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<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is the outlook for Mycosis Fungoides and the Szary Syndrome ? [/INST] Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) and treatment options depend on the following: The stage of the cancer. The type of lesion (patches, plaques, or tumors). Mycosis fungoides and the Szary syndrome are hard to cure. Treatment is usually palliative, to relieve symptoms and improve the quality of life. Patients with early stage disease may live many years.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Mycosis Fungoides and the Szary Syndrome ? [/INST] Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the stages of Mycosis Fungoides and the Szary Syndrome ? [/INST] After mycosis fungoides and the Szary syndrome have been diagnosed, tests are done to find out if cancer cells have spread from the skin to other parts of the body. There are three ways that cancer spreads in the body. Cancer may spread from where it began to other parts of the body. The following stages are used for mycosis fungoides and the Szary syndrome: Stage I Mycosis Fungoides Stage II Mycosis Fungoides Stage III Mycosis Fungoides Stage IV Mycosis Fungoides Stage IV Szary Syndrome After mycosis fungoides and the Szary syndrome have been diagnosed, tests are done to find out if cancer cells have spread from the skin to other parts of the body. The process used to find out if cancer has spread from the skin to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following procedures may be used in the staging process: Chest xray : An xray of the organs and bones inside the chest. An xray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the lymph nodes, chest, abdomen, and pelvis, taken from different angles. The pictures are made by a computer linked to an xray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. Lymph node biopsy : The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells. Bone marrow aspiration and biopsy : The removal of bone marrow and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow and bone under a microscope to look for signs of cancer. There are three ways that cancer spreads in the body. Cancer can spread through tissue, the lymph system, and the blood: Tissue. The cancer spreads from where it began by growing into nearby areas. Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body. Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body. Cancer may spread from where it began to other parts of the body. When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood. Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body. Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body. The metastatic tumor is the same type of cancer as the primary tumor. For example, if mycosis fungoides spreads to the liver, the cancer cells in the liver are actually mycosis fungoides cells. The disease is metastatic mycosis fungoides, not liver cancer. The following stages are used for mycosis fungoides and the Szary syndrome: Stage I Mycosis Fungoides Stage I is divided into stage IA and stage IB as follows: Stage IA: Less than 10% of the skin surface is covered with patches, papules, and/or plaques. Stage IB: Ten percent or more of the skin surface is covered with patches, papules, and/or plaques. There may be abnormal lymphocytes in the blood but they are not cancerous. Stage II Mycosis Fungoides Stage II is divided into stage IIA and stage IIB as follows: Stage IIA: Any amount of the skin surface is covered with patches, papules, and/or plaques. Lymph nodes are enlarged but cancer has not spread to them. Stage IIB: One or more tumors that are 1 centimeter or larger are found on the skin. Lymph nodes may be enlarged but cancer has not spread to them. There may be abnormal lymphocytes in the blood but they are not cancerous. Stage III Mycosis Fungoides In stage III, nearly all of the skin is reddened and may have patches, papules, plaques, or tumors. Lymph nodes may be enlarged but cancer has not spread to them. There may be abnormal lymphocytes in the blood but they are not cancerous. Stage IV Mycosis Fungoides Stage IV is divided into stage IVA and stage IVB as follows: Stage IVA: Most of the skin is reddened and any amount of the skin surface is covered with patches, papules, plaques, or tumors, and either: cancer has spread to lymph nodes and there may be cancerous lymphocytes in the blood; or there are cancerous lymphocytes in the blood and lymph nodes may be enlarged, but cancer has not spread to them. Stage IVB: Most of the skin is reddened and any amount of the skin surface is covered with patches, papules, plaques, or tumors. Cancer has spread to other organs in the body. Lymph nodes may be enlarged and cancer may have spread to them. There may be cancerous lymphocytes in the blood. Stage IV Szary Syndrome In stage IV: Most of the skin is reddened and covered with patches, papules, plaques, or tumors; and There is a high level of cancerous lymphocytes in the blood; and Lymph nodes may be enlarged and cancer may have spread to them.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Mycosis Fungoides and the Szary Syndrome ? [/INST] There are different types of treatment for patients with mycosis fungoides and the Szary syndrome cancer. Six types of standard treatment are used: Photodynamic therapy Radiation therapy Chemotherapy Other drug therapy Biologic therapy Targeted therapy New types of treatment are being tested in clinical trials. Highdose chemotherapy and radiation therapy with stem cell transplant Treatment for mycosis fungoides and the Szary syndrome may cause side effects. Patients may want to think about taking part in a clinical trial. Patients can enter clinical trials before, during, or after starting their cancer treatment. Followup tests may be needed. There are different types of treatment for patients with mycosis fungoides and the Szary syndrome cancer. Different types of treatment are available for patients with mycosis fungoides and the Szary syndrome. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment. Six types of standard treatment are used: Photodynamic therapy Photodynamic therapy is a cancer treatment that uses a drug and a certain type of laser light to kill cancer cells. A drug that is not active until it is exposed to light is injected into a vein. The drug collects more in cancer cells than in normal cells. For skin cancer, laser light is shined onto the skin and the drug becomes active and kills the cancer cells. Photodynamic therapy causes little damage to healthy tissue. Patients undergoing photodynamic therapy will need to limit the amount of time spent in sunlight. In one type of photodynamic therapy, called psoralen and ultraviolet A (PUVA) therapy, the patient receives a drug called psoralen and then ultraviolet radiation is directed to the skin. In another type of photodynamic therapy, called extracorporeal photochemotherapy, the patient is given drugs and then some blood cells are taken from the body, put under a special ultraviolet A light, and put back into the body. Radiation therapy Radiation therapy is a cancer treatment that uses highenergy xrays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy: External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is used to treat mycosis fungoides and the Szary syndrome, and may also be used as palliative therapy to relieve symptoms and improve quality of life. Sometimes, total skin electron beam (TSEB) radiation therapy is used to treat mycosis fungoides and the Szary syndrome. This is a type of external radiation treatment in which a radiation therapy machine aims electrons (tiny, invisible particles) at the skin covering the whole body. Ultraviolet B (UVB) radiation therapy uses a special lamp or laser that directs UVB radiation at the skin. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Sometimes the chemotherapy is topical (put on the skin in a cream, lotion, or ointment). The way the chemotherapy is given depends on the type and stage of the cancer being treated. See Drugs Approved for NonHodgkin Lymphoma for more information. (Mycosis fungoides and the Szary syndrome are types of nonHodgkin lymphoma.) Other drug therapy Topical corticosteroids are used to relieve red, swollen, and inflamed skin. They are a type of steroid. Topical corticosteroids may be in a cream, lotion, or ointment. Retinoids, such as bexarotene, are drugs related to vitamin A that can slow the growth of certain types of cancer cells. The retinoids may be taken by mouth or put on the skin. See Drugs Approved for NonHodgkin Lymphoma for more information. (Mycosis fungoides and the Szary syndrome are types of nonHodgkin lymphoma.) Biologic therapy Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy. Interferon is a type of biologic therapy used to treat mycosis fungoides and the Szary syndrome. It interferes with the division of cancer cells and can slow tumor growth. See Drugs Approved for NonHodgkin Lymphoma for more information. (Mycosis fungoides and the Szary syndrome are types of nonHodgkin lymphoma.) Targeted therapy Targeted therapy is a treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Monoclonal antibody therapy and other types of targeted therapies are used to treat mycosis fungoides and the Szary syndrome. Alemtuzumab is a monoclonal antibody used to treat mycosis fungoides and the Szary syndrome. Monoclonal antibody therapy uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Other types of monoclonal antibody therapy are being studied in clinical trials to treat mycosis fungoides and the Szary syndrome. Vorinostat and romidepsin are two of the histone deacetylase (HDAC) inhibitors used to treat mycosis fungoides and the Szary syndrome. HDAC inhibitors cause a chemical change that stops tumor cells from dividing. Pralatrexate is a dihydrofolate reductase (DHFR) inhibitor used to treat mycosis fungoides and the Szary syndrome. It builds up in cancer cells and stops them from using folate, a nutrient needed for cells to divide. Pralatrexate may slow the growth of tumors and kill cancer cells. See Drugs Approved for NonHodgkin Lymphoma for more information. (Mycosis fungoides and the Szary syndrome are types of nonHodgkin lymphoma.) New types of treatment are being tested in clinical trials. This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website. Highdose chemotherapy and radiation therapy with stem cell transplant This treatment is a method of giving high doses of chemotherapy and radiation therapy and replacing bloodforming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the bone marrow or blood of the patient or a donor and are frozen and stored. After therapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells. Treatment for mycosis fungoides and the Szary syndrome may cause side effects. For information about side effects caused by treatment for cancer, see our Side Effects page. Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials. Followup tests may be needed. Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called followup tests or checkups. Treatment Options by Stage Stage I Mycosis Fungoides Treatment of stage I mycosis fungoides may include the following: PUVA therapy. Biologic therapy may also be given. Radiation therapy. In some cases, radiation therapy is given to skin lesions, as palliative therapy to reduce tumor size or relieve symptoms and improve quality of life. Topical corticosteroid therapy. Retinoid therapy. Topical or systemic chemotherapy. Biologic therapy. Topical chemotherapy may also be given. Targeted therapy. A clinical trial of a new treatment. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage I mycosis fungoides/Sezary syndrome. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website. Stage II Mycosis Fungoides Treatment of stage II mycosis fungoides is palliative (to relieve symptoms and improve the quality of life) and may include the following: PUVA therapy. Biologic therapy may also be given. Radiation therapy. Topical corticosteroid therapy. Retinoid therapy. Topical or systemic chemotherapy. Biologic therapy. Topical chemotherapy may also be given. Targeted therapy. A clinical trial of a new treatment. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage II mycosis fungoides/Sezary syndrome. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website. Stage III Mycosis Fungoides Treatment of stage III mycosis fungoides is palliative (to relieve symptoms and improve the quality of life) and may include the following: PUVA therapy. Systemic chemotherapy or biologic therapy may also be given. Extracorporeal photochemotherapy. Radiation therapy. Topical corticosteroid therapy. Retinoid therapy. Systemic chemotherapy with one or more drugs. Topical chemotherapy or radiation therapy may also be given. Topical chemotherapy. Biologic therapy. Topical chemotherapy may also be given. Targeted therapy. A clinical trial of a new treatment. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage III mycosis fungoides/Sezary syndrome. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website. Stage IV Mycosis Fungoides and the Szary Syndrome Treatment of stage IV mycosis fungoides and stage IV Szary syndrome is palliative (to relieve symptoms and improve the quality of life) and may include the following: PUVA therapy. Systemic chemotherapy or biologic therapy may also be given. Extracorporeal photochemotherapy. Radiation therapy may also be given. Radiation therapy. Topical corticosteroid therapy. Retinoid therapy. Systemic chemotherapy with one or more drugs, or topical chemotherapy. Biologic therapy. Topical chemotherapy may also be given. Targeted therapy. A clinical trial of a new treatment. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage IV mycosis fungoides/Sezary syndrome. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Childhood Soft Tissue Sarcoma ? [/INST] Childhood soft tissue sarcoma is a disease in which malignant (cancer) cells form in soft tissues of the body. Soft tissue sarcoma occurs in children and adults. Having certain diseases and inherited disorders can increase the risk of childhood soft tissue sarcoma. The most common sign of childhood soft tissue sarcoma is a painless lump or swelling in soft tissues of the body. Diagnostic tests are used to detect (find) and diagnose childhood soft tissue sarcoma. If tests show there may be a soft tissue sarcoma, a biopsy is done. There are many different types of soft tissue sarcomas. Fat tissue tumors Bone and cartilage tumors Fibrous (connective) tissue tumors Skeletal muscle tumors Smooth muscle tumors Socalled fibrohistiocytic tumors Peripheral nervous system tumors Pericytic (Perivascular) Tumors Tumors of unknown origin Blood vessel tumors Certain factors affect prognosis (chance of recovery) and treatment options. Childhood soft tissue sarcoma is a disease in which malignant (cancer) cells form in soft tissues of the body. Soft tissues of the body connect, support, and surround other body parts and organs. The soft tissues include the following: Fat. A mix of bone and cartilage. Fibrous tissue. Muscles. Nerves. Tendons (bands of tissue that connect muscles to bones). Synovial tissues (tissues around joints). Blood vessels. Lymph vessels. Soft tissue sarcoma may be found anywhere in the body. In children, the tumors form most often in the arms, legs, or trunk (chest and abdomen). Soft tissue sarcoma occurs in children and adults. Soft tissue sarcoma in children may respond differently to treatment, and may have a better prognosis than soft tissue sarcoma in adults. (See the PDQ summary on Adult Soft Tissue Sarcoma Treatment for information on treatment in adults.) There are many different types of soft tissue sarcomas. The cells of each type of sarcoma look different under a microscope. The soft tissue tumors are grouped based on the type of soft tissue cell where they first formed. This summary is about the following types of soft tissue sarcoma: Fat tissue tumors Liposarcoma . This is a rare cancer of the fat cells. Liposarcoma usually forms in the fat layer just under the skin. In children and adolescents, liposarcoma is often low grade (likely to grow and spread slowly). There are several different types of liposarcoma. Myxoid liposarcoma is usually low grade and responds well to treatment. The cells of myxoid liposarcoma have a certain genetic change called a translocation (part of one chromosome switches places with part of another chromosome). In order to diagnose myxoid liposarcoma, the tumor cells are checked for this genetic change. Pleomorphic liposarcoma is usually high grade (likely to grow and spread quickly) and is less likely to respond well to treatment. Bone and cartilage tumors Bone and cartilage tumors are a mix of bone cells and cartilage cells. Bone and cartilage tumors include the following types: Extraskeletal mesenchymal chondrosarcoma . This type of bone and cartilage tumor often affects young adults and occurs in the head and neck. Extraskeletal osteosarcoma . This type of bone and cartilage tumor is very rare in children and adolescents. It is likely to come back after treatment and may spread to the lungs. Fibrous (connective) tissue tumors Fibrous (connective) tissue tumors include the following types: Desmoidtype fibromatosis (also called desmoid tumor or aggressive fibromatosis). This fibrous tissue tumor is low grade (likely to grow slowly). It may come back in nearby tissues but usually does not spread to distant parts of the body. Rarely, the tumor may disappear without treatment. Desmoid tumors sometimes occur in children with changes in the adenomatous polyposis coli (APC) gene. Changes in this gene cause familial adenomatous polyposis (FAP). FAP is an inherited condition in which many polyps (growths on mucous membranes) form on the inside walls of the colon and rectum. Genetic counseling (a discussion with a trained professional about inherited diseases and a possible need for gene testing) may be needed. Dermatofibrosarcoma protuberans . This is a rare tumor of the deep layers of the skin found in children and adults. The cells of this tumor have a certain genetic change called a translocation (part of one chromosome switches places with part of another chromosome). In order to diagnose dermatofibrosarcoma protuberans, the tumor cells are checked for this genetic change. Fibrosarcoma . There are two types of fibrosarcoma in children and adolescents: Infantile fibrosarcoma (also called congenital fibrosarcoma). This type of fibrosarcoma is found in children aged 4 years and younger. It most often occurs in infants and may be seen in a prenatal ultrasound exam. This tumor is often large and fast growing, but rarely spreads to distant parts of the body. The cells of this tumor usually have a certain genetic change called a translocation (part of one chromosome switches places with part of another chromosome). In order to diagnose infantile fibrosarcoma, the tumor cells are checked for this genetic change. Adulttype fibrosarcoma. This is the same type of fibrosarcoma found in adults. The cells of this tumor do not have the genetic change found in infantile fibrosarcoma. See the PDQ summary on Adult Soft Tissue Sarcoma Treatment for more information. Inflammatory myofibroblastic tumor . This is a fibrous tissue tumor that occurs in children and adolescents. It is likely to come back after treatment but rarely spreads to distant parts of the body. A certain genetic change has been found in about half of these tumors. Lowgrade fibromyxoid sarcoma . This is a slowgrowing tumor that affects young and middleaged adults. The cells of this tumor usually have a certain genetic change called a translocation (part of one chromosome switches places with part of another chromosome). In order to diagnose lowgrade fibromyxoid sarcoma, the tumor cells are checked for this genetic change. The tumor may come back many years after treatment and spread to the lungs and the lining of the wall of the chest cavity. Lifelong followup is needed. Myxofibrosarcoma . This is a rare fibrous tissue tumor that is found less often in children than in adults. Sclerosing epithelioid fibrosarcoma . This is a rare fibrous tissue tumor that can come back and spread to other places years after treatment. Longterm followup is needed. Skeletal muscle tumors Skeletal muscle is attached to bones and helps the body move. Rhabdomyosarcoma . Rhabdomyosarcoma is the most common childhood soft tissue sarcoma in children 14 years and younger. See the PDQ summary on Childhood Rhabdomyosarcoma Treatment for more information. Smooth muscle tumors Smooth muscle lines the inside of blood vessels and hollow internal organs such as the stomach, intestines, bladder, and uterus. Leiomyosarcoma . This smooth muscle tumor has been linked with EpsteinBarr virus in children who also have HIV disease or AIDS. Leiomyosarcoma may also form as a second cancer in survivors of inherited retinoblastoma, sometimes many years after the initial treatment for retinoblastoma. Socalled fibrohistiocytic tumors Plexiform fibrohistiocytic tumor . This is a rare tumor that usually affects children and young adults. The tumor usually starts as a painless growth on or just under the skin on the arm, hand, or wrist. It may rarely spread to nearby lymph nodes or to the lungs. Peripheral nervous system tumors Peripheral nervous system tumors include the following types: Ectomesenchymoma . This is a rare, fastgrowing tumor of the nerve sheath (protective covering of nerves that are not part of the brain or spinal cord) that occurs mainly in children. Ectomesenchymomas may form in the head and neck, abdomen, perineum, scrotum, arms, or legs. Malignant peripheral nerve sheath tumor . This is a tumor that forms in the nerve sheath. Some children who have a malignant peripheral nerve sheath tumor have a rare genetic condition called neurofibromatosis type 1 (NF1). This tumor may be low grade or high grade. Malignant triton tumor . These are very rare, fastgrowing tumors that occur most often in children with NF1. Pericytic (Perivascular) Tumors Pericytic tumors form in cells that wrap around blood vessels. Pericytic tumors include the following types: Myopericytoma . Infantile hemangiopericytoma is a type of myopericytoma. Children younger than 1 year at the time of diagnosis may have a better prognosis. In patients older than 1 year, infantile hemangiopericytoma is more likely to spread to other parts of the body, including the lymph nodes and lungs. Infantile myofibromatosis . Infantile myofibromatosis is another type of myopericytoma. It is a fibrous tumor that often forms in the first 2 years of life. There may be one nodule under the skin, usually in the head and neck area (myofibroma), or nodules in several skin areas, muscle, and bone (myofibromatosis). These tumors may go away without treatment. Tumors of unknown origin Tumors of unknown origin (the place where the tumor first formed is not known) include the following types: Alveolar soft part sarcoma . This is a rare tumor of the soft supporting tissue that connects and surrounds the organs and other tissues. It is most commonly found in the limbs but can occur in the tissues of the mouth, jaws, and face. It may grow slowly and may have spread to other parts of the body at the time of diagnosis. Alveolar soft part sarcoma may have a better prognosis when the tumor is 5 centimeters or smaller or when the tumor is completely removed by surgery. The cells of this tumor usually have a certain genetic change called a translocation (part of one chromosome switches places with part of another chromosome). In order to diagnose alveolar soft part sarcoma, the tumor cells are checked for this genetic change. Clear cell sarcoma of soft tissue . This is a slowgrowing soft tissue tumor that begins in a tendon (tough, fibrous, cordlike tissue that connects muscle to bone or to another part of the body). Clear cell sarcoma most commonly occurs in deep tissue of the foot, heel, and ankle. It may spread to nearby lymph nodes. The cells of this tumor usually have a certain genetic change called a translocation (part of one chromosome switches places with part of another chromosome). In order to diagnose clear cell sarcoma of soft tissue, the tumor cells are checked for this genetic change. Desmoplastic small round cell tumor . This tumor most often forms in the abdomen, pelvis or tissues around the testes, but it may form in the kidney. Desmoplastic small round cell tumor may also spread to the lungs and other parts of the body. The cells of this tumor usually have a certain genetic change called a translocation (part of one chromosome switches places with part of another chromosome). In order to diagnose desmoplastic small round cell tumor, the tumor cells are checked for this genetic change. Epithelioid sarcoma . This is a rare sarcoma that usually starts deep in soft tissue as a slow growing, firm lump and may spread to the lymph nodes. Extrarenal (extracranial) rhabdoid tumor . This is a rare, fastgrowing tumor of soft tissues such as the liver and peritoneum. It usually occurs in young children, including newborns, but it can occur in older children and adults. Rhabdoid tumors may be linked to a change in a tumor suppressor gene called SMARCB1. This type of gene makes a protein that helps control cell growth. Changes in the SMARCB1 gene may be inherited (passed on from parents to offspring). Genetic counseling (a discussion with a trained professional about inherited diseases and a possible need for gene testing) may be needed. Extraskeletal myxoid chondrosarcoma . This is a rare soft tissue sarcoma that may be found in children and adolescents. Over time, it tends to spread to other parts of the body, including the lymph nodes and lungs. The cells of this tumor usually have a genetic change, often a translocation (part of one chromosome switches places with part of another chromosome). In order to diagnose extraskeletal myxoid chondrosarcoma, the tumor cells are checked for this genetic change. The tumor may come back many years after treatment. Perivascular epithelioid cell tumors (PEComas). Benign (not cancer) PEComas may be found in children with an inherited condition called tuberous sclerosis. They occur in the stomach, intestines, lungs, female reproductive organs, and genitourinary organs. Primitive neuroectodermal tumor (PNET)/extraskeletal Ewing tumor . See the PDQ summary on Ewing Sarcoma Treatment for information. Synovial sarcoma . Synovial sarcoma is a common type of soft tissue sarcoma in children and adolescents. Synovial sarcoma usually forms in the tissues around the joints in the arms or legs, but may also form in the trunk, head, or neck. The cells of this tumor usually have a certain genetic change called a translocation (part of one chromosome switches places with part of another chromosome). Larger tumors have a greater risk of spreading to other parts of the body, including the lungs. Children younger than 10 years and those whose tumor is 5 centimeters or smaller have a better prognosis. Undifferentiated /unclassified sarcoma . These tumors usually occur in the muscles that are attached to bones and that help the body move. Undifferentiated pleomorphic sarcoma /malignant fibrous histiocytoma (highgrade). This type of soft tissue tumor may form in parts of the body where patients have received radiation therapy in the past, or as a second cancer in children with retinoblastoma. The tumor is usually found on the arms or legs and may spread to other parts of the body. See the PDQ summary on Osteosarcoma and Malignant Fibrous Histiocytoma of Bone Treatment for information about malignant fibrous histiocytoma of bone. Blood vessel tumors Blood vessel tumors include the following types: Angiosarcoma of the soft tissue. Angiosarcoma of the soft tissue is a fastgrowing tumor that forms in blood vessels or lymph vessels in any part of the body. Most angiosarcomas are in or just under the skin. Those in deeper soft tissue can form in the liver, spleen, and lung. They are very rare in children, who sometimes have more than one tumor in the skin or liver. Rarely, infantile hemangioma may become angiosarcoma of the soft tissue. (See the PDQ summary on Childhood Vascular Tumors Treatment for more information.) Epithelioid hemangioendothelioma. Epithelioid hemangioendotheliomas can occur in children, but are most common in adults between 30 and 50 years of age. They usually occur in the liver, lung, or bone. They may be either fast growing or slow growing. In about a third of cases, the tumor spreads to other parts of the body very quickly. (See the PDQ summary on Childhood Vascular Tumors Treatment for more information.) See the following PDQ summaries for information about types of soft tissue sarcoma not included in this summary: Childhood Rhabdomyosarcoma Treatment. Ewing Sarcoma Treatment. Unusual Cancers of Childhood Treatment (gastrointestinal stromal tumors).