovery and Systemic Benefits
In some cases, LVADs allow the heart to recover sufficient function, potentially reducing the need for further interventions. They also help manage fluid retention and improve organ function by ensuring a more consistent blood flow, alleviating strain on other body systems.
Possible Limitations
While LVAD therapy has revolutionized heart failure management, there are still certain drawbacks and potential issues. Device malfunctions, hemorrhage, thrombosis, infection, and other complications can occur, necessitating careful management and close monitoring. Additionally, the cost of long-term care and LVAD implantation presents challenges for both patients and healthcare systems. Despite these difficulties, patients who are appropriately selected for LVAD therapy have shown remarkable improvements in survival, functional ability, and quality of life.
LVADs have significantly improved heart failure patients' quality of life by increasing physical capacity, and survival rates. It is anticipated that as technology advances, LVADs will become increasingly important in enhancing the quality of life for heart failure patients.
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