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Abdominal aortic aneurysm

Abdominal aortic aneurysm | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Heart and blood vessels Conditions Abdominal aortic aneurysm Abdominal aortic aneurysm About abdominal aortic aneurysms Symptoms of an abdominal aortic aneurysm Causes of an abdominal aortic aneurysm Diagnosing an abdominal aortic aneurysm Treating an abdominal aortic aneurysm Preventing an abdominal aortic aneurysm About abdominal aortic aneurysms An abdominal aortic aneurysm (AAA) is a swelling (aneurysm) of the aorta the main blood vessel that leads away from the heart, down through the abdomen to the rest of the body. The abdominal aorta is the largest blood vessel in the body and is usually around 2cm wide roughly the width of a garden hose. However, it can swell to over 5.5cm what doctors class as a large AAA. Large aneurysms are rare, but can be very serious. If a large aneurysm bursts, it causes huge internal bleeding and is usually fatal. The bulging occurs when the wall of the aorta weakens. Although what causes this weakness is unclear, smoking and high blood pressure are thought to increase the risk of an aneurysm. AAAs are most common in men aged over 65. A rupture accounts for more than 1 in 50 of all deaths in this group. This is why all men are invited for a screening test when they turn 65. The test involves a simple ultrasound scan , which takes around 10-15 minutes. Symptoms of an AAA In most cases, an AAA causes no noticeable symptoms. However, if it becomes large, some people may develop a pain or a pulsating feeling in theirabdomen (tummy)or persistent back pain. An AAA doesnt usually pose a serious threat to health, but theres a risk that a larger aneurysm could burst (rupture). A ruptured aneurysm can cause massive internal bleeding, which is usually fatal. Around 8 out of 10 people with a rupture either die before they reach hospital or dont survive surgery. The most common symptom of a ruptured aortic aneurysm is sudden and severe pain in the abdomen. If you suspect that you or someone else has had a ruptured aneurysm, call 999 immediately and ask for an ambulance. Read more about the symptoms of an AAA . Causes of an AAA Its not known exactly what causes the aortic wall to weaken, although increasing age and being male are known to be the biggest risk factors. There are other risk factors you can do something about, including smoking and having high blood pressure and cholesterol level. Having a family history of aortic aneurysms also means that you have an increased risk of developing one yourself. Read more about the causes of an AAA . Diagnosing an AAA Because AAAs usually cause no symptoms, they tend to be diagnosed either as a result of screening or during a routine examination for example, if a GP notices a pulsating sensation in your abdomen. The screening test is an ultrasound scan ,which allows the size of your abdominal aorta to be measured on a monitor. This is also how an aneurysm will be diagnosed if your doctor suspects you have one. Read more about diagnosing an AAA . Treating an AAA If a large AAA is detected before it ruptures, most people will be advised to have treatment, to preventit rupturing. This is usually done with surgery to replace the weakened section of the blood vessel with a piece of synthetic tubing. If surgery is not advisable or if you decide not to have it there are a number of non-surgical treatments that can reduce the risk of an aneurysm rupturing. They include medications to loweryour cholesterol and blood pressure , and quitting smoking . You will also have the size of your aneurysm checked regularly with ultrasound scanning. Read more about treating AAAs . Prevention The best way to prevent getting an aneurysm or reduce the risk of an aneurysm growing bigger and possibly rupturing is to avoid anything that could damage your blood vessels, such as: smoking eating a high-fat diet not exercising regularly being overweight or obese Read more about preventing aneurysms . Screening Read more about screening for an AAA . Symptoms of an abdominal aortic aneurysm In most cases, an unruptured abdominal aortic aneurysm (AAA) will cause no symptoms, unless it becomes particularly large. Symptoms of an unruptured AAA may include: a pulsating feeling in your stomach (abdomen), usually near your belly button, thats usually only noticeable when you touch it persistent back pain persistent abdominal pain If you have any of the symptoms above, you should see your GP as soon as possible. Ruptured AAA If your aortic aneurysm ruptures, you will feel a sudden and severe pain in the middle or side of your abdomen. In men, the pain can also radiate down into the scrotum. Other symptoms include: dizziness sweaty and clammy skin rapid heartbeat (tachycardia) shortness of breath feeling faint loss of consciousness Medical emergency A ruptured aortic aneurysm is a medical emergency, and its important to get to hospital as soon as possible. Around 80% of people with a rupture die before they reach hospital or dont survive emergency surgery. This is why the NHS AAA Screening Programme was introduced, so dangerously large aneurysms can be treated before they burst. If you suspect that you or someone in your care has had a ruptured aneurysm, call 999 immediately and ask for an ambulance. Causes of an abdominal aortic aneurysm The aorta is the largest blood vessel in the body. It transports oxygen-rich blood away from the heart to the rest of the body. An abdominal aortic aneurysm (AAA) occurs when part of the aorta wall becomes weakened and the large amount of blood that passes through it puts pressure on the weak spot, causing it to bulge outwards to form an aneurysm. The abdominal aorta is usually around 2cm wide about the width of a garden hosepipe but can swell to over 5.5cm, which is what doctors classify as a large aneurysm. Risk factors for an AAA Its not known exactly what causes the aortic wall to weaken, although increasing age and being male are known to be the biggest risk factors. One study found that people aged over 75 are seven times more likely to be diagnosed with an AAA than people under 55 years old. Men are around six times more likely to be diagnosed with an AAA than women. However, there are other risk factors that you can do something about described below the most important of which is smoking. Smoking Research has found that smokers are seven times more likely to develop an AAA than people who have never smoked. The more you smoke, the greater your risk of developing an AAA. People who regularly smoke more than 20 cigarettes a day may have more than 10 times the risk of non-smokers. The risk may increase because tobacco smoke contains harmful substances that can damage and weaken the wall of the aorta. Atherosclerosis Atherosclerosisis a potentially serious condition where arteries become clogged up by fatty deposits, such as cholesterol. An AAA is thought to develop because these deposits (called plaques) cause the aorta to widen in an attempt to keep blood flowing through it. As it widens, it also gets weaker. Smoking, eating a high-fat diet and high blood pressure all increase your risk of developing atherosclerosis. High blood pressure As well as contributing to atherosclerosis, high blood pressure (hypertension) can place increased pressure on the aortas wall. Family history Having a family history of AAAs means that you have an increased risk of developing one. One study found that people who had a brother or sister with an AAA were eight times more likely to develop one than people whose siblings were unaffected. This suggests that certain genes you inherit from your parents may make you more vulnerable to developing an AAA. However, no specific genes have yet been identified. Read about how to reduce your risk of developing an AAA . Diagnosing an abdominal aortic aneurysm An abdominal aortic aneurysm (AAA) usually causes no symptoms. Therefore, they tend to be diagnosed as a result of screening, or during a routine physical examination when a GP notices a distinctive pulsating sensation in your abdomen. A diagnosis can be confirmed using an ultrasound scan. Ultrasound can also determine the size of the aneurysm, which is an important factor in deciding on a course of treatment. Screening All men in the UK who are 65 or over are offered an ultrasound scan to check for AAAs. All men should receive an invitation in the year they turn 65 years old. Men who are older than 65 can refer themselves for screening by contacting their local NHS AAA screening service . For more information, visit our page on AAA screening . Treating an abdominal aortic aneurysm Treatment for an abdominal aortic aneurysm (AAA) depends on several factors, including the aneurysms size, your age and general health. In general, if you have a large aneurysm (5.5cm or larger) you will be advised to have surgery, either to strengthen the swollen section of the aorta or to replace it with a piece of synthetic tubing. This is because the risk of the aneurysm rupturing is usually greater than the risk of having it repaired. If you have a small (3.0-4.4cm) or medium (4.5-5.4cm) aneurysm, you will be offered regular scans to check its size. You will also be given advice on how to slow its growth and reduce the risk of it rupturingfor example, stopping smoking and perhaps medications to reduce your blood pressure and cholesterol level. If you have a large AAA If you are diagnosed with an AAA that is 5.5cm or larger, you will be referred to a vascular surgeon (a surgeon who specialises in diseases of the blood vessels), who may recommend an operation. The surgeon will discuss treatment options with you, taking into account your general health and fitness, as well as the size of your aneurysm. If its decided that surgery isnt suitable for you, its still possible to reduce the risk of the aneurysm bursting, and you will have regular scans to check its size in the same way people with small or medium aneurysms are treated. See below for more information on treating small and medium aneurysms. There are two surgical techniques used to treat a large aneurysm: endovascular surgery open surgery Although both techniques are equally effective at reducing the risk of the aneurysm bursting, each has its own advantages and disadvantages. The surgeon will discuss with you which is most suitable. Endovascular surgery Endovascular surgery is a type of keyhole surgery where the surgeon makes small cuts in your groin. A small piece of tubing called a graft made of metal mesh lined with fabric is then guided up through the leg artery, into the swollen section of aorta, and sealed to the wall of the aorta at both ends. This reinforces the aorta, reducing the risk of it bursting. This is the safest of the two types of surgery available. Around 98-99% of patients make a full recovery, and recovery time from the operation is shorter than if you have open surgery. There are also fewer major complications, such as wound infection or deep vein thrombosis (DVT). However, the way the graft is attached is not as secure as open surgery. Youll need regular scans to make sure the graft hasnt slipped, and in some patients, the seal at each end of the graft starts to leak and will need to be resealed. You will need to have surgery again if either of these occurs. Open surgery In open surgery, the surgeon cuts into your stomach (abdomen) to reach the abdominal aorta and replaces the enlarged section with a graft. This type of graft is a tube made of a synthetic material. Because the graft is stitched (sutured) into place by the surgeon, its more likely to stay in place, and will usually work well for the rest of your life. The risk of complications linked to the graft after surgery is lower than in people who have endovascular surgery. Open surgery isnt usually recommended for people who are in poor health as it is a major operation. It is slightly more risky than endovascular surgery, with 93-97% of patients making a full recovery. The main risk of open surgery is death or heart attack, and recovery time is longer than with endovascular surgery. There is also a greater risk of complications, such as wound infection, chest infection and DVT. If you have a small or medium AAA If you are diagnosed with a small (3.0-4.4cm) or medium (4.5-5.4cm) aneurysm, you wont be referred to see a vascular surgeon, as its unlikely youd benefit from surgery. Youll be invited back for regular scans to check the size of the aneurysm, in case it gets bigger every year if you have a small aneurysm and every three months if you have a medium aneurysm. You will also be given advice on how to prevent the aneurysm from getting bigger, including: stopping smoking eating a balanced diet ensuring you maintain a healthy weight taking regular exercise If you smoke, the most important change you can make is to quit. Aneurysms have been shown to grow faster in smokers than in non-smokers. Read more about stopping smoking and nicotine replacement therapies (NRTs) that can make it easier to stop smoking. Your GP will be sent your test result and may decide to change your current medication or start you on a new one, especially if you have: high blood pressure which you will probably be treated for with a medication called an angiotensin-converting enzyme (ACE) inhibitor high cholesterol which you will probably be treated for with a medication called a statin Treating a ruptured AAA Emergency treatment for a ruptured AAA is based on the same principle as preventative treatment. Grafts are used to repair the ruptured aneurysm. The decision on whether to perform open or endovascular surgery is made on a case-by-case basis by the surgeon carrying out the operation. Preventing an abdominal aortic aneurysm The best way to prevent getting an aneurysm, or reduce the risk of an aneurysm growing bigger and possibly rupturing, is to avoid anything that could damage your blood vessels. This includes: smoking eating a high-fat diet not exercising regularly being overweight or obese If your GP finds out you have high blood pressure or a high cholesterol level, you may be prescribed medication for both. This will reduce the risk of developing an abdominal aortic aneurysm (AAA). Smoking Smoking is a major risk factor for aneurysms because it causes atherosclerosis (hardening of the arteries) and raises your blood pressure. Tobacco smoke contains substances that can damage the walls of the arteries. It is known that smokers are seven times more likely than non-smokers to develop an AAA. The more you smoke, the greater your risk. People who regularly smoke more than 20 cigarettes a day may have more than 10 times the risk of non-smokers. If you want to stop smoking, your GP will be able to refer you to an NHS Stop Smoking Service, which will give you dedicated help and advice about the best ways to quit. You can also call or chat online with Quit Your Way Scotland .The specially trained helpline staff can offer you free expert advice and encouragement. Read more about stopping smoking and nicotine replacement therapies (NRTs) , which can make it easier to quit. Diet Eating a high-fat diet increases your risk of atherosclerosis. Its especially important to limit the amount of foods you eat that are high in saturated fat, such as biscuits, cakes, butter, sausages and bacon. This is because eating too much saturated fat can lead to high cholesterol, which can build up in the artery walls. Read more about high cholesterol . Find out more about healthy eating and how to reduce the amount of saturated fat you eat . Exercise Being active and doing regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition. Regular exercise can also help you lose weight, which will also help lower your blood pressure. Adults should do at least 150 minutes (two hours and 30 minutes) of moderate-intensity aerobic activity every week. Examples of moderate intensity activity include cycling or fast walking. For it to count, the activity should make you feel warm and slightly out of breath. Someone who is overweight may only have to walk up a slope to get this feeling. Physical activity can include anything from sport to walking and gardening. Get more ideas on being active . Weight Being overweight forces your heart to work harder to pump blood around your body. This can raise your blood pressure, which in turn puts pressure on your arteries. Use a BMI healthy weight calculator to find out if you need to lose weight. If you need to shed some weight, its worth remembering that losing just a few pounds will make a big difference to your blood pressure and overall health. Get tips on losing weight safely and read more about preventing high blood pressure