</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Childhood Soft Tissue Sarcoma? ? [/INST] Having certain diseases and inherited disorders can increase the risk of childhood soft tissue sarcoma. Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesnt mean that you will not get cancer. Talk with your childs doctor if you think your child may be at risk. Risk factors for childhood soft tissue sarcoma include having the following inherited disorders: LiFraumeni syndrome. Familial adenomatous polyposis (FAP). Retinoblastoma 1 gene changes. Neurofibromatosis type 1 (NF1). Werner syndrome. Other risk factors include the following: Past treatment with radiation therapy. Having AIDS (acquired immune deficiency syndrome) and EpsteinBarr virus infection at the same time.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Childhood Soft Tissue Sarcoma ? [/INST] The most common sign of childhood soft tissue sarcoma is a painless lump or swelling in soft tissues of the body. A sarcoma may appear as a painless lump under the skin, often on an arm, a leg, or the trunk. There may be no other signs or symptoms at first. As the sarcoma gets bigger and presses on nearby organs, nerves, muscles, or blood vessels, it may cause signs or symptoms, such as pain or weakness. Other conditions may cause the same signs and symptoms. Check with your childs doctor if your child has any of these problems.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Childhood Soft Tissue Sarcoma ? [/INST] Diagnostic tests are used to detect (find) and diagnose childhood soft tissue sarcoma. The following tests and procedures may be used: Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patients health habits and past illnesses and treatments will also be taken. Xrays : An xray is a type of energy beam that can go through the body onto film, making pictures of areas inside the body. MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas of the body, such as the chest, abdomen, arms, or legs. This procedure is also called nuclear magnetic resonance imaging (NMRI). CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest or abdomen, taken from different angles. The pictures are made by a computer linked to an xray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. Ultrasound exam: A procedure in which highenergy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later. If tests show there may be a soft tissue sarcoma, a biopsy is done. One of the following types of biopsies is usually used: Core needle biopsy : The removal of tissue using a wide needle. This procedure may be guided using ultrasound, CT scan, or MRI. Incisional biopsy : The removal of part of a lump or a sample of tissue. Excisional biopsy : The removal of an entire lump or area of tissue that doesnt look normal. A pathologist views the tissue under a microscope to look for cancer cells. An excisional biopsy may be used to completely remove smaller tumors that are near the surface of the skin. This type of biopsy is rarely used because cancer cells may remain after the biopsy. If cancer cells remain, the cancer may come back or it may spread to other parts of the body. An MRI of the tumor is done before the excisional biopsy. This is done to show where the original tumor is and may be used to guide future surgery or radiation therapy. The placement of needles or incisions for the biopsy can affect the success of later surgery to remove the tumor. If possible, the surgeon who will remove any tumor that is found should be involved in planning the biopsy. In order to plan the best treatment, the sample of tissue removed during the biopsy must be large enough to find out the type of soft tissue sarcoma and do other laboratory tests. Tissue samples will be taken from the primary tumor, lymph nodes, and other areas that may have cancer cells. A pathologist views the tissue under a microscope to look for cancer cells and to find out the type and grade of the tumor. The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the cells are dividing. Highgrade and midgrade tumors usually grow and spread more quickly than lowgrade tumors. Because soft tissue sarcoma can be hard to diagnose, the tissue sample should be checked by a pathologist who has experience in diagnosing soft tissue sarcoma. One or more of the following laboratory tests may be done to study the tissue samples: Molecular test : A laboratory test to check for certain genes, proteins, or other molecules in a sample of tissue, blood, or other body fluid. A molecular test may be done with other procedures, such as biopsies, to help diagnose some types of cancer. Molecular tests check for certain gene or chromosome changes that occur in some soft tissue sarcomas. Reverse transcriptionpolymerase chain reaction (RTPCR) test: A laboratory test in which cells in a sample of tissue are studied using chemicals to look for changes in the expression of certain genes. When genes are expressed they make specific proteins that are needed for the structure, function, and monitoring of the bodys tissues and organs. This test is done in order to identify the type of tumor. Cytogenetic analysis : A laboratory test in which cells in a sample of bone marrow, blood, amniotic fluid, tumor or other tissue is viewed under a microscope to look for changes in the chromosomes. Fluorescence in situ hybridization (FISH) is a type of cytogenetic analysis. Immunocytochemistry : A test that uses antibodies to check for certain antigens (markers) in a sample of cells. The antibody is usually linked to an enzyme or fluorescent dye that causes the cells that have that marker to become visible under a microscope. This type of test may be used to tell the difference between different types of soft tissue sarcoma.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is the outlook for Childhood Soft Tissue Sarcoma ? [/INST] Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) and treatment options depend on the following: The part of the body where the tumor first formed. The size and grade of the tumor. The type of soft tissue sarcoma. How deep the tumor is under the skin. Whether the tumor has spread to other places in the body. The amount of tumor remaining after surgery to remove it. Whether radiation therapy was used to treat the tumor. The age and gender of the patient. Whether the cancer has just been diagnosed or has recurred (come back).</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the stages of Childhood Soft Tissue Sarcoma ? [/INST] After childhood soft tissue sarcoma has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body. There are three ways that cancer spreads in the body. Cancer may spread from where it began to other parts of the body. After childhood soft tissue sarcoma has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body. The process used to find out if cancer has spread within the soft tissue or to other parts of the body is called staging. There is no standard staging system for childhood soft tissue sarcoma. In order to plan treatment, it is important to know the type of soft tissue sarcoma, whether the tumor can be removed by surgery, and whether cancer has spread to other parts of the body. The following procedures may be used to find out if cancer has spread: Sentinel lymph node biopsy: A sentinel lymph node biopsy is done to check if cancer has spread to the lymph nodes. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. It is the first lymph node the cancer is likely to spread to from the tumor. A small amount of a radioactive substance and/or blue dye is injected near the tumor. The radioactive substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes. This procedure is used for epithelioid and clear cell sarcoma. PET scan: A PET scan is a procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. This procedure is also called positron emission tomography (PET) scan. PETCT scan: A procedure that combines the pictures from a PET scan and a computed tomography (CT) scan. The PET and CT scans are done at the same time on the same machine. The pictures from both scans are combined to make a more detailed picture than either test would make by itself. There are three ways that cancer spreads in the body. Cancer can spread through tissue, the lymph system, and the blood: Tissue. The cancer spreads from where it began by growing into nearby areas. Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body. Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body. Cancer may spread from where it began to other parts of the body. When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood. Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body. Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body. The metastatic tumor is the same type of cancer as the primary tumor. For example, if soft tissue sarcoma spreads to the lung, the cancer cells in the lung are soft tissue sarcoma cells. The disease is metastatic soft tissue sarcoma, not lung cancer.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Childhood Soft Tissue Sarcoma ? [/INST] New types of treatment are being tested in clinical trials. This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website. Gene therapy Gene therapy is being studied for childhood synovial sarcoma that has recurred, spread, or cannot be removed by surgery. Some of the patient's T cells (a type of white blood cell) are removed and the genes in the cells are changed in a laboratory (genetically engineered) so that they will attack specific cancer cells. They are then given back to the patient by infusion. Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Childhood Soft Tissue Sarcoma ? [/INST] There are different types of treatment for patients with childhood soft tissue sarcoma. Children with childhood soft tissue sarcoma should have their treatment planned by a team of health care providers who are experts in treating cancer in children. Treatment for childhood soft tissue sarcoma may cause side effects. Eight types of standard treatment are used: Surgery Radiation therapy Chemotherapy Observation Hormone therapy Nonsteroidal antiinflammatory drugs Targeted therapy Immunotherapy New types of treatment are being tested in clinical trials. Gene therapy Patients may want to think about taking part in a clinical trial. Patients can enter clinical trials before, during, or after starting their cancer treatment. Followup tests may be needed. There are different types of treatment for patients with childhood soft tissue sarcoma. Different types of treatments are available for patients with childhood soft tissue sarcoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment. Children with childhood soft tissue sarcoma should have their treatment planned by a team of health care providers who are experts in treating cancer in children. Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other health care providers who are experts in treating children with soft tissue sarcoma and who specialize in certain areas of medicine. These may include a pediatric surgeon with special training in the removal of soft tissue sarcomas. The following specialists may also be included: Pediatrician. Radiation oncologist. Pediatric hematologist. Pediatric nurse specialist. Rehabilitation specialist. Psychologist. Social worker. Childlife specialist. Treatment for childhood soft tissue sarcoma may cause side effects. For information about side effects that begin during treatment for cancer, see our Side Effects page. Side effects from cancer treatment that begin after treatment and continue for months or years are called late effects. Late effects of cancer treatment may include: Physical problems. Changes in mood, feelings, thinking, learning, or memory. Second cancers (new types of cancer). Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information.) Eight types of standard treatment are used: Surgery Surgery to completely remove the soft tissue sarcoma is done when possible. If the tumor is very large, radiation therapy or chemotherapy may be given first, to make the tumor smaller and decrease the amount of tissue that needs to be removed during surgery. This is called neoadjuvant therapy. The following types of surgery may be used: Wide local excision: Removal of the tumor along with some normal tissue around it. Amputation: Surgery to remove all or part of the limb or appendage with cancer, such as the arm or hand. Lymphadenectomy: Removal of the lymph nodes with cancer. Mohs surgery: A surgical procedure used to treat cancer in the skin. Individual layers of cancer tissue are removed and checked under a microscope one at a time until all cancer tissue has been removed. This type of surgery is used to treat dermatofibrosarcoma protuberans. It is also called Mohs micrographic surgery. Hepatectomy: Surgery to remove all or part of the liver. A second surgery may be needed to: Remove any remaining cancer cells. Check the area around where the tumor was removed for cancer cells and then remove more tissue if needed. If cancer is in the liver, a hepatectomy and liver transplant may be done (the liver is removed and replaced with a healthy one from a donor). Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy or chemotherapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy. Radiation therapy Radiation therapy is a cancer treatment that uses highenergy xrays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy: External radiation therapy uses a machine outside the body to send radiation toward the cancer. Certain ways of giving radiation therapy can help keep radiation from damaging nearby healthy tissue. This type of radiation therapy may include the following: Stereotactic body radiation therapy: Stereotactic body radiation therapy is a type of external radiation therapy. Special equipment is used to place the patient in the same position for each radiation treatment. Once a day for several days, a radiation machine aims a larger than usual dose of radiation directly at the tumor. By having the patient in the same position for each treatment, there is less damage to nearby healthy tissue. This procedure is also called stereotactic externalbeam radiation therapy and stereotaxic radiation therapy. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated and whether the tumor was completely removed by surgery. External and internal radiation therapy are used to treat childhood soft tissue sarcoma. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is the use of more than one anticancer drug. The way the chemotherapy is given depends on the type of cancer being treated. Most types of soft tissue sarcoma do not respond to treatment with chemotherapy. See Drugs Approved for Soft Tissue Sarcoma for more information. Observation Observation is closely monitoring a patients condition without giving any treatment until signs or symptoms appear or change. Observation may be done when: Complete removal of the tumor is not possible. No other treatments are available. The tumor is not likely to damage any vital organs. Hormone therapy Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances made by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy is used to reduce the production of hormones or block them from working. Antiestrogens (drugs that block estrogen), such as tamoxifen, may be used to treat desmoidtype fibromatosis. Nonsteroidal antiinflammatory drugs Nonsteroidal antiinflammatory drugs (NSAIDs) are drugs (such as aspirin, ibuprofen, and naproxen) that are commonly used to decrease fever, swelling, pain, and redness. In the treatment of desmoidtype fibromatosis, an NSAID called sulindac may be used to help block the growth of cancer cells. Targeted therapy Targeted therapy is a type of treatment that uses drugs or other substances to attack cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation do. Kinase inhibitors are a type of targeted therapy that block an enzyme called kinase (a type of protein). There are different types of kinases in the body that have different actions. ALK inhibitors may stop the cancer from growing and spreading: Crizotinib may be used to treat inflammatory myofibroblastic tumor. Tyrosine kinase inhibitors (TKIs) block signals needed for tumors to grow: Imatinib is used to treat dermatofibrosarcoma protuberans. Pazopanib may be used to treat recurrent and progressive soft tissue sarcoma. It is being studied for many types of newly diagnosed soft tissue sarcoma. Sorafenib may be used to treat desmoidtype fibromatosis. New types of tyrosine kinase inhibitors are being studied such as LOXO101 and entrectinib for infantile fibrosarcoma. Other types of targeted therapy are being studied in clinical trials, including the following: mTOR inhibitors are a type of targeted therapy that stops the protein that helps cells divide and survive. mTOR inhibitors are being studied to treat perivascular epithelioid cell tumors (PEComas) and epithelioid hemangioendothelioma. Sirolimus is a type of mTOR inhibitor therapy. Angiogenesis inhibitors are a type of targeted therapy that prevent the growth of new blood vessels needed for tumors to grow. Angiogenesis inhibitors, such as cediranib, sunitinib, and thalidomide are being studied to treat alveolar soft part sarcoma and epithelioid hemangioendothelioma. Bevacizumab is being studied for blood vessel tumors. Histone methyltransferase (HMT) inhibitors are targeted therapy drugs that work inside cancer cells and block signals needed for tumors to grow. HMT inhibitors are being studied for the treatment of epithelioid sarcoma, malignant peripheral nerve sheath tumor, extrarenal (extracranial) rhabdoid tumor, extraskeletal myxoid chondrosarcoma, and synovial sarcoma. Heatshock protein inhibitors block certain proteins that protect tumor cells and help them grow. Ganetespib is a heat shock protein inhibitor being studied in combination with the mTOR inhibitor sirolimus for malignant peripheral nerve sheath tumors that cannot be removed by surgery. Antibodydrug conjugates are made up of a monoclonal antibody attached to a drug. The monoclonal antibody binds to specific proteins or receptors found on certain cells, including cancer cells. The drug enters these cells and kills them without harming other cells. Lorvotuzumab mertansine is an antibodydrug conjugate being studied for the treatment of rhabdomyosarcoma, malignant peripheral nerve sheath tumor, and synovial sarcoma. See Drugs Approved for Soft Tissue Sarcoma for more information. Immunotherapy Immunotherapy is a treatment that uses the patients immune system to fight disease. Substances made by the body or made in a laboratory are used to boost, direct, or restore the bodys natural defenses against disease. Interferon is a type of immunotherapy used to treat epithelioid hemangioendothelioma. It interferes with the division of tumor cells and can slow tumor growth. Followup tests may be needed. Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the cancer has recurred (come back). These tests are sometimes called followup tests or checkups. Treatment Options for Childhood Soft Tissue Sarcoma Newly Diagnosed Childhood Soft Tissue Sarcoma Fat Tissue Tumors Liposarcoma Treatment of liposarcoma may include the following: Surgery to completely remove the tumor. If the cancer is not completely removed, a second surgery may be done. Chemotherapy to shrink the tumor, followed by surgery. Radiation therapy before or after surgery. A clinical trial of targeted therapy, radiation therapy, and surgery with or without chemotherapy. Bone and Cartilage Tumors Extraskeletal mesenchymal chondrosarcoma Treatment of extraskeletal mesenchymal chondrosarcoma may include the following: Surgery to completely remove the tumor. Radiation therapy may be given before and/or after surgery. Chemotherapy followed by surgery. Chemotherapy with or without radiation therapy is given after surgery. A clinical trial of targeted therapy, radiation therapy, and surgery with or without chemotherapy. Extraskeletal osteosarcoma Treatment of extraskeletal osteosarcoma may include the following: Surgery to completely remove the tumor, followed by chemotherapy. A clinical trial of targeted therapy, radiation therapy, and surgery with or without chemotherapy. See the PDQ summary on Osteosarcoma and Malignant Fibrous Histiocytoma of Bone Treatment for more information. Fibrous (Connective) Tissue Tumors Desmoidtype fibromatosis Treatment of desmoidtype fibromatosis may include the following: Surgery to completely remove the tumor. Treatment before surgery may include the following: Observation. Chemotherapy. Radiation therapy. Antiestrogen drug therapy. Nonsteroidal antiinflammatory drug (NSAID) therapy. If the tumor is not completely removed by surgery, treatment may include the following: Observation, if other treatment options are not possible. Radiation therapy. Radiation therapy or chemotherapy for tumors that cannot be removed by surgery. A clinical trial of targeted therapy. A clinical trial of targeted therapy, radiation therapy, and surgery with or without chemotherapy. Treatment of desmoidtype fibromatosis that has come back may include the following: Observation and possibly surgery at a later time. Chemotherapy. Dermatofibrosarcoma protuberans Treatment of dermatofibrosarcoma protuberans may include the following: Surgery to completely remove the tumor when possible. This may include Mohs surgery. Radiation therapy before or after surgery. Targeted therapy (imatinib) if the tumor cannot be removed or has come back. A clinical trial of targeted therapy, radiation therapy, and surgery with or without chemotherapy. Fibrosarcoma Infantile fibrosarcoma Treatment of infantile fibrosarcoma may include the following: Surgery to remove the tumor when possible, followed by observation. Surgery followed by chemotherapy. Chemotherapy to shrink the tumor, followed by surgery. A clinical trial of targeted therapy, radiation therapy, and surgery with or without chemotherapy. A clinical trial of targeted therapy (tyrosine kinase inhibitor). Adulttype fibrosarcoma Treatment of adulttype fibrosarcoma may include the following: Surgery to completely remove the tumor when possible. Inflammatory myofibroblastic tumor Treatment of inflammatory myofibroblastic tumor may include the following: Surgery to completely remove the tumor when possible. Chemotherapy. Steroid therapy. Nonsteroidal antiinflammatory drug (NSAID) therapy. Targeted therapy (ALK inhibitors). A clinical trial of targeted therapy, radiation therapy, and surgery with or without chemotherapy. Lowgrade fibromyxoid sarcoma Treatment of lowgrade fibromyxoid sarcoma may include the following: Surgery to completely remove the tumor. A clinical trial of targeted therapy, radiation therapy, and surgery with or without chemotherapy. Myxofibrosarcoma Treatment of myxofibrosarcoma may include the following: Surgery to completely remove the tumor. A clinical trial of targeted therapy, radiation therapy, and surgery with or without chemotherapy. Sclerosing epithelioid fibrosarcoma Treatment of sclerosing epithelioid fibrosarcoma may include the following: Surgery to completely remove the tumor. A clinical trial of targeted therapy, radiation therapy, and surgery with or without chemotherapy. Skeletal Muscle Tumors Rhabdomyosarcoma See the PDQ summary on Childhood Rhabdomyosarcoma Treatment. Smooth Muscle Tumors Leiomyosarcoma Treatment of leiomyosarcoma may include the following: Chemotherapy. A clinical trial of targeted therapy, radiation therapy, and surgery with or without chemotherapy. Socalled Fibrohistiocytic Tumors Plexiform fibrohistiocytic tumor Treatment of plexiform fibrohistiocytic tumor may include the following: Surgery to completely remove the tumor. A clinical trial of targeted therapy, radiation therapy, and surgery with or without chemotherapy. Peripheral Nervous System Tumors Ectomesenchymoma Treatment of ectomesenchymoma may include the following: Surgery and chemotherapy. Radiation therapy. Malignant peripheral nerve sheath tumor Treatment of malignant peripheral nerve sheath tumor may include the following: Surgery to completely remove the tumor when possible. Radiation therapy before or after surgery. Chemotherapy, for tumors that cannot be removed by surgery. A clinical trial of targeted therapy, radiation therapy, and surgery with or without chemotherapy. A clinical trial of targeted therapy, for tumors that cannot be removed by surgery. A clinical trial of targeted therapy (histone methyltransferase inhibitor). A clinical trial of an antibodydrug conjugate. It is not clear whether giving radiation therapy or chemotherapy after surgery improves the tumor's response to treatment. Malignant triton tumor Malignant triton tumors may be treated the same as rhabdomyosarcomas and include surgery, chemotherapy, or radiation therapy. A regimen of targeted therapy, radiation therapy, and surgery with or without chemotherapy is being studied. Pericytic (Perivascular) Tumors Infantile hemangiopericytoma Treatment of infantile hemangiopericytoma may include the following: Chemotherapy. Infantile myofibromatosis Treatment of infantile myofibromatosis may include the following: Combination chemotherapy. Tumors of Unknown Origin (the place where the tumor first formed is not known) Alveolar soft part sarcoma Treatment of alveolar soft part sarcoma may include the following: Surgery to completely remove the tumor when possible. Radiation therapy before or after surgery, if the tumor cannot be completely removed by surgery. Targeted therapy (angiogenesis inhibitor). A clinical trial of targeted therapy (angiogenesis inhibitor) for children. A clinical trial of targeted therapy, radiation therapy, and surgery with or without chemotherapy. Clear cell sarcoma of soft tissue Treatment of clear cell sarcoma of soft tissue may include the following: Surgery to remove the tumor when possible. Radiation therapy before or after surgery. A clinical trial of targeted therapy, radiation therapy, and surgery with or without chemotherapy. Desmoplastic small round cell tumor There is no standard treatment for desmoplastic small round cell tumor. Treatment may include the following: Surgery to completely remove the tumor when possible. Chemotherapy followed by surgery. Radiation therapy. Epithelioid sarcoma Treatment of epithelioid sarcoma may include the following: Surgery to remove the tumor when possible. Chemotherapy before or after surgery. Radiation therapy before or after surgery. A clinical trial of targeted therapy (histone methyltransferase inhibitor). Extrarenal (extracranial) rhabdoid tumor Treatment of extrarenal (extracranial) rhabdoid tumor may include the following: A combination of surgery to remove the tumor when possible, chemotherapy, and radiation therapy. A clinical trial of targeted therapy (histone methyltransferase inhibitor). Extraskeletal myxoid chondrosarcoma Treatment of extraskeletal myxoid chondrosarcoma may include the following: Surgery to remove the tumor when possible. Radiation therapy. A clinical trial of targeted therapy, radiation therapy, and surgery with or without chemotherapy. A clinical trial of targeted therapy (histone methyltransferase inhibitor). Perivascular epithelioid cell tumors (PEComas) Treatment of perivascular epithelioid cell tumors may include the following: Surgery to remove the tumor. Observation followed by surgery. Targeted therapy (mTOR inhibitor), for tumors that have certain gene changes and cannot be removed by surgery. A clinical trial of targeted therapy, radiation therapy, and surgery with or without chemotherapy. Primitive neuroectodermal tumor (PNET)/extraskeletal Ewing tumor See the PDQ summary on Ewing Sarcoma Treatment. Synovial sarcoma Treatment of synovial sarcoma may include the following: Chemotherapy. Surgery. Radiation therapy and/or chemotherapy may be given before or after surgery. A clinical trial of gene therapy. A clinical trial of targeted therapy, radiation therapy, and surgery with or without chemotherapy. A clinical trial of targeted therapy (histone methyltransferase inhibitor). A clinical trial of an antibodydrug conjugate. Undifferentiated/unclassified sarcoma These tumors include undifferentiated pleomorphic sarcoma /malignant fibrous histiocytoma (highgrade). There is no standard treatment for these tumors. Treatment may include the following: A clinical trial of targeted therapy, radiation therapy, and surgery with or without chemotherapy. See the PDQ summary on Osteosarcoma and Malignant Fibrous Histiocytoma of Bone Treatment for information about the treatment of malignant fibrous histiocytoma of bone. Blood Vessel Tumors Angiosarcoma of soft tissue Treatment of angiosarcoma may include the following: Surgery to completely remove the tumor. A combination of surgery, chemotherapy, and radiation therapy for angiosarcomas that have spread. Targeted therapy (bevacizumab) and chemotherapy for angiosarcomas that began as infantile hemangiomas. A clinical trial of targeted therapy, radiation therapy, and surgery with or without chemotherapy. Epithelioid hemangioendothelioma Treatment of epithelioid hemangioendothelioma may include the following: Surgery to remove the tumor when possible. Immunotherapy (interferon) and targeted therapy (thalidomide, sorafenib, pazopanib, sirolimus) for tumors that are likely to spread. Chemotherapy. Total hepatectomy and liver transplant when the tumor is in the liver. Metastatic Childhood Soft Tissue Sarcoma Treatment of childhood soft tissue sarcoma that has spread to other parts of the body at diagnosis may include the following: Chemotherapy and radiation therapy. Surgery may be done to remove tumors that have spread to the lung. Stereotactic body radiation therapy for tumors that have spread to the lung. For treatment of specific tumor types, see the Treatment Options for Childhood Soft Tissue Sarcoma section. Check the list of NCIsupported cancer clinical trials that are now accepting patients with nonmetastatic childhood soft tissue sarcoma and metastatic childhood soft tissue sarcoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website. Recurrent and Progressive Childhood Soft Tissue Sarcoma Treatment of recurrent or progressive childhood soft tissue sarcoma may include the following: Surgery to remove cancer that has come back where it first formed or that has spread to the lung. Surgery followed by external or internal radiation therapy, if radiation therapy has not already been given. Surgery to remove the arm or leg with cancer, if radiation therapy was already given. Chemotherapy. Targeted therapy (tyrosine kinase inhibitor). A clinical trial of a new chemotherapy regimen. Check the list of NCIsupported cancer clinical trials that are now accepting patients with recurrent childhood soft tissue sarcoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Childhood Acute Myeloid Leukemia and Other Myeloid Malignancies ? [/INST] Childhood acute myeloid leukemia (AML) is a type of cancer in which the bone marrow makes a large number of abnormal blood cells. Leukemia and other diseases of the blood and bone marrow may affect red blood cells, white blood cells, and platelets. Other myeloid diseases can affect the blood and bone marrow. Chronic myelogenous leukemia Juvenile myelomonocytic leukemia Myelodysplastic syndromes AML or MDS may occur after treatment with certain anticancer drugs and/or radiation therapy. The risk factors for childhood AML, childhood CML, JMML, and MDS are similar. Signs and symptoms of childhood AML, childhood CML, JMML, or MDS include fever, feeling tired, and easy bleeding or bruising. Tests that examine the blood and bone marrow are used to detect (find) and diagnose childhood AML, childhood CML, JMML, and MDS. Certain factors affect prognosis (chance of recovery) and treatment options. Childhood acute myeloid leukemia (AML) is a type of cancer in which the bone marrow makes a large number of abnormal blood cells. Childhood acute myeloid leukemia (AML) is a cancer of the blood and bone marrow. AML is also called acute myelogenous leukemia, acute myeloblastic leukemia, acute granulocytic leukemia, and acute nonlymphocytic leukemia. Cancers that are acute usually get worse quickly if they are not treated. Cancers that are chronic usually get worse slowly. Leukemia and other diseases of the blood and bone marrow may affect red blood cells, white blood cells, and platelets. Normally, the bone marrow makes blood stem cells (immature cells) that become mature blood cells over time. A blood stem cell may become a myeloid stem cell or a lymphoid stem cell. A lymphoid stem cell becomes a white blood cell. A myeloid stem cell becomes one of three types of mature blood cells: Red blood cells that carry oxygen and other substances to all tissues of the body. White blood cells that fight infection and disease. Platelets that form blood clots to stop bleeding. In AML, the myeloid stem cells usually become a type of immature white blood cell called myeloblasts (or myeloid blasts). The myeloblasts, or leukemia cells, in AML are abnormal and do not become healthy white blood cells. The leukemia cells can build up in the blood and bone marrow so there is less room for healthy white blood cells, red blood cells, and platelets. When this happens, infection, anemia, or easy bleeding may occur. The leukemia cells can spread outside the blood to other parts of the body, including the central nervous system (brain and spinal cord), skin, and gums. Sometimes leukemia cells form a solid tumor called a granulocytic sarcoma or chloroma. There are subtypes of AML based on the type of blood cell that is affected. The treatment of AML is different when it is a subtype called acute promyelocytic leukemia (APL) or when the child has Down syndrome. Other myeloid diseases can affect the blood and bone marrow. Chronic myelogenous leukemia In chronic myelogenous leukemia (CML), too many bone marrow stem cells become a type of white blood cell called granulocytes. Some of these bone marrow stem cells never become mature white blood cells. These are called blasts. Over time, the granulocytes and blasts crowd out the red blood cells and platelets in the bone marrow. CML is rare in children. Juvenile myelomonocytic leukemia Juvenile myelomonocytic leukemia (JMML) is a rare childhood cancer that occurs more often in children around the age of 2 years and is more common in boys. In JMML, too many bone marrow stem cells become 2 types of white blood cells called myelocytes and monocytes. Some of these bone marrow stem cells never become mature white blood cells. These immature cells, called blasts, are unable to do their usual work. Over time, the myelocytes, monocytes, and blasts crowd out the red blood cells and platelets in the bone marrow. When this happens, infection, anemia, or easy bleeding may occur. Myelodysplastic syndromes Myelodysplastic syndromes (MDS) occur less often in children than in adults. In MDS, the bone marrow makes too few red blood cells, white blood cells, and platelets. These blood cells may not mature and enter the blood. The treatment for MDS depends on how low the numbers of red blood cells, white blood cells, or platelets are. Over time, MDS may become AML. Transient myeloproliferative disorder (TMD) is a type of MDS. This disorder of the bone marrow can develop in newborns who have Down syndrome. It usually goes away on its own within the first 3 weeks of life. Infants who have Down syndrome and TMD have an increased chance of developing AML before the age of 3 years. This summary is about childhood AML, childhood CML, JMML, and MDS. See the following PDQ summaries for more information about other types of leukemia and diseases of the blood and bone marrow in children and adults: Childhood Acute Lymphoblastic Leukemia Treatment Adult Acute Myeloid Leukemia Treatment Adult Acute Lymphoblastic Leukemia Treatment Chronic Myelogenous Leukemia Treatment Chronic Lymphocytic Leukemia Treatment Hairy Cell Leukemia Treatment Myelodysplastic Syndromes Treatment Myelodysplastic/Myeloproliferative Neoplasms Treatment AML or MDS may occur after treatment with certain anticancer drugs and/or radiation therapy. Cancer treatment with certain anticancer drugs and/or radiation therapy may cause therapy related AML (tAML) or therapyrelated MDS (tMDS). The risk of these therapyrelated myeloid diseases depends on the total dose of the anticancer drugs used and the radiation dose and treatment field. Some patients also have an inherited risk for tAML and tMDS. These therapyrelated diseases usually occur within 7 years after treatment, but are rare in children.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Childhood Acute Myeloid Leukemia and Other Myeloid Malignancies? ? [/INST] The risk factors for childhood AML, childhood CML, JMML, and MDS are similar. Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesnt mean that you will not get cancer. Talk with your childs doctor if you think your child may be at risk. These and other factors may increase the risk of childhood AML, childhood CML, JMML, and MDS: Having a brother or sister, especially a twin, with leukemia. Being Hispanic. Being exposed to cigarette smoke or alcohol before birth. Having a personal history of aplastic anemia. Having a personal or family history of MDS. Having a family history of AML. Past treatment with chemotherapy or radiation therapy. Being exposed to ionizing radiation or chemicals such as benzene. Having certain genetic disorders, such as: Down syndrome. Fanconi anemia. Neurofibromatosis type 1. Noonan syndrome. ShwachmanDiamond syndrome.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Childhood Acute Myeloid Leukemia and Other Myeloid Malignancies ? [/INST] Signs and symptoms of childhood AML, childhood CML, JMML, or MDS include fever, feeling tired, and easy bleeding or bruising. These and other signs and symptoms may be caused by childhood AML, childhood CML, JMML, or MDS or by other conditions. Check with a doctor if your child has any of the following: Fever with or without an infection. Night sweats. Shortness of breath. Weakness or feeling tired. Easy bruising or bleeding. Petechiae (flat, pinpoint spots under the skin caused by bleeding). Pain in the bones or joints. Pain or feeling of fullness below the ribs. Painless lumps in the neck, underarm, stomach, groin, or other parts of the body. In childhood AML, these lumps, called leukemia cutis, may be blue or purple. Painless lumps that are sometimes around the eyes. These lumps, called chloromas, are sometimes seen in childhood AML and may be bluegreen. An eczema like skin rash. The signs and symptoms of TMD may include the following: Swelling all over the body. Shortness of breath. Trouble breathing. Weakness or feeling tired. Pain below the ribs.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Childhood Acute Myeloid Leukemia and Other Myeloid Malignancies ? [/INST] Tests that examine the blood and bone marrow are used to detect (find) and diagnose childhood AML, childhood CML, JMML, and MDS. The following tests and procedures may be used: Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patients health habits and past illnesses and treatments will also be taken. Complete blood count (CBC) with differential: A procedure in which a sample of blood is drawn and checked for the following: The number of red blood cells and platelets. The number and type of white blood cells. The amount of hemoglobin (the protein that carries oxygen) in the red blood cells. The portion of the blood sample made up of red blood cells. Peripheral blood smear : A procedure in which a sample of blood is checked for blast cells, the number and kinds of white blood cells, number of platelets, and changes in the shape of the blood cells. Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease. Chest xray : An xray of the organs and bones inside the chest. An xray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. Biopsy : The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. Biopsies that may be done include the following: Bone marrow aspiration and biopsy : The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. Tumor biopsy: A biopsy of a chloroma may be done. Lymph node biopsy: The removal of all or part of a lymph node. Cytogenetic analysis : A laboratory test in which cells in a sample of blood or bone marrow are viewed under a microscope to look for certain changes in the chromosomes. Changes in the chromosomes may include when part of one chromosome is switched with part of another chromosome, part of one chromosome is missing or repeated, or part of one chromosome is turned upside down. The following test is a type of cytogenetic analysis: FISH (fluorescence in situ hybridization): A laboratory technique used to look at genes or chromosomes in cells and tissues. Pieces of DNA that contain a fluorescent dye are made in the laboratory and added to cells or tissues on a glass slide. When these pieces of DNA bind to specific genes or areas of chromosomes on the slide, they light up when viewed under a microscope with a special light. Reverse transcriptionpolymerase chain reaction (RTPCR) test: A laboratory test in which cells in a sample of tissue are studied using chemicals to look for certain changes in the structure or function of genes. Immunophenotyping : A process used to identify cells, based on the types of antigens or markers on the surface of the cell, that may include special staining of the blood and bone marrow cells. This process is used to diagnose the subtype of AML by comparing the cancer cells to normal cells of the immune system. Molecular testing : A laboratory test to check for certain genes, proteins, or other molecules in a sample of blood or bone marrow. Molecular tests also check for certain changes in a gene or chromosome that may cause or affect the chance of developing AML. A molecular test may be used to help plan treatment, find out how well treatment is working, or make a prognosis. Lumbar puncture : A procedure used to collect a sample of cerebrospinal fluid (CSF) from the spinal column. This is done by placing a needle between two bones in the spine and into the CSF around the spinal cord and removing a sample of the fluid. The sample of CSF is checked under a microscope for signs that leukemia cells have spread to the brain and spinal cord. This procedure is also called an LP or spinal tap.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is the outlook for Childhood Acute Myeloid Leukemia and Other Myeloid Malignancies ? [/INST] Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) and treatment options for childhood AML depend on the following: The age of the child when the cancer is diagnosed. The race or ethnic group of the child. Whether the child is greatly overweight. Number of white blood cells in the blood at diagnosis. Whether the AML occurred after previous cancer treatment. The subtype of AML. Whether there are certain chromosome or gene changes in the leukemia cells. Whether the child has Down syndrome. Most children with AML and Down syndrome can be cured of their leukemia. Whether the leukemia is in the central nervous system (brain and spinal cord). How quickly the leukemia responds to treatment. Whether the AML is newly diagnosed (untreated) or has recurred (come back) after being treated. The length of time since treatment ended, for AML that has recurred. The prognosis and treatment options for childhood CML depend on how long it has been since the patient was diagnosed and how many blast cells are in the blood. The prognosis (chance of recovery) and treatment options for JMML depend on the following: The age of the child when the cancer is diagnosed. The type of gene affected and the number of genes that have changes. How many red blood cells, white blood cells, or platelets are in the blood. Whether the JMML is newly diagnosed (untreated) or has recurred after treatment. The prognosis (chance of recovery) and treatment options for MDS depend on the following: Whether the MDS was caused by previous cancer treatment. How low the numbers of red blood cells, white blood cells, or platelets are. Whether the MDS is newly diagnosed (untreated) or has recurred after treatment.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the stages of Childhood Acute Myeloid Leukemia and Other Myeloid Malignancies ? [/INST] Once childhood acute myeloid leukemia (AML) has been diagnosed, tests are done to find out if the cancer has spread to other parts of the body. There is no standard staging system for childhood AML, childhood chronic myelogenous leukemia (CML), juvenile myelomonocytic leukemia (JMML), or myelodysplastic syndromes (MDS). Once childhood acute myeloid leukemia (AML) has been diagnosed, tests are done to find out if the cancer has spread to other parts of the body. The following tests and procedures may be used to determine if the leukemia has spread: Lumbar puncture : A procedure used to collect a sample of cerebrospinal fluid (CSF) from the spinal column. This is done by placing a needle between two bones in the spine and into the CSF around the spinal cord and removing a sample of the fluid. The sample of CSF is checked under a microscope for signs that leukemia cells have spread to the brain and spinal cord. This procedure is also called an LP or spinal tap. Biopsy of the testicles, ovaries, or skin: The removal of cells or tissues from the testicles, ovaries, or skin so they can be viewed under a microscope to check for signs of cancer. This is done only if something unusual about the testicles, ovaries, or skin is found during the physical exam. There is no standard staging system for childhood AML, childhood chronic myelogenous leukemia (CML), juvenile myelomonocytic leukemia (JMML), or myelodysplastic syndromes (MDS). The extent or spread of cancer is usually described as stages. Instead of stages, treatment of childhood AML, childhood CML, JMML, and MDS is based on one or more of the following: The type of disease or the subtype of AML. Whether leukemia has spread outside the blood and bone marrow. Whether the disease is newly diagnosed, in remission, or recurrent. Newly diagnosed childhood AML Newly diagnosed childhood AML has not been treated except to relieve signs and symptoms such as fever, bleeding, or pain, and one of the following is true: More than 20% of the cells in the bone marrow are blasts (leukemia cells). or Less than 20% of the cells in the bone marrow are blasts and there is a specific change in the chromosome. Childhood AML in remission In childhood AML in remission, the disease has been treated and the following are true: The complete blood count is almost normal. Less than 5% of the cells in the bone marrow are blasts (leukemia cells). There are no signs or symptoms of leukemia in the brain, spinal cord, or other parts of the body.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Childhood Acute Myeloid Leukemia and Other Myeloid Malignancies ? [/INST] New types of treatment are being tested in clinical trials. This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website. Biologic therapy Biologic therapy is a treatment that uses the patients immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the bodys natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy. Natural killer (NK) cells are a type of biologic therapy. NK cells are white blood cells that can kill tumor cells. These may be taken from a donor and given to the patient by infusion to help kill leukemia cells. Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Childhood Acute Myeloid Leukemia and Other Myeloid Malignancies ? [/INST] There are different types of treatment for children with acute myeloid leukemia (AML), chronic myelogenous leukemia (CML), juvenile myelomonocytic leukemia (JMML), or myelodysplastic syndromes (MDS). Treatment is planned by a team of health care providers who are experts in treating childhood leukemia and other diseases of the blood. Some cancer treatments cause side effects months or years after treatment has ended. The treatment of childhood AML usually has two phases. Seven types of standard treatment are used for childhood AML, childhood CML, JMML, or MDS. Chemotherapy Radiation therapy Stem cell transplant Targeted therapy Other drug therapy Watchful waiting Supportive care New types of treatment are being tested in clinical trials. Biologic therapy Patients may want to think about taking part in a clinical trial. Patients can enter clinical trials before, during, or after starting their cancer treatment. Followup tests may be needed. There are different types of treatment for children with acute myeloid leukemia (AML), chronic myelogenous leukemia (CML), juvenile myelomonocytic leukemia (JMML), or myelodysplastic syndromes (MDS). Different types of treatment are available for children with AML, CML, JMML, or MDS. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment. Treatment is planned by a team of health care providers who are experts in treating childhood leukemia and other diseases of the blood. Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other healthcare providers who are experts in treating children with leukemia and who specialize in certain areas of medicine. These may include the following specialists: Pediatrician. Hematologist. Medical oncologist. Pediatric surgeon. Radiation oncologist. Neurologist. Neuropathologist. Neuroradiologist. Pediatric nurse specialist. Social worker. Rehabilitation specialist. Psychologist. Some cancer treatments cause side effects months or years after treatment has ended. Regular followup exams are very important. Some cancer treatments cause side effects that continue or appear months or years after cancer treatment has ended. These are called late effects. Late effects of cancer treatment may include: Physical problems. Changes in mood, feelings, thinking, learning, or memory. Second cancers (new types of cancer). Some late effects may be treated or controlled. It is important that parents of children who are treated for AML or other blood diseases talk with their doctors about the effects cancer treatment can have on their child. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information). The treatment of childhood AML usually has two phases. The treatment of childhood AML is done in phases: Induction therapy: This is the first phase of treatment. The goal is to kill the leukemia cells in the blood and bone marrow. This puts the leukemia into remission. Consolidation /intensification therapy: This is the second phase of treatment. It begins once the leukemia is in remission. The goal of therapy is to kill any remaining leukemia cells that may not be active but could begin to regrow and cause a relapse. Treatment called central nervous system (CNS) sanctuary therapy may be given during the induction phase of therapy. Because standard doses of chemotherapy may not reach leukemia cells in the CNS (brain and spinal cord), the cells are able to find sanctuary (hide) in the CNS. Intrathecal chemotherapy is able to reach leukemia cells in the CNS. It is given to kill the leukemia cells and lessen the chance the leukemia will recur (come back). CNS sanctuary therapy is also called CNS prophylaxis. Seven types of standard treatment are used for childhood AML, childhood CML, JMML, or MDS. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid (intrathecal chemotherapy), an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug. The way the chemotherapy is given depends on the type of cancer being treated. In AML, the leukemia cells may spread to the brain and/or spinal cord. Chemotherapy given by mouth or vein to treat AML may not cross the bloodbrain barrier to get into the fluid that surrounds the brain and spinal cord. Instead, chemotherapy is injected into the fluidfilled space to kill leukemia cells that may have spread there (intrathecal chemotherapy). See Drugs Approved for Acute Myeloid Leukemia for more information. Radiation therapy Radiation therapy is a cancer treatment that uses highenergy xrays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy: External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type of the cancer being treated. In childhood AML, external radiation therapy may be used to treat a chloroma that does not respond to chemotherapy. Stem cell transplant Stem cell transplant is a way of giving chemotherapy and replacing bloodforming cells that are abnormal or destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells. Targeted therapy Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Types of targeted therapy include the following: Tyrosine kinase inhibitor therapy: Tyrosine kinase inhibitor (TKI) therapy blocks signals needed for tumors to grow. TKIs block the enzyme (tyrosine kinase) that causes stem cells to become more white blood cells (granulocytes or blasts) than the body needs. TKIs may be used with other anticancer drugs as adjuvant therapy (treatment given after the initial treatment, to lower the risk that the cancer will come back). Imatinib is a type of TKI that is approved to treat childhood CML. Sorafenib, dasatinib, and nilotinib are being studied in the treatment of childhood leukemia. Monoclonal antibody therapy: Monoclonal antibody therapy uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Gemtuzumab is a type of monoclonal antibody used in the treatment of a subtype of AML called acute promyelocytic leukemia (APL). Gemtuzumab is not available in the United States unless special approval is given. Monoclonal antibodies may be used with chemotherapy as adjuvant therapy. Proteasome inhibitor therapy: Proteasome inhibitors break down proteins in cancer cells and kill them. Bortezomib is a proteasome inhibitor used to treat childhood APL. See Drugs Approved for Leukemia for more information. Other drug therapy Lenalidomide may be used to lessen the need for transfusions in patients who have myelodysplastic syndromes caused by a specific chromosome change. Arsenic trioxide and alltrans retinoic acid (ATRA) are anticancer drugs that kill leukemia cells, stop the leukemia cells from dividing, or help the leukemia cells mature into white blood cells. These drugs are used in the treatment of acute promyelocytic leukemia. See Drugs Approved for Acute Myeloid Leukemia for more information. Watchful waiting Watchful waiting is closely monitoring a patients condition without giving any treatment until signs or symptoms appear or change. It is sometimes used to treat MDS or TMD. Supportive care Supportive care is given to lessen the problems caused by the disease or its treatment. Supportive care may include the following: Transfusion therapy: A way of giving red blood cells, white blood cells, or platelets to replace blood cells destroyed by disease or cancer treatment. The blood may be donated from another person or it may have been taken from the patient earlier and stored until needed. Drug therapy, such as antibiotics or antifungal agents. Leukapheresis: A procedure in which a special machine is used to remove white blood cells from the blood. Blood is taken from the patient and put through a blood cell separator where the white blood cells are removed. The rest of the blood is then returned to the patient's bloodstream. New types of treatment are being tested in clinical trials. This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website. Biologic therapy Biologic therapy is a treatment that uses the patients immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the bodys natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy. Natural killer (NK) cells are a type of biologic therapy. NK cells are white blood cells that can kill tumor cells. These may be taken from a donor and given to the patient by infusion to help kill leukemia cells. Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials. Followup tests may be needed. Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the cancer has recurred (come back). These tests are sometimes called followup tests or checkups. Treatment Options for Childhood Acute Myeloid Leukemia, Childhood Chronic Myelogenous Leukemia, Juvenile Myelomonocytic Leukemia, and Myelodysplastic Syndromes Newly Diagnosed Childhood Acute Myeloid Leukemia Treatment of newly diagnosed childhood acute myeloid leukemia may include the following: Combination chemotherapy plus central nervous system sanctuary therapy with intrathecal chemotherapy. A clinical trial comparing different chemotherapy regimens (doses and schedules of treatment). A clinical trial of combination chemotherapy and targeted therapy with a proteasome inhibitor or a tyrosine kinase inhibitor with or without stem cell transplant. Treatment of newly diagnosed childhood acute leukemia with a granulocytic sarcoma (chloroma) may include chemotherapy with or without radiation therapy. Treatment of therapy related AML is usually the same as for newly diagnosed AML, followed by stem cell transplant. Check the list of NCIsupported cancer clinical trials that are now accepting patients with untreated childhood acute myeloid leukemia and other myeloid malignancies. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website. Children with Newly Diagnosed Childhood AML and Down Syndrome Treatment of acute myeloid leukemia (AML) in children aged 4 years or younger who have Down syndrome may include the following: Combination chemotherapy plus central nervous system sanctuary therapy with intrathecal chemotherapy. Treatment of AML in children older than 4 years who have Down syndrome may be the same as treatment for children without Down syndrome. Childhood Acute Myeloid Leukemia in Remission Treatment of childhood acute myeloid leukemia (AML) during the remission phase (consolidation /intensification therapy) depends on the subtype of AML and may include the following: Combination chemotherapy. Highdose chemotherapy followed by stem cell transplant using blood stem cells from a donor. A clinical trial of chemotherapy followed by an infusion of natural killer cells. A clinical trial of combination chemotherapy and targeted therapy with a proteasome inhibitor or a tyrosine kinase inhibitor with or without stem cell transplant. Check the list of NCIsupported cancer clinical trials that are now accepting patients with childhood acute myeloid leukemia in remission. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website. Recurrent Childhood Acute Myeloid Leukemia Treatment of recurrent childhood acute myeloid leukemia (AML) may include the following: Combination chemotherapy. Combination chemotherapy and stem cell transplant. A second stem cell transplant. A clinical trial of combinations of new anticancer drugs, new biologic agents, and stem cell transplant using different sources of stem cells. Treatment of recurrent AML in children with Down syndrome is chemotherapy. It is not clear if stem cell transplant after chemotherapy is helpful in treating these children. Check the list of NCIsupported cancer clinical trials that are now accepting patients with recurrent childhood acute myeloid leukemia. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website. Acute Promyelocytic Leukemia Treatment of acute promyelocytic leukemia may include the following: Alltrans retinoic acid (ATRA) plus chemotherapy. Arsenic trioxide therapy. Central nervous system sanctuary therapy with intrathecal chemotherapy. Check the list of NCIsupported cancer clinical trials that are now accepting patients with childhood acute promyelocytic leukemia (M3). For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website. Recurrent Acute Promyelocytic Leukemia Treatment of recurrent acute promyelocytic leukemia may include the following: Alltrans retinoic acid therapy (ATRA) plus chemotherapy. Arsenic trioxide therapy. Targeted therapy with a monoclonal antibody (gemtuzumab), if special approval is given. Stem cell transplant using blood stem cells from the patient or a donor. Childhood Chronic Myelogenous Leukemia Treatment for childhood chronic myelogenous leukemia may include the following: Targeted therapy with a tyrosine kinase inhibitor (imatinib). A clinical trial of targeted therapy with other tyrosine kinase inhibitors. For patients whose disease does not respond to therapy with imatinib or whose disease comes back after treatment, treatment may include the following: Stem cell transplant using blood stem cells from a donor. A clinical trial of targeted therapy with other tyrosine kinase inhibitors. Check the list of NCIsupported cancer clinical trials that are now accepting patients with childhood chronic myelogenous leukemia. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website. Juvenile Myelomonocytic Leukemia Treatment of juvenile myelomonocytic leukemia (JMML) may include the following: Combination chemotherapy followed by stem cell transplant. If JMML recurs after stem cell transplant, a second stem cell transplant may be done. Check the list of NCIsupported cancer clinical trials that are now accepting patients with juvenile myelomonocytic leukemia. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website. Myelodysplastic Syndromes Treatment of myelodysplastic syndromes (MDS) may include the following: Watchful waiting. Stem cell transplant using blood stem cells from a donor. Combination chemotherapy. Lenalidomide therapy. A clinical trial of stem cell transplant using lower doses of chemotherapy. A clinical trial of a new anticancer drug or targeted therapy. If the MDS becomes acute myeloid leukemia (AML), treatment will be the same as treatment for newly diagnosed AML. Treatment of therapyrelated MDS is usually the same as for newly diagnosed AML, followed by stem cell transplant. Transient myeloproliferative disorder (TMD), a type of MDS, usually goes away on its own. For TMD that does not go away on its own, treatment may include the following: Transfusion therapy. Leukapheresis. Chemotherapy. Check the list of NCIsupported cancer clinical trials that are now accepting patients with childhood myelodysplastic syndromes. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Breast Cancer ? [/INST] Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. Breast cancer is the second most common type of cancer in American women. Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes, which have many smaller sections called lobules. Lobules end in dozens of tiny bulbs that can make milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts. Each breast also has blood vessels and lymph vessels. The lymph vessels carry an almost colorless fluid called lymph. Lymph vessels lead to organs called lymph nodes. Lymph nodes are small beanshaped structures that are found throughout the body. They filter lymph and store white blood cells that help fight infection and disease. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest. See the following PDQ summaries for more information about breast cancer: Breast Cancer Screening Breast Cancer Treatment Breast Cancer Treatment and Pregnancy Male Breast Cancer Treatment Genetics of Breast and Ovarian Cancer Breast cancer is the second most common type of cancer in American women. Women in the United States get breast cancer more than any other type of cancer except skin cancer. Breast cancer is second to lung cancer as a cause of cancer death in American women. However, deaths from breast cancer have decreased a little bit every year between 2003 and 2012. Breast cancer also occurs in men, but the number of new cases is small.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to prevent Breast Cancer ? [/INST] Avoiding risk factors and increasing protective factors may help prevent cancer. The following are risk factors for breast cancer: Older age A personal history of breast cancer or benign (noncancer) breast disease Inherited risk of breast cancer Dense breasts Exposure of breast tissue to estrogen made in the body Taking hormone therapy for symptoms of menopause Radiation therapy to the breast or chest Obesity Drinking alcohol The following are protective factors for breast cancer: Less exposure of breast tissue to estrogen made by the body Taking estrogenonly hormone therapy after hysterectomy, selective estrogen receptor modulators, or aromatase inhibitors and inactivators Estrogenonly hormone therapy after hysterectomy Selective estrogen receptor modulators Aromatase inhibitors and inactivators Riskreducing mastectomy Ovarian ablation Getting enough exercise It is not clear whether the following affect the risk of breast cancer: Oral contraceptives Environment Studies have shown that some factors do not affect the risk of breast cancer. Cancer prevention clinical trials are used to study ways to prevent cancer. New ways to prevent breast cancer are being studied in clinical trials. Avoiding risk factors and increasing protective factors may help prevent cancer. Avoiding cancer risk factors may help prevent certain cancers. Risk factors include smoking, being overweight, and not getting enough exercise. Increasing protective factors such as quitting smoking and exercising may also help prevent some cancers. Talk to your doctor or other health care professional about how you might lower your risk of cancer. NCI's Breast Cancer Risk Assessment Tool uses a woman's risk factors to estimate her risk for breast cancer during the next five years and up to age 90. This online tool is meant to be used by a health care provider. For more information on breast cancer risk, call 18004CANCER. The following are risk factors for breast cancer: Older age Older age is the main risk factor for most cancers. The chance of getting cancer increases as you get older. A personal history of breast cancer or benign (noncancer) breast disease Women with any of the following have an increased risk of breast cancer: A personal history of invasive breast cancer, ductal carcinoma in situ (DCIS), or lobular carcinoma in situ (LCIS). A personal history of benign (noncancer) breast disease. Inherited risk of breast cancer Women with a family history of breast cancer in a firstdegree relative (mother, sister, or daughter) have an increased risk of breast cancer. Women who have inherited changes in the BRCA1 and BRCA2 genes or in certain other genes have a higher risk of breast cancer. The risk of breast cancer caused by inherited gene changes depends on the type of gene mutation, family history of cancer, and other factors. Dense breasts Having breast tissue that is dense on a mammogram is a factor in breast cancer risk. The level of risk depends on how dense the breast tissue is. Women with very dense breasts have a higher risk of breast cancer than women with low breast density. Increased breast density is often an inherited trait, but it may also occur in women who have not had children, have a first pregnancy late in life, take postmenopausal hormones, or drink alcohol. Exposure of breast tissue to estrogen made in the body Estrogen is a hormone made by the body. It helps the body develop and maintain female sex characteristics. Being exposed to estrogen over a long time may increase the risk of breast cancer. Estrogen levels are highest during the years a woman is menstruating. A woman's exposure to estrogen is increased in the following ways: Early menstruation: Beginning to have menstrual periods at age 11 or younger increases the number of years the breast tissue is exposed to estrogen. Starting menopause at a later age: The more years a woman menstruates, the longer her breast tissue is exposed to estrogen. Older age at first birth or never having given birth: Because estrogen levels are lower during pregnancy, breast tissue is exposed to more estrogen in women who become pregnant for the first time after age 35 or who never become pregnant. Taking hormone therapy for symptoms of menopause Hormones, such as estrogen and progesterone, can be made into a pill form in a laboratory. Estrogen, progestin, or both may be given to replace the estrogen no longer made by the ovaries in postmenopausal women or women who have had their ovaries removed. This is called hormone replacement therapy (HRT) or hormone therapy (HT). Combination HRT/HT is estrogen combined with progestin. This type of HRT/HT increases the risk of breast cancer. Studies show that when women stop taking estrogen combined with progestin, the risk of breast cancer decreases. Radiation therapy to the breast or chest Radiation therapy to the chest for the treatment of cancer increases the risk of breast cancer, starting 10 years after treatment. The risk of breast cancer depends on the dose of radiation and the age at which it is given. The risk is highest if radiation treatment was used during puberty, when breasts are forming. Radiation therapy to treat cancer in one breast does not appear to increase the risk of cancer in the other breast. For women who have inherited changes in the BRCA1 and BRCA2 genes, exposure to radiation, such as that from chest xrays, may further increase the risk of breast cancer, especially in women who were xrayed before 20 years of age. Obesity Obesity increases the risk of breast cancer, especially in postmenopausal women who have not used hormone replacement therapy. Drinking alcohol Drinking alcohol increases the risk of breast cancer. The level of risk rises as the amount of alcohol consumed rises. The following are protective factors for breast cancer: Less exposure of breast tissue to estrogen made by the body Decreasing the length of time a woman's breast tissue is exposed to estrogen may help prevent breast cancer. Exposure to estrogen is reduced in the following ways: Early pregnancy: Estrogen levels are lower during pregnancy. Women who have a fullterm pregnancy before age 20 have a lower risk of breast cancer than women who have not had children or who give birth to their first child after age 35. Breastfeeding: Estrogen levels may remain lower while a woman is breastfeeding. Women who breastfed have a lower risk of breast cancer than women who have had children but did not breastfeed. Taking estrogenonly hormone therapy after hysterectomy, selective estrogen receptor modulators, or aromatase inhibitors and inactivators Estrogenonly hormone therapy after hysterectomy Hormone therapy with estrogen only may be given to women who have had a hysterectomy. In these women, estrogenonly therapy after menopause may decrease the risk of breast cancer. There is an increased risk of stroke and heart and blood vessel disease in postmenopausal women who take estrogen after a hysterectomy. Selective estrogen receptor modulators Tamoxifen and raloxifene belong to the family of drugs called selective estrogen receptor modulators (SERMs). SERMs act like estrogen on some tissues in the body, but block the effect of estrogen on other tissues. Treatment with tamoxifen lowers the risk of estrogen receptorpositive (ERpositive) breast cancer and ductal carcinoma in situ in premenopausal and postmenopausal women at high risk. Treatment with raloxifene also lowers the risk of breast cancer in postmenopausal women. With either drug, the reduced risk lasts for several years or longer after treatment is stopped. Lower rates of broken bones have been noted in patients taking raloxifene. Taking tamoxifen increases the risk of hot flashes, endometrial cancer, stroke, cataracts, and blood clots (especially in the lungs and legs). The risk of having these problems increases markedly in women older than 50 years compared with younger women. Women younger than 50 years who have a high risk of breast cancer may benefit the most from taking tamoxifen. The risk of having these problems decreases after tamoxifen is stopped. Talk with your doctor about the risks and benefits of taking this drug. Taking raloxifene increases the risk of blood clots in the lungs and legs, but does not appear to increase the risk of endometrial cancer. In postmenopausal women with osteoporosis (decreased bone density), raloxifene lowers the risk of breast cancer for women who have a high or low risk of breast cancer. It is not known if raloxifene would have the same effect in women who do not have osteoporosis. Talk with your doctor about the risks and benefits of taking this drug. Other SERMs are being studied in clinical trials. Aromatase inhibitors and inactivators Aromatase inhibitors (anastrozole, letrozole) and inactivators (exemestane) lower the risk of recurrence and of new breast cancers in women who have a history of breast cancer. Aromatase inhibitors also decrease the risk of breast cancer in women with the following conditions: Postmenopausal women with a personal history of breast cancer. Women with no personal history of breast cancer who are 60 years and older, have a history of ductal carcinoma in situ with mastectomy, or have a high risk of breast cancer based on the Gail model tool (a tool used to estimate the risk of breast cancer). In women with an increased risk of breast cancer, taking aromatase inhibitors decreases the amount of estrogen made by the body. Before menopause, estrogen is made by the ovaries and other tissues in a woman's body, including the brain, fat tissue, and skin. After menopause, the ovaries stop making estrogen, but the other tissues do not. Aromatase inhibitors block the action of an enzyme called aromatase, which is used to make all of the body's estrogen. Aromatase inactivators stop the enzyme from working. Possible harms from taking aromatase inhibitors include muscle and joint pain, osteoporosis, hot flashes, and feeling very tired. Riskreducing mastectomy Some women who have a high risk of breast cancer may choose to have a riskreducing mastectomy (the removal of both breasts when there are no signs of cancer). The risk of breast cancer is much lower in these women and most feel less anxious about their risk of breast cancer. However, it is very important to have a cancer risk assessment and counseling about the different ways to prevent breast cancer before making this decision. Ovarian ablation The ovaries make most of the estrogen that is made by the body. Treatments that stop or lower the amount of estrogen made by the ovaries include surgery to remove the ovaries, radiation therapy, or taking certain drugs. This is called ovarian ablation. Premenopausal women who have a high risk of breast cancer due to certain changes in the BRCA1 and BRCA2 genes may choose to have a riskreducing oophorectomy (the removal of both ovaries when there are no signs of cancer). This decreases the amount of estrogen made by the body and lowers the risk of breast cancer. Riskreducing oophorectomy also lowers the risk of breast cancer in normal premenopausal women and in women with an increased risk of breast cancer due to radiation to the chest. However, it is very important to have a cancer risk assessment and counseling before making this decision. The sudden drop in estrogen levels may cause the symptoms of menopause to begin. These include hot flashes, trouble sleeping, anxiety, and depression. Longterm effects include decreased sex drive, vaginal dryness, and decreased bone density. Getting enough exercise Women who exercise four or more hours a week have a lower risk of breast cancer. The effect of exercise on breast cancer risk may be greatest in premenopausal women who have normal or low body weight. It is not clear whether the following affect the risk of breast cancer: Oral contraceptives Certain oral contraceptives contain estrogen. Some studies have shown that taking oral contraceptives ("the pill") may slightly increase the risk of breast cancer in current users. This risk decreases over time. Other studies have not shown an increased risk of breast cancer in women who take oral contraceptives. Progestin only contraceptives that are injected or implanted do not appear to increase the risk of breast cancer. More studies are needed to know whether progestinonly oral contraceptives increase the risk of breast cancer. Environment Studies have not proven that being exposed to certain substances in the environment, such as chemicals, increases the risk of breast cancer. Studies have shown that some factors do not affect the risk of breast cancer. The following do not affect the risk of breast cancer: Having an abortion. Making diet changes such as eating less fat or more fruits and vegetables. Taking vitamins, including fenretinide (a type of vitamin A). Cigarette smoking, both active and passive (inhaling secondhand smoke). Using underarm deodorant or antiperspirant. Taking statins (cholesterol lowering drugs). Taking bisphosphonates (drugs used to treat osteoporosis and hypercalcemia) by mouth or by intravenous infusion. Cancer prevention clinical trials are used to study ways to prevent cancer. Cancer prevention clinical trials are used to study ways to lower the risk of developing certain types of cancer. Some cancer prevention trials are conducted with healthy people who have not had cancer but who have an increased risk for cancer. Other prevention trials are conducted with people who have had cancer and are trying to prevent another cancer of the same type or to lower their chance of developing a new type of cancer. Other trials are done with healthy volunteers who are not known to have any risk factors for cancer. The purpose of some cancer prevention clinical trials is to find out whether actions people take can prevent cancer. These may include exercising more or quitting smoking or taking certain medicines, vitamins, minerals, or food supplements. New ways to prevent breast cancer are being studied in clinical trials.