Cancer Education Slides

1
Cancer Education Slides

• Acute Myeloid Leukemia

2009
2
What is Cancer?

• A group of 100 different diseases
• The uncontrolled, abnormal growth of cells
• Cancer may spread to other parts of the body

3
What is Acute Myeloid Leukemia (AML)?

• An estimated 12,810 people diagnosed in the
  United States in 2009
• Second most common type of leukemia in adults
• Affects the production of neutrophils (type of
  white blood cell)
• Found in the blood and bone marrow (spongy, red
  tissue in the inner part of large bones) can
  invade other areas such as the brain and skin
• Develops quickly and often requires immediate
  treatment

4
What is the Function of Neutrophils?

• Part of the immune system
• Help fight infections caused by bacteria
• Develop from immature white blood cells
  (differentiation)
• Produced rapidly during an infection and return
  to regular level when infection is controlled

5
Function of Neutrophils, continued

• In AML, too many immature cells called
  myeloblasts or blasts accumulate due to
  differentiation disruption
• Blasts do not function like fully developed,
  healthy blood cells

6
What are the Risk Factors for AML?

• Age
• High doses of radiation
• Previous chemotherapy treatment
• Certain genetic disorders
• Smoking

7
Hereditary Disorders Associated With an Increased
Risk of AML

• Down syndrome
• Ataxia telangiectasia
• Li-Fraumeni syndrome
• Klinefelters syndrome
• Fanconis anemia
• Wiskott-Aldrich syndrome
• Blooms syndrome

8
What are the Symptoms of AML?

• Fatigue
• Weakness
• Easy bruising or bleeding
• Weight loss
• Fever
• Bone or abdominal pain
• Difficulty breathing dyspnea (shortness of
  breath)
• Frequent infections
• Swollen lymph nodes
• Swollen or bleeding gums

9
How is AML Diagnosed?

• Blood tests to count the number of white blood
  cells and examine their morphology (the
  appearance of the cancerous cells under a
  microscope)
• Diagnosis is confirmed with a bone marrow biopsy
• Flow cytometry (immunophenotyping) and
  cytochemistry to distinguish AML from other types
  of leukemia
• Cytogenetics to identify genetic changes in AML
  cells

10
What are the Types of AML?

• There are several different subtypes of AML
• All subtypes cause a decrease in normal blood
  counts
• Some subtypes have specific symptoms and problems
• There can be widely different results after
  treatment based on the subtype
• Subtype is named according to the type of normal,
  immature white blood cell it most closely
  resembles

11
How is AML Classified?

• Subtype is described by morphology
• The World Health Organization (WHO) and
  French-American-British (FAB) classification
  systems are frequently used to describe AML
• Also classified by the cytogenetic (chromosome)
  changes in the leukemia cells

12
Cytogenetic Classification

• Cytogenetic changes can determine prognosis
  (chance of recovery), influence the choice of
  treatment, and help predict the results of
  treatment
• Favorable presence of changes associated with a
  good outcome after treatment
• Intermediate presence of changes associated with
  a less favorable prognosis
• Unfavorable presence of changes associated with
  a poor prognosis

13
How is AML Treated?

• Treatment depends on subtype, morphology,
  cytogenetics, and the patients overall health
• Chemotherapy (options include a combination of
  drugs)
• Radiation therapy
• Bone marrow transplantation/stem cell
  transplantation
• More than one treatment may be used

14
AML Treatment Chemotherapy

• Drugs used to kill cancer cells
• Primary treatment for AML
• Systemic chemotherapy is given directly into the
  bloodstream, or by mouth, targeting cancer cells
  throughout the body
• Chemotherapy may also be injected into the
  cerebrospinal fluid

• Divided into three phases remission induction,
  post-remission consolidation, and maintenance
  (not commonly used in AML)
• Side effects may include hair loss, mouth sores,
  fatigue, infection, bleeding, nausea, vomiting,
  and infertility

15
Remission Induction Chemotherapy

• Initial period of treatment after diagnosis
• Intensive therapy kills both leukemia cells and
  healthy cells
• Goal is complete remission (normal blood counts,
  no evidence of leukemia in bone marrow, and no
  AML symptoms)

• Combination therapy of cytarabine (Cytosar-U) and
  daunorubicin (Daunomycin, Cerubidine) or
  idarubicin (Idamycin) is common
• May require hospitalization for three to five
  weeks
• May require two courses of induction chemotherapy
  for complete remission