Acne

Acne symptoms & treatments - Illnesses & conditions Illnesses and conditions Skin, hair and nails Acne Acne About acne Causes of acne Diagnosing acne Treating acne Complications of acne About acne Acne is a common skin condition that affects most people at some point. It causes spots, oily skin and sometimes skin thats hot or painful to touch. Acne most commonly develops on the: face this affects almost everyone with acne back this affectsmore thanhalf of people with acne chest this affectsabout 15% ofpeople with acne Types of spots There are 6main types of spot caused by acne: blackheads small black or yellowish bumps that develop on the skin;theyre not filled with dirt, but are black because the inner lining of the hair follicle produces pigmentation (colouring) whiteheads have a similar appearance to blackheads, butmay be firmer and wont empty when squeezed papules small red bumps that may feel tender or sore pustules similar to papules, but have a white tip in the centre, caused by a build-up of pus nodules large hard lumps that build up beneath the surface of the skin and can bepainful cysts the most severe type of spot caused by acne; theyre large pus-filled lumps that look similar to boilsand carry the greatest risk of causing permanent scarring Papules are small red bumps that may feel tender or sore. Source: https://dermnetnz.org/ Blackheads are small black or yellow lumps that form on the skin. Source: https://dermnetnz.org/ What can I do if I have acne? The self-help techniques below may be useful: Dont wash affected areas of skin more than twice a day. Frequent washing can irritate the skin and make symptoms worse Wash the affected area witha mild soap or cleanser and lukewarm water. Very hot or cold water can make acne worse Dont try to clean out blackheads or squeeze spots.This can make them worse and cause permanent scarring Avoid using too much make-up and cosmetics. Use water-based products that are described as non-comedogenic (this means the product is less likely to block the pores in your skin) Completely remove make-up before going to bed If dry skin is a problem, use a fragrance-free, water-based emollient Regular exercise cant improve your acne, but it can boost your mood and improve your self-esteem.Shower as soon as possible once you finish exercising, as sweat can irritate your acne Wash your hair regularlyand try to avoid lettingyour hair fall across your face Although acne cant be cured, it can be controlled with treatment. Several creams, lotions and gelsfor treating spots are available at pharmacies. If you develop acne, its a good idea to speak to your pharmacist for advice. Treatments can take up to 3months to work, so dont expect results overnight. Once they do start to work, the results are usually good. When to get professional advice Pharmacy First Scotland: Acne treatment from your pharmacy If you have acne you can get advice and treatment directly from a pharmacy. Find your local pharmacy on Scotlands Service Directory. Search for a pharmacy near you Acne isnt usually serious and can be treated by a pharmacist. If your acne is severe or appears on your chest and back,it may need to be treated with antibiotics or stronger creams that are onlyavailable on prescription. Your pharmacist can advise on whether you need to see your GP for further treatment. If you develop nodules or cysts, they need to be treated properly through your GP to avoid scarring.Try to resist the temptation to pick or squeeze the spots, as this can lead to permanent scarring. Why do I have acne? Acne is most commonlylinked to the changes in hormone levels during puberty, but can start at any age. Certain hormones causethe grease-producing glands next to hair follicles in the skin to produce larger amounts of oil (abnormal sebum). This abnormal sebum changes the activity of a usually harmless skin bacterium called P. acnes, which becomes more aggressive and causes inflammation and pus. The hormones also thicken the inner lining of the hair follicle, causing blockage of the pores (opening of the hair follicles). Cleaning the skin doesnt help to remove this blockage. Other possible causes Acne is known to run in families. If both your mother and father had acne, its likely that youll also have acne. Hormonal changes, such as those that occur during the menstrual cycle or pregnancy, can also lead to episodes of acne in women. Theres no evidence that diet, poor hygiene or sexual activity play a role in acne. Read more about the causes of acne ,including some common acne myths. Whos affected? Acne is very common in teenagers and younger adults. About 80% of people aged 11to 30are affected by acne. Acne is most common in girls from the ages of 14to 17, and in boys from the ages of 16to 19. Most people have acne on and off for several years before their symptoms start to improve as they get older. Acne often disappears when a person is in their mid-twenties. In some cases, acne can continue into adult life. About5% ofwomen and 1% of men have acne over the age of 25. Further information You can find support and information from organisations like: Changing Faces a charity for people who have a visible difference or facial disfigurement, who can be contacted on 0300 012 0275 for counselling and advice Causes of acne Acne is caused when tiny holes in the skin, known as hair follicles, become blocked. Sebaceous glands are tiny glands found near the surface of your skin. The glands are attached to hair follicles, which are small holes in your skin that an individual hair grows out of. Sebaceous glands lubricate the hair and the skin to stop it drying out. They do this by producing an oily substance called sebum. In acne, the glands begin to produce too much sebum. The excess sebum mixes with dead skin cells and both substances form a plug in the follicle. If the plugged follicle is close to the surface of the skin, it bulges outwards, creating a whitehead. Alternatively, the plugged follicle can be open to the skin, creating a blackhead. Normally harmless bacteria that live on the skin can then contaminate and infect the plugged follicles, causing papules, pustules, nodules or cysts. Testosterone Teenage acneis thought to be triggered by increased levels of a hormone called testosterone, which occurs during puberty. The hormone plays an important role in stimulating the growth and development of the penis and testicles in boys, and maintaining muscle and bone strength in girls. The sebaceous glands are particularly sensitive to hormones.Its thought that increased levels oftestosterone cause the glands to produce much more sebum than the skin needs. Acne in families Acnecan run in families. If your parents had acne, its likely that youll also develop it. One study has found that if both your parents had acne, youre more likely to get more severe acne at an early age. It also found that if one or both of your parents had adult acne, youre more likely to get adult acne too. Acne in women More than80% ofcases of adult acneoccur in women. Its thought that many cases of adult acne arecaused bythe changes in hormone levels that many women have at certain times. These timesinclude: periods some women have a flare-up of acne just before their period pregnancy many women have symptoms of acne at this time, usually during the first 3months of their pregnancy polycystic ovary syndrome a common condition that can cause acne, weight gain and the formation of small cysts inside the ovary Other triggers Other possible triggers of an acne flare-up include: some cosmetic productshowever, this is less common as most products are now tested,so they dont cause spots(non-comedogenic) certain medicationssuch as steroid medications , lithium(used to treat depression and bipolar disorder ) andsome anti-epileptic drugs (used to treat epilepsy ) regularly wearing items that place pressure on an affected area of skin, such asa headband or backpack smoking which can contribute to acne in older people Acne myths Despite being one of the most widespread skin conditions, acne is also one of the most poorly understood.There aremany myths and misconceptions about it: Acne is caused by a poor diet So far, research hasnt found any foods that cause acne. Eating a healthy, balanced diet is recommended because its good for your heart and your health in general. Acne is caused by having dirty skin and poor hygiene Most of the biological reactions that trigger acne occur beneath the skin, not on the surface, sothe cleanliness of your skinhasno effect on your acne. Washing your face more than twice a day could just aggravate your skin. Squeezing blackheads, whiteheads and spots is the best way to get rid of acne This could actually make symptoms worse and may leave you with scarring. Sexual activity can influence acne Having sex or masturbating wont make acne any better or worse. Sunbathing, sunbeds and sunlamps help improve the symptoms of acne Theres no conclusive evidence that prolonged exposure to sunlight or using sunbeds or sunlamps can improve acne. Many medications used to treat acne can make your skin more sensitive to light, so exposure could cause painful damage to your skin, and also increase your risk of skin cancer. Acne is infectious You cant pass acne on to other people. Diagnosing acne Your pharmacist can diagnose acne by looking at your skin. This involves examining your face and possibly your chest and back for different types of spot, such as blackheads or sore, red nodules. How many spots you have and how painful and inflamed they are will help determine how severe your acne is. This isimportant in planning your treatment. 4grades can be used to measure the severity of acne: grade 1 (mild) acne is mostly confined to whiteheads and blackheads, with just a few papules and pustules grade 2 (moderate) there are multiple papules and pustules, which are mostly confined to the face grade 3 (moderately severe) theres a large number of papules and pustules, as well as the occasional inflamed nodule, and the back and chest are also affected by acne grade 4 (severe) theres a large number of large, painful pustules and nodules More severe acne can affect the back and neck. Source: https://dermnetnz.org/ Acne in women If acne suddenly startsin adult women, itcan be a sign of a hormonal imbalance, especially if its accompanied by other symptoms such as: excessive body hair (hirsutism) irregular or light periods The most common cause of hormonal imbalances in women ispolycystic ovary syndrome (PCOS). PCOS can be diagnosed using a combination of ultrasound scans and blood tests . Treating acne Treatment for acne depends on how severe it is. It can take several months of treatment before acne symptoms improve. The various treatments for acne are outlined below. If you just have a few blackheads, whiteheads and spots, you should be able to treat them successfully with over-the-counter gels or creams (topical treatments) that contain benzoyl peroxide. Treatments from your GP See your GP if your acne is more widespread,as you probably need prescription medication.For example, if: you have a large number of papules and pustules over-the-counter medication hasnt worked Prescription medications that can be used to treat acne include: topical retinoids topical antibiotics azelaic acid antibiotic tablets in women, the combined oral contraceptive pill isotretinoin tablets If you have severe acne,your GP can refer you to an expert in treating skin conditions (dermatologist). For example, if you have: a large number of papules and pustules on your chest and back, as well as your face painful nodules A combination ofantibiotic tablets and topical treatments is usually the first treatment option for severe acne. If this doesnt work, a medication calledisotretinoin may be prescribed. Hormonal therapies or the combined oral contraceptive pill can also be effective in women who have acne. However, the progestogen-only pill or contraceptive implant can sometimes make acne worse. Many of these treatments can take 2to 3months before they start to work. Its important to be patient and persist with a recommended treatment, even iftheres no immediate effect. Topical treatments (gels, creams and lotions) Benzoyl peroxide Benzoyl peroxide works as an antiseptic to reduce the number of bacteria on the surface of the skin. It also helps to reduce the number of whiteheads and blackheads, and has an anti-inflammatory effect. Benzoyl peroxide is usually available as a cream or gel. Its used either once or twice a day. It should be applied 20 minutes after washing to all of the parts of your face affected by acne. It should be used sparingly, as too much can irritate your skin. It also makes your face more sensitive to sunlight, so avoid too much sun and ultraviolet (UV) light, or wear sun cream. Benzoyl peroxide can have a bleaching effect, so avoid getting it on your hair orclothes. Common side effects of benzoyl peroxide include: dry and tense skin a burning, itching or stinging sensation some redness and peeling of the skin Side effects are usually mild and should pass once the treatment has finished. Most people need a 6 week course of treatment to clear most or all of their acne. You may be advised to continue treatment less frequently to prevent acne returning. Topical retinoids Topical retinoids work byremoving dead skin cells from the surface of the skin (exfoliating)which helpsto prevent them building up within hair follicles. Tretinoin and adapalene are topical retinoids used to treat acne. Theyre available in a gel or cream and are usually applied once a day before you go to bed. Apply to all the parts of your face affected by acne 20 minutes after washing your face. Its important to apply topical retinoids sparingly and avoid excessive exposure to sunlight and UV. Topical retinoids arent suitable for use during pregnancy, as theres a risk they might cause birth defects. The most common side effects of topical retinoids are mild irritation and stinging of the skin. A 6 week course is usually required, but you may be advised to continue using the medication less frequently after this. Topical antibiotics Topical antibiotics help kill the bacteria on the skin that can infect plugged hair follicles. Theyre available as a lotion or gel that is applied once or twice a day. A 6 to 8week course is usually recommended. After this, treatment is usually stopped, as theres a risk that the bacteria on your face could become resistant to the antibiotics. This could make your acne worse and cause additional infections. Side effects are uncommon, but can include: minor irritation of the skin redness and burning of the skin peeling of the skin Azelaic acid Azelaic acid is often used as an alternative treatment for acne if the side effects of benzoyl peroxide or topical retinoids are particularly irritating or painful. Azelaic acid works by getting rid of dead skin and killing bacteria. Its availableas acream or gel and is usually applied twice a day (or once a day if your skin is particularly sensitive). The medication doesnt make your skin sensitive to sunlight, so you dont have to avoid exposure to the sun. Youll usually need to use azelaic acid for a month before your acne improves. The side effects of azelaic acid are usually mild and include: burning or stinging skin itchiness dry skin redness of the skin Antibiotic tablets Antibiotic tablets (oral antibiotics) are usually used in combination with a topical treatment to treat more severe acne. In most cases, a class of antibiotics called tetracyclines is prescribed, unless youre pregnant or breastfeeding. Pregnant or breastfeeding women are usually advised to take an antibiotic called erythromycin, which is known to be safer to use. It usually takes about 6weeks before you notice an improvement in your acne. Depending on how well you react to the treatment, a course of oral antibiotics can last 4to 6months. Tetracyclines can make your skin sensitive to sunlight and UV light, and can also make the oral contraceptive pill less effective during the first few weeks of treatment. Youll need to use an alternative method of contraception, such as condoms , during this time. Hormonal therapies Hormonal therapies can often benefit women with acne, especially if the acne flares up aroundperiods oris associated with hormonal conditions such as polycystic ovary syndrome. If you dont already use it, your GP may recommend the combined oral contraceptive pill , even if youre not sexually active. This combined pill can often help improve acne in women, but may take up to a year before the full benefits are seen. Co-cyprindiol Co-cyprindiol is a hormonal treatment that can be used for more severe acnethat doesnt respond to antibiotics. It helps to reduce the production of sebum. Youll probably have to use co-cyprindiol for 2to 6months before you notice a significant improvement in your acne. Theres a small riskthat women taking co-cyprindiol may develop breast cancer in later life. For example, out of a group of 10,000 women who havent taken co-cyprindiol, you would expect 16 of them to develop breast cancer by the time they were 35. This figure rises to 17 or 18 for women who were treated with co-cyprindiol for at least 5years in their early twenties. Theres also a very small chance of co-cyprindiol causing a blood clot. The riskisestimated tobe around 1 in 2,500 in any given year. Its not thought to be safe to take co-cyprindiol if youre pregnant or breastfeeding.Women may need to have a pregnancy test before treatment can begin. Other side effects of co-cyprindiol include: bleeding and spotting between your periods, whichcan sometimes occur for the first few months headaches sore breasts mood changes loss of interest in sex weight gain or weight loss Isotretinoin Isotretinoinhas a number of beneficial effects: it helps to normalise sebum and reduce how much isproduced it helps to prevent follicles becoming clogged it decreases the amount of bacteria on the skin it reduces redness and swelling in and around spots However,the drugcan also cause a wide range of side effects. Its only recommended for severe cases of acne that havent responded to other treatments. Because of the risk of side effects, isotretinoin can only be prescribed by a specially trained GP or adermatologist. Isotretinoin is takenas atablet. Most people take a 4to 6 month course. Your acne may get worse during the first 7 to 10 days of treatment. However, this is normal and soon settles. Common side effects of isotretinoin include: inflammation, dryness and cracking of the skin, lips and nostrils changes in your blood sugar levels inflammation of your eyelids (blepharitis) inflammation and irritation of your eyes (conjunctivitis) blood in your urine Rarer side effects of isotretinoin include: inflammation of the liver (hepatitis) inflammation of the pancreas (pancreatitis) kidney disease Because of the risk of these rarer side effects, youll need a blood test before and during treatment. Isotretinoin and birth defects Isotretinoin will damage an unborn baby. If youre a woman of childbearing age: dont use isotretinoin if yourepregnant or you think youre pregnant use 1, or ideally 2, methods of contraception for 1month before treatment begins, during treatment and for 1month after treatment has finished have a pregnancy test before, during and after treatment Youll be asked to sign a form confirming that you understand the risk of birth defects and are willing to use contraceptives to prevent this risk, even if youre not currently sexually active. If you think you mayhave become pregnant when taking isotretinoin, contact your dermatologist immediately. Isotretinoin is also not suitable if youre breastfeeding. Isotretinoin and mood changes There have been reports of people experiencing mood changes while taking isotretinoin. Theres no evidence that these mood changes were the result of the medication. However, as a precaution, contact your doctor immediately if you feel depressed or anxious, have feelings of aggression or suicidal thoughts. Non-pharmaceutical treatments Several treatments for acne dont involve medication. These include: comedone extractor a small pen-shaped instrument that can be used to clean out blackheads and whiteheads chemical peels where a chemical solution is applied to the face, causing the skin to peel off and new skin to replace it photodynamic therapy where light is applied to the skin in an attempt to improve symptoms of acne However, these treatments may not work and cant be routinely recommended. Complications of acne Acne scarring can sometimes develop as a complication of acne. Any type of acne spot can lead to scarring, but its more common when the most serious types of spots (nodules and cysts) burst and damage nearby skin. Scarringcan also occur if you pick or squeeze your spots, so its important not to do this. There are 3main types of acne scars: ice pick scars small, deep holes in the surface of your skin that look like the skin has been punctured with a sharp object rolling scars caused by bands of scar tissue that form under the skin, giving the surface of the skin a rolling and uneven appearance boxcar scars round or oval depressions, or craters, in the skin Treating acne scarring Treatments for acne scarring are regarded as a type of cosmetic surgery, which isnt usually available on the NHS. However, in the past, exceptions have been made when its been shown that acne scarring has caused serious psychological distress. See your GP if youre considering having cosmetic surgery. Theyll be able to discuss your options with you and advise you about the likelihood of having the procedure carried out on the NHS. Many private clinics offer treatment for acne scarring. Prices can vary widely (from 500 tomore than10,000) depending on the type of treatment needed. The British Association of Plastic, Reconstructive and Aesthetic Surgeons website has more information about private treatment available in your area. Its important to have realistic expectations about what cosmetic treatment can achieve. While treatment can certainly improve the appearance of your scars, it cant get rid of them completely. After treatment for acne scarring, most people notice a 50-75% improvement in their appearance. Some of the available treatments for acne scarring are explained below. Dermabrasion Dermabrasion involves removing the top layer of skin, either using lasers or a specially made wire brush. After the procedure, your skin will look red and sore for several months, but as it heals you should notice an improvement in the appearance of your scars. Laser treatment Laser treatment can be used to treat mild to moderate acne scarring. There are 2types of laser treatment: ablative laser treatment where lasers are used to remove a small patch of skin around the scar to produce a new, smooth-looking area of skin non-ablative laser treatment where lasers are used to stimulate the growth of new collagen (a type of protein found in skin), which helps to repair some of the damage caused by scarring, and improves the appearance Punch techniques Punch techniques are used to treat ice pick scars and boxcar scars. There are 3types of punch technique: punch excision used to treat mild ice pick scars. The scar is surgically removed and the remaining wound is sealed. After the wound heals, it leaves a smoother and more even area of skin. punch elevation used to treat boxcar scars. The base of the scar is surgically removed, leaving the sides of the scar in place. The base is then reattached to the sides, but lifted up so its level with the surface of the skin. This makes the scar much less noticeable. punch grafting used to treat very deep ice pick scars. As with a punch excision, the scar is removed, but the wound is plugged with a sample of skin taken from elsewhere on the body (usually from the back of the ear). Subcision Subcision is a surgical treatment that can be used to treat rolling scars. During surgery, the upper layer of the skin is removed from the underlying scar tissue. This allows blood to pool under the affected area. The blood clot helps form connective tissue, which pushes up the rolling scar so its level with the rest of the surface of the skin. Once subscision has been completed, additional treatment, such as laser treatment and dermabrasion, can be used to further improve the appearance of the scar. Depression Acne can often cause intense feelings of anxiety and stress, which can sometimes make people with the condition become socially withdrawn. This combination of factors can lead to people with acne becoming depressed . You may be depressed if during the last month youve often felt down, depressed or hopeless, and have little interest or pleasure in doing things. If you think that you or your child may have depression, its important to speak to your GP. Treatments for depression include: talking therapies such as cognitive behavioural therapy (CBT) a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs)