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Breast Cancer? ? [/INST] Avoiding risk factors and increasing protective factors may help prevent cancer. The following are risk factors for breast cancer: Older age A personal history of breast cancer or benign (noncancer) breast disease Inherited risk of breast cancer Dense breasts Exposure of breast tissue to estrogen made in the body Taking hormone therapy for symptoms of menopause Radiation therapy to the breast or chest Obesity Drinking alcohol The following are protective factors for breast cancer: Less exposure of breast tissue to estrogen made by the body Taking estrogenonly hormone therapy after hysterectomy, selective estrogen receptor modulators, or aromatase inhibitors and inactivators Estrogenonly hormone therapy after hysterectomy Selective estrogen receptor modulators Aromatase inhibitors and inactivators Riskreducing mastectomy Ovarian ablation Getting enough exercise It is not clear whether the following affect the risk of breast cancer: Oral contraceptives Environment Studies have shown that some factors do not affect the risk of breast cancer. Cancer prevention clinical trials are used to study ways to prevent cancer. New ways to prevent breast cancer are being studied in clinical trials. Avoiding risk factors and increasing protective factors may help prevent cancer. Avoiding cancer risk factors may help prevent certain cancers. Risk factors include smoking, being overweight, and not getting enough exercise. Increasing protective factors such as quitting smoking and exercising may also help prevent some cancers. Talk to your doctor or other health care professional about how you might lower your risk of cancer. NCI's Breast Cancer Risk Assessment Tool uses a woman's risk factors to estimate her risk for breast cancer during the next five years and up to age 90. This online tool is meant to be used by a health care provider. For more information on breast cancer risk, call 18004CANCER. The following are risk factors for breast cancer: Older age Older age is the main risk factor for most cancers. The chance of getting cancer increases as you get older. A personal history of breast cancer or benign (noncancer) breast disease Women with any of the following have an increased risk of breast cancer: A personal history of invasive breast cancer, ductal carcinoma in situ (DCIS), or lobular carcinoma in situ (LCIS). A personal history of benign (noncancer) breast disease. Inherited risk of breast cancer Women with a family history of breast cancer in a firstdegree relative (mother, sister, or daughter) have an increased risk of breast cancer. Women who have inherited changes in the BRCA1 and BRCA2 genes or in certain other genes have a higher risk of breast cancer. The risk of breast cancer caused by inherited gene changes depends on the type of gene mutation, family history of cancer, and other factors. Dense breasts Having breast tissue that is dense on a mammogram is a factor in breast cancer risk. The level of risk depends on how dense the breast tissue is. Women with very dense breasts have a higher risk of breast cancer than women with low breast density. Increased breast density is often an inherited trait, but it may also occur in women who have not had children, have a first pregnancy late in life, take postmenopausal hormones, or drink alcohol. Exposure of breast tissue to estrogen made in the body Estrogen is a hormone made by the body. It helps the body develop and maintain female sex characteristics. Being exposed to estrogen over a long time may increase the risk of breast cancer. Estrogen levels are highest during the years a woman is menstruating. A woman's exposure to estrogen is increased in the following ways: Early menstruation: Beginning to have menstrual periods at age 11 or younger increases the number of years the breast tissue is exposed to estrogen. Starting menopause at a later age: The more years a woman menstruates, the longer her breast tissue is exposed to estrogen. Older age at first birth or never having given birth: Because estrogen levels are lower during pregnancy, breast tissue is exposed to more estrogen in women who become pregnant for the first time after age 35 or who never become pregnant. Taking hormone therapy for symptoms of menopause Hormones, such as estrogen and progesterone, can be made into a pill form in a laboratory. Estrogen, progestin, or both may be given to replace the estrogen no longer made by the ovaries in postmenopausal women or women who have had their ovaries removed. This is called hormone replacement therapy (HRT) or hormone therapy (HT). Combination HRT/HT is estrogen combined with progestin. This type of HRT/HT increases the risk of breast cancer. Studies show that when women stop taking estrogen combined with progestin, the risk of breast cancer decreases. Radiation therapy to the breast or chest Radiation therapy to the chest for the treatment of cancer increases the risk of breast cancer, starting 10 years after treatment. The risk of breast cancer depends on the dose of radiation and the age at which it is given. The risk is highest if radiation treatment was used during puberty, when breasts are forming. Radiation therapy to treat cancer in one breast does not appear to increase the risk of cancer in the other breast. For women who have inherited changes in the BRCA1 and BRCA2 genes, exposure to radiation, such as that from chest xrays, may further increase the risk of breast cancer, especially in women who were xrayed before 20 years of age. Obesity Obesity increases the risk of breast cancer, especially in postmenopausal women who have not used hormone replacement therapy. Drinking alcohol Drinking alcohol increases the risk of breast cancer. The level of risk rises as the amount of alcohol consumed rises. The following are protective factors for breast cancer: Less exposure of breast tissue to estrogen made by the body Decreasing the length of time a woman's breast tissue is exposed to estrogen may help prevent breast cancer. Exposure to estrogen is reduced in the following ways: Early pregnancy: Estrogen levels are lower during pregnancy. Women who have a fullterm pregnancy before age 20 have a lower risk of breast cancer than women who have not had children or who give birth to their first child after age 35. Breastfeeding: Estrogen levels may remain lower while a woman is breastfeeding. Women who breastfed have a lower risk of breast cancer than women who have had children but did not breastfeed. Taking estrogenonly hormone therapy after hysterectomy, selective estrogen receptor modulators, or aromatase inhibitors and inactivators Estrogenonly hormone therapy after hysterectomy Hormone therapy with estrogen only may be given to women who have had a hysterectomy. In these women, estrogenonly therapy after menopause may decrease the risk of breast cancer. There is an increased risk of stroke and heart and blood vessel disease in postmenopausal women who take estrogen after a hysterectomy. Selective estrogen receptor modulators Tamoxifen and raloxifene belong to the family of drugs called selective estrogen receptor modulators (SERMs). SERMs act like estrogen on some tissues in the body, but block the effect of estrogen on other tissues. Treatment with tamoxifen lowers the risk of estrogen receptorpositive (ERpositive) breast cancer and ductal carcinoma in situ in premenopausal and postmenopausal women at high risk. Treatment with raloxifene also lowers the risk of breast cancer in postmenopausal women. With either drug, the reduced risk lasts for several years or longer after treatment is stopped. Lower rates of broken bones have been noted in patients taking raloxifene. Taking tamoxifen increases the risk of hot flashes, endometrial cancer, stroke, cataracts, and blood clots (especially in the lungs and legs). The risk of having these problems increases markedly in women older than 50 years compared with younger women. Women younger than 50 years who have a high risk of breast cancer may benefit the most from taking tamoxifen. The risk of having these problems decreases after tamoxifen is stopped. Talk with your doctor about the risks and benefits of taking this drug. Taking raloxifene increases the risk of blood clots in the lungs and legs, but does not appear to increase the risk of endometrial cancer. In postmenopausal women with osteoporosis (decreased bone density), raloxifene lowers the risk of breast cancer for women who have a high or low risk of breast cancer. It is not known if raloxifene would have the same effect in women who do not have osteoporosis. Talk with your doctor about the risks and benefits of taking this drug. Other SERMs are being studied in clinical trials. Aromatase inhibitors and inactivators Aromatase inhibitors (anastrozole, letrozole) and inactivators (exemestane) lower the risk of recurrence and of new breast cancers in women who have a history of breast cancer. Aromatase inhibitors also decrease the risk of breast cancer in women with the following conditions: Postmenopausal women with a personal history of breast cancer. Women with no personal history of breast cancer who are 60 years and older, have a history of ductal carcinoma in situ with mastectomy, or have a high risk of breast cancer based on the Gail model tool (a tool used to estimate the risk of breast cancer). In women with an increased risk of breast cancer, taking aromatase inhibitors decreases the amount of estrogen made by the body. Before menopause, estrogen is made by the ovaries and other tissues in a woman's body, including the brain, fat tissue, and skin. After menopause, the ovaries stop making estrogen, but the other tissues do not. Aromatase inhibitors block the action of an enzyme called aromatase, which is used to make all of the body's estrogen. Aromatase inactivators stop the enzyme from working. Possible harms from taking aromatase inhibitors include muscle and joint pain, osteoporosis, hot flashes, and feeling very tired. Riskreducing mastectomy Some women who have a high risk of breast cancer may choose to have a riskreducing mastectomy (the removal of both breasts when there are no signs of cancer). The risk of breast cancer is much lower in these women and most feel less anxious about their risk of breast cancer. However, it is very important to have a cancer risk assessment and counseling about the different ways to prevent breast cancer before making this decision. Ovarian ablation The ovaries make most of the estrogen that is made by the body. Treatments that stop or lower the amount of estrogen made by the ovaries include surgery to remove the ovaries, radiation therapy, or taking certain drugs. This is called ovarian ablation. Premenopausal women who have a high risk of breast cancer due to certain changes in the BRCA1 and BRCA2 genes may choose to have a riskreducing oophorectomy (the removal of both ovaries when there are no signs of cancer). This decreases the amount of estrogen made by the body and lowers the risk of breast cancer. Riskreducing oophorectomy also lowers the risk of breast cancer in normal premenopausal women and in women with an increased risk of breast cancer due to radiation to the chest. However, it is very important to have a cancer risk assessment and counseling before making this decision. The sudden drop in estrogen levels may cause the symptoms of menopause to begin. These include hot flashes, trouble sleeping, anxiety, and depression. Longterm effects include decreased sex drive, vaginal dryness, and decreased bone density. Getting enough exercise Women who exercise four or more hours a week have a lower risk of breast cancer. The effect of exercise on breast cancer risk may be greatest in premenopausal women who have normal or low body weight. It is not clear whether the following affect the risk of breast cancer: Oral contraceptives Certain oral contraceptives contain estrogen. Some studies have shown that taking oral contraceptives ("the pill") may slightly increase the risk of breast cancer in current users. This risk decreases over time. Other studies have not shown an increased risk of breast cancer in women who take oral contraceptives. Progestin only contraceptives that are injected or implanted do not appear to increase the risk of breast cancer. More studies are needed to know whether progestinonly oral contraceptives increase the risk of breast cancer. Environment Studies have not proven that being exposed to certain substances in the environment, such as chemicals, increases the risk of breast cancer. Studies have shown that some factors do not affect the risk of breast cancer. The following do not affect the risk of breast cancer: Having an abortion. Making diet changes such as eating less fat or more fruits and vegetables. Taking vitamins, including fenretinide (a type of vitamin A). Cigarette smoking, both active and passive (inhaling secondhand smoke). Using underarm deodorant or antiperspirant. Taking statins (cholesterol lowering drugs). Taking bisphosphonates (drugs used to treat osteoporosis and hypercalcemia) by mouth or by intravenous infusion.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Breast Cancer ? [/INST] Cancer prevention clinical trials are used to study ways to prevent cancer. Cancer prevention clinical trials are used to study ways to lower the risk of developing certain types of cancer. Some cancer prevention trials are conducted with healthy people who have not had cancer but who have an increased risk for cancer. Other prevention trials are conducted with people who have had cancer and are trying to prevent another cancer of the same type or to lower their chance of developing a new type of cancer. Other trials are done with healthy volunteers who are not known to have any risk factors for cancer. The purpose of some cancer prevention clinical trials is to find out whether actions people take can prevent cancer. These may include exercising more or quitting smoking or taking certain medicines, vitamins, minerals, or food supplements. New ways to prevent breast cancer are being studied in clinical trials.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Testicular Cancer ? [/INST] Testicular cancer is a disease in which malignant (cancer) cells form in the tissues of one or both testicles. Testicular cancer is the most common cancer in men aged 15 to 34 years. Testicular cancer can usually be cured. A condition called cryptorchidism (an undescended testicle) is a risk factor for testicular cancer. Testicular cancer is a disease in which malignant (cancer) cells form in the tissues of one or both testicles. The testicles are 2 eggshaped glands inside the scrotum (a sac of loose skin that lies directly below the penis). The testicles are held within the scrotum by the spermatic cord. The spermatic cord also contains the vas deferens and vessels and nerves of the testicles. The testicles are the male sex glands and make testosterone and sperm. Germ cells in the testicles make immature sperm. These sperm travel through a network of tubules (tiny tubes) and larger tubes into the epididymis (a long coiled tube next to the testicles). This is where the sperm mature and are stored. Almost all testicular cancers start in the germ cells. The two main types of testicular germ cell tumors are seminomas and nonseminomas. See the PDQ summary on Testicular Cancer Treatment for more information about testicular cancer.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Testicular Cancer? ? [/INST] Testicular cancer is the most common cancer in men aged 15 to 34 years. Testicular cancer is very rare, but it is the most common cancer found in men between the ages of 15 and 34. White men are four times more likely than black men to have testicular cancer</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is the outlook for Testicular Cancer ? [/INST] Testicular cancer can usually be cured. Although the number of new cases of testicular cancer has doubled in the last 40 years, the number of deaths caused by testicular cancer has decreased greatly because of better treatments. Testicular cancer can usually be cured, even in late stages of the disease. (See the PDQ summary on Testicular Cancer Treatment for more information.)</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Testicular Cancer? ? [/INST] A condition called cryptorchidism (an undescended testicle) is a risk factor for testicular cancer. Anything that increases the chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk to your doctor if you think you may be at risk. Risk factors for testicular cancer include the following: Having cryptorchidism (an undescended testicle). Having a testicle that is not normal, such as a small testicle that does not work the way it should. Having testicular carcinoma in situ. Being white. Having a personal or family history of testicular cancer. Having Klinefelter syndrome. Men who have cryptorchidism, a testicle that is not normal, or testicular carcinoma in situ have an increased risk of testicular cancer in one or both testicles, and need to be followed closely.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Adult Primary Liver Cancer ? [/INST] Adult primary liver cancer is a disease in which malignant (cancer) cells form in the tissues of the liver. There are two types of adult primary liver cancer. Having hepatitis or cirrhosis can affect the risk of adult primary liver cancer. Signs and symptoms of adult primary liver cancer include a lump or pain on the right side. Tests that examine the liver and the blood are used to detect (find) and diagnose adult primary liver cancer. Certain factors affect prognosis (chance of recovery) and treatment options. Adult primary liver cancer is a disease in which malignant (cancer) cells form in the tissues of the liver. The liver is one of the largest organs in the body. It has four lobes and fills the upper right side of the abdomen inside the rib cage. Three of the many important functions of the liver are: To filter harmful substances from the blood so they can be passed from the body in stools and urine. To make bile to help digest fat that comes from food. To store glycogen (sugar), which the body uses for energy. There are two types of adult primary liver cancer. The two types of adult primary liver cancer are: Hepatocellular carcinoma. Cholangiocarcinoma (bile duct cancer). (See the PDQ summary on Bile Duct Cancer Treatment for more information.) The most common type of adult primary liver cancer is hepatocellular carcinoma. This type of liver cancer is the third leading cause of cancerrelated deaths worldwide. This summary is about the treatment of primary liver cancer (cancer that begins in the liver). Treatment of cancer that begins in other parts of the body and spreads to the liver is not covered in this summary. Primary liver cancer can occur in both adults and children. However, treatment for children is different than treatment for adults. (See the PDQ summary on Childhood Liver Cancer Treatment for more information.)</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Adult Primary Liver Cancer? ? [/INST] Having hepatitis or cirrhosis can affect the risk of adult primary liver cancer. Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesnt mean that you will not get cancer. Talk with your doctor if you think you may be at risk. The following are risk factors for adult primary liver cancer: Having hepatitis B or hepatitis C. Having both hepatitis B and hepatitis C increases the risk even more. Having cirrhosis, which can be caused by: hepatitis (especially hepatitis C); or drinking large amounts of alcohol for many years or being an alcoholic. Having metabolic syndrome, a set of conditions that occur together, including extra fat around the abdomen, high blood sugar, high blood pressure, high levels of triglycerides and low levels of highdensity lipoproteins in the blood. Having liver injury that is longlasting, especially if it leads to cirrhosis. Having hemochromatosis, a condition in which the body takes up and stores more iron than it needs. The extra iron is stored in the liver, heart, and pancreas Eating foods tainted with aflatoxin (poison from a fungus that can grow on foods, such as grains and nuts, that have not been stored properly).</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Adult Primary Liver Cancer ? [/INST] Signs and symptoms of adult primary liver cancer include a lump or pain on the right side. These and other signs and symptoms may be caused by adult primary liver cancer or by other conditions. Check with your doctor if you have any of the following: A hard lump on the right side just below the rib cage. Discomfort in the upper abdomen on the right side. A swollen abdomen. Pain near the right shoulder blade or in the back. Jaundice (yellowing of the skin and whites of the eyes). Easy bruising or bleeding. Unusual tiredness or weakness. Nausea and vomiting. Loss of appetite or feelings of fullness after eating a small meal. Weight loss for no known reason. Pale, chalky bowel movements and dark urine. Fever.