16
Consolidation or Intensification Chemotherapy

• Used to kill remaining AML cells after successful
  induction
• Two to four courses of high-dose cytarabine is
  used for younger adults in remission
• Many different regimens are used for older
  patients
• Stem cell transplantation may be recommended
  instead

17
AML Treatment Stem Cell Transplantation/Bone
Marrow Transplantation

• High-dose chemotherapy used to kill cancer cells
• New stem cells are introduced from the patient
  (autologous) or a donor (allogeneic) to form new
  blood cells
• May be used for patients at high risk for
  recurrence
• Graft-versus-host disease a serious complication
  in which the donors immune cells attack the
  patients healthy cells

18
AML Treatment Radiation Therapy

• The use of high-energy x-rays or other particles
  to destroy cancer cells
• External beam outside the body
• Used most often for AML that has spread to the
  brain or to shrink localized masses called
  chloromas
• Side effects may include fatigue, mild skin
  reactions, nausea and vomiting, and diarrhea

19
Current Research

• Inhibition of the products of genetic mutations
  found in AML cells
• Inhibition of proteins that cause chemotherapy
  resistance
• Use of antibody therapy against AML cells
• Use of new or existing drugs given in different
  doses and schedules
• Techniques to make stem cell transplantation
  safer, easier, and more effective
• Evaluation of drugs called hypomethylating therapy

20
The Role of Clinical Trials for the Treatment of
AML

• Clinical trials are research studies involving
  people
• They test new treatment and prevention methods to
  determine whether they are safe, effective, and
  better than the standard treatment
• The purpose of a clinical trial is to answer a
  specific medical question in a highly structured,
  controlled process
• Clinical trials can evaluate methods of cancer
  prevention, screening, diagnosis, treatment,
  and/or quality of life

21
Clinical Trials Patient Safety

• Informed consent participants should understand
  why they are being offered entry into a clinical
  trial and the potential benefits and risks
  informed consent is an ongoing process
• Participation is always voluntary, and patients
  can leave the trial at any time
• Other safeguards exist to ensure ongoing patient
  safety

22
Clinical Trials Phases

• Phase I trials determine the safety and dose of a
  new treatment in a small group of people
• Phase II trials provide more detail about the
  safety of the new treatment and determine how
  well it works for treating a specific type of
  cancer
• Phase III trials take a new treatment that has
  shown promising results when used to treat a
  small number of patients with cancer and compare
  it with the standard treatment for that disease
  phase III trials involve a large number of
  patients

23
Clinical Trials Resources

• Coalition of Cancer Cooperative Groups
  (www.CancerTrialsHelp.org)
• CenterWatch (www.centerwatch.com)
• National Cancer Institute (www.cancer.gov/clinical
  _trials)
• EmergingMed (www.emergingmed.com)
• Leukemia Lymphoma Society (www.leukemia-lymphoma
  .org)

24
Coping with Side Effects

• Side effects are treatable talk with the doctor
  or nurse
• Fatigue is a common, treatable side effect
• Pain is treatable non-narcotic pain-relievers
  are available
• Antiemetic drugs can reduce or prevent nausea and
  vomiting
• For more information, visit www.cancer.net/sideeff
  ects

25
After Treatment

• Talk with the doctor about developing a follow-up
  care plan
• Doctor may recommend regular physical
  examinations, imaging tests, and blood tests
• Blood tests to monitor recovery from treatment
• Bone marrow biopsies to determine post-treatment
  remission status
• Long-term follow-ups to monitor for late effects
  of treatment
• Fear of recurrence is common talk with your
  doctor about ways to cope

26
Where to Find More InformationCancer.Net Guide
to AML(www.cancer.net/aml)

• Overview
• Medical Illustrations
• Risk Factors
• Symptoms
• Diagnosis
• Staging
• Treatment

• Clinical Trials
• Side Effects
• After Treatment
• Current Research
• Questions to Ask the Doctor
• Patient Information Resources

27
Cancer.Net (www.cancer.net)

• Comprehensive, oncologist-approved cancer
  information
• Guides to more than 120 types of cancer and
  cancer-related syndromes
• Coping resources
• Survivorship information
• Cancer information in Spanish
• Weekly feature articles
• The latest cancer news
• For patient information resources, please call
  888-651-3038