Acute cholecystitis

Acute cholecystitis Illnesses and conditions Stomach, liver and gastrointestinal tract Acute cholecystitis Acute cholecystitis Acute cholecystitis is swelling (inflammation) of the gallbladder. It is a potentially serious condition that usually needs to be treated in hospital. Themain symptomof acute cholecystitis is a sudden sharp pain in the upper right side of your tummy (abdomen) that spreads towards your right shoulder. The affected part of the abdomen is usually extremely tender, and breathing deeply can make the pain worse. Unlike some others types of abdominal pain , the pain associated with acute cholecystitis is usually persistent, and doesnt go away within a few hours. Some people may additional symptoms, such as: a high temperature (fever) nausea and vomiting sweating loss of appetite yellowing of the skin and the whites of the eyes (jaundice) a bulge in the abdomen When to seek medical advice Contact your GP practice if: you develop sudden and severe abdominal pain, particularly if the pain lasts longer than a few hours or you have other symptoms, such as jaundice and a fever If your GP practice is closed, phone 111. Its important for acute cholecystitis to be diagnosed as soon as possible, because there is a risk that serious complications could develop if the condition is not treated promptly. What causes acute cholecystitis? The causes of acute cholecystitis can be grouped into 2main categories: calculous cholecystitis and acalculous cholecystitis. Calculous cholecystitis Calculous cholecystitis is the most common, and usually less serious, type of acute cholecystitis. It accounts for around 95% of all cases. Calculous cholecystitis develops when the main opening to the gallbladder, called the cystic duct, gets blocked by a gallstone or by a substance known as biliary sludge. Biliary sludge is a mixture of bile (a liquid produced by the liver that helps digest fats) and small crystals of cholesterol and salt. The blockage in the cystic duct results in a build-up of bile in the gallbladder, increasing thepressure inside it and causing it tobecome inflamed. In around 1in every 5cases, the inflamed gallbladder also becomes infected by bacteria. Acalculous cholecystitis Acalculous cholecystitis is a less common, but usually more serious, type of acute cholecystitis. Itusually develops as a complication of a serious illness, infection or injury that damages the gallbladder. Acalculous cholecystitis is often associated with problems such as accidental damage to the gallbladder during major surgery, serious injuries or burns , blood poisoning (sepsis) , severe malnutrition or AIDS . Who is affected Acute cholecystitis is a relatively common complication of gallstones. Its estimated that around 10%to 15% of adults in the UK have gallstones. Thesedont usually cause any symptoms, but in a small proportion of people they can causeinfrequent episodes of pain (known as biliary colic) or acute cholecystitis. Diagnosing cholecystitis To diagnose acute cholecystitis, your GP will examine your abdomen. They will probably carry out a simple test called Murphys sign. You willbe asked to breathe in deeply with your GPs hand pressed on your tummy, just below your rib cage. Your gallbladder will move downwards as your breathe in and, if you have cholecystitis, you will experience sudden pain as your gallbladder reaches your doctors hand. If your symptoms suggest you have acute cholecystitis, your GPwill refer you to hospital immediately for further tests and treatment. Tests you may have in hospital include: blood tests to check for signs of inflammation in your body an ultrasound scan of your abdomen to check for gallstones or other signs of a problem with your gallbladder Other scans such as an X-ray , a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan may also be carried out to examine your gallbladder in more detail if there is any uncertainty about your diagnosis. Treating acute cholecystitis If you are diagnosed with acute cholecystitis, you will probably need to be admitted to hospital for treatment. Initial treatment Initial treatment will usually involve: fasting (not eating or drinking) to take the strain off your gallbladder receiving fluids through a drip directly into a vein (intravenously) to prevent dehydration taking medication to relieve your pain If you have a suspected infection, you will also be given antibiotics . Theseoften need to be continued for up to a week, during which time you may need to stay in hospital or you may be able to go home. With this initial treatment, any gallstones that may have caused theconditionusually fall back into the gallbladder and the inflammationoften settles down. Surgery In order to prevent acute cholecystitis recurring, and reduce your risk of developing potentially serious complications, the removal of your gallbladder will often be recommended at some pointafter the initial treatment.This type of surgeryis known as a cholecystectomy . Although uncommon, an alternative procedure called a percutaneous cholecystostomy may be carried out if you are too unwell to have surgery. This is where a needle is inserted through your abdomen to drain away the fluid that has built up in the gallbladder. If you are fit enough to have surgery, your doctors willneed to decide when the best time to remove your gallbladder may be. In some cases, you may need to have surgery immediately or in the next day or 2, while in other cases you may be advised towait for the inflammation to fully resolve over the next few weeks. Surgery can be carried out in two main ways: laparoscopic cholecystectomy a type of keyhole surgery where the gallbladder is removed using special surgical instruments inserted through a number of small cuts (incisions) in your abdomen open cholecystectomy where the gallbladder is removed through a single, larger incision in your abdomen Although some people who have had their gallbladder removed have reported symptoms of bloating and diarrhoea after eating certain foods, youcan lead a perfectly normal life without a gallbladder. The organ can be useful but its not essential, as your liver will still produce bile to digest food. Possible complications Without appropriate treatment, acute cholecystitis can sometimes lead to potentially life-threatening complications. The main complications of acute cholecystitis are: the death of the tissue of the gallbladder, called gangrenous cholecystitis, which can cause a serious infection that could spread throughout the body the gallbladder splitting open, known as a perforated gallbladder, which can spread the infection within your abdomen (peritonitis) or lead to a build-up of pus (abscess) In about 1in every 5cases of acute cholecystitis, emergency surgery to remove the gallbladder is needed to treat these complications. Preventing acute cholecystitis Its not always possible to prevent acute cholecystitis, but you can reduce your risk of developing the condition by cutting your risk of gallstones. One of the main steps you can take to help lower your chances of developing gallstones isadopting ahealthy, balanced diet and reducing the number of high-cholesterol foods you eat, as cholesterol is thought to contribute to the formation of gallstones. Being overweight, particularly being obese, also increases your risk of developing gallstones. You should therefore control your weight by eating a healthy diet and exercising regularly. However, low-calorie, rapid weight loss diets should be avoided, because there is evidence they can disrupt your bile chemistry and actually increase your risk of developing gallstones. A more gradual weight loss plan is best.

Acute lymphoblastic leukaemia

Acute lymphoblastic leukaemia Illnesses and conditions Cancer Cancer types in adults Acute lymphoblastic leukaemia Acute lymphoblastic leukaemia About acute lymphoblastic leukaemia Symptoms of acute lymphoblastic leukaemia Causes of acute lymphoblastic leukaemia Diagnosing acute lymphoblastic leukaemia Treating acute lymphoblastic leukaemia Complications of acute lymphoblastic leukaemia About acute lymphoblastic leukaemia Leukaemia is cancer of the white blood cells. Acute leukaemia means the condition progresses rapidly and aggressively and requires immediate treatment. Acute leukaemia is classified according to the type of white blood cells affected by cancer. There are 2 main types: lymphocytes, which are mostly used to fight viral infections neutrophils, which perform several functions, such as fighting bacterial infections, defending the body against parasites and preventing the spread of tissue damage These pages focus on acute lymphoblastic leukaemia, which is cancer of the lymphocytes. The following other types of leukaemia are covered elsewhere: chronic lymphocytic leukaemia chronic myeloid leukaemia acute myeloid leukaemia Warning signs of acute leukaemia Symptoms of acute lymphoblastic leukaemiausually begin slowly before rapidly getting severe as the number of immature white blood cells in your blood increases. Symptomsinclude: pale skin tiredness breathlessness having repeated infections over a short space of time unusual and frequent bleeding Read more about the symptoms of acute lymphoblastic leukaemia What happens in acute leukaemia All of the blood cells in the body are produced by bone marrow a spongy material found inside bones. Bone marrow produces specialised cells called stem cells which have the ability to develop into three important types of blood cells: red blood cells, which carry oxygen around the body white blood cells, which help fight infection platelets, which help stop bleeding The bone marrow usually produces stem cells which are allowed to fully develop before being released into the blood. But in acute leukaemia, bone marrow starts releasing large numbers of immature white blood cells known as blast cells. As the number of blast cells increases there is a drop in the number of red blood cells and platelet cells. This drop causes the symptoms of anaemia, such as tiredness, and increases the risk of excessive bleeding. Also, blast cells are less effective than mature white blood cells at fighting bacteria and viruses, making you more vulnerable to infection. Despite being uncommon overall, acute lymphoblastic leukaemia is the most common type of cancer to affect children. The cause or causes of acute leukaemia are uncertain, but known risk factors include: exposure to high levels of radiation exposure to benzene, a chemical used in manufacturing that is also found in cigarettes Read more information about the causes of acute lymphoblastic leukaemia Symptoms of acute lymphoblastic leukaemia Symptoms of acute lymphoblastic leukaemia usually begin slowly before rapidly getting severe as the number of blast cells (immature white blood cells) in your blood increases. Most of the symptoms are caused by the lack of healthy blood cells in your blood supply. Symptoms of acute lymphoblastic leukaemia include: pale skin feeling tired and breathless having repeated infections over a short space of time unusual and frequent bleeding, such as bleeding gums or nose bleeds high temperature (fever) of 38C (100.4F) or above night sweats bone and joint pain easily bruised skin swollen lymph nodes (glands) abdominal pain caused by a swollen liver or spleen unexplained weight loss a purple skin rash (purpura) In some cases of acute lymphoblastic leukaemia, the affected cells can spread from your bloodstream into your central nervous system. This can cause a series of neurological symptoms (related to the brain and nervous system), including: headaches seizures (fits) vomiting blurred vision dizziness When to seek medical advice If you or your child has some or even all of these symptoms, it is still highly unlikely that acute leukaemia is the cause. However, see your GP as soon as possible because any condition that causes these symptoms needs to be promptly investigated and treated. Causes of acute lymphoblastic leukaemia Acute lymphoblastic leukaemia is caused by a DNA mutation in the stem cells causing too many white blood cells to be produced. The white blood cellsare also released from the bone marrow before they are matureand able to fight infection like fully developed white blood cells. As the number of immature cells increases,the number ofhealthy red blood cells and platelets fall, and its thisfallwhich causes many of thesymptoms of leukaemia. It is not known exactly what causes this DNA mutation to occur, but there area fewfactors which may increase therisk ofdeveloping acute lymphoblastic leukaemia. Risk factors Genetic disorders A small numberof childhood acute lymphoblasticleukaemia cases are thought to be caused by related genetic disorders. For example, rates of leukaemia tend to be higher in children with Downs syndrome . Radiation exposure Exposure to very high levels of radiation, either before birth or afterwards, is a known risk factor. However, it would require a significant level of radiation, such as the amount released during the nuclear reactor accident at Chernobyl. Due to the potential risk of radiation to unborn babies, medical techniques and equipment that use radiation, such as X-rays , are rarely used on pregnant women. Most cases of childhood leukaemia occur in children with no history of genetic disorders or exposure to radiation. Possible environmental factors Experts have also carried out extensive research to determine whether the following environmental factors could be a trigger for leukaemia: living near a nuclear power station living near a power line living near a building or facility that releases electromagnetic radiation, such as a mobile phone mast At the moment there is no evidence to confirm that any of these environmental factors increase the risk of developing leukaemia. Benzene Exposure to the chemical benzene is a known risk factor for adult acute leukaemia. Benzene is found in petrol and is also used in the rubber industry. However, there are strict controls to protect people from prolonged exposure. Benzene is also found in cigarettes, which could explain why smokers are three times more likely to develop acute leukaemia than non-smokers. People who have had chemotherapy and radiotherapy to treat earlier, unrelated cancers also have an increased risk of developing acute leukaemia. Other risk factors There is some evidence to show an increased risk ofacute lymphoblasticleukaemia in people who: are obese have a weakened immune system due to HIV or AIDS or taking immunosuppressants after an organ transplant Diagnosing acute lymphoblastic leukaemia The first step in diagnosing acute lymphoblastic leukaemia is for your GP to check for physical signs of the condition, such as swollen glands, and to take a blood sample. A high number of abnormal white blood cells in the blood sample could indicate the presence of acute leukaemia and you will then be referred to a haematologist (a specialist in treating blood conditions). Bone marrow biopsy To confirm a diagnosis of acute leukaemia, the haematologist will take a small sample of your bone marrow to examine under a microscope. The haematologist will use a local anaesthetic to numb the skin over a bone usually the hip bone and then use a needle to remove a sample of bone marrow. You may experience some pain once the anaesthetic wears off and some bruising and discomfort for a few days afterwards. The procedure takes around 15 minutes to complete and you shouldnt have to stay in hospital overnight. The bone marrow will be checked for cancerous cells and if found the type of acute leukaemia will be determined at the same time. Further tests There are various additional tests that can be used to help reveal more information about the progress and extent of the leukaemia. They can also provide an insight into how the leukaemia should be treated. These tests are described below. Cytogenetic testing Cytogenetic testing involves identifying the genetic make-up of the cancerous cells. There are specific genetic variations that can occur during leukaemia, and knowing what these variations are can have an important impact on treatment. Immunophenotyping Immunophenotyping is a test to help identify the exact type of acute lymphoblastic leukaemia. A sample of blood, bone marrow or another type of fluid is studied. This testing is important as the treatment needed may be slightly different for each type. Polymerase chain reaction (PCR) A polymerase chain reaction (PCR) test can be done on a blood sample. This is an important test to diagnose and monitor the response to treatment. The blood test is repeated every three months for at least two years after starting treatment, then less often once remission is achieved. Lymph node biopsy If you have been diagnosed with acute leukaemia, further biopsies may be carried out on any enlarged lymph nodes that you have. These will be able to establish how far the leukaemia has spread. CT scans If you have acute leukaemia, a computerised tomography scan (CT scan) may be used to check that your organs, such as your heart and lungs, are healthy. Chest X-ray An X-ray may be performed to examine the chest for any swollen lymph nodes. Lumbar puncture If it is felt that there is a risk that acute leukaemia has spread to your nervous system, a lumbar puncture may be carried out. A lumbar puncture is a test where a needle is used under local anaesthetic to extract a sample of cerebrospinal fluid (fluid that surrounds and protects your spine) from your back. The fluid is tested to determine whether the leukaemia has reached your nervous system. Treating acute lymphoblastic leukaemia Treatment for acute lymphoblastic leukaemia usually begins a few days after diagnosis as its an aggressive condition that develops rapidly. Stages of treatment Treatment for acute lymphoblastic leukaemia is carried out in stages: induction the aim of the initial stage of treatment is to kill the leukaemia cells in your bone marrow, restore the balance of cells in your bloodand resolve any symptoms you may have consolidation this stage aims to kill any remaining leukaemia cells in your central nervous system maintenance the final stage involves taking regular doses of chemotherapy tablets to prevent the leukaemia returning Maintenance only seems to be effective in treating acute lymphoblastic leukaemia; its not usually used in the treatment of acute myeloid leukaemia . Induction The induction stage of treatment is carried out in hospital or in a specialist centre. This is because you will probably need to have regular blood transfusions as its likely that your blood will not contain enough healthy blood cells. You will also be vulnerable to infection, so it is important that you are in a sterile environment where your health can be carefully monitored and any infection that you have can be promptly treated. You may also be prescribed antibiotics to help prevent further infection. Chemotherapy You will be given chemotherapy to kill the leukaemia cells in your bone marrow. Although some medications may be given as pills, you will need more than one medication given as an injection. To make things easier and avoid repeated injections, they can all be given via one flexible tubeinto a vein in your chest (called a central line). Some chemotherapy medication may also be directly administered into your cerebrospinal fluid to kill any leukaemia cells that may have spread to your nervous system. Thisis given using a needle that is placed into your spine, in a similar way to a lumbar puncture . Side effects that occur following chemotherapy are common. They can include: nausea vomiting diarrhoea loss of appetite mouth ulcers tiredness skin rashes infertility hair loss The side effects should resolve once treatment has finished. Your hair will usually take between three to six months to grow back. Steroid therapy You may also be given corticosteroid injections or tablets to help improve the effectiveness of chemotherapy. Imatinib If you have a type of leukaemia known as Philadelphia chromosome-positiveacute lymphoblastic leukaemia, you will also be given a medicine called imatinib. Imatinib works by blocking the signals in the cancerous cells that cause them to grow and reproduce. This kills the cancerous cells. Imatinib is taken orally (as a tablet). The side effects of imatinib are usually mild and should improve over time. They include: nausea vomiting swelling in the face and lower legs muscle cramps rash diarrhoea Depending on how well you respond to treatment, the induction phase can last from two weeks to several months. In some cases, you or your child may be able to leave hospital and receive treatment on an outpatient basis if your symptoms improve. Consolidation Leukaemia can return if just one cancerous cell remains in your body. Therefore the aim of consolidation treatment is to ensure that any remaining leukaemia cells are killed. Treatment involves receiving regular injections of chemotherapy medication. This is usually done on an outpatient basis, which means you will not have to stay in hospital overnight. However, you may require some short stays in hospital if your symptoms suddenly get worse or if you develop an infection. The consolidation phase of treatment lasts several months. Maintenance The maintenance phase is designed to act as further insurance against the possibility of the leukaemia returning. It involves taking regular doses of chemotherapy tablets while undergoing regular check-ups to monitor how effective your treatment is proving. The maintenance phase can often last for two years. Other treatments As well as chemotherapy and imatinib, other treatments are used in some circumstances. These are described below. Dasatinib Dasatinib is a new type of medication used to treat Philadelphia chromosome-positive acute lymphoblastic leukaemia, when all other treatments have proved unsuccessful. Dasatinib blocks a protein called tyrosine kinase that helps stimulate the growth of cancer cells. Dasatinib cannot cure acute leukaemia but it can slow its growth, helping to relieve symptoms and prolong life. The National Institute for Health and Care Excellence (NICE) has not yet made a decision about whether the NHS should provide treatment with dasatinib for people with acute lymphoblasticleukaemia. This means it will be at the discretion of your localclinical commissioning groupas to whether you will be offered the drug. Radiotherapy Radiotherapy involves using high doses of controlled radiation to kill cancerous cells. There are two main reasons why radiotherapy is usually used to treat acute leukaemia: to sometimes treat advanced cases of acute lymphoblastic leukaemia that have spread to the nervous system or brain to prepare the body for a bone marrow transplant (see below) Side effects of both types of radiotherapy include: hair loss nausea fatigue The side effects should pass once your course of radiotherapy has been completed. However, your skin may be very sensitive to the effects of light for several months after the treatment has finished. If this is the case, avoid sunbathing or exposure to sources of artificial light, such as sunbeds, for several months. Many younger children treated with radiotherapy will go on to have restricted physical growth during puberty. A small number of people develop cataracts several years after radiotherapy. Cataracts are cloudy patches in the lens (the transparent structure at the front of the eye) that can make your vision blurred or misty. Cataracts can usually be successfully treated using surgery. Read more about cataracts Bone marrow and stem cell transplants If you or your child do not respond to chemotherapy, a possible alternative treatment option is bone marrow or stem cell transplantation. Transplantations are more successful if the donor has the same tissue type as you, so the ideal donor is usually a brother or sister. Before transplantation can take place, the person receiving the transplant will need to have aggressive high-dose chemotherapy and radiotherapy to destroy any cancerous cells in their body. This can put a bigstrain on the bodyso transplantations are usually only successful when they are carried out in children and young people, or older people who are in good health, and when there is a suitable donor, such as a brother or sister. Readabout bone marrow transplantation for more information Complications of acute lymphoblastic leukaemia Being immunocompromised (having a weakened immune system) is a possible complication for some patients with acute leukaemia. There are 2 reasons for this: the lack of healthy white blood cells means that your immune system is less able to fight infection many of the medicines used to treatacute leukaemiacan weaken the immune system This means thatyou are more vulnerable to developing an infection, and that any infection you have has an increased potential to cause serious complications. You may be advised to take regular doses of antibiotics to prevent infections occurring. You should immediately report any possible symptoms of an infection to your GP orcare teambecause prompt treatment may be required to prevent serious complications. Symptoms of infection include: high temperature (fever) of 38C (101.4F) or above headache aching muscles diarrhoea tiredness Avoid contact with anyone who is known to have an infection, even if it is a type of infection that you were previously immune to, such as chickenpox or measles. This is because your previous immunity to these conditions will probably be lower. While it is important to go outside on a regular basis, both for exercise and for your psychological wellbeing, avoid visiting crowded places and using public transport during rush hour. Also ensure that all of your vaccinations are up-to-date. Your GP or care team will be able to advise you about this. You will be unable to have any vaccine containing activated particles of viruses of bacteria such as: themumps, measles and rubella (MMR) vaccine the polio vaccine the oral typhoid vaccine the BCG vaccine (used to vaccinate against tuberculosis) the yellow fever vaccine Bleeding If you have acute leukaemia, you will bleed and bruise more easily due to the low levels of platelets (clot-forming cells) in your blood. Bleeding may also be excessive when it does occur. Bleeding can occur: inside the skull (intracranial haemorrhage) inside the lungs (pulmonary haemorrhage) inside the stomach (gastrointestinal haemorrhage) The symptoms of an intracranial haemorrhage include: severe headache stiff neck vomiting change in mental state, such as confusion The most common symptoms of a pulmonary haemorrhage are: coughing up blood from your nose and mouth breathing difficulties a bluish skin tone (cyanosis) The 2 most common symptoms of a gastrointestinal haemorrhage are: vomiting blood passing stools (faeces) that are very dark or tar-like All 3 types of haemorrhages should be regarded as medical emergencies. Phone 999 to request an ambulance if you suspect that you or your child is experiencing a haemorrhage. Infertility Many of the treatments that are used to treat acute leukaemia can cause infertility. Infertility is often temporary, although in some cases it may be permanent. People who are particularly at risk of becoming infertile are those who have received high doses of chemotherapy and radiotherapy in preparation for bone marrow or stem cell transplantation. It may be possible to guard against any risk of infertility before you begin your treatment. For example, men can have samples of their sperm stored. Similarly, women can have fertilised embryos stored, which can then be placed back into their womb following treatment. Read more about infertility Psychological effects of leukaemia Receiving a diagnosis of leukaemia can be very distressing, particularly if it is unlikely that your condition can be cured. At first, the news may be difficult to take in. The situation can be made worse if you are confronted with the knowledge that even though your leukaemia may not currently be causing any symptoms, it could be a serious problem in later life. Having to wait many years to see how the leukaemia develops can be immensely stressful and can trigger feelings of stress, anxiety and depression . If you have been diagnosed with leukaemia, talking to a counsellor or psychiatrist (a doctor who specialises in treating mental health conditions) may help you to combat feelings of depression and anxiety. Antidepressants or medicines that help to reduce feelings of anxiety may also help you cope better with the condition. You may find it useful to talk to other people who are living with leukaemia. Your GP or multidisciplinary team may be able to provide you with details of local support groups. Another excellent resource is Macmillan Cancer Support . Their helpline number is 0808 808 00 00 and is open Monday to Friday, 9am8pm. Further information You can read more information on all aspects of living and coping with cancer at the following links: living with cancer including information on treatment, support and personal experiences of cancer living with acute lymphoblastic leukaemia Cancer Research