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Adult Primary Liver Cancer ? [/INST] Tests that examine the liver and the blood are used to detect (find) and diagnose adult primary liver cancer. The following tests and procedures may be used: Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patients health habits and past illnesses and treatments will also be taken. Serum tumor marker test : A procedure in which a sample of blood is examined to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called tumor markers. An increased level of alphafetoprotein (AFP) in the blood may be a sign of liver cancer. Other cancers and certain noncancerous conditions, including cirrhosis and hepatitis, may also increase AFP levels. Sometimes the AFP level is normal even when there is liver cancer. Liver function tests : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by the liver. A higher than normal amount of a substance can be a sign of liver cancer. CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the abdomen, taken from different angles. The pictures are made by a computer linked to an xray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. Images may be taken at three different times after the dye is injected, to get the best picture of abnormal areas in the liver. This is called triplephase CT. A spiral or helical CT scan makes a series of very detailed pictures of areas inside the body using an xray machine that scans the body in a spiral path. MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the liver. This procedure is also called nuclear magnetic resonance imaging (NMRI). To create detailed pictures of blood vessels in and near the liver, dye is injected into a vein. This procedure is called MRA (magnetic resonance angiography). Images may be taken at three different times after the dye is injected, to get the best picture of abnormal areas in the liver. This is called triplephase MRI. Ultrasound exam: A procedure in which highenergy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later. Biopsy : The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. Procedures used to collect the sample of cells or tissues include the following: Fineneedle aspiration biopsy : The removal of cells, tissue or fluid using a thin needle. Core needle biopsy : The removal of cells or tissue using a slightly wider needle. Laparoscopy : A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Another instrument is inserted through the same or another incision to remove the tissue samples. A biopsy is not always needed to diagnose adult primary liver cancer.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is the outlook for Adult Primary Liver Cancer ? [/INST] Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) and treatment options depend on the following: The stage of the cancer (the size of the tumor, whether it affects part or all of the liver, or has spread to other places in the body). How well the liver is working. The patients general health, including whether there is cirrhosis of the liver.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the stages of Adult Primary Liver Cancer ? [/INST] After adult primary liver cancer has been diagnosed, tests are done to find out if cancer cells have spread within the liver or to other parts of the body. There are three ways that cancer spreads in the body. Cancer may spread from where it began to other parts of the body. The Barcelona Clinic Liver Cancer Staging System may be used to stage adult primary liver cancer. The following groups are used to plan treatment. BCLC stages 0, A, and B BCLC stages C and D After adult primary liver cancer has been diagnosed, tests are done to find out if cancer cells have spread within the liver or to other parts of the body. The process used to find out if cancer has spread within the liver or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process: CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest, abdomen, and pelvis, taken from different angles. The pictures are made by a computer linked to an xray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. There are three ways that cancer spreads in the body. Cancer can spread through tissue, the lymph system, and the blood: Tissue. The cancer spreads from where it began by growing into nearby areas. Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body. Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body. Cancer may spread from where it began to other parts of the body. When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood. Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body. Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body. The metastatic tumor is the same type of cancer as the primary tumor. For example, if primary liver cancer spreads to the lung, the cancer cells in the lung are actually liver cancer cells. The disease is metastatic liver cancer, not lung cancer. The Barcelona Clinic Liver Cancer Staging System may be used to stage adult primary liver cancer. There are several staging systems for liver cancer. The Barcelona Clinic Liver Cancer (BCLC) Staging System is widely used and is described below. This system is used to predict the patient's chance of recovery and to plan treatment, based on the following: Whether the cancer has spread within the liver or to other parts of the body. How well the liver is working. The general health and wellness of the patient. The symptoms caused by the cancer. The BCLC staging system has five stages: Stage 0: Very early Stage A: Early Stage B: Intermediate Stage C: Advanced Stage D: Endstage The following groups are used to plan treatment. BCLC stages 0, A, and B Treatment to cure the cancer is given for BCLC stages 0, A, and B. BCLC stages C and D Treatment to relieve the symptoms caused by liver cancer and improve the patient's quality of life is given for BCLC stages C and D. Treatments are not likely to cure the cancer.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Adult Primary Liver Cancer ? [/INST] New types of treatment are being tested in clinical trials. Information about clinical trials is available from the NCI website. Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Adult Primary Liver Cancer ? [/INST] There are different types of treatment for patients with adult primary liver cancer. Patients with liver cancer are treated by a team of specialists who are experts in treating liver cancer. Seven types of standard treatment are used: Surveillance Surgery Liver transplant Ablation therapy Embolization therapy Targeted therapy Radiation therapy New types of treatment are being tested in clinical trials. Patients may want to think about taking part in a clinical trial. Patients can enter clinical trials before, during, or after starting their cancer treatment. Followup tests may be needed. There are different types of treatment for patients with adult primary liver cancer. Different types of treatments are available for patients with adult primary liver cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment. Patients with liver cancer are treated by a team of specialists who are experts in treating liver cancer. The patient's treatment will be overseen by a medical oncologist, a doctor who specializes in treating people with cancer. The medical oncologist may refer the patient to other health professionals who have special training in treating patients with liver cancer. These may include the following specialists: Hepatologist (specialist in liver disease). Surgical oncologist. Transplant surgeon. Radiation oncologist. Interventional radiologist (a specialist who diagnoses and treats diseases using imaging and the smallest incisions possible). Pathologist. Seven types of standard treatment are used: Surveillance Surveillance for lesions smaller than 1 centimeter found during screening. Followup every three months is common. Surgery A partial hepatectomy (surgery to remove the part of the liver where cancer is found) may be done. A wedge of tissue, an entire lobe, or a larger part of the liver, along with some of the healthy tissue around it is removed. The remaining liver tissue takes over the functions of the liver and may regrow. Liver transplant In a liver transplant, the entire liver is removed and replaced with a healthy donated liver. A liver transplant may be done when the disease is in the liver only and a donated liver can be found. If the patient has to wait for a donated liver, other treatment is given as needed. Ablation therapy Ablation therapy removes or destroys tissue. Different types of ablation therapy are used for liver cancer: Radiofrequency ablation: The use of special needles that are inserted directly through the skin or through an incision in the abdomen to reach the tumor. Highenergy radio waves heat the needles and tumor which kills cancer cells. Microwave therapy: A type of treatment in which the tumor is exposed to high temperatures created by microwaves. This can damage and kill cancer cells or make them more sensitive to the effects of radiation and certain anticancer drugs. Percutaneous ethanol injection: A cancer treatment in which a small needle is used to inject ethanol (pure alcohol) directly into a tumor to kill cancer cells. Several treatments may be needed. Usually local anesthesia is used, but if the patient has many tumors in the liver, general anesthesia may be used. Cryoablation: A treatment that uses an instrument to freeze and destroy cancer cells. This type of treatment is also called cryotherapy and cryosurgery. The doctor may use ultrasound to guide the instrument. Electroporation therapy: A treatment that sends electrical pulses through an electrode placed in a tumor to kill cancer cells. Electroporation therapy is being studied in clinical trials. Embolization therapy Embolization therapy is the use of substances to block or decrease the flow of blood through the hepatic artery to the tumor. When the tumor does not get the oxygen and nutrients it needs, it will not continue to grow. Embolization therapy is used for patients who cannot have surgery to remove the tumor or ablation therapy and whose tumor has not spread outside the liver. The liver receives blood from the hepatic portal vein and the hepatic artery. Blood that comes into the liver from the hepatic portal vein usually goes to the healthy liver tissue. Blood that comes from the hepatic artery usually goes to the tumor. When the hepatic artery is blocked during embolization therapy, the healthy liver tissue continues to receive blood from the hepatic portal vein. There are two main types of embolization therapy: Transarterial embolization (TAE): A small incision (cut) is made in the inner thigh and a catheter (thin, flexible tube) is inserted and threaded up into the hepatic artery. Once the catheter is in place, a substance that blocks the hepatic artery and stops blood flow to the tumor is injected. Transarterial chemoembolization (TACE): This procedure is like TAE except an anticancer drug is also given. The procedure can be done by attaching the anticancer drug to small beads that are injected into the hepatic artery or by injecting the anticancer drug through the catheter into the hepatic artery and then injecting the substance to block the hepatic artery. Most of the anticancer drug is trapped near the tumor and only a small amount of the drug reaches other parts of the body. This type of treatment is also called chemoembolization. Targeted therapy Targeted therapy is a treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Adult liver cancer may be treated with a targeted therapy drug that stops cells from dividing and prevents the growth of new blood vessels that tumors need to grow. See Drugs Approved for Liver Cancer for more information. Radiation therapy Radiation therapy is a cancer treatment that uses highenergy xrays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy: External radiation therapy uses a machine outside the body to send radiation toward the cancer. Certain ways of giving radiation therapy can help keep radiation from damaging nearby healthy tissue. These types of external radiation therapy include the following: Conformal radiation therapy: Conformal radiation therapy is a type of external radiation therapy that uses a computer to make a 3dimensional (3D) picture of the tumor and shapes the radiation beams to fit the tumor. This allows a high dose of radiation to reach the tumor and causes less damage to nearby healthy tissue. Stereotactic body radiation therapy: Stereotactic body radiation therapy is a type of external radiation therapy. Special equipment is used to place the patient in the same position for each radiation treatment. Once a day for several days, a radiation machine aims a larger than usual dose of radiation directly at the tumor. By having the patient in the same position for each treatment, there is less damage to nearby healthy tissue. This procedure is also called stereotactic externalbeam radiation therapy and stereotaxic radiation therapy. Proton beam radiation therapy: Protonbeam therapy is a type of highenergy, external radiation therapy. A radiation therapy machine aims streams of protons (tiny, invisible, positivelycharged particles) at the cancer cells to kill them. This type of treatment causes less damage to nearby healthy tissue. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is used to treat adult primary liver cancer. New types of treatment are being tested in clinical trials. Information about clinical trials is available from the NCI website. Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials. Followup tests may be needed. Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called followup tests or checkups. Treatment Options for Adult Primary Liver Cancer Stages 0, A, and B Adult Primary Liver Cancer Treatment of stages 0, A, and B adult primary liver cancer may include the following: Surveillance for lesions smaller than 1 centimeter. Partial hepatectomy. Total hepatectomy and liver transplant. Ablation of the tumor using one of the following methods: Radiofrequency ablation. Microwave therapy. Percutaneous ethanol injection. Cryoablation. A clinical trial of electroporation therapy. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage 0 adult primary liver cancer (BCLC), stage A adult primary liver cancer (BCLC) and stage B adult primary liver cancer (BCLC). For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website. Stages C and D Adult Primary Liver Cancer Treatment of stages C and D adult primary liver cancer may include the following: Embolization therapy using one of the following methods: Transarterial embolization (TAE). Transarterial chemoembolization (TACE). Targeted therapy. Radiation therapy. A clinical trial of targeted therapy after chemoembolization or combined with chemotherapy. A clinical trial of new targeted therapy drugs. A clinical trial of targeted therapy with or without stereotactic body radiation therapy. A clinical trial of stereotactic body radiation therapy or protonbeam radiation therapy. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage C adult primary liver cancer (BCLC) and stage D adult primary liver cancer (BCLC). For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Chronic Eosinophilic Leukemia ? [/INST] Chronic eosinophilic leukemia is a disease in which too many white blood cells (eosinophils) are made in the bone marrow. Signs and symptoms of chronic eosinophilic leukemia include fever and feeling very tired. Chronic eosinophilic leukemia is a disease in which too many white blood cells (eosinophils) are made in the bone marrow. Eosinophils are white blood cells that react to allergens (substances that cause an allergic response) and help fight infections caused by certain parasites. In chronic eosinophilic leukemia, there are too many eosinophils in the blood, bone marrow, and other tissues. Chronic eosinophilic leukemia may stay the same for many years or it may progress quickly to acute leukemia.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Chronic Eosinophilic Leukemia ? [/INST] Signs and symptoms of chronic eosinophilic leukemia include fever and feeling very tired. Chronic eosinophilic leukemia may not cause early signs or symptoms. It may be found during a routine blood test. Signs and symptoms may be caused by chronic eosinophilic leukemia or by other conditions. Check with your doctor if you have any of the following: Fever. Feeling very tired. Cough. Swelling under the skin around the eyes and lips, in the throat, or on the hands and feet. Muscle pain. Itching. Diarrhea.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Chronic Eosinophilic Leukemia ? [/INST] Treatment of chronic eosinophilic leukemia may include the following: Bone marrow transplant. Biologic therapy using interferon alfa. A clinical trial of a new treatment. Check the list of NCIsupported cancer clinical trials that are now accepting patients with chronic eosinophilic leukemia. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Chronic Neutrophilic Leukemia ? [/INST] Chronic neutrophilic leukemia is a disease in which too many blood stem cells become a type of white blood cell called neutrophils. Neutrophils are infection fighting blood cells that surround and destroy dead cells and foreign substances (such as bacteria). The spleen and liver may swell because of the extra neutrophils. Chronic neutrophilic leukemia may stay the same or it may progress quickly to acute leukemia.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Chronic Neutrophilic Leukemia ? [/INST] Treatment of chronic neutrophilic leukemia may include the following: Donor bone marrow transplant. Chemotherapy. Biologic therapy using interferon alfa. A clinical trial of a new treatment. Check the list of NCIsupported cancer clinical trials that are now accepting patients with chronic neutrophilic leukemia. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to prevent Anal Cancer ? [/INST] Avoiding risk factors and increasing protective factors may help prevent cancer. The following are risk factors for anal cancer: Anal HPV infection Certain medical conditions History of cervical, vaginal, or vulvar cancer HIV infection/AIDS Immunosuppression Certain sexual practices Cigarette smoking The following protective factor decreases the risk of anal cancer: HPV vaccine It is not clear if the following protective factor decreases the risk of anal cancer: Condom use Cancer prevention clinical trials are used to study ways to prevent cancer. New ways to prevent anal cancer are being studied in clinical trials. Avoiding risk factors and increasing protective factors may help prevent cancer. Avoiding cancer risk factors may help prevent certain cancers. Risk factors include smoking, being overweight, and not getting enough exercise. Increasing protective factors such as quitting smoking and exercising may also help prevent some cancers. Talk to your doctor or other health care professional about how you might lower your risk of cancer. The following are risk factors for anal cancer: Anal HPV infection Being infected with human papillomavirus (HPV) is the main risk factor for anal cancer. Being infected with HPV can lead to squamous cell carcinoma of the anus, the most common type of anal cancer. About nine out of every ten cases of anal cancer are found in patients with anal HPV infection. Patients with healthy immune systems are usually able to fight HPV infections. Patients with weakened immune systems who are infected with HPV have a higher risk of anal cancer. Certain medical conditions History of cervical, vaginal, or vulvar cancer Cervical cancer, vaginal cancer, and vulvar cancer are related to HPV infection. Women who have had cervical, vaginal, or vulvar cancer have a higher risk of anal cancer. HIV infection/AIDS Being infected with human immunodeficiency virus (HIV) is a strong risk factor for anal cancer. HIV is the cause of acquired immunodeficiency syndrome (AIDS). HIV weakens the body's immune system and its ability to fight infection. HPV infection of the anus is common among patients who are HIVpositive. The risk of anal cancer is higher in men who are HIVpositive and have sex with men compared with men who are HIVnegative and have sex with men. Women who are HIVpositive also have an increased risk of anal cancer compared with women who are HIVnegative. Studies show that intravenous drug use or cigarette smoking may further increase the risk of anal cancer in patients who are HIVpositive. Immunosuppression Immunosuppression is a condition that weakens the body's immune system and its ability to fight infections and other diseases. Chronic (longterm) immunosuppression may increase the risk of anal cancer because it lowers the body's ability to fight HPV infection. Patients who have an organ transplant and receive immunosuppressive medicine to prevent organ rejection have an increased risk of anal cancer. Having an autoimmune disorder such as Crohn disease or psoriasis may increase the risk of anal cancer. It is not clear if the increased risk is due to the autoimmune condition, the treatment for the condition, or a combination of both. Certain sexual practices The following sexual practices increase the risk of anal cancer because they increase the chance of being infected with HPV: Having receptive anal intercourse (anal sex). Having many sexual partners. Sex between men. Men and women who have a history of anal warts or other sexually transmitted diseases also have an increased risk of anal cancer. Cigarette smoking Studies show that cigarette smoking increases the risk of anal cancer. Studies also show that current smokers have a higher risk of anal cancer than smokers who have quit or people who have never smoked. The following protective factor decreases the risk of anal cancer: HPV vaccine The human papillomavirus (HPV) vaccine is used to prevent anal cancer, cervical cancer, vulvar cancer, and vaginal cancer caused by HPV. It is also used to prevent lesions caused by HPV that may become cancer in the future. Studies show that being vaccinated against HPV lowers the risk of anal cancer. The vaccine may work best when it is given before a person is exposed to HPV. It is not clear if the following protective factor decreases the risk of anal cancer: Condom use It is not known if the use of condoms protects against anal HPV infection. This is because not enough studies have been done to prove this. Cancer prevention clinical trials are used to study ways to prevent cancer. Cancer prevention clinical trials are used to study ways to lower the risk of developing certain types of cancer. Some cancer prevention trials are conducted with healthy people who have not had cancer but who have an increased risk for cancer. Other prevention trials are conducted with people who have had cancer and are trying to prevent another cancer of the same type or to lower their chance of developing a new type of cancer. Other trials are done with healthy volunteers who are not known to have any risk factors for cancer. The purpose of some cancer prevention clinical trials is to find out whether actions people take can prevent cancer. These may include eating fruits and vegetables, exercising, quitting smoking, or taking certain medicines, vitamins, minerals, or food supplements. New ways to prevent anal cancer are being studied in clinical trials. Clinical trials are taking place in many parts of the country. Information about clinical trials for anal cancer prevention can be found in the Clinical Trials section of the NCI Web site.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Langerhans Cell Histiocytosis ? [/INST] Langerhans cell histiocytosis is a type of cancer that can damage tissue or cause lesions to form in one or more places in the body. Family history or having a parent who was exposed to certain chemicals may increase the risk of LCH. The signs and symptoms of LCH depend on where it is in the body. Skin and nails Mouth Bone Lymph nodes and thymus Endocrine system Central nervous system (CNS) Liver and spleen Lung Bone marrow Tests that examine the organs and body systems where LCH may occur are used to detect (find) and diagnose LCH. Certain factors affect prognosis (chance of recovery) and treatment options. Langerhans cell histiocytosis is a type of cancer that can damage tissue or cause lesions to form in one or more places in the body. Langerhans cell histiocytosis (LCH) is a rare cancer that begins in LCH cells (a type of dendritic cell which fights infection). Sometimes there are mutations (changes) in LCH cells as they form. These include mutations of the BRAF gene. These changes may make the LCH cells grow and multiply quickly. This causes LCH cells to build up in certain parts of the body, where they can damage tissue or form lesions. LCH is not a disease of the Langerhans cells that normally occur in the skin. LCH may occur at any age, but is most common in young children. Treatment of LCH in children is different from treatment of LCH in adults. The treatments for LCH in children and adults are described in separate sections of this summary. Check the list of NCIsupported cancer clinical trials that are now accepting patients with childhood Langerhans cell histiocytosis. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Langerhans Cell Histiocytosis? ? [/INST] Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors for LCH include the following: Having a parent who was exposed to certain chemicals such as benzene. Having a parent who was exposed to metal, granite, or wood dust in the workplace. A family history of cancer, including LCH. Having infections as a newborn. Having a personal history or family history of thyroid disease. Smoking, especially in young adults. Being Hispanic.