Acute lymphoblastic leukaemia: Children

Acute lymphoblastic leukaemia: Children | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in children Acute lymphoblastic leukaemia: Children Acute lymphoblastic leukaemia: Children Acute lymphoblastic leukaemia (ALL) is a type of blood cancer. One third of all childhood cancers are leukaemia. Approximately, 3 out of 4 of these are acute lymphoblastic (ALL). ALL can affect children of any age but is more common in children aged 1 to 4 years old. More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. Its devastating to hear that your child has cancer. At times it can feel overwhelming but there are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your childs specialist will give you more detailed information, and if you have any questions its important to ask the specialist doctor or nurse who knows your childs individual situation. Leukaemia Leukaemia is a cancer of the white blood cells. All blood cells are made in the bone marrow, the spongy substance at the core of some bones in the body. Bone marrow contains: red blood cells, which carry oxygen around the body platelets, which help the blood to clot and control bleeding white blood cells, which help fight infection There are 2 different types of white blood cells: lymphocytes and myeloid cells (including neutrophils). These white blood cells work together to fight infection. Normally, white blood cells develop, repair and reproduce themselves in an orderly and controlled way. In leukaemia, however, the process gets out of control and the cells continue to divide in the bone marrow, but do not mature. These immature dividing cells fill up the bone marrow and stop it from making healthy blood cells. As the leukaemia cells are not mature, they cannot work properly. This leads to an increased risk of infection. There are 4 main types of leukaemia: acute lymphoblastic (ALL) acute myeloid (AML) chronic lymphocyte (CLL) chronic myeloid (CML) Chronic leukaemias usually affect adults and each type of leukaemia has its own characteristics and treatment. ALL is a cancer of immature lymphocytes, called lymphoblasts or blast cells. There are two different types of lymphocytes; T-cells and B-cells. Often, leukaemia occurs at a very early stage in the immature lymphocytes, before they have developed into either T-cells or B-cells. However, if the cells have developed this far before becoming leukaemic, the type of leukaemia may be known as T-cell or B-cell leukaemia. This page is about acute lymphoblastic leukaemia (ALL). Causes The exact cause of ALL is unknown. Research is going on all the time into possible causes of this disease. Children with certain genetic disorders, such asDowns syndrome, are known to have a higher risk of developing leukaemia. Brothers and sisters of a child with ALL (particularly identical twins) have a slightly increased risk of developing ALL themselves, althoughthis risk is still small. Like all cancers, ALL is not infectious and cannot be passed on to other people. Signs and symptoms As the leukaemia cells multiply in the bone marrow, the production of normal blood cells is reduced. Children may therefore become tired and lethargic because of anaemia, which is caused by a lack of red blood cells. Children may develop bruises, and bleeding may take longer to stop because of the low number of platelets present in their blood (which help blood to clot). Sometimes, children suffer from infections because of low numbers of normal white blood cells. A child is likely to feel generally unwell and may complain of aches and pains in the limbs or may have swollen lymph glands. At first, the symptoms are just like those of a viral infection, but when they continue for more than a week or two, the diagnosis usually becomes clear. How ALL is diagnosed A blood test usually shows low numbers of normal white blood cells and the presence of the abnormal leukaemia cells. A sample of bone marrow is usually needed to confirm the diagnosis. A sample is also sent to the genetics department to look for any abnormal chromosomes, and for a test called MRD (minimal residual disease) analysis. A test called a lumbar puncture is done to see if the spinal fluid contains any leukaemia cells. A chest X-ray is also done, which will show if there are any enlarged glands in the chest. Other tests may be necessary, depending on your childs symptoms. These tests will help to identify the precise type of leukaemia and help doctors decide on the best treatment. Treatment The aim of treatment for ALL is to destroy the leukaemia cells and enable the bone marrow to work normally again. Chemotherapy is the main treatment for ALL and is given according to a treatment plan (often called a protocol or regimen). The treatment is given in several phases, or blocks. Induction This phase involves intensive treatment, aimed at destroying as many leukaemia cells as possible and is usually started within days of being diagnosed. The induction phase lasts 4 to 6 weeks. A bone marrow test is taken at the end of induction treatment to confirm whether or not the child still has leukaemia. The sample that is taken is looked at under a microscope and when there is no evidence of leukaemia, the childs condition is referred to as being in remission. Consolidation and central nervous system (CNS) treatment The next phase of treatment is aimed at maintaining the remission and preventing the spread of leukaemia cells into the brain and spinal cord (the central nervous system, or CNS). CNS treatment involves injecting a drug, usually methotrexate lumbar puncture. After this consolidation treatment there is a recovery period which is called interim maintenance. This is when more drugs will be given to try to keep the leukaemia in remission. The exact details will depend on which arm of treatment your child follows and will be discussed in detail by your childs doctor as it depends on your childs response to treatment so far. Further doses of chemotherapy treatment, called delayed intensification, are given to kill off any remaining leukaemia cells. Maintenance treatment This phase of treatment lasts for 2 years from the start of interim maintenance for girls and 3 years from the start of interim maintenance for boys. It involves the child taking daily and weekly tablets, some children also have monthly injections of chemotherapy and oral pulses of steroids and 3-monthly intrathecal treatment. Children will be able to take part in their normal daily activities as soon as they feel able to. Most children return to school before beginning maintenance treatment. Bone marrow transplantation Bone marrow treatment is only needed by a minority of patients and is used for children with ALL that is likely to come back following standard chemotherapy. Testicular radiotherapy In some situations, it may be necessary for boys to have radiotherapy to their testicles. This is because leukaemia cells can survive in the testicles despite chemotherapy. Central nervous system (CNS) radiotherapy Children who have leukaemia cells in their CNS when they are first diagnosed with ALL need more frequent lumbar punctures with intrathecal chemotherapy. Your childs specialist will discuss with you which treatment and how much of it your child needs, and will answer any questions you have. Side effects of treatment Many cancer treatments will cause side effects . This is because while the treatments are killing the cancer cells, they can also damage some normal cells. Some of the main side effects of chemotherapy are: hair loss reduction in the number of blood cells produced by the bone marrow, which can cause anaemia (increased risk of bruising, bleeding and infection loss of appetite feeling sick (nausea) and being sick (vomiting) Steroid medicines can also cause side effects such as: increased appetite mood changes and irritability weight gain muscle weakness (especially in the legs) Most side effects are temporary, and there are ways of reducing them and supporting your child through them. Your childs doctor or nurse will talk to you about any possible side effects. Its important to discuss any side effects your child is having with the team treating them, so that they know how your child is feeling. Late side effects of treatment A small number of children may develop late side effects, sometimes many years later. These include possible problems with puberty and fertility, a change in the way their heart works and a small increase in the risk of developing another cancer later in life. Your childs doctor or nurse will talk to you about any possible late side effects. Clinical trials Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Specialist doctors carry out trials for ALL. If appropriate, your childs medical team will talk to you about taking part in a clinical trial and will answer any questions you have. Written information is provided to help explain things. Taking part in a research trial is completely voluntary, and youll be given enough time to decide if it is right for your child. Treatment guidelines Sometimes, clinical trials are not available for your child. This may be because a recent trial has just finished, or because the condition is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the UK. The Childrens Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care Most children with ALL are cured. If the leukaemia recurs after initial treatment, it usually does so within the first three years. Further treatment can then be given. Long-term side effects (late side effects) are rare, and most children with ALL grow and develop normally. If you have specific concerns about your childs condition and treatment, its best to discuss them with your childs doctor, who knows the situation in detail. Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. Its not possible to address here all of the feelings you may have. However, the CCLG booklet Children & Young Peoples Cancer; A Parents Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support. Your child may have a variety of powerful emotions throughout their experience with cancer. The Parents Guide discusses these further and talks about how you can support your child.

Acute lymphoblastic leukaemia: Teenagers and young adults

Acute lymphoblastic leukaemia Illnesses and conditions Cancer Cancer types in teenagers and young adults Acute lymphoblastic leukaemia: Teenagers and young adults Acute lymphoblastic leukaemia: Teenagers and young adults Introduction Leukaemia, blood tests and bone marrow Tests for ALL Treating ALL Introduction This section is for teenagers and young adults and is about a type of cancer called acute lymphoblastic leukaemia (ALL). The other main type of leukaemia that can affect teenagers and young adults is acute myeloid leukaemia. If youre looking for information about ALL in people of all ages, please see our general ALL section. Leukaemia is a cancer of the white blood cells. In leukaemia, the process for making new white blood cells gets out of control.Immature white blood cells (called blasts) keep being made and build up in the bone marrow until there isnt enough room for the bone marrow to make healthy white blood cells, red blood cells and platelets. The body needs these cells to: help fight infection (white cells) carry oxygen from the lungs aroundthe body (red blood cells) stop cuts bleeding by clotting blood (platelets) Symptoms Many of the symptoms of ALL are caused by having fewer than normal healthy blood cells in the body. Symptoms can include: looking paler than usual and feeling tired because of too few red blood cells (anaemia) bruises you may bruise more easily and it could take longer for bleeding to stop, if you have less blood clotting cells (platelets) than normal infections because there are too few mature white blood cells to fight infection aches and pains in your bones swollen glands (lymph nodes) in your neck, under your arm or in your groin feeling unwell and run down fever and sweats you may have a high temperature without any obvious cause, such as an infection headaches and visual disturbance There can be other reasons you may have these symptoms. But if you are worried that you may have ALL, you should speak to your GP. Theyll examine you and refer you to a hospital if they think you need to see a specialist doctor. Causes Its not known exactly what causes ALL. Research is going on to try to find out. Young people with some genetic conditions, such as Downs syndrome or Li-Fraumeni syndrome, are at an increased risk of developing ALL. A genetic condition is something you are born with. If youre worried about ALL If you think you have some of the symptoms of ALL you should speak to your GP. They can talk to you about your symptoms and arrange any tests they think you might need. Leukaemia, blood tests and bone marrow To understand leukaemia, it can help to know a little about the blood and bone marrow. Leukaemia is a cancer of the white blood cells. All blood cells are made in the bone marrow, which is like a blood cell factory inside bones. A type of cell in the bone marrow, called a stem cell, can make any kind of blood cell your body needs. There are 3 main types of blood cells: white blood cells which help fight infection red blood cells which carry oxygen from the lungs around the body platelets which clot blood to stop cuts bleeding The bone marrow normally makes millions of blood cells every day. To begin with, these new blood cells, called blasts, are not fully developed (theyre immature). The main job of blast cells is to make more blood cells like themselves. They cant do any of the jobs that mature blood cells can do, like carrying oxygen or fighting infection. Blast cells normally stay inside the bone marrow until theyve matured into fully-developed blood cells. Once blood cells are mature, theyre ready to do their jobs. They leave the bone marrow and go into the bloodstream, where they can be carried to wherever theyre needed. How leukaemia develops In leukaemia, the process for making new white blood cells gets out of control and immature white blood cells (blasts) keep being made. They build up in the bone marrow until there isnt enough room for the bone marrow to make healthy white cells, red cells and platelets. Types of leukaemia Leukaemia is a cancer of the white blood cells. Healthy white blood cells are made from two types of blood cells: lymphoblasts that make lymphocytes myeloid cells (myeloblasts) that make other types of white blood cells such as neutrophils Leukaemias are named after the type of white blood cell that has become abnormal and started growing out of control. The most common types in teenagers and young adults are AML and ALL: acute myeloid leukaemia (AML) is leukaemia that starts from abnormal myeloid cells acute lymphoblastic leukaemia (ALL) is leukaemia that starts from abnormal lymphoblasts There are other types of leukaemia that are more common in older people. The information in this section is about ALL, but if you have a different type of leukaemia and want to know more,contact Macmillan . We also have more information about: symptoms and causes of ALL having tests for ALL being treated for ALL If youre looking for information about ALL in people of all ages, read our general ALL section. Tests for ALL Its important to remember that the symptoms of ALL can be caused by lots of different things. But you should go to your GP if youre worried. They can talk to you about your symptoms and arrange any tests they think you might need. Visiting your GP Your GP will examine you and arrange for you to have blood tests. There can be different reasons for your symptoms, so youll need a blood test to help diagnose acute lymphoblastic leukaemia (ALL). If you have ALL, a blood test will usually find leukaemia cells and youll be referred to a specialist at the hospital. This specialist is called a haematologist and is a doctor who treats people with blood problems. At the hospital The haematologist will examine you and ask you about your symptoms and any recent illnesses. They will also arrange for you to have some more tests. These may include: blood tests youll need more blood tests even if youve had some alreadyto look at the changes in the leukaemia cells and helpthe doctors decide on the best treatment for you bone marrow testto count the numbers of leukaemia cells in the bone marrowand get samples for cytogenetic and immunophenotyping testing lumbar puncture a small sample of the fluid that surrounds your brain and spinal cord is taken to check for leukaemia cells chest X-ray this may also be done to see if there are any swollen lymph nodes (glands) in your chest If you have ALL, you might need a few more tests to check how your body is working in general. These could be blood tests, or an ultrasound scan of the tummy (abdomen) to look at your liver, spleen and kidneys, and an echocardiogram (an ultrasound of the heart). This may seem like a lot of tests, but they give the doctors important information that will help them give you the right treatment. Waiting for test results can be a scary time, but understanding a little about them what will happen, how youll feel and when youll get the results can help you cope. Thinking about how you feel and getting support from family, friends or your specialist nurse and doctor can also make it a bit easier. You could also talk to a Macmillan cancer support specialist ontheir free helpline. We also have more information about: symptoms of ALL being treated for ALL leukaemia, blood cells and bone marrow If youre looking for information about ALL in people of all ages, readour general ALL section. Treating ALL The main treatment for acute lymphoblastic leukaemia (ALL) is chemotherapy . This means having anti-cancer drugs to destroy the leukaemia cells. Youll also have drugs called steroids , which help the chemotherapy to work. The treatment for ALL is pretty intensive at times and can cause unpleasant side effects. But youll be in close contact with the hospital when youre most likely to feel unwell and the staff will be able to help if things get tough. Dont feel you have to be brave. Be honest about how you are feeling with your doctors and nurses. They can give you medicines that can help you feel better. ALL is treated in3phases: getting rid of the leukaemia remission induction keeping the leukaemia away consolidation and delayed intensification therapy keeping the leukaemia away long-term continuing or maintenance therapy You usually start chemotherapy pretty quickly after finding out that you have ALL. Youll be in hospital for your treatment to begin with.If youre 18 or younger, youll be treated in a specialist Principal Treatment Centre (PTC) for teenagers and young adults (TYA).If youre 19 or older, youll be offered the choice of having treatment at the PTC or another hospital closer to home called a TYA designated hospital. Youll be given chemotherapy as tablets, by injection and into your bloodstream (intravenously). Youll also be given chemotherapy into the fluid around the spinal cord to make sure the leukaemia cells cant hide there. This is called central nervous system (CNS) therapy. Its also known as intrathecal therapy. Youll have a line put in to one of your main veins to make it easier for you to have intravenous treatment. Your nurses and doctors can also use the line to take blood samples for blood tests. There are different kinds of lines. Having chemotherapy can be hard. But the staff looking after you will give you medicines to help you cope with any side effects so you can stay strong enough to have treatment. And youll be given medicines to stop you feeling sick and antibiotics to help prevent infections. There will probably be times when you feel rough and other times when youll feel better. You might also feel upset, down or irritable. Talking to someone you trust can help you cope with these feelings. Being in hospital or coming up to hospital for clinics and treatment can be frustrating, especially when you miss out on stuff happening at school, college, university or work, or on things your friends are doing. You could try talking to your friends and family about this and see what they can do to help you. It can also help to talk to any new friends youve made who are going through similar experiences to you. We have more information about chemotherapy that has been written for people of all ages, not just teens and young adults. Getting rid of the leukaemia (remission induction) The first phase of your treatment is about getting rid of the leukaemia. Youll be given chemotherapy to kill as many leukaemia cells as possible. Remission means there is no sign of leukaemia cells in your blood or bone marrow. This type of treatment involves: chemotherapy to kill the leukaemia cells (including CNS therapy) steroids to help the chemotherapy work drugs (allopurinol or rasburicase) to help protect your kidneys from problems that can happen when lots of leukaemia cells are destroyed at once another tablet (for example ranitidine or lansoprazole) to stop indigestion or ulcers You need to stay in hospital during this phase of your treatment so the doctors can check how things are going. Treatment to get you into remission takes about5 weeks, sometimes a bit longer. Being in hospital that long can be really difficult at times. If youre struggling to cope, try and talk to your friends, family, doctors and nurses. Its important not to bottle up your feelings otherwise your might end up finding it hard to cope. Drugs you may be given include: vincristine asparaginase daunorubicin mercaptopurine methotrexate Side effects Different chemotherapy can cause different side effects. There is information about the specific ones inMacmillans chemotherapy section . Central nervous system therapy Chemotherapy given as tablets or into the blood can reach most places in your body. But it isnt good at getting into the brain or spinal cord (called the central nervous system or CNS). So youll be given treatment into the fluid that goes around the CNS to target any leukaemia cells that might be hiding there. This is called CNS therapy. CNS therapy is given during remission induction treatment (to get rid of the leukaemia) and continues right until the end of maintenance therapy. Chemotherapy is given into the fluid, called cerebrospinal fluid or CSF, around your spinal cord. Drug treatment given into the CSF is called intrathecal therapy. Its a bit like having a lumbar puncture but with chemotherapy added. A doctor puts a needle into the space between 2 small bones (vertebrae) near the bottom of your spine. Then they inject chemotherapy into the CSF. The CSF will carry the chemotherapy around your CNS so it can reach any leukaemia cells that might be there. The chemotherapy drug used for CNS therapy is called methotrexate. Side effects Most people dont have side effects after having intrathecal methotrexate. But occasionally it can cause headaches, dizziness, tiredness or blurry vision for a few hours. Rarely other side effects like seizures (fits), weakness of your arms or legs and changes in how awake you are can happen. But these almost always go away completely and you can still have the intrathecal injections in the future. Keeping leukaemia away This treatment is called consolidation and delayed intensification therapy. When youre in remission, it means the doctors cant see any leukaemia cells in your blood or bone marrow samples when they check them under the microscope. But there may still be leukaemia cells hiding in your body, so you need further treatment to get rid of these cells. Youll be given different types of chemotherapy drugs. This is so the leukaemia cells dont have a chance to get used to them (which is called drug resistance). This phase of treatment takes about 5 to 6 months. Most of the treatment can be given as an outpatient but you might need to stay in hospital for some parts of it. Drugs you may be given include: cyclophosphamide cytarabine (ara-C) mercaptopurine methotrexate vincristine asparaginase doxorubicin Side effects Chemotherapy does cause side effects. There is information about the specific ones inMacmillans chemotherapy section . Keeping the leukaemia away long term (maintenance therapy) This treatment is given to prevent the leukaemia from returning (known as relapse). The chemotherapy is given in low doses. You have it as an outpatient so you can keep doing all your normal, everyday activities when youre having maintenance therapy. Maintenance therapy is given in 12-week cycles. Youll have: mercaptopurine tablets each day methotrexate tablets once a week steroid tablets for 5 days every4weeks vincristine chemotherapy every 4 weeks methotrexate chemotherapy into your cerebrospinal fluid (CSF) every 12 weeks At the moment, boys have just over3 years of maintenance therapy and girls have just over2 years. This is because it takes a bit longer in boys to get rid of any remaining leukaemia cells. During this time, youll have regular check-ups usually every week or two to check if your drug doses need to be adjusted and to make sure youre OK. Very often, things like blood tests can be done at your GP practice or at home by a district nurse.

Acute myeloid leukaemia

Acute myeloid leukaemia Illnesses and conditions Cancer Cancer types in adults Acute myeloid leukaemia Acute myeloid leukaemia About acute myeloid leukaemia Symptoms of acute myeloid leukaemia Causes of acute myeloid leukaemia Diagnosing acute myeloid leukaemia Treating acute myeloid leukaemia Complications of acute myeloid leukaemia About acute myeloid leukaemia Leukaemia is cancer of the white blood cells. Acute leukaemia means it progresses rapidly and aggressively, and usually requires immediate treatment. Acute leukaemia is classified according to the type of white blood cells affected. The 2 main types of white blood cells are: lymphocytes mostly used to fight viral infections myeloid cells which perform a number of different functions, such as fighting bacterial infections, defendingthe body against parasites and preventing the spread of tissue damage This topic focuses on acute myeloid leukaemia (AML), which is an aggressivecancer of the myeloid cells. The following types of leukaemia are covered separately: acute lymphoblastic leukaemia chronic myeloid leukaemia chronic lymphocytic leukaemia Signs and symptoms of AML The symptoms of AML usually develop over a few weeks and become increasingly more severe. Symptoms can include: pale skin tiredness breathlessness frequent infections unusual and frequent bleeding, such as bleeding gums or nosebleeds In more advanced cases, AML can make you extremely vulnerable to life-threatening infections or serious internal bleeding. Read more about the complications of AML Seeking medical advice You should see your GP if you or your child have possible symptomsof AML. Although its highly unlikely that leukaemia is the cause,these symptoms should be investigated. If your GP thinks you may have leukaemia, theyll arrange blood tests to check your blood cell production. If the tests suggest theres a problem, youll be urgently referred to a haematologist (a specialist in treating blood conditions) for further tests and any necessary treatment. Read more about diagnosing AML What causes AML? AMLoccurs when specialised cells called stem cells, which are found in the bone marrow (a spongy material inside the bones),produce too many immature white blood cells. These immature cells are known as blast cells. Blast cells dont have the infection-fighting properties of healthy white blood cells, and producing too many canlead to adecrease in the number of red blood cells (which carry oxygen in the blood) and platelets (cells that help the blood to clot). Its not clear exactly why this happens and, in most cases, theres no identifiable cause. However,a number of factors that can increase your risk of developing AML have been identified. These include: previous chemotherapy or radiotherapy exposure to very high levels of radiation(including previous radiotherapytreatment) exposure to benzene a chemical used in manufacturing thats also found in cigarette smoke having an underlying blood disorder or genetic disorder, such as Downs syndrome Read more about the causes of AML Whos affected AMLis a rare type of cancer.The risk of developing AML increases withage. Itsmost common in people over 65. How AML is treated AML is an aggressive type of cancer that can develop rapidly, so treatment usually needs to begin soon after a diagnosis is confirmed. Chemotherapy is the main treatment for AML. Its used to kill as many leukaemia cells in your body as possible and reduce the risk of the condition coming back (relapsing). In some cases, intensive chemotherapy and radiotherapy may be needed, in combination with a bone marrow or stem cell transplant , to achieve a cure. Read more about treating AML Symptoms of acute myeloid leukaemia The symptoms of acute myeloid leukaemia (AML) usually develop over a few weeks, becoming more severe as the number of immature white blood cells (blast cells) in your blood increases. Symptoms of AML caninclude: pale skin tiredness breathlessness a high temperature (fever) excessive sweating weight loss frequent infections unusual and frequent bleeding, such as bleeding gums or nosebleeds easily bruised skin flatred or purple spots on the skin (petechiae) bone and joint pain a feeling of fullness or discomfort in your tummy (abdomen), caused by swelling of the liver or spleen Inrare cases of AML, the affected cells can spread into the central nervous system. This can cause symptoms such as headaches , fits (seizures), vomiting, blurred vision and dizziness. When to seek medical advice See your GP if you or your child have these symptoms. Although its highly unlikely that AML is the cause, these symptoms need to be investigated and treatedpromptly. Causes of acute myeloid leukaemia Acute myeloid leukaemia (AML) is caused by a DNA mutation in the stem cells in your bone marrow that produce red blood cells, platelets and infection-fighting white blood cells. The mutationcauses the stem cellsto produce many more white blood cells that are needed. The white blood cells produced are still immature, so they dont have the infection-fighting properties of fully developed white blood cells. These immature cells are known as blast cells. As the number of immature cells increases, the amount of healthy red blood cells and platelets decrease, and its this fall that causes many of the symptoms of leukaemia . Increased risk Its not known what triggers the genetic mutationin AML, although a number of different factors thatcan increase your risk of developing the condition have been identified. The main risk factors for AML areoutlined below. Radiation exposure Being exposed toa significant level of radiationcan increase your chances of developing AML, although this usually requires exposureat very high levels. For example, rates of AML are higher in people who survivedthe atomic bomb explosions in Japan in 1945. In the UK, most peopleare unlikely to be exposed to levels of radiation high enough to cause AML.However, some people who have had radiotherapy as part of their treatment for previous cancer (see below) can be the exception. Benzene and smoking Exposure to the chemical benzene is a known risk factor for AML in adults. Benzene is found in petrol, and its also used in the rubber industry, although there are strict controls to protect people from prolonged exposure. Benzene is also found in cigarette smoke, which could explain why people who smoke have an increased risk of developing AML. Previous cancer treatment Treatment with radiotherapy and certain chemotherapy medications foran earlier, unrelated cancer can increase your risk of developing AML many years later. Leukaemia that develops as a result of previous cancer treatment is called secondary leukaemia or treatment-related leukaemia. Blood disorders People with certain blood disorders such as myelodysplasia, myelofibrosis or polycythaemia vera (PCV) have an increased risk of developing AML. Genetic disorders People with certain genetic disorders, including Downs syndrome and Fanconis anaemia, have an increased risk of developing leukaemia. Other suggested triggers A number of other environmental factors that could trigger AML have also been suggested, including childhood vaccinations and living near a nuclear power station or a high-voltage power line. However, theres no clearevidence to suggest that these can increase your risk of developing AML. Diagnosing acute myeloid leukaemia In the initial stages of diagnosing acute myeloid leukaemia (AML), your GP will check for physical signs of the condition and arrange for you to have blood tests . A high number of abnormal white blood cells, or a very low blood count in the test sample, could indicate the presence of leukaemia. If this is the case, youll be urgently referred to a haematologist (a specialist in treating blood conditions). A haematologist may carry out further blood tests, in addition to some of the tests outlined on this page. Bone marrow biopsy To confirm a diagnosis of AML, the haematologist will take a small sample of your bone marrow to examine under a microscope. This procedure is known as a bone marrow biopsy, which is usually carried out under a local anaesthetic . The haematologist will numb an area of skin at the back of your hip bone, before using a thin needle to remove a sample of liquid bone marrow. In some cases, a larger needle may also be used to remove a small amount of bone and bone marrow together. You wont feel any pain during the procedure, but you may experience some bruising and discomfort for a few days afterwards. The procedure takes around 15 minutes to complete, and you shouldnt have to stay in hospital overnight. The bone marrow sample will be checked for cancerous cells. If cancerous cells are present, the biopsy can also be used to determine the type of leukaemia you have. Further tests Additional tests can be used to reveal more information about the progress and extent of your AML. They can also provide insight into how the condition should be treated. These tests are described below. Genetic testing Genetic tests can be carried out on blood and bone marrow samples to identify the genetic makeup of the cancerous cells. There are many specific genetic variations that can occur in AML, and knowing the exact type of AML you have can help doctors make decisions about the most appropriate treatment. For example, people who have a type of AML known as acute promyelocytic leukaemia (APML) are known to respond well to a medicine called All Trans-Retinoic Acid (ATRA). Scans If you have AML, a computerised tomography (CT) scan , X-ray or echocardiogram (an ultrasound scan of the heart) may be used to check that your organs, such as your heart and lungs, are healthy. These tests are carried out because its important for doctors to assess your general health before they can decide on the most appropriate treatment for you. Lumbar puncture In rare situations where its thought theres a risk that AML has spread to your nervous system, a lumbar puncture may be carried out. In this procedure, a needle is used to extract a sample of cerebrospinal fluid (which surrounds and protects your spine) from your back, so it can be checked for cancerous cells. If cancerous cells are found in your nervous system, you may need to have injections of chemotherapy medication directly into your cerebrospinal fluid as part of your treatment. Treating acute myeloid leukaemia Acute myeloid leukaemia (AML) is an aggressive condition that develops rapidly, so treatment will usually begin a few days after a diagnosis has been confirmed. As AML is a complex condition, its usually treated by a multidisciplinary team (MDT) a group of different specialists working together. Your treatment plan Treatment for AML is often carried out in 2 stages: induction the aim of this initial stage of treatment is to kill as many leukaemia cells in your blood and bone marrow as possible, restore your blood to proper working order and treat any symptoms you may have consolidation this stage aims to prevent the cancer returning (relapsing), by killing any remaining leukaemia cells that may be present in your body The induction stage of treatment isnt always successful and sometimes needs to be repeated before consolidation can begin. If you have a relapse after treatment, both re-induction and consolidation may need to be carried out. This may be the same as your first treatment, although its likely to involve different medications or a stem cell transplant. If youre thought to have a high risk of experiencing complications of AML treatment for example, if youre over 75 years of age or have another underlying health condition less intensive chemotherapy treatment may be carried out. This is less likely to successfully kill all of the cancerous cells in your body, but it can help control your condition. Induction The initial treatment you have for AML will largely depend on whether youre fit enough to have intensive chemotherapy , or whether treatment at a lower dosage is recommended. Intensive chemotherapy If you can have intensive induction chemotherapy, youll usually be given a combination of chemotherapy medication at a high dose to kill the cancerous cells in your blood and bone marrow. This stage of treatment will be carried out in hospital or in a specialist centre, as youll need very close medical and nursing supervision. Youll have regular blood transfusions because your blood wont contain enough healthy blood cells. Youll also be vulnerable to infection, so its important that youre in a clean and stable environment where your health can be carefully monitored and any infection you have can be promptly treated. You may also be prescribedantibiotics to help prevent further infection. Depending on how well you respond to treatment, the induction phase can last from four weeks to a couple of months. You may be able to leave hospital and receive treatment on an outpatient basis if your symptoms improve. For intensive treatment, the chemotherapy medications will be injected into a thin tube thats inserted either into a blood vessel near your heart (central line) or into your arm (a peripherally inserted central catheter, or PICC). In very rare cases, chemotherapy medication may also be directly administered into your cerebrospinal fluid to kill any leukaemia cells that may have spread to your nervous system. This is done using a needle thats placed into your spine, in a similar way to a lumbar puncture . Side effects of intensive chemotherapy for AML are common. They can include: nausea vomiting diarrhoea loss of appetite sore mouth and mouth ulcers (mucositis) tiredness skin rashes hair loss infertility which may be temporary or permanent (see complications of AML for more information) Most side effects should resolve once treatment has finished. Tell a member of your care team if side effects become particularly troublesome, as there are medicines that can help you cope better with certain side effects. Read more about the side effects of chemotherapy Non-intensive chemotherapy If your doctors dont think youre fit enough to withstand the effects of intensive chemotherapy, they may recommend non-intensive treatment. This involves using an alternative type of chemotherapy to the standard intensive therapy, whichis designed more to control leukaemia rather than cure it. The main aim of this treatment is to control the level of cancerous cells in your body and limit any symptoms you have, while reducing your risk of experiencing significant side effects of treatment. The medications used during non-intensive chemotherapy may be given through a drip into a vein, by mouth or by injection under the skin, and can often be given on an outpatient basis. All Trans-Retinoic Acid (ATRA) If you have the sub-type of AML known as acute promyelocytic leukaemia, youll usually be given capsules of a medicine called ATRA, in addition to chemotherapy. ATRA works by changing the immature white blood cells (blast cells) into mature healthy cells, and can reduce symptoms very quickly. Side effects of ATRA can include headaches , nausea, bone pain, and dry mouth , skin and eyes. Consolidation If induction is successful, the next stage of treatment will be consolidation. This often involves receiving regular injections of chemotherapy medication that are usually given on an outpatient basis, which means that you wont have to stay in hospital overnight. However, you may need some short stays in hospital if your symptoms suddenly get worse or if you develop an infection. The consolidation phase of treatment lasts several months. Other treatments Many other treatments are used for AML. Radiotherapy Radiotherapy involves using high doses of controlled radiationto kill cancerous cells. There are 2 main reasons why radiotherapy is usually used to treat AML: to prepare the body for a bone marrow or stem cell transplant to treat advanced cases that have spread to the nervous system and/or brain, although this is uncommon Side effects of radiotherapy can include hair loss, nausea and fatigue. The side effects should pass once your course of radiotherapy has been completed. Bone marrow and stem cell transplants If chemotherapy doesnt work, a possible alternative treatment option is a bone marrow or stem cell transplant . Before transplantation can take place, the person receiving the transplant will need to haveintensive high-dose chemotherapy and possibly radiotherapy to destroy the cells in their bone marrow. The donated stem cells are given through a tube into a blood vessel, in a similar way to chemotherapy medication. This process can put an enormous amount of strain on the body and cause significant side effects and potential complications, so youll usually need to stay in hospital for a few weeks. Transplantations have better outcomes if the donor has the same tissue type as the person receiving the donation. The best candidate to provide a donation is usually a brother or sister with the same tissue type. Transplantations are most successful when theyre carried out on children and young people, or older people who are otherwise in good health, and when theres a suitable donor, such as a brother or sister. Readabout bone marrow donation Azacitidine Azacitidine is a possible alternative treatment for adults with AML who cant have a stem cell transplant. Its recommended by the National Institute for Health and Care Excellence (NICE) for usein certain circumstances for example, depending on the characteristics of the persons blood and bone marrow. Azacitidine is a chemotherapy medication thats given by injection under the skin. It interferes with the growth of cancer cells and destroys them, and also helps bone marrow to produce normal blood cells. NICE hasmore information about azacitidine for the treatment of AML Clinical trials andnewer unlicensed treatments In the UK, a number of clinical trialsare currently underway that aim to find the best way of treating AML. Clinical trials are studies that use new and experimental techniques to see how well they work in treating, and possibly curing, AML. As part of your treatment, your care team may suggest taking part in a clinical trial to help researchers learn more about the best way to treat yourAML, and AML in general. Search for clinical trials for AML . If you take part in a clinical trial, you may be offered medication that isnt licensed for use in the UK and isnt normally available. However, theres no guarantee that the techniques being studied in the clinical trial will work better than current treatments. Your care team can tell you whether there are any clinical trials available in your area, and can explain the benefits and risks involved. Complications of acute myeloid leukaemia If you have acute myeloid leukaemia (AML), you may experience a number of complications. These can be caused by the condition itself, although they can also occur as a side effect of treatment. Weakened immune system Having a weakened immune system being immunocompromised is a common complication of AML. Even if your blood is restored to normal working order with treatment, many of the medications that are used to treatAML can temporarily weaken your immune system. This means youre more vulnerable to developing an infection, and any infection you develop could be more serious than usual. Complications arising from infection are the leading cause of death in people with AML. However, if treated early, nearly all infections respond to appropriate treatment. Therefore, you may be advised to: take regular doses of antibiotics to prevent bacterial infections maintain good personal and dental hygiene avoid contact with anyone whosknown to have an infection even if its a type of infection that you were previously immune to, such as chickenpox or measles check with your GP to ensure that all of your vaccinations are up to date, althoughyou wont be able to have any vaccine that contains live viruses or bacteria, such as the shingles vaccine and MMR vaccine (against measles, mumps and rubella) Report any possible symptoms of an infectionto yourtreatment unit immediately because prompt treatment may be needed to prevent complications. Symptoms of an infection caninclude: a high temperature (fever) a headache aching muscles diarrhoea tiredness Bleeding If you have AML, youll bleed and bruise more easily due to the low levels of platelets (clot-forming cells) in your blood. Bleeding may also be excessive. People with advanced AML are morevulnerable to excessive bleeding inside their body, which is the second most common cause of death in people with the condition. Serious bleeding can occur: insidethe skull (intracranial haemorrhage) causing symptoms such as asevere headache, stiff neck, vomiting and confusion inside the lungs (pulmonary haemorrhage) causingsymptoms such as coughing up blood,breathing difficulties and abluish skin tone (cyanosis) inside the stomach (gastrointestinal haemorrhage) causing symptoms such asvomiting blood andpassing stools (faeces) that are very dark or tar-like in colour All these types of haemorrhage should be regarded as medical emergencies. Dial 999 immediately and ask for an ambulance if you think a haemorrhage is occurring. Infertility Many of the treatments that are used to treat AML can cause infertility .This is often temporary, but in some cases can be permanent. People who are particularly at risk of permanent infertility, are those who have received high doses of chemotherapy and radiotherapy in preparation for a bone marrow or stem cell transplant . Your treatment team can give a good estimation of the risk of infertility in your specific circumstances. It may be possible to guard against any risk of infertility before you begin your treatment. For example, men can have their sperm samples stored. Similarly, women can have eggs orfertilised embryos stored, which can then be placed back into their womb, following treatment. However, as AML is an aggressive condition that develops rapidly, there may not always be time to do this before treatment needs to start.