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Langerhans Cell Histiocytosis ? [/INST] These and other signs and symptoms may be caused by LCH or by other conditions. Check with your doctor if you or your child have any of the following: Skin and nails LCH in infants may affect the skin only. In some cases, skinonly LCH may get worse over weeks or months and become a form called highrisk multisystem LCH. In infants, signs or symptoms of LCH that affects the skin may include: Flaking of the scalp that may look like cradle cap. Raised, brown or purple skin rash anywhere on the body. In children and adults, signs or symptoms of LCH that affects the skin and nails may include: Flaking of the scalp that may look like dandruff. Raised, red or brown, crusted rash in the groin area, abdomen, back, or chest, that may be itchy. Bumps or ulcers on the scalp. Ulcers behind the ears, under the breasts, or in the groin area. Fingernails that fall off or have discolored grooves that run the length of the nail. Mouth Signs or symptoms of LCH that affects the mouth may include: Swollen gums. Sores on the roof of the mouth, inside the cheeks, or on the tongue or lips. Teeth that become uneven. Tooth loss. Bone Signs or symptoms of LCH that affects the bone may include: Swelling or a lump over a bone, such as the skull, ribs, spine, thigh bone, upper arm bone, elbow, eye socket, or bones around the ear. Pain where there is swelling or a lump over a bone. Children with LCH lesions in bones around the ears or eyes have a high risk for diabetes insipidus and other central nervous system disease. Lymph nodes and thymus Signs or symptoms of LCH that affects the lymph nodes or thymus may include: Swollen lymph nodes. Trouble breathing. Superior vena cava syndrome. This can cause coughing, trouble breathing, and swelling of the face, neck, and upper arms. Endocrine system Signs or symptoms of LCH that affects the pituitary gland may include: Diabetes insipidus. This can cause a strong thirst and frequent urination. Slow growth. Early or late puberty. Being very overweight. Signs or symptoms of LCH that affects the thyroid may include: Swollen thyroid gland. Hypothyroidism. This can cause tiredness, lack of energy, being sensitive to cold, constipation, dry skin, thinning hair, memory problems, trouble concentrating, and depression. In infants, this can also cause a loss of appetite and choking on food. In children and adolescents, this can also cause behavior problems, weight gain, slow growth, and late puberty. Trouble breathing. Central nervous system (CNS) Signs or symptoms of LCH that affects the CNS (brain and spinal cord) may include: Loss of balance, uncoordinated body movements, and trouble walking. Trouble speaking. Trouble seeing. Headaches. Changes in behavior or personality. Memory problems. These signs and symptoms may be caused by lesions in the CNS or by CNS neurodegenerative syndrome. Liver and spleen Signs or symptoms of LCH that affects the liver or spleen may include: Swelling in the abdomen caused by a buildup of extra fluid. Trouble breathing. Yellowing of the skin and whites of the eyes. Itching. Easy bruising or bleeding. Feeling very tired. Lung Signs or symptoms of LCH that affects the lung may include: Collapsed lung. This condition can cause chest pain or tightness, trouble breathing, feeling tired, and a bluish color to the skin. Trouble breathing, especially in adults who smoke. Dry cough. Chest pain. Bone marrow Signs or symptoms of LCH that affects the bone marrow may include: Easy bruising or bleeding. Fever. Frequent infections.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Langerhans Cell Histiocytosis ? [/INST] The following tests and procedures may be used to detect (find) and diagnose LCH or conditions caused by LCH: Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken. Neurological exam : A series of questions and tests to check the brain, spinal cord, and nerve function. The exam checks a person's mental status, coordination, and ability to walk normally, and how well the muscles, senses, and reflexes work. This may also be called a neuro exam or a neurologic exam. Complete blood count (CBC) with differential : A procedure in which a sample of blood is drawn and checked for the following: The amount of hemoglobin (the protein that carries oxygen) in the red blood cells. The portion of the blood sample made up of red blood cells. The number and type of white blood cells. The number of red blood cells and platelets. Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the body by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease. Liver function test : A blood test to measure the blood levels of certain substances released by the liver. A high or low level of these substances can be a sign of disease in the liver. BRAF gene testing : A laboratory test in which a sample of blood or tissue is tested for mutations of the BRAF gene. Urinalysis : A test to check the color of urine and its contents, such as sugar, protein, red blood cells, and white blood cells. Water deprivation test : A test to check how much urine is made and whether it becomes concentrated when little or no water is given. This test is used to diagnose diabetes insipidus, which may be caused by LCH. Bone marrow aspiration and biopsy : The removal of bone marrow and a small piece of bone by inserting a hollow needle into the hipbone. A pathologist views the bone marrow and bone under a microscope to look for signs of LCH. The following tests may be done on the tissue that was removed: Immunohistochemistry : A test that uses antibodies to check for certain antigens in a sample of tissue. The antibody is usually linked to a radioactive substance or a dye that causes the tissue to light up under a microscope. This type of test may be used to tell the difference between different types of cancer. Flow cytometry : A laboratory test that measures the number of cells in a sample, how many cells are live, and the size of the cells. It also shows the shapes of the cells and whether there are tumor markers on the surface of the cells. The cells are stained with a lightsensitive dye, placed in a fluid, and passed in a stream before a laser or other type of light. The measurements are based on how the lightsensitive dye reacts to the light. Bone scan : A procedure to check if there are rapidly dividing cells in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner. Xray : An xray of the organs and bones inside the body. An xray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. Sometimes a skeletal survey is done. This is a procedure to xray all of the bones in the body. CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an xray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. A substance called gadolinium may be injected into a vein. The gadolinium collects around the LCH cells so that they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI). PET scan (positron emission tomography scan): A procedure to find tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. Ultrasound exam: A procedure in which highenergy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later. Bronchoscopy : A procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope is inserted through the nose or mouth into the trachea and lungs. A bronchoscope is a thin, tubelike instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer. Endoscopy : A procedure to look at organs and tissues inside the body to check for abnormal areas in the gastrointestinal tract or lungs. An endoscope is inserted through an incision (cut) in the skin or opening in the body, such as the mouth. An endoscope is a thin, tubelike instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of disease. Biopsy : The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for LCH cells. To diagnose LCH, a biopsy of bone lesions, skin, lymph nodes, or the liver may be done.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is the outlook for Langerhans Cell Histiocytosis ? [/INST] LCH in organs such as the skin, bones, lymph nodes, or pituitary gland usually gets better with treatment and is called "low risk". LCH in the spleen, liver, or bone marrow is harder to treat and is called "highrisk". The prognosis (chance of recovery) and treatment options depend on the following: Whether there are mutations of the BRAF gene. How old the patient is when diagnosed with LCH. How many organs or body systems the cancer affects. Whether the cancer is found in the liver, spleen, bone marrow, or certain bones in the skull. How quickly the cancer responds to initial treatment. Whether the cancer has just been diagnosed or has come back (recurred). In infants up to one year of age, LCH may go away without treatment.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the stages of Langerhans Cell Histiocytosis ? [/INST] There is no staging system for Langerhans cell histiocytosis (LCH). Treatment of LCH is based on where LCH cells are found in the body and how many body systems are affected. There is no staging system for Langerhans cell histiocytosis (LCH). The extent or spread of cancer is usually described as stages. There is no staging system for LCH. Treatment of LCH is based on where LCH cells are found in the body and how many body systems are affected. LCH is described as singlesystem disease or multisystem disease, depending on how many body systems are affected: Singlesystem LCH: LCH is found in one part of an organ or body system (unifocal) or in more than one part of that organ or body system (multifocal). Bone is the most common single place for LCH to be found. Multisystem LCH: LCH occurs in two or more organs or body systems or may be spread throughout the body. Multisystem LCH is less common than singlesystem LCH. LCH may affect lowrisk organs or highrisk organs: Lowrisk organs include the skin, bone, lungs, lymph nodes, gastrointestinal tract, pituitary gland, and central nervous system (CNS). Highrisk organs include the liver, spleen, and bone marrow.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Langerhans Cell Histiocytosis ? [/INST] There are different types of treatment for patients with Langerhans cell histiocytosis (LCH). Children with LCH should have their treatment planned by a team of health care providers who are experts in treating childhood cancer. Some cancer treatments cause side effects months or years after treatment for childhood cancer has ended. Nine types of standard treatment are used: Chemotherapy Surgery Radiation therapy Photodynamic therapy Biologic therapy Targeted therapy Other drug therapy Stem cell transplant Observation New types of treatment are being tested in clinical trials. Patients may want to think about taking part in a clinical trial. Patients can enter clinical trials before, during, or after starting their treatment. When treatment of LCH stops, new lesions may appear or old lesions may come back. Followup tests may be needed. There are different types of treatment for patients with Langerhans cell histiocytosis (LCH). Different types of treatments are available for patients with LCH. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Whenever possible, patients should take part in a clinical trial in order to receive new types of treatment for LCH. Some clinical trials are open only to patients who have not started treatment. Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI website. Choosing the most appropriate treatment is a decision that ideally involves the patient, family, and health care team. Children with LCH should have their treatment planned by a team of health care providers who are experts in treating childhood cancer. Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other pediatric healthcare providers who are experts in treating children with LCH and who specialize in certain areas of medicine. These may include the following specialists: Pediatrician. Primary care physician. Pediatric surgeon. Pediatric hematologist. Radiation oncologist. Neurologist. Endocrinologist. Pediatric nurse specialist. Rehabilitation specialist. Psychologist. Social worker. Some cancer treatments cause side effects months or years after treatment for childhood cancer has ended. Side effects from cancer treatment that begin during or after treatment and continue for months or years are called late effects. Late effects of cancer treatment may include the following: Slow growth and development. Hearing loss. Bone, tooth, liver, and lung problems. Changes in mood, feeling, learning, thinking, or memory. Second cancers, such as leukemia, retinoblastoma, Ewing sarcoma, brain or liver cancer. Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information.) Many patients with multisystem LCH have late effects caused by treatment or by the disease itself. These patients often have longterm health problems that affect their quality of life. Nine types of standard treatment are used: Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly onto the skin or into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Chemotherapy agents given by injection or by mouth are used to treat LCH. Chemotherapy agents include vinblastine, cytarabine, cladribine, and methotrexate. Nitrogen mustard is a drug that is put directly on the skin to treat small LCH lesions. Surgery Surgery may be used to remove LCH lesions and a small amount of nearby healthy tissue. Curettage is a type of surgery that uses a curette (a sharp, spoonshaped tool) to scrape LCH cells from bone. When there is severe liver or lung damage, the entire organ may be removed and replaced with a healthy liver or lung from a donor. Radiation therapy Radiation therapy is a cancer treatment that uses highenergy xrays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the cancer. In LCH, a special lamp may be used to send ultraviolet B (UVB) radiation toward LCH skin lesions. Photodynamic therapy Photodynamic therapy is a cancer treatment that uses a drug and a certain type of laser light to kill cancer cells. A drug that is not active until it is exposed to light is injected into a vein. The drug collects more in cancer cells than in normal cells. For LCH, laser light is aimed at the skin and the drug becomes active and kills the cancer cells. Photodynamic therapy causes little damage to healthy tissue. Patients who have photodynamic therapy should not spend too much time in the sun. In one type of photodynamic therapy, called psoralen and ultraviolet A (PUVA) therapy, the patient receives a drug called psoralen and then ultraviolet A radiation is directed to the skin. Biologic therapy Biologic therapy is a treatment that uses the patients immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the bodys natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy. Interferon is a type of biologic therapy used to treat LCH of the skin. Immunomodulators are also a type of biologic therapy. Thalidomide is an immunomodulator used to treat LCH. Targeted therapy Targeted therapy is a type of treatment that uses drugs or other substances to find and attack LCH cells without harming normal cells. Imatinib mesylate is a type of targeted therapy called a tyrosine kinase inhibitor. It stops blood stem cells from turning into dendritic cells that may become cancer cells. Other types of kinase inhibitors that affect cells with mutations (changes) in the BRAF gene, such as dabrafenib and vemurafenib, are being studied in clinical trials for LCH. A family of genes, called ras genes, may cause cancer when they are mutated. Ras genes make proteins that are involved in cell signaling pathways, cell growth, and cell death. Ras pathway inhibitors are a type of targeted therapy being studied in clinical trials. They block the actions of a mutated ras gene or its protein and may stop the growth of cancer. Other drug therapy Other drugs used to treat LCH include the following: Steroid therapy, such as prednisone, is used to treat LCH lesions. Bisphosphonate therapy (such as pamidronate, zoledronate, or alendronate) is used to treat LCH lesions of the bone and to lessen bone pain. Nonsteroidal antiinflammatory drugs (NSAIDs) are drugs (such as aspirin and ibuprofen) that are commonly used to decrease fever, swelling, pain, and redness. Sometimes an NSAID called indomethacin is used to treat LCH. Retinoids, such as isotretinoin, are drugs related to vitamin A that can slow the growth of LCH cells in the skin. The retinoids are taken by mouth. Stem cell transplant Stem cell transplant is a method of giving chemotherapy and replacing bloodforming cells destroyed by the LCH treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells. Observation Observation is closely monitoring a patient's condition without giving any treatment until signs or symptoms appear or change. New types of treatment are being tested in clinical trials. Information about clinical trials is available from the NCI website. Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. See the Treatment Options for Childhood LCH and the Treatment Options for Adult LCH sections for links to current treatment clinical trials. These have been retrieved from NCI's clinical trials database. When treatment of LCH stops, new lesions may appear or old lesions may come back. Many patients with LCH get better with treatment. However, when treatment stops, new lesions may appear or old lesions may come back. This is called reactivation (recurrence) and may occur within one year after stopping treatment. Patients with multisystem disease are more likely to have a reactivation. More common sites of reactivation are bone, ears, or skin. Diabetes insipidus also may develop. Less common sites of reactivation include lymph nodes, bone marrow, spleen, liver, or lung. Some patients may have more than one reactivation over a number of years. Followup tests may be needed. Some of the tests that were done to diagnose LCH may be repeated. This is to see how well the treatment is working and if there are any new lesions. These tests may include: Physical exam. Neurological exam. Ultrasound exam. MRI. CT scan. PET scan. Other tests that may be needed include: Brain stem auditory evoked response (BAER) test: A test that measures the brain's response to clicking sounds or certain tones. Pulmonary function test (PFT): A test to see how well the lungs are working. It measures how much air the lungs can hold and how quickly air moves into and out of the lungs. It also measures how much oxygen is used and how much carbon dioxide is given off during breathing. This is also called a lung function test. Chest xray: An xray of the organs and bones inside the chest. An xray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called followup tests or checkups. Treatment Options for LCH in Children Treatment of LowRisk Disease in Children Skin Lesions Treatment of childhood Langerhans cell histiocytosis (LCH) skin lesions may include the following: Observation. When severe rashes, pain, ulceration, or bleeding occur, treatment may include the following: Steroid therapy. Chemotherapy, given by mouth. Nitrogen mustard applied to the skin. Photodynamic therapy with psoralen and ultraviolet A (PUVA) therapy. UVB radiation therapy. Lesions in Bones or Other LowRisk Organs Treatment of childhood LCH bone lesions in the front, sides, or back of the skull, or in any other single bone may include the following: Surgery (curettage) with or without steroid therapy. Lowdose radiation therapy for lesions that affect nearby organs. Treatment of childhood LCH lesions in bones around the ears or eyes is done to lower the risk of diabetes insipidus and other longterm problems. Treatment may include: Chemotherapy and steroid therapy. Surgery (curettage). Treatment of childhood LCH lesions of the spine or thigh bone lesions may include: Observation. Lowdose radiation therapy. Chemotherapy, for lesions that spread from the spine into nearby tissue. Surgery to strengthen the weakened bone by bracing or fusing the bones together. Treatment of two or more bone lesions may include: Chemotherapy and steroid therapy. Treatment of two or more bone lesions combined with childhood LCH skin lesions, lymph node lesions, or diabetes insipidus may include: Chemotherapy with or without steroid therapy. Bisphosphonate therapy. Treatment of HighRisk Disease in Children Treatment of childhood LCH multisystem disease lesions in the spleen, liver, or bone marrow (with or without skin, bone, lymph node, lung, or pituitary gland lesions) may include: Chemotherapy and steroid therapy. Higher doses of combination chemotherapy and steroid therapy may be given to patients whose tumors do not respond to initial chemotherapy. A liver transplant for patients with severe liver damage. Treatment of childhood LCH central nervous system (CNS) lesions may include: Chemotherapy with or without steroid therapy. Steroid therapy. Treatment of LCH CNS neurodegenerative syndrome may include: Retinoid therapy. Chemotherapy. Treatment Options for Recurrent, Refractory, and Progressive Childhood LCH in Children Recurrent LCH is cancer that cannot be detected for some time after treatment and then comes back. Treatment of recurrent childhood LCH in the skin, bone, lymph nodes, gastrointestinal tract, pituitary gland, or central nervous system (lowrisk organs) may include: Chemotherapy with or without steroid therapy. Bisphosphonate therapy. Nonsteroidal antiinflammatory drug (NSAID) therapy with indomethacin. A clinical trial of a targeted therapy. Refractory LCH is cancer that does not get better with treatment. Treatment of refractory childhood LCH in highrisk organs and in multisystem lowrisk organs may include highdose chemotherapy. Treatment of childhood LCH in multisystem highrisk organs that did not respond to chemotherapy may include stem cell transplant. Progressive LCH is cancer that continues to grow during treatment. Treatment of progressive childhood LCH in patients with multisystem disease may include anticancer drugs that have not been given to the patient before. Treatment Options for LCH in Adults Treatment Options for LCH of the Lung in Adults Treatment for LCH of the lung in adults may include: Quitting smoking for all patients who smoke. Lung damage will get worse over time in patients who do not quit smoking. In patients who quit smoking, lung damage may get better or it may get worse over time. Chemotherapy. Lung transplant for patients with severe lung damage. Sometimes LCH of the lung will go away or not get worse even if it's not treated. Treatment Options for LCH of the Bone in Adults Treatment for LCH that affects only the bone in adults may include: Surgery with or without steroid therapy. Chemotherapy with or without lowdose radiation therapy. Radiation therapy. Bisphosphonate therapy, for severe bone pain. Treatment Options for LCH of the Skin in Adults Treatment for LCH that affects only the skin in adults may include: Surgery. Steroid or other drug therapy applied or injected into the skin. Photodynamic therapy with psoralen and ultraviolet A (PUVA) radiation. UVB radiation therapy. Chemotherapy or biologic therapy given by mouth, such as methotrexate, thalidomide, or interferon. Retinoid therapy may be used if the skin lesions do not get better with other treatment. Treatment for LCH that affects the skin and other body systems in adults may include: Chemotherapy. Treatment Options for SingleSystem and Multisystem LCH in Adults Treatment of singlesystem and multisystem disease in adults may include: Chemotherapy with or without a drug given to weaken the immune system. Bisphosphonate therapy, for severe bone pain. A clinical trial of a targeted therapy.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Langerhans Cell Histiocytosis ? [/INST] New types of treatment are being tested in clinical trials. Information about clinical trials is available from the NCI website. Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. See the Treatment Options for Childhood LCH and the Treatment Options for Adult LCH sections for links to current treatment clinical trials. These have been retrieved from NCI's clinical trials database.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Breast Cancer ? [/INST] Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. Breast cancer is the second leading cause of death from cancer in American women. Different factors increase or decrease the risk of breast cancer. Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes, which have many smaller sections called lobules. Lobules end in dozens of tiny bulbs that can produce milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts. Each breast also contains blood vessels and lymph vessels. The lymph vessels carry an almost colorless fluid called lymph. Lymph vessels lead to organs called lymph nodes. Lymph nodes are small beanshaped structures that are found throughout the body. They filter substances in lymph and help fight infection and disease. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest. See the following PDQ summaries for more information about breast cancer: Breast Cancer Prevention Breast Cancer Treatment Genetics of Breast and Gynecologic Cancers Breast cancer is the second leading cause of death from cancer in American women. Women in the United States get breast cancer more than any other type of cancer except for skin cancer. Breast cancer is second only to lung cancer as a cause of cancer death in women. Breast cancer occurs more often in white women than in black women. However, black women are more likely than white women to die from the disease. Breast cancer occurs in men also, but the number of cases is small.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Breast Cancer? ? [/INST] Different factors increase or decrease the risk of breast cancer. Anything that increases your chance of getting a disease is called a risk factor. Anything that decreases your chance of getting a disease is called a protective factor. For information about risk factors and protective factors for breast cancer, see the PDQ summary on Breast Cancer Prevention.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Breast Cancer ? [/INST] Other screening tests are being studied in clinical trials. Thermography Thermography is a procedure in which a special camera that senses heat is used to record the temperature of the skin that covers the breasts. A computer makes a map of the breast showing the changes in temperature. Tumors can cause temperature changes that may show up on the thermogram. There have been no clinical trials of thermography to find out how well it detects breast cancer or if having the procedure decreases the risk of dying from breast cancer. Tissue sampling Breast tissue sampling is taking cells from breast tissue to check under a microscope. Abnormal cells in breast fluid have been linked to an increased risk of breast cancer in some studies. Scientists are studying whether breast tissue sampling can be used to find breast cancer at an early stage or predict the risk of developing breast cancer. Three ways of taking tissue samples are being studied: Fineneedle aspiration: A thin needle is inserted into the breast tissue around the areola (darkened area around the nipple) to take out a sample of cells and fluid. Nipple aspiration: The use of gentle suction to collect fluid through the nipple. This is done with a device similar to the breast pumps used by women who are breastfeeding. Ductal lavage: A hairsize catheter (tube) is inserted into the nipple and a small amount of salt water is released into the duct. The water picks up breast cells and is removed. Screening clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI website.