Acute myeloid leukaemia: Children

Acute myeloid leukaemia: Children Illnesses and conditions Cancer Cancer types in children Acute myeloid leukaemia: Children Acute myeloid leukaemia: Children Acute myeloid leukaemia (AML) is a type of blood cancer. A third of all childhood cancers are leukaemia. Less than a quarter of these are acute myeloid leukaemia (AML). AML can affect children of any age. Girls and boys are equally affected More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. Its devastating to hear that your child has cancer. At times it can feel overwhelming but there are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has and the treatments that may be used can often help parents to cope. Your childs specialist will give you more detailed information and if you have any questions its important to ask the specialist doctor or nurse who knows your childs individual situation. Leukaemia Leukaemia is a cancer of the white blood cells. All blood cells are produced in the bone marrow, the spongy substance at the core of some of the bones in the body. Bone marrow contains: red blood cells, which carry oxygen around the body platelets, which help the blood to clot and control bleeding white blood cells, which help to fight infection There are 2 different types of white blood cells: lymphocytes and myeloid cells (including neutrophils). These white blood cells work together to fight infection. Normally, white blood cells develop, repair and reproduce themselves in an orderly and controlled way. In leukaemia, however, the process gets out of control and the cells continue to divide in the bone marrow, but do not mature. These immature dividing cells fill up the bone marrow and stop it from making healthy blood cells. As the leukaemia cells are not mature, they cannot work properly. This leads to an increased risk of infection. There are 4 main types of leukaemia: acute lymphoblastic (ALL) acute myeloid (AML) chronic lymphocytic (CLL) chronic myeloid (CML) Chronic leukaemias occur mostly in adults. CLL is exclusively an adult condition, whereas CML does occur rarely in children and young people. Each type of leukaemia has its own characteristics and treatment. This page is about acute myeloid leukaemia (AML). Acute myeloid leukaemia (AML) Acute myeloid leukaemia is an overproduction of immature myeloid white blood cells (blast cells). Cells that have started to show some of the features of myeloid cells are said to show differentiation. Cells that do not show signs of becoming a particular type of white blood cell are known as undifferentiated. There are different sub-types of AML, depending on exactly which type of cell has become leukaemic, the stage of development (maturation) the cells are at, and whether the cells are differentiated. Knowing the sub-type of AML is important, as it helps doctors decide on the best treatment. There are several classification systems for the sub-types of AML. The most commonly used system in the UK is the French-American-British (FAB) system. FAB classification of AML M0 AML with minimal evidence of myeloid differentiation M1 AML without maturation M2 AML with maturation M3 Acute promyelocytic leukaemia (APL) M4 Acute myelomonocytic leukaemia M5 Acute monocytic/monoblastic leukaemia M6 Acute erythroleukaemia M7 Acute megakaryoblastic leukaemia A newer system known as the WHO (World Health Organization) classification system is also sometimes used. Causes The exact cause of AML is unknown. Research into possible causes of this disease is ongoing. Children with certain genetic disorders, such as Downs syndrome or Li-Fraumeni syndrome, are known to have a higher risk of developing leukaemia. Brothers and sisters of a child with AML have a slightly increased risk of developing it, although this risk is still small. Other non-cancerous conditions, such as aplastic anaemia or the myelodysplastic syndromes (MDS), may increase a childs risk of developing AML. AML, like all types of cancer, is not infectious and cannot be passed on to other people. Signs and symptoms As the leukaemia cells multiply in the bone marrow, the production of normal blood cells is reduced. Children may therefore become tired and lethargic because of anaemia, which is caused by a lack of red blood cells. Children may develop bruises, and bleeding may take longer to stop because of the low number of platelets present in their blood. Sometimes they may suffer from infections because of low numbers of normal white blood cells. A child is likely to feel generally unwell and may complain of aches and pains in the limbs or may have swollen lymph glands. At first, the symptoms are just like those of a viral infection, but when they continue for more than a week or two, the diagnosis usually becomes clear. How AML is diagnosed A blood test usually shows low numbers of normal white blood cells and the presence of abnormal leukaemia cells. A sample of bone marrow is needed to confirm the diagnosis. The bone marrow sample is also examined to check for any abnormalities in the chromosomes of the leukaemia cells. A test called a lumbar puncture is done to see if the spinal fluid contains any leukaemia cells. A chest X-ray is also done, which will show if there are any enlarged glands in the chest. Other tests may be necessary, depending on your childs symptoms. These tests will help to identify the precise type of leukaemia, and help doctors to decide on the best treatment. Treatment The aim of treatment for AML is to destroy the leukaemia cells and enable the bone marrow to work normally again. Chemotherapy is the main treatment for AML. Usually a combination of chemotherapy drugs is given, according to a treatment plan (often called a protocol or regimen). The treatment usually has different phases. Induction This phase involves intensive treatment, aimed at destroying as many leukaemia cells as possible. It usually involves 2 courses (cycles) of a combination of chemotherapy drugs. A bone marrow test is taken at the end of induction treatment to confirm whether or not the child still has leukaemia. When there is no evidence of leukaemia, the childs condition is referred to as being in remission. Post-remission treatment When there are no signs of the leukaemia in the blood or bone marrow, further treatment is often given. This phase of the treatment aims to destroy any leukaemia cells that may be left and to help stop the AML from coming back. This treatment usually involves 2 more courses of chemotherapy. Bone marrow transplant This treatment is usually only used for children with AML that is likely to come back or has come back (recurred) following standard chemotherapy. Central nervous system (CNS) treatment AML may sometimes develop in the brain and spinal cord. This can be prevented by injecting chemotherapy drugs directly into the spinal fluid during a lumbar puncture (intrathecal chemotherapy). Intrathecal chemotherapy is usually given after each of the first 2 courses of chemotherapy. Sometimes a more intensive treatment is needed, and the intrathecal drugs are given more frequently until all the regular chemotherapy has been completed. Occasionally, radiotherapy to the brain is also necessary. Side effects of treatment Many cancer treatments will cause side effects . This is because while the treatments are killing the cancer cells, they can also damage some normal cells. Some of the main side effects are: hair loss reduction in the number of blood cells produced by the bone marrow, which can cause anaemia (increased risk of bruising, bleeding and infection) loss of appetite and weight feeling sick (nausea) and being sick (vomiting) Most side effects are temporary, and there are ways of reducing them and supporting your child through them. Your childs doctor or nurse will talk to you about side effects. Late side effects of treatment A small number of children may develop late side effects, sometimes many years later. These include possible problems with puberty and fertility, a change in the way the heart works, and a small increase in the risk of developing a second cancer in later life. Your childs doctor or nurse will talk to you about any possible late side effects. Clinical trials Many children have their treatment as part of a clinical research trial. Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Specialist doctors carry out trials for AML. If appropriate, your childs medical team will talk to you about taking part in a clinical trial and will answer any questions you have. Written information is often provided to help explain things. Taking part in a research trial is completely voluntary, and youll be given plenty of time to decide if its right for your child. Treatment guidelines Sometimes, clinical trials are not available for your childs cancer. This may be because a recent trial has just finished, or because the cancer is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Childrens Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care Many children with AML are cured. If the leukaemia comes back after initial treatment, it usually does so within the first 3 years. Most children with AML grow and develop normally. If you have specific concerns about your childs condition and treatment, its best to discuss them with your childs doctor, who knows the situation in detail. Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. Its not possible to addresshere all of the feelings you may have. However, the CCLG booklet Children & Young Peoples Cancer; A Parents Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support. Your child may have a variety of powerful emotions throughout their experience of cancer. The Parents Guide discusses these further and talks about how you can support your child.

Acute myeloid leukaemia: Teenagers and young adults

Acute Myeloid Leukaemia in young adults Illnesses and conditions Cancer Cancer types in teenagers and young adults Acute myeloid leukaemia: Teenagers and young adults Acute myeloid leukaemia: Teenagers and young adults Introduction Leukaemia, blood tests and bone marrow Tests for AML Treating AML Introduction This section is for teenagers and young adults and is about a type of cancer called acute myeloid leukaemia (AML). The other main type of leukaemia that can affect teenagers and young adults is acute lymphoblastic leukaemia . For information about AML in people of all ages,read our general AML section. Leukaemia is a cancer of the white blood cells. In leukaemia, the process for making new white blood cells gets out of control. Immature white blood cells (called blasts) keep being made and build up in the bone marrow until there isnt enough room for the bone marrow to make healthy white blood cells, red blood cells and platelets. The body needs these cells to: help fight infection (white cells) carry oxygen from the lungs around the body (red blood cells) stopcuts bleeding by clotting blood (platelets) Symptoms Many of the symptoms of AML are caused by having fewer than normal healthy blood cells in the body. Symptoms can include: looking paler than usual and feeling tired because of too few red blood cells (anaemia) bruises or bleeding you may bruise more easily and it could take longer for bleeding to stop, if you have less blood clotting cells (platelets) than normal infections because there are too few mature white blood cells to fight infection aches and pains in your bones swollen glands (lymph nodes) in your neck, under your arm or in your groin feeling unwell and run down fever and sweats you may have a high temperature without any obvious cause, such as an infection headaches and blurred vision because of too many white blood cells breathlessness because of too many white blood cells. Causes Its not knownexactly what causes AML. Research is going on to try to find out. We do know some things might increase the risk of AML: some genetic conditions, like Downs Syndrome (agenetic condition is something you are born with) some non-cancerous conditions of the bone marrow, such as aplastic anaemia or myelodysplastic syndromes If youre worried about AML If you think you might have any of the symptoms of AML, you should go to your GP. Theyll talk to you about your symptoms, examine you and can arrangetests or refer you to see a specialist.Remember that the symptoms can be caused by other things, but its important to go and get checked if you are worried. Leukaemia, blood tests and bone marrow To understand leukaemia, it can help to know a little about the blood and bone marrow. Leukaemia is a cancer of the white blood cells. All blood cells are made in the bone marrow, which is like a blood cell factory inside bones. A type of cell in the bone marrow, called a stem cell, can make any kind of blood cell your body needs. There are3 main types of blood cells: white blood cells which help fight infection red blood cells which carry oxygen from the lungs around the body platelets which clot blood to stop cuts bleeding The bone marrow normally makes millions of blood cells every day. To begin with, these new blood cells, called blasts, are not fully developed (theyre immature). The main job of blast cells is to make more blood cells like themselves. They cant do any of the jobs that mature blood cells can do, like carrying oxygen or fighting infection. Blast cells normally stay inside the bone marrow until theyve matured into fully-developed blood cells. Once blood cells are mature, theyre ready to do their jobs. They leave the bone marrow and go into the bloodstream, where they can be carried to wherever theyre needed. How leukaemia develops In leukaemia, the process for making new white blood cells gets out of control and immature white blood cells (blasts) keep being made. They build up in the bone marrow until there isnt enough room for the bone marrow to make healthy white cells, red cells and platelets. Types of leukaemia Leukaemia is a cancer of the white blood cells. Healthy white blood cells are made from2 types of blood cells: lymphoblasts that make lymphocytes myeloid cells (myeloblasts) that make other types of white blood cells such as neutrophils Leukaemias are named after the type of white blood cell that has become abnormal and started growing out of control. The most common types in teenagers and young adults are AML and ALL: acute myeloid leukaemia(AML) is leukaemia that starts from abnormal myeloid cells acute lymphoblastic leukaemia (ALL) is leukaemia that starts from abnormal lymphoblasts There are other types of leukaemia that are more common in older people. The information in this section is about ALL, but if you have a different type of leukaemia and want to know more,contact Macmillan . We also have more information about: symptoms and causes of AML having tests for AML being treated for AML If youre looking for information about ALL in people of all ages, read general AML section. Tests for AML You should speak to your GP as soon as possible if you think you have some of the symptoms of AML. But remember that the symptoms of AML can be caused by other things. Visiting your GP Your GP will examine you and arrange for you to have blood tests. There can be different reasons for your symptoms, so youll need to have a blood test to help diagnose acute myeloid leukaemia (AML). If you have AML, a blood test will usually find leukaemia cells and youll be referred to a specialist at the hospital. This specialist is called a haematologist and is a doctor who treats people with blood disorders. At the hospital The haematologist will examine you and ask you about your symptoms and any recent illnesses. They will also arrange for you to have some more tests. These may include: blood tests youll need more blood tests even if youve had some already tolook at the changes in the leukaemia cells and help the doctors decide on the best treatment for you; these tests may be called cytogenetics and immunophenotyping bone marrow test to count the numbers of leukaemia cells in the bone marrowand get send samples for cytogenetic and immunophenotyping testing lumbar puncture a small sample of the fluid that surrounds your brain and spinal cord is taken to check for leukaemia cells chest X-ray this may also be done to see if there are any swollen lymph nodes (glands) in your chest If you have AML, you might need a few more tests to check how your body is working in general. These could be blood tests, an ultrasound scan of the tummy (abdomen) to look at your liver, spleen and kidneys, or an echocardiogram (which is an ultrasound of the heart). This may seem like a lot of tests, but they give the doctors important information that will help them give you the right treatment. Waiting for test results can be a scary time, but understanding a little about them what will happen, how youll feel and when youll get the results can help you cope. Thinking about how you feel and getting support from family, friends or your specialist nurse and doctor can also make it a bit easier. You could also talk to a cancer support specialist on Macmillans free helpline . We also have more information about: symptoms and causes of AML being treated for AML leukaemia, blood cells and bone marrow If youre looking for information about AML in people of all ages, read our general AML section. Treating AML The main treatment for acute myeloid leukaemia (AML) is chemotherapy. This means having anti-cancer drugs to destroy the leukaemia cells. Youll also have drugs called steroids, which help the chemotherapy to work. The treatment for AML is pretty intensive at times and can cause unpleasant side effects. But youll be in hospital when youre most likely to feel unwell, and the staff can help if things get tough. Dont feel you have to be brave. Be honest about how youre feeling with your doctors and nurses. They can give you medicines to help you feel better. There are different phases of treatment for AML: getting rid of the leukaemia remission induction keeping the leukaemia away consolidation and delayed intensification therapy central nervous system (CNS) therapy (mainly for teenagers under 16) Very often, treatment is given as part of a clinical trial or research study, but it will be your decision whether to take part in the trial or not. Clinical trials help doctors to keep improving treatment for leukaemia. You usually start chemotherapy pretty quickly after finding out that you have AML. Youll be in hospital for your treatment to begin with.If youre 18 or younger, youll be treated in a specialist Principal Treatment Centre (PTC) for teenage and young adults (TYA).If youre 19 or older, youll be offered the choice of having treatment at the PTC or another hospital closer to home called a TYA designated hospital. Most chemotherapy for AML is given into the bloodstream (intravenously). So youll have a line put into one of your main veins to make it easier for you to have intravenous chemotherapy. There are different kinds of lines. Youll also be given chemotherapy into the fluid around your spinal cord and brain. This is to get rid of any leukaemia cells that might be hiding there. This type of treatment is called central nervous system (CNS) therapy. Having chemotherapy can be hard, but the staff looking after you will give you medicines to help you cope with any side effects so you can stay strong enough to have treatment. And youll be given medicines to help you feel less sick and antibiotics to help prevent infections. There will probably be times when you feel rough and other times when youll feel better. You might also feel upset, down or irritable. Talking to someone you trust can help you cope with these feelings. Being in hospital for long periods can be frustrating, especially when you miss out on stuff happening at school, college, university or work or on things your friends are doing. You could try talking to your friends and family about this and see what they can do to help you. Getting rid of the leukaemia (remission induction) The first phase of your treatment is about getting rid of the leukaemia. Youll be given chemotherapy to kill as many leukaemia cells as possible. Remission means there is no sign of leukaemia cells in your blood or bone marrow. You have chemotherapy over a few days, then you have a few weeks off so that your body can recover from any side effects. The days you have the chemotherapy and the rest period afterwards is called a cycle. Youll usually have4 cycles of chemotherapy overall with2 courses in the induction phase. Some people might also need to have a bone marrow transplant. This normally happens after 2 cycles of chemotherapy. Youll probably need to stay in hospital most of the time that youre having remission induction. This is so that the doctors can check how things are going. Chemotherapy drugs Drugs you may have include: cytarabine (Ara-C) daunorubicin, doxorubicin or idarubicin etoposide thioguanine Side effects Different chemotherapy can cause different side effects. There is information about the specific ones inMacmillans chemotherapy section . As well as the chemotherapy drugs, youll be given other drugs to: help prevent you from feeling sick or being sick help prevent infections protect your kidneys as sometimes when lots of leukaemia cells are destroyed at once it can cause kidney problems Youll probably also need blood and platelet transfusions to top up the numbers of red cells and platelets in your blood. Chemotherapy can cause side effects. Most of them are short-term (temporary) and gradually disappear once treatment stops. The most common side effects are: being more at risk of infections feeling sick hair loss a sore mouth Sometimes side effects can be long-term. For example, some chemotherapy treatments can affect fertility (your ability to have a baby). If you are a young man, you will be offered the chance to store sperm before chemotherapy is started. There may be other late effects of treatment and your specialist can talk to you about this. Remission induction is pretty intense treatment and youll probably feel a bit wiped out sometimes. Youll need to stay in hospital for most of the time and you might not have the energy to do much. You might feel fed up, tearful or irritable. Its normal to feel like this. Its hard to be in hospital and you might worry about losing touch with your friends or falling behind at school or college. It can help to talk about this with a friend, doctor, nurse or counsellor. Keeping the leukaemia away (post-remission treatment) This phase of treatment is sometimes also called consolidation or intensification treatment. Its given to prevent the leukaemia from returning (known as a relapse). When youre in remission, it means the doctors cant see any leukaemia cells in your blood or bone marrow samples under the microscope. But there may still be leukaemia cells hiding in your body, so further treatment is needed to get rid of these cells. You start post-remission treatment soon after you complete remission induction. Youll usually have2 courses of treatment. You might be given the same chemotherapy drugs youve had before (perhaps at similar or higher doses) or you might be given different chemotherapy drugs. When your doctors decide what chemotherapy treatment plan to give you, they will take into account: how well your leukaemia responded to the first lot of treatment (remission induction) the results of the tests that were done when you were diagnosed The following drugs may be used to treat you: cytarabine (ara-C) methotrexate Central nervous system therapy (CNS) You usually wont need this treatment if youre 16 or over. But if youre under 16, youll probably have it. CNS therapy is given to get rid of any leukaemia cells that might be in the brain or spinal cord. (The CNS or central nervous system is the name for the brain and spinal cord.) CNS therapy involves giving chemotherapy into the fluid, called cerebrospinal fluid or CSF, around the spinal cord and brain. Its a bit like having a lumbar puncture but with chemotherapy added. A doctor puts a needle into the space between two small bones (vertebrae) near the bottom of your spine. Then they inject chemotherapy into the CSF. The CSF will carry the chemotherapy around your CNS so it can reach any leukaemia cells that might be there. Youll have a lumbar puncture before you start treatment to check for leukaemia cells in the CSF. If there is no sign of leukaemia cells, youll have2 lots of CNS therapy,1 after each cycle of remission induction therapy. If there are leukaemia cells in the CSF, youll have CNS therapy twice a week until all traces of leukaemia cells in your CSF have gone. Youll then have2 more lots of CNS therapy just to make sure. For CNS therapy for AML, youll have chemotherapy drugs called methotrexate and cytarabine and a steroid called hydrocortisone. Side effects The most common side effect is feeling sick but you can be given anti-sickness treatment to help this. Rarer side effects include a headache, dizziness, tiredness or blurry vision for a few hours afterwards. We also have more information about: symptoms and causes of AML having tests for AML leukaemia, blood cells and bone marrow If youre looking for information about AML in people of all ages, read our general AML section.

Acute pancreatitis

Acute pancreatitis Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Stomach, liver and gastrointestinal tract Acute pancreatitis Acute pancreatitis About acute pancreatitis Symptoms of acute pancreatitis Causes of acute pancreatitis Diagnosing acute pancreatitis Treating acute pancreatitis Complications of acute pancreatitis Preventing acute pancreatitis About acute pancreatitis Acute pancreatitis is a serious condition where the pancreas becomes inflamed over a short period of time. The pancreas is a small organ located behind the stomach and below the ribcage. Most people withacute pancreatitis improve within a week and experience no further problems, but severe cases can have serious complications and can even be fatal. Acute pancreatitis is different to chronic pancreatitis , where the inflammation of the pancreas persists for many years. The most common symptoms of acute pancreatitis include: suddenly getting severe pain in the centre of your abdomen (tummy) feeling or being sick diarrhoea Read more about the symptoms of acute pancreatitis and diagnosing acute pancreatitis . When to seek medical help Contact your GP immediately if you suddenly develop severe abdominal pain. If this isnt possible, contact NHS 24s 111service or your local out-of-hours service for advice. Why it happens Its thought that acute pancreatitis occurs when a problem develops with some of the enzymes (chemicals) in the pancreas, which causes them totry to digestthe organ. Acutepancreatitisis most often linked to: gallstones which accounts for around half of all cases alcohol consumption which accounts for about a quarter of all cases By reducing your alcohol intake and altering your diet to make gallstones less likely, you canhelp to reduce your chances of developing acute pancreatitis. Read more about the causes of acute pancreatitis and preventing acute pancreatitis . Who is affected? Acute pancreatitisis more common in middle-aged and elderly people, but it can affect people of any age. Men are more likely to develop alcohol-related pancreatitis, while women are more likely to develop it as a result of gallstones. How its treated Treatment for acute pancreatitis focuses on supporting the functions of the body until the inflammation has passed. Thisusually involves admission to hospital so you can be given fluids into a vein (intravenous fluids), as well as pain relief, nutritional support and oxygen through tubes into your nose. Most people with acute pancreatitis improve within a week and are well enough to leave hospital after 5 to 10 days. However, recovery takes longer in severe cases, as complicationsthat require additional treatmentmay develop. Read more about treating acute pancreatitis . Complications About 4out of 5cases of acute pancreatitis improve quickly anddont cause any serious further problems. However, 1in 5cases are severe andcan result in life-threatening complications, such asmultiple organ failure. In severe cases wherecomplications develop, theres a highrisk ofthe conditionbeing fatal. If a person survives the effects of severe acute pancreatitis, its likely to be several weeks or months before theyre well enough to leave hospital. Read more about the possible complications of acute pancreatitis . Symptoms of acute pancreatitis The main symptom of acute pancreatitis is a severe, dull pain around the top of your stomach that develops suddenly. This aching pain often gets steadily worse and can travel along your back or below your left shoulder blade. Eating or drinkingmay also make you feel worse very quickly, especially fatty foods. Leaning forward or curling into a ball may help to relieve the pain, but lying flat on your back often increases the pain. Acute pancreatitis caused by gallstones usually develops after eating a large meal. If the condition is caused by alcohol, the pain often develops 6 to 12 hours after drinking a significant amount of alcohol. Other symptoms Other symptoms of acute pancreatitis can include: nausea (feeling sick) or vomiting diarrhoea indigestion a high temperature (fever) of 38C (100.4F) or above jaundice yellowing of the skin and the whites of the eyes tenderness or swelling of the abdomen (tummy) When to seek medical advice Contact your GP immediately if you suddenly develop severe abdominal pain. If this isnt possible,contact NHS 24 111 Service or your local out-of-hours service for advice. Causes of acute pancreatitis Most cases of acute pancreatitis are closely linked to gallstones or to alcohol consumption, although the exact cause isnt always clear. Gallstones Gallstones are hard pieces of stone-like material that form in your gallbladder. They can trigger acute pancreatitis if they move out of the gallbladder and block the opening of the pancreas. The blockage can disrupt some of the enzymes (chemicals) produced by the pancreas. These enzymes are normally used to help digest food in your intestines, but theycanstart to digest the pancreas instead ifthe opening isblocked. However, not everyone with gallstones will develop acute pancreatitis. Most gallstones dont cause any problems. Alcohol consumption Its not fully understood how alcohol causes the pancreas to become inflamed. One theory is that it interferes with the normal workings of the pancreas, causing the enzymes to start digesting it. Whatever the cause, there is a clear link between alcohol use and acute pancreatitis. A very large study found that people who regularly drank more than 35 units of alcohola week were 4times more likely to develop acute pancreatitis than people who never drank alcohol (35 units is the equivalentof drinking around 16 cans of strong lager or 4bottles of wine a week). Binge drinking ,which is drinking a lot of alcohol in a short period of time, is also thought to increase your risk of developing acute pancreatitis. Other causes Less common causes of acute pancreatitis include: accidental damage or injury to the pancreas for example, duringa procedureto remove gallstones or examine the pancreas certain types of medication,such as some antibiotics or chemotherapy medication acute pancreatitis can bean unexpected side effect of these in a small number of people a viral infection such as mumps or measles a complication of cystic fibrosis certain rare conditions including hyperparathyroidism, Reyes syndromeand Kawasaki disease Severe pancreatitis Little is known about why some people develop severe acute pancreatitis. Factors thought to increase your risk include: being 70 years of age or over being obese (a person is considered obese if they have a body mass index (BMI) of 30 or above) having 2or more alcoholic drinks a day smoking Researchers have also discovered that people with a specific genetic mutation, known as the MCP-1 mutation, are 8times more likely to develop severe acute pancreatitis than the general population. A genetic mutation is where the instructions (DNA) found in all living cells become scrambled, resulting in a genetic disorder or a change in characteristics. Diagnosing acute pancreatitis Most cases of acute pancreatitis are diagnosed in hospital because of the risk of serious complications. The doctor in charge of your care will ask you about the history of your symptoms. They may also carry out a physical examination. If you have acute pancreatitis, certain areas of your abdomen will be very tender to touch. A blood test will be carried out to help confirm a diagnosis. Thiscan detect signs of acute pancreatitis,such asa high level of 2chemicals called lipase and amylase. At first, it can be difficult to tell whether your acute pancreatitis is mild or severe. Youll be monitored closely for signs of serious problems, such as organ failure. People with mild acute pancreatitis tend to improve within a week and experience either no further problems or problems that resolve within 48 hours. People with severe acute pancreatitis develop persistent serious problems. Further testing Several tests may be used to help determine the severity of your condition andassess your risk of developing more serious complications. You may have any of the following tests: a computerised tomography (CT) scan where a series of X-rays are taken to build up a more detailed, 3D image of your pancreas a magnetic resonance imaging (MRI) scan where strong magnetic fields and radio waves are used to produce a detailed image of the inside of your body an ultrasound scan where high-frequency sound waves are used to create an image of part of the inside of the body endoscopic retrograde cholangiopancreatography (ERCP) An ERCP uses a narrow, flexible tube known as an endoscope, which has a camera on one end. The endoscope will be passed through your mouth and towards your stomach. A special dye that shows up on X-rays is then injected through the endoscope into your bile and pancreatic ducts. After the dye has been injected, X-rays will be taken. This test can be useful in cases of gallbladder-associated acute pancreatitis, because it can pinpoint exactly where the gallstone is located. In some cases, it may be possible to pass surgical instruments down the endoscope, so the gallstone can be removed. Treating acute pancreatitis Acute pancreatitis is treated in hospital, where youll be closely monitored for signs of serious problems and given supportive treatment, such as fluids and oxygen. Many people are well enough to leave hospital after 5 to 10 days. In severe cases, complications can develop that require specific additional treatment and youll need to be admitted to a high dependency unit or intensive care unit (ICU). In these cases, recoverymay take much longer, and the condition can be fatal. Read about the potential complications of acute pancreatitis for more informationon severe cases. Fluids Your body can become dehydrated during an episode of acute pancreatitis, so fluids are provided through a tube connected to one of your veins (this is known as intravenous, or IV, fluid). In severe cases of acute pancreatitis, IV fluids can help to prevent a serious problem called hypovolemic shock, which occurs when a drop in your fluid levels lowers the amount of blood in your body. Nutritional support Although the diet of many people with mild acute pancreatitis isnt restricted, somepeople are advised not toeat. This is because trying to digest solid food could place too much strain on your pancreas. Depending on the severity of the condition, you may not be able to eat solid foodsfor a few days or longer. If youneed to avoid solid food, a feeding tube may beused to provide your body with nutrients. This is known as enteral feeding andoften involves usinga tube inserted into your stomach through your nose (nasogastric tube). Oxygen To ensure your vital organs have enough oxygen, it will usually be supplied through tubes into your nose. The tubes can be removed after a few days, once your condition is improving. In severe cases, ventilation equipment may also be used to assist with your breathing. Painkillers Acute pancreatitis often causes severe abdominal (tummy) pain, so strong painkilling medication will probably be required, such as morphine. Some of the painkillers used can make you feel very drowsy. If youre visiting someone who is in hospital with acute pancreatitis, dont be alarmed or concerned if they appear drowsy or unresponsive. Treating the underlying cause Oncethe condition is under control, the underlying cause may need to be treated. Gallstones If a gallstone is responsible for the pancreatitis,you may needa procedure calledendoscopic retrograde cholangiopancreatography (ERCP),or your gallbladder may need to be removed. Gallbladder removal surgery may be done while youre in hospital, or itmay be planned for several weeks time. Having your gallbladder removed should have no significant effect on your health, other than making it more difficult to digest certain foods, such as fatty or spicy foods. An ERCP procedure is an alternative treatment for gallstones. It involves using a narrow, flexible tube known as an endoscope, which has a camera on one end. X-rays guide the endoscope into your digestive system, andsurgical instrumentsare passeddown the endoscopeto removethe gallstones. Alcohol consumption After recovering from acute pancreatitis, alcohol should be completely avoidedif this was the cause of the condition. If you find this difficult, youll probably need additional treatment. Treatment options for alcohol dependence include: one-to-onecounselling self-help groups such as Alcoholics Anonymous a medication called acamprosate which helps to reduce your alcohol cravings Complications of acute pancreatitis Although most people with acute pancreatitis recover without experiencing further problems, severe cases can have serious complications. Pseudocysts Pseudocysts are sacs of fluid that can develop on the surface of the pancreas. Theyre a common complication of acute pancreatitis, thought to affect around 1 in 20 people with the condition. Pseudocysts usually develop 4 weeks after the symptoms of acute pancreatitis start. In many cases, they dont cause any symptoms and are only detected during a computerised tomography (CT) scan . However, in some people, pseudocysts can cause bloating, indigestion and a dull abdominal (tummy) pain. If the pseudocysts are small and not causing any symptoms, there may be no need for further treatment, as they usually go away on their own. Treatment is usually recommended if youre experiencing symptoms or ifthe pseudocysts are large. Larger pseudocysts are at risk of bursting, which could cause internal bleeding or trigger an infection. Pseudocysts can be treated by draining the fluid out of the cyst by inserting a needle intoit through your skin. This can also be done by carrying out an endoscopy, wherea thin, flexible tube called an endoscope is passed down your throat, and tiny tools are used to drain away the fluid. Infected pancreatic necrosis In around 1in 3severe cases of acute pancreatitis,a serious complication called infected pancreatic necrosis occurs. In infected pancreatic necrosis, high levels of inflammation cause an interruption to the blood supply of your pancreas. Without a consistent supply of blood, some of the tissue of your pancreas will die. Necrosis is the medical term for the death of tissue. The dead tissue is extremely vulnerable to infection from bacteria. Once an infection has occurred, it can quickly spread into the blood ( blood poisoning ) and cause multiple organ failure. If left untreated, infected pancreatic necrosis is almost always fatal. Infected pancreatic necrosis usually develops 2to 6weeks after thesymptoms of acute pancreatitis starts. Symptoms include increased abdominal pain and a high temperature. The infectionis treated with injections of antibiotics , and the dead tissue needs to be removed to prevent the infection returning. In some cases, it may be possible to drain away the dead tissue using a thin tube called a catheter, which is placed through the skin. Alternatively, laparoscopic surgery (keyhole surgery) can be used.A small cutis made in your back and an endoscope is inserted to wash away any dead tissue. If laparoscopic surgeryisnt possible, a cutcan bemade in your abdomen to allow the dead tissue to be removed. Infected pancreatic necrosis is a very serious complication. Even with the highest standards of medical care, the risk of dying from organ failure is estimated to be around 1in 5. Systemic inflammatory response syndrome (SIRS) Another common complication of severe acute pancreatitis is systemic inflammatory response syndrome (SIRS). SIRS develops in an estimated 1 in 10 severe cases of acute pancreatitis. In SIRS, the inflammation affecting the pancreas spreads throughout the body, which can cause one or more organs to fail. It usually develops during the first week after thesymptoms start, with most cases developing on the same day. Symptoms of SIRS include: a rise in body temperature to above 38C (100.4F) or a fall in body temperature to below 36C (96.8F) a rapid heartbeat of more than 90 beats a minute an unusually fast breathing rate (more than 20 breaths a minute) Theres currently no cure for SIRS, so treatment involves trying to support the bodys functions until the inflammation has passed. The outcome depends on how many organs fail. The higher the number of organs affected, the greater the risk of death. Chronic pancreatitis If you have repeated episodes of acute pancreatitis, the damage to your pancreas may lead to chronic pancreatitis . Chronic pancreatitis is a long-term condition that can have a serious impact on your quality of life. Preventing acute pancreatitis As acute pancreatitis is often caused by gallstones or excessive alcohol consumption, a healthy lifestyle can reduce your chances of developing the condition. Gallstones The most effective wayof preventing gallstones is eating a healthy, balanceddiet that includes plenty of fresh fruit and vegetables (at least 5portions a day). Your diet should also include wholegrains, found in wholemeal bread, oats and brown rice. This helps lower the amount of cholesterol in your body. There is also evidence that regularly eating nuts, such as peanuts or cashews, can help reduce your risk of developing gallstones. Because of the role cholesterol appears to play in the formation of gallstones, its advisable to avoid eating too many fatty foods with a high cholesterol content. Foods high in cholesterol include: meat pies sausages and fatty cuts of meat butter and lard cakes and biscuits Being overweight also increases your chances of developing gallstones, so maintaining a healthyweight by eating abalanced diet and taking plenty of regular exercise can alsohelp reduce your risk of developingthe condition. Read more information and advice about exercise , healthy eating and losing weight . Alcohol Limiting the amount of alcohol you drink can help prevent your pancreas being damaged, andreduce your risk of developing acute pancreatitis. It can also lower your chances of developing other serious conditions, such as liver cancer . Read the pages on drinking and alcohol for more information and advice.