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Childhood Acute Lymphoblastic Leukemia ? [/INST] Childhood acute lymphoblastic leukemia (ALL) is a type of cancer in which the bone marrow makes too many immature lymphocytes (a type of white blood cell). Leukemia may affect red blood cells, white blood cells, and platelets. Past treatment for cancer and certain genetic conditions affect the risk of having childhood ALL. Signs of childhood ALL include fever and bruising. Tests that examine the blood and bone marrow are used to detect (find) and diagnose childhood ALL. Certain factors affect prognosis (chance of recovery) and treatment options. Childhood acute lymphoblastic leukemia (ALL) is a type of cancer in which the bone marrow makes too many immature lymphocytes (a type of white blood cell). Childhood acute lymphoblastic leukemia (also called ALL or acute lymphocytic leukemia) is a cancer of the blood and bone marrow. This type of cancer usually gets worse quickly if it is not treated. ALL is the most common type of cancer in children. Leukemia may affect red blood cells, white blood cells, and platelets. In a healthy child, the bone marrow makes blood stem cells (immature cells) that become mature blood cells over time. A blood stem cell may become a myeloid stem cell or a lymphoid stem cell. A myeloid stem cell becomes one of three types of mature blood cells: Red blood cells that carry oxygen and other substances to all tissues of the body. Platelets that form blood clots to stop bleeding. White blood cells that fight infection and disease. A lymphoid stem cell becomes a lymphoblast cell and then one of three types of lymphocytes (white blood cells): B lymphocytes that make antibodies to help fight infection. T lymphocytes that help B lymphocytes make the antibodies that help fight infection. Natural killer cells that attack cancer cells and viruses. In a child with ALL, too many stem cells become lymphoblasts, B lymphocytes, or T lymphocytes. The cells do not work like normal lymphocytes and are not able to fight infection very well. These cells are cancer (leukemia) cells. Also, as the number of leukemia cells increases in the blood and bone marrow, there is less room for healthy white blood cells, red blood cells, and platelets. This may lead to infection, anemia, and easy bleeding. This summary is about acute lymphoblastic leukemia in children, adolescents, and young adults. See the following PDQ summaries for information about other types of leukemia: Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies Treatment Adult Acute Lymphoblastic Leukemia Treatment Chronic Lymphocytic Leukemia Treatment Adult Acute Myeloid Leukemia Treatment Chronic Myelogenous Leukemia Treatment Hairy Cell Leukemia Treatment</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Childhood Acute Lymphoblastic Leukemia ? [/INST] Signs of childhood ALL include fever and bruising. These and other signs and symptoms may be caused by childhood ALL or by other conditions. Check with your child's doctor if your child has any of the following: Fever. Easy bruising or bleeding. Petechiae (flat, pinpoint, darkred spots under the skin caused by bleeding). Bone or joint pain. Painless lumps in the neck, underarm, stomach, or groin. Pain or feeling of fullness below the ribs. Weakness, feeling tired, or looking pale. Loss of appetite.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Childhood Acute Lymphoblastic Leukemia ? [/INST] Tests that examine the blood and bone marrow are used to detect (find) and diagnose childhood ALL. The following tests and procedures may be used to diagnose childhood ALL and find out if leukemia cells have spread to other parts of the body such as the brain or testicles: Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken. Complete blood count (CBC) with differential : A procedure in which a sample of blood is drawn and checked for the following: The number of red blood cells and platelets. The number and type of white blood cells. The amount of hemoglobin (the protein that carries oxygen) in the red blood cells. The portion of the sample made up of red blood cells. Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease. Bone marrow aspiration and biopsy : The removal of bone marrow and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow and bone under a microscope to look for signs of cancer. The following tests are done on blood or the bone marrow tissue that is removed: Cytogenetic analysis : A laboratory test in which the cells in a sample of blood or bone marrow are viewed under a microscope to look for certain changes in the chromosomes of lymphocytes. For example, in Philadelphia chromosome positive ALL, part of one chromosome switches places with part of another chromosome. This is called the Philadelphia chromosome. Immunophenotyping : A laboratory test in which the antigens or markers on the surface of a blood or bone marrow cell are checked to see if they are lymphocytes or myeloid cells. If the cells are malignant lymphocytes (cancer) they are checked to see if they are B lymphocytes or T lymphocytes. Lumbar puncture : A procedure used to collect a sample of cerebrospinal fluid (CSF) from the spinal column. This is done by placing a needle between two bones in the spine and into the CSF around the spinal cord and removing a sample of the fluid. The sample of CSF is checked under a microscope for signs that leukemia cells have spread to the brain and spinal cord. This procedure is also called an LP or spinal tap. This procedure is done after leukemia is diagnosed to find out if leukemia cells have spread to the brain and spinal cord. Intrathecal chemotherapy is given after the sample of fluid is removed to treat any leukemia cells that may have spread to the brain and spinal cord. Chest xray : An xray of the organs and bones inside the chest. An xray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. The chest xray is done to see if leukemia cells have formed a mass in the middle of the chest.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is the outlook for Childhood Acute Lymphoblastic Leukemia ? [/INST] Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) depends on: How quickly and how low the leukemia cell count drops after the first month of treatment. Age at the time of diagnosis, gender, race, and ethnic background. The number of white blood cells in the blood at the time of diagnosis. Whether the leukemia cells began from B lymphocytes or T lymphocytes. Whether there are certain changes in the chromosomes or genes of the lymphocytes with cancer. Whether the child has Down syndrome. Whether leukemia cells are found in the cerebrospinal fluid. The child's weight at the time of diagnosis and during treatment. Treatment options depend on: Whether the leukemia cells began from B lymphocytes or T lymphocytes. Whether the child has standardrisk, highrisk, or very highrisk ALL. The age of the child at the time of diagnosis. Whether there are certain changes in the chromosomes of lymphocytes, such as the Philadelphia chromosome. Whether the child was treated with steroids before the start of induction therapy. How quickly and how low the leukemia cell count drops during treatment. For leukemia that relapses (comes back) after treatment, the prognosis and treatment options depend partly on the following: How long it is between the time of diagnosis and when the leukemia comes back. Whether the leukemia comes back in the bone marrow or in other parts of the body.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Childhood Acute Lymphoblastic Leukemia ? [/INST] New types of treatment are being tested in clinical trials. This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website. Chimeric antigen receptor (CAR) Tcell therapy CAR Tcell therapy is a type of immunotherapy that changes the patient's T cells (a type of immune system cell) so they will attack certain proteins on the surface of cancer cells. T cells are taken from the patient and special receptors are added to their surface in the laboratory. The changed cells are called chimeric antigen receptor (CAR) T cells. The CAR T cells are grown in the laboratory and given to the patient by infusion. The CAR T cells multiply in the patient's blood and attack cancer cells. CAR Tcell therapy is being studied in the treatment of childhood ALL that has relapsed (come back) a second time. Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Childhood Acute Lymphoblastic Leukemia? ? [/INST] Past treatment for cancer and certain genetic conditions affect the risk of having childhood ALL. Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesnt mean that you will not get cancer. Talk with your child's doctor if you think your child may be at risk. Possible risk factors for ALL include the following: Being exposed to xrays before birth. Being exposed to radiation. Past treatment with chemotherapy. Having certain genetic conditions, such as: Down syndrome. Neurofibromatosis type 1. Bloom syndrome. Fanconi anemia. Ataxiatelangiectasia. LiFraumeni syndrome. Constitutional mismatch repair deficiency (mutations in certain genes that stop DNA from repairing itself, which leads to the growth of cancers at an early age). Having certain changes in the chromosomes or genes. Risk Groups In childhood ALL, risk groups are used to plan treatment. Relapsed childhood ALL is cancer that has come back after it has been treated. In childhood ALL, risk groups are used to plan treatment. There are three risk groups in childhood ALL. They are described as: Standard (low) risk: Includes children aged 1 to younger than 10 years who have a white blood cell count of less than 50,000/L at the time of diagnosis. High risk: Includes children 10 years and older and/or children who have a white blood cell count of 50,000/L or more at the time of diagnosis. Very high risk: Includes children younger than age 1, children with certain changes in the genes, children who have a slow response to initial treatment, and children who have signs of leukemia after the first 4 weeks of treatment. Other factors that affect the risk group include the following: Whether the leukemia cells began from B lymphocytes or T lymphocytes. Whether there are certain changes in the chromosomes or genes of the lymphocytes. How quickly and how low the leukemia cell count drops after initial treatment. Whether leukemia cells are found in the cerebrospinal fluid at the time of diagnosis. It is important to know the risk group in order to plan treatment. Children with highrisk or very highrisk ALL usually receive more anticancer drugs and/or higher doses of anticancer drugs than children with standardrisk ALL. Relapsed childhood ALL is cancer that has come back after it has been treated. The leukemia may come back in the blood and bone marrow, brain, spinal cord, testicles, or other parts of the body. Refractory childhood ALL is cancer that does not respond to treatment.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Childhood Acute Lymphoblastic Leukemia ? [/INST] There are different types of treatment for childhood acute lymphoblastic leukemia (ALL). Children with ALL should have their treatment planned by a team of doctors who are experts in treating childhood leukemia. Children and adolescents may have treatmentrelated side effects that appear months or years after treatment for acute lymphoblastic leukemia. The treatment of childhood ALL usually has three phases. Four types of standard treatment are used: Chemotherapy Radiation therapy Chemotherapy with stem cell transplant Targeted therapy Treatment is given to kill leukemia cells that have spread or may spread to the brain, spinal cord, or testicles. New types of treatment are being tested in clinical trials. Chimeric antigen receptor (CAR) Tcell therapy Patients may want to think about taking part in a clinical trial. Patients can enter clinical trials before, during, or after starting their cancer treatment. Followup tests may be needed. There are different types of treatment for childhood acute lymphoblastic leukemia (ALL). Different types of treatment are available for children with acute lymphoblastic leukemia (ALL). Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment. Children with ALL should have their treatment planned by a team of doctors who are experts in treating childhood leukemia. Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other pediatric health professionals who are experts in treating children with leukemia and who specialize in certain areas of medicine. These may include the following specialists: Pediatrician. Hematologist. Medical oncologist. Pediatric surgeon. Radiation oncologist. Neurologist. Pathologist. Radiologist. Pediatric nurse specialist. Social worker. Rehabilitation specialist. Psychologist. Childlife specialist. Children and adolescents may have treatmentrelated side effects that appear months or years after treatment for acute lymphoblastic leukemia. Regular followup exams are very important. Treatment can cause side effects long after it has ended. These are called late effects. Late effects of cancer treatment may include: Physical problems, including problems with the heart, blood vessels, liver, or bones, and fertility. When dexrazoxane is given with chemotherapy drugs called anthracyclines, the risk of late heart effects is lessened. Changes in mood, feelings, thinking, learning, or memory. Children younger than 4 years who have received radiation therapy to the brain have a higher risk of these effects. Second cancers (new types of cancer) or other conditions, such as brain tumors, thyroid cancer, acute myeloid leukemia, and myelodysplastic syndrome. Some late effects may be treated or controlled. It is important to talk with your child's doctors about the possible late effects caused by some treatments. See the PDQ summary on Late Effects of Treatment for Childhood Cancer. The treatment of childhood ALL usually has three phases. The treatment of childhood ALL is done in phases: Remission induction: This is the first phase of treatment. The goal is to kill the leukemia cells in the blood and bone marrow. This puts the leukemia into remission. Consolidation /intensification: This is the second phase of treatment. It begins once the leukemia is in remission. The goal of consolidation/intensification therapy is to kill any leukemia cells that remain in the body and may cause a relapse. Maintenance: This is the third phase of treatment. The goal is to kill any remaining leukemia cells that may regrow and cause a relapse. Often the cancer treatments are given in lower doses than those used during the remission induction and consolidation/intensification phases. Not taking medication as ordered by the doctor during maintenance therapy increases the chance the cancer will come back. This is also called the continuation therapy phase. Four types of standard treatment are used: Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid (intrathecal), an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug. The way the chemotherapy is given depends on the child's risk group. Children with highrisk ALL receive more anticancer drugs and higher doses of anticancer drugs than children with standardrisk ALL. Intrathecal chemotherapy may be used to treat childhood ALL that has spread, or may spread, to the brain and spinal cord. See Drugs Approved for Acute Lymphoblastic Leukemia for more information. Radiation therapy Radiation therapy is a cancer treatment that uses highenergy xrays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy: External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type of cancer being treated. External radiation therapy may be used to treat childhood ALL that has spread, or may spread, to the brain, spinal cord, or testicles. It may also be used to prepare the bone marrow for a stem cell transplant. Chemotherapy with stem cell transplant Stem cell transplant is a method of giving high doses of chemotherapy and sometimes totalbody irradiation, and then replacing the bloodforming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of a donor. After the patient receives treatment, the donor's stem cells are given to the patient through an infusion. These reinfused stem cells grow into (and restore) the patient's blood cells. The stem cell donor doesn't have to be related to the patient. Stem cell transplant is rarely used as initial treatment for children and adolescents with ALL. It is used more often as part of treatment for ALL that relapses (comes back after treatment). See Drugs Approved for Acute Lymphoblastic Leukemia for more information. Targeted therapy Targeted therapy is a treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Tyrosine kinase inhibitors (TKIs) are targeted therapy drugs that block the enzyme, tyrosine kinase, which causes stem cells to become more white blood cells or blasts than the body needs. Imatinib mesylate is a TKI used in the treatment of children with Philadelphia chromosome positive ALL. Dasatinib and ruxolitinib are TKIs that are being studied in the treatment of newly diagnosed highrisk ALL. Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Blinatumomab and inotuzumab are monoclonal antibodies being studied in the treatment of refractory childhood ALL. New kinds of targeted therapies are also being studied in the treatment of childhood ALL. See Drugs Approved for Acute Lymphoblastic Leukemia for more information. Treatment is given to kill leukemia cells that have spread or may spread to the brain, spinal cord, or testicles. Treatment to kill leukemia cells or prevent the spread of leukemia cells to the brain and spinal cord (central nervous system; CNS) is called CNSdirected therapy. Chemotherapy may be used to treat leukemia cells that have spread, or may spread, to the brain and spinal cord. Because standard doses of chemotherapy may not reach leukemia cells in the CNS, the cells are able to hide in the CNS. Systemic chemotherapy given in high doses or intrathecal chemotherapy (into the cerebrospinal fluid) is able to reach leukemia cells in the CNS. Sometimes external radiation therapy to the brain is also given. These treatments are given in addition to treatment that is used to kill leukemia cells in the rest of the body. All children with ALL receive CNSdirected therapy as part of induction therapy and consolidation/intensification therapy and sometimes during maintenance therapy. If the leukemia cells spread to the testicles, treatment includes high doses of systemic chemotherapy and sometimes radiation therapy. New types of treatment are being tested in clinical trials. This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website. Chimeric antigen receptor (CAR) Tcell therapy CAR Tcell therapy is a type of immunotherapy that changes the patient's T cells (a type of immune system cell) so they will attack certain proteins on the surface of cancer cells. T cells are taken from the patient and special receptors are added to their surface in the laboratory. The changed cells are called chimeric antigen receptor (CAR) T cells. The CAR T cells are grown in the laboratory and given to the patient by infusion. The CAR T cells multiply in the patient's blood and attack cancer cells. CAR Tcell therapy is being studied in the treatment of childhood ALL that has relapsed (come back) a second time. Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials. Followup tests may be needed. Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the cancer has recurred (come back). These tests are sometimes called followup tests or checkups. Bone marrow aspiration and biopsy is done during all phases of treatment to see how well the treatment is working. Treatment Options for Childhood Acute Lymphoblastic Leukemia Newly Diagnosed Childhood Acute Lymphoblastic Leukemia (Standard Risk) The treatment of standardrisk childhood acute lymphoblastic leukemia (ALL) during the remission induction, consolidation /intensification, and maintenance phases always includes combination chemotherapy. When children are in remission after remission induction therapy, a stem cell transplant using stem cells from a donor may be done. When children are not in remission after remission induction therapy, further treatment is usually the same treatment given to children with highrisk ALL. Intrathecal chemotherapy is given to prevent the spread of leukemia cells to the brain and spinal cord. Treatments being studied in clinical trials for standardrisk ALL include new chemotherapy regimens. Check the list of NCIsupported cancer clinical trials that are now accepting patients with untreated childhood acute lymphoblastic leukemia. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website. Newly Diagnosed Childhood Acute Lymphoblastic Leukemia (High Risk) The treatment of highrisk childhood acute lymphoblastic leukemia (ALL) during the remission induction, consolidation /intensification, and maintenance phases always includes combination chemotherapy. Children in the highrisk ALL group are given more anticancer drugs and higher doses of anticancer drugs, especially during the consolidation/intensification phase, than children in the standardrisk group. Intrathecal and systemic chemotherapy are given to prevent or treat the spread of leukemia cells to the brain and spinal cord. Sometimes radiation therapy to the brain is also given. Treatments being studied in clinical trials for highrisk ALL include new chemotherapy regimens with or without targeted therapy or stem cell transplant. Check the list of NCIsupported cancer clinical trials that are now accepting patients with untreated childhood acute lymphoblastic leukemia. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website. Newly Diagnosed Childhood Acute Lymphoblastic Leukemia (Very High Risk) The treatment of very highrisk childhood acute lymphoblastic leukemia (ALL) during the remission induction, consolidation /intensification, and maintenance phases always includes combination chemotherapy. Children in the very highrisk ALL group are given more anticancer drugs than children in the highrisk group. It is not clear whether a stem cell transplant during first remission will help the child live longer. Intrathecal and systemic chemotherapy are given to prevent or treat the spread of leukemia cells to the brain and spinal cord. Sometimes radiation therapy to the brain is also given. Treatments being studied in clinical trials for very highrisk ALL include new chemotherapy regimens with or without targeted therapy. Check the list of NCIsupported cancer clinical trials that are now accepting patients with untreated childhood acute lymphoblastic leukemia. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website. Newly Diagnosed Childhood Acute Lymphoblastic Leukemia (Special Groups) Tcell childhood acute lymphoblastic leukemia The treatment of Tcell childhood acute lymphoblastic leukemia (ALL) during the remission induction, consolidation /intensification, and maintenance phases always includes combination chemotherapy. Children with Tcell ALL are given more anticancer drugs and higher doses of anticancer drugs than children in the newly diagnosed standardrisk group. Intrathecal and systemic chemotherapy are given to prevent the spread of leukemia cells to the brain and spinal cord. Sometimes radiation therapy to the brain is also given. Treatments being studied in clinical trials for Tcell ALL include new anticancer agents and chemotherapy regimens with or without targeted therapy. Infants with ALL The treatment of infants with ALL during the remission induction, consolidation /intensification, and maintenance phases always includes combination chemotherapy. Infants with ALL are given different anticancer drugs and higher doses of anticancer drugs than children 1 year and older in the standardrisk group. It is not clear whether a stem cell transplant during first remission will help the child live longer. Intrathecal and systemic chemotherapy are given to prevent the spread of leukemia cells to the brain and spinal cord. Treatments being studied in clinical trials for infants with ALL include the following: A clinical trial of chemotherapy followed by a donor stem cell transplant for infants with certain gene changes. Children 10 years and older and adolescents with ALL The treatment of ALL in children and adolescents (10 years and older) during the remission induction, consolidation /intensification, and maintenance phases always includes combination chemotherapy. Children 10 years and older and adolescents with ALL are given more anticancer drugs and higher doses of anticancer drugs than children in the standardrisk group. Intrathecal and systemic chemotherapy are given to prevent the spread of leukemia cells to the brain and spinal cord. Sometimes radiation therapy to the brain is also given. Treatments being studied in clinical trials for children 10 years and older and adolescents with ALL include new anticancer agents and chemotherapy regimens with or without targeted therapy. Philadelphia chromosomepositive ALL The