Adenomyosis

Adenomyosis Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Healthy living Women's health Girls and young women (puberty to around 25) Periods and menstrual health Adenomyosis Adenomyosis | | Polski | | | British Sign Language (BSL) | Easy Read Adenomyosis is a condition that causes the lining of the womb (the endometrium) to bury into the muscular wall of the womb. It can affect the whole womb or just one part of the womb. Adenomyosis is not a life-threatening condition, but the symptoms can have a big impact on your day-to-day life so its important to get the support you need. Symptoms Its possible to have adenomyosis and have no symptoms. Symptoms you might experience include: heavy periods that last for a long time severe period pain a feeling of pressure in your tummy bloating (your tummy sticks out more than normal) Causes Its not known exactly why adenomyosis happens. Adenomyosis is not an infection and its not contagious. It is benign (not cancerous). Diagnosis When you see your doctor about your symptoms, theyll carry out what is called a pelvic examination. Theyll look at your vulva, vagina and cervix (the opening between the vagina and the womb) to see if there is something that could be causing your symptoms. Sometimes other tests might be needed. Your doctor will discuss this with you and you can ask any questions that you might have. As this is an intimate examination, the doctor who performs it will have another person (chaperone) present. You can ask for a female doctor to carry it out. If there isnt a female doctor available, you can ask if theres a female health professional who could carry out the examination. You might be referred to a specialist wholl carry out more tests. This might include an ultrasound or an MRI, which will allow a doctor to look at your womb. This can also help rule out any other health conditions. Treatment Depending on your symptoms, there are different options to treat adenomyosis, including: anti-inflammatory medication to help relieve mild pain treatment during your period to help reduce the amount of menstrual blood loss hormone therapy such as the contraceptive pill, to help control heavy or painful periods a hysterectomy (removal of the womb) this would only be considered in extreme cases, where other treatments do not work and if you do not wish to become pregnant Your doctor will discuss this with you and you can ask any questions that you might have.

Addisons disease

Addison's disease Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Glands Addisons disease Addisons disease About Addisons disease Symptoms of Addisons disease Causes of Addisons disease Diagnosing Addisons disease Treating Addisons disease About Addisons disease Addisons disease (also known as primary adrenal insufficiency or hypoadrenalism) is a rare disorder of the adrenal glands. The adrenal glands are 2 small glands that sit on top of the kidneys. They produceessential hormones: cortisol,aldosterone and adrenaline. In Addisons disease, the adrenal gland is damaged, and not enough cortisol and aldosterone are produced. About 8,400 people in the UK have Addisons disease. It can affect people of any age. Its most common between the ages of 30 and 50.Its also more common in women thanmen. Early-stage symptoms of Addisons disease are similar to other more common health conditions, such as depression or flu .You may experience: fatigue (lack of energy or motivation) muscle weakness low mood loss of appetite and unintentional weight loss increased thirst Over time, theseproblems may become more severe and you may experience further symptoms, such as dizziness, fainting,crampsand exhaustion. You may also develop small areas of darkened skin, or darkened lips or gums. Although these symptoms arent always caused by Addisons disease, you shouldsee your GP, so they can be investigated. Read more about the symptoms of Addisons disease and diagnosing Addisons disease Why it happens The conditionisusually the result of a problem with the immune system, which causes it to attack the outer layer of the adrenal gland (the adrenal cortex), disrupting the production of steroid hormones aldosterone and cortisol. Its not clear why this happens, but its responsible for 70% to 90% of cases in the UK. Other potential causes include conditions that can damage the adrenal glands, such as tuberculosis (TB) , although this is uncommon in the UK. Read more about the causes of Addisons disease Treating Addisons disease Addisons disease is treated with medication to replace the missing hormones. Youll need to take the medication for the rest of your life. With treatment, symptoms of Addisons disease can largely be controlled. Most people with the condition live a normal lifespan andare able tolive an active life, with few limitations. However,many people with Addisons disease also find they must learn to managebouts of fatigue and there may be associated health conditions, such as diabetes or an underactive thyroid . People with Addisons disease must be awareof the risk of a sudden worsening of symptoms, called an adrenal crisis. Thiscan happenwhen the levels of cortisolin your body fallsignificantly due to not taking your medicines, or during another illness. An adrenal crisis is a medical emergency and warning signs include severe nausea, confusion, fever, headache and weakness. If left untreated, it can be fatal. If you or someone you know has Addisons disease and is experiencing severe symptoms, phone 999 for an ambulance. Read more about treating Addisons disease Information about you If you have Addisons disease, your clinical team will pass information about you on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS). This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time. Find out more about the register Symptoms of Addisons disease Addisons disease can be difficult to detect at first, because early symptoms are similar to symptoms of many other health conditions. Initial symptoms of Addisons disease caninclude: fatigue (lack of energy or motivation) lethargy (abnormal drowsiness or tiredness) muscle weakness low mood (mild depression ) or irritability loss of appetite and unintentional weight loss the need to urinate frequently increased thirst craving for salty foods Dehydration can also be an early sign of Addisons disease. Its caused by lack of the hormone aldosterone in your body, which is used to regulate the balance of salt and water. Later symptoms Furthersymptoms of Addisons disease tend to develop gradually over months or years. However,additional stress, caused by another illness or an accident, for example, may cause your symptoms to suddenly get worse. You may go on to develop: low blood pressure when you stand up, which can cause dizziness and fainting feeling sick (nausea) vomiting diarrhoea abdominal,joint or back pain muscle cramps chronic exhaustion, which may cause depression brownish discolouration of the skin, lipsand gums (hyperpigmentation), particularly in the creases on your palms, on scars or on pressure points, such as your knuckles or knees a reduced libido (lack of interest in sex) , particularly in women Some women may also have irregular periodsor miss some periods completely.Children with Addisons disease may experience pubertylater than usual. Some people with Addisons disease also develop low blood sugar (hypoglycaemia) . This can cause symptoms such asdifficulty concentrating, confusion, anxiety and even unconsciousness (particularly in children). If youre experiencingsymptoms of Addisons disease, see your GP so they can diagnose or rule out the condition.These symptomswill usually improve withappropriate treatment. Read more about diagnosing Addisons disease and treating Addisons disease Adrenal crisis If Addisons disease is left untreated, the levels of hormones produced by the adrenal glandgradually decrease in the body. This causes your symptoms to get progressively worse and eventually lead to a life-threatening situationcalledan adrenal or Addisonian crisis. During an adrenal crisis, the symptoms of Addisons disease appear quickly andseverely. This could happen whenyoure already experiencing initial symptoms or without any symptoms at all. Signs of an adrenal crisis include: severe dehydration pale, cold, clammy skin sweating rapid, shallow breathing dizziness severe vomiting and diarrhoea severe muscle weakness headache severe drowsiness or loss of consciousness An adrenal crisis is a medical emergency. If left untreated, it can be fatal. If you think you or someone you knowwith Addisons diseaseis having an adrenal crisis, phone 999 for an ambulance. If an adrenal crisis isnt treated, it can lead to a coma and death. Theres also a risk your brain wont get enough oxygen if treatment is delayed, whichcan cause permanent disability. Causes of Addisons disease Addisons disease develops when the outer layer of your adrenal glands (your adrenal cortex) is damaged, reducing the levels of hormones it produces. Problems with the immune system In the UK, a problem with the immune system is the most common cause of Addisons disease, accounting for 70% to 90% of cases. Theimmune system is your bodys defence against infection and disease. If youre ill, your immune system produces antibodies (a special type of protein that destroys disease-carrying organisms and toxins). These antibodies attack the cause of the illness. However, if you develop a problem with your immune system, it can start to attack your own healthy tissues and organs. This is known as an autoimmune disorder. Addisons disease can develop if your immune system attacks your adrenal glands and severely damages your adrenal cortex. When 90% of the adrenal cortex is destroyed, your adrenal glands wont be able to produce enough of the steroid hormones cortisol and aldosterone. Once levels of these start decreasing, youll experience symptoms of Addisons disease . Its not clear why some people develop this problem with their immune system, although it can run in families. Genetics Research has shown that some people withcertain genesare more likely to develop autoimmune disorders. Its not clear how these genes lead to Addisons diseaseandsimilar conditions, but it does meanyour risk of developing Addisons disease is increased if you or aclose family memberhave another autoimmune condition, such as: vitiligo a chronic (long-term) condition that causes pale, white patches to develop on the skin type 1 diabetes a chronic condition caused by too much glucose in the blood underactive thyroid gland (hypothyroidism) Other causes Tuberculosis (TB) is the most common cause of Addisons disease worldwide, but is rare in the UK. TB is a bacterial infection that mostly affects the lungs, but can also spread to other parts of your body.It can cause Addisons disease if it damages your adrenal glands. Other possible causes of Addisons disease include: infections such as those linked to AIDS , or fungal infections a haemorrhage very heavy bleeding into the adrenal glands, sometimes associated with meningitis or other types of severe sepsis cancer if cancer cells from elsewhere in your body spread to your adrenal glands amyloidosis a disease where amyloid, a protein produced by your bone marrow cells, builds up in your adrenal glands and damages them surgical removal ofboth adrenal glands (adrenalectomy) for example, to remove a tumour adrenoleukodystrophy (ALD) a rare, life-limiting, inherited condition affecting the adrenal glands and nerve cells in the brain thatmost oftenaffects young boys certain treatments needed for Cushings syndrome a collection of symptoms caused by very high levels of cortisol in the body Diagnosing Addisons disease To help diagnose Addisons disease, your GP will first ask about your symptoms and review your medical history. Theyre also likely to ask if anyone in your family hasan autoimmune disorder (a condition caused by a problem with their immune system). Your GP will examine your skin for any evidence of brownish discolouration (hyperpigmentation), particularly in certain areas, such as: where skin creases on your palm in your elbow crease on any scars your lips and gums However, hyperpigmentation doesnt occur in all cases of Addisons disease. Youll also be tested for low blood pressure (hypotension) while youre lying down and again shortly after you stand up. This is to see whether you have postural or orthostatic hypotension (low blood pressure when you change position). Blood tests If Addisons disease is suspected, blood tests will be carried out to measure the levels ofsodium, potassium and cortisolin your body. A low sodium, high potassium or low cortisol level may indicateAddisons disease. You may need to see a hospital hormone specialist (endocrinologist) for your bloodto be tested for the following: a low level of the hormone aldosterone a high level of adrenocorticotrophic hormone (ACTH) a low level of glucose (sugar used for energy) positive adrenal antibodies (antibodies designed to attack the adrenal gland) Any of these could be a sign of Addisons disease. Synacthen stimulation test If cortisolin your bloodislow, or your symptoms strongly suggest Addisons disease, youll need to have a synacthen stimulation test to confirm the diagnosis. Your GP may refer you to an endocrinology unit (a unit that specialises in the study of hormones) for the test. How urgently youre referred depends on how severe your symptoms are. Synacthen is a man-made (synthetic) copy of the adrenocorticotrophic hormone (ACTH). ACTH is naturally produced by the pituitary gland (a pea-sized gland below the brain) to encourage the adrenal glands to release the hormones cortisol and aldosterone. When synacthen is administered, the adrenal glands should respond in the same way as they would to ACTH, and release cortisol andother steroid hormonesinto the blood. A blood sample will be taken and tested for cortisol, before an injection ofsynacthen is given into your arm. After 30 and 60 minutes, a furtherblood sample will be taken for cortisol measurement. If the ACTH level is high, but the cortisol and aldosterone levels are low, its usually confirmation of Addisons disease. Thyroid function test As well as a synacthen stimulation test, your thyroid gland may also be tested to see if its working properly. Your thyroid gland is found in your neck. It produces hormones that control your bodys growth and metabolism. People with Addisons disease often have an underactive thyroid gland (hypothyroidism) , where the thyroid gland does not produce enough hormones. By testing the levels of certain hormones in your blood, your endocrinologist (a specialist in hormone conditions) can determine whether you have hypothyroidism. Scans In some cases, yourspecialist may refer you for a scan of your adrenal glands. This could be a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan . Diagnosis during an adrenal crisis If Addisons disease is left untreated, it eventually leads to an adrenal crisis. This is wherethe symptoms of Addisons disease appear quickly and severely. During an adrenal crisis, theres not enough time to perform a synacthen stimulation test to confirm Addisons disease. If possible, blood will be taken and tested for any of the abnormalities listed above. While youre waiting for the results, treatment may be started with steroid injections, and fluids containing salt and glucose. Read more about treatingAddisons disease Driving If youre diagnosed with Addisons disease andhave a bus, coach or lorry licence, its your legal obligation to inform the Driver and Vehicle Licensing Agency (DVLA). Readabout driving andAddisons disease on the GOV.UK website. Treating Addisons disease If you have Addisons disease, youll need to take daily medication to replace the lost hormones. This should help you to live an active life, although many people find they still need to manage their fatigue. Insome cases, the underlying causes of Addisons disease can be treated. For example, tuberculosis (TB) is treated with a course of antibiotics over a period of at least 6 months. However, most cases are caused by a problem with the immune system that cant be cured. Medication forAddisons disease Treatment usually involves corticosteroid (steroid) replacement therapy for life. Corticosteroid medication is used to replace the hormones cortisol and aldosterone thatyour body no longer produces.Its usually taken in tablet form 2 or 3 times a day. In most cases, a medication calledhydrocortisoneis used to replace the cortisol. Other possible medicines areprednisolone or dexamethasone, though these are less commonly used. Aldosterone is replaced with a medication called fludrocortisone. Your GP may also ask you to add extra salt to your daily diet, although if youre taking enough fludrocortisone medicine thismay not be necessary.Unlike most people, if you feel the urge to eat something salty, then you should eat it. In general, the medications used for Addisons disease dont have side effects, unless your dose is too high. If you take a higher dose than necessary for a long time, theres a risk of problems such as weakened bones (osteoporosis) , mood swings and difficulty sleeping (insomnia) . Living with Addisons disease Many people with Addisons disease findthat taking their medication enables them to continuewith theirnormal diet and exercise routines. However, bouts of fatigue are also common, and it cantake some time to learn how to manage these periods of low energy. Some people find that needing to take regular doses of medication is restrictive and affects their daily life or emotional health.Missing a dose of medication, or taking it late,can also lead to exhaustion or insomnia. Some people can develop associated health conditions, such as diabetes or an underactive thyroid , which require extra treatment and management. Youll usually need to have appointments with an endocrinologist every 6 to 12 months, so they can review your progress and adjust your medication dose, if necessary.Your GP can provide support and repeat prescriptions in between these visits. Failing to take your medication could lead to a serious condition called an adrenal crisis, soyou must: remember to collect your repeat prescriptions keep spare medication as necessary for example, in the car or at work, and always carry some spare medication with you take your medication every day at the right time pack extra medication if you are going away usually double what you would normally need, plus your injection kit (see below) carry your medication in your hand luggage if you are travelling by plane, with a note from your doctor explaining why it is necessary You could also inform close friends or colleagues of your condition. Tell them about the signs of adrenal crisis and what they should do if you experience one. Medical alert bracelets Its also a good idea to wear a medical alert bracelet or necklace that informs peopleyou have Addisons disease. After a serious accident, such as a car crash, a healthy person produces morecortisol. This helps you cope with the stressful situation and additional strain on your body that results from serious injury. As your body cannot produce cortisol, youll need a hydrocortisone injection to replace it and prevent an adrenal crisis. Wearing a medical alert bracelet will inform any medical stafftreating you about your condition, and what medication you require. Medical alert bracelets or necklaces are pieces of jewellery engraved with your medical condition and an emergency contact number. They are available from a number of retailers. Ask your GP if theres one they recommend, or go to the MedicAlert website. If you need to stay in hospital, the healthcare professionals responsible for your care will also need to know you need steroid replacement medication throughout your stay. Its important to note that this advice still applies if youre not supposed to eat or drink (nil by mouth) for any reason. Adjusting your medication At certain times, your medication may need to be adjusted to take into account any additional strain on your body. For example, you may need to increase the dosage of your medication if you experience any of the following: an illness or infection particularly if you have a high temperature of 37.5C (99.5F) an accident, such as a car crash an operation, dental or medical procedure (such as a tooth filling or endoscopy) youre taking part in strenuous exercisenot usually part of your daily life This will help your body cope with the additional stress. Your endocrinologist will monitor your dosage and advise about any changes. Over time, as you get used to the condition and learn what can trigger your symptoms, you may learn how to adjust your medication yourself. However, always consult your GP or specialist if youre unsure. Emergency treatment You and a partner or family member may be trained to administer an injection of hydrocortisone in an emergency. This could be necessary if you go into shockafter an injury, or if you experience vomiting or diarrhoea and are unable to keep down oral medication. This may occur if youre pregnant and have morning sickness. Yourendocrinologist will discuss with you when an injection might be necessary. If you need to administer emergency hydrocortisone, always phone your GP immediately afterwards. Check what out-of-hours services are available in your local area, in case the emergency is outside normal working hours. You can alsoregister yourself with your local ambulance service , so they have a record of your requirement for a steroid injection or tablets, if you need their assistance. Treating adrenal crisis Adrenal crisis, or Addisonian crisis, needs urgent medical attention. Phone 999 for an ambulance if you or someone you know are experiencing adrenal crisis. Signs of an adrenal crisis include: severe dehydration pale, cold, clammy skin sweating rapid, shallow breathing dizziness severe vomiting and diarrhoea severe muscle weakness headache severe drowsiness or loss of consciousness In hospital, youll be given lots of fluid through a vein in your arm to rehydrate you. This will contain a mixture of salts and sugars (sodium, glucose and dextrose) to replace those that your body is lacking. Youll also be injected with hydrocortisone to replace the missing cortisol hormone. Any underlying causes of the adrenal crisis, such as an infection, will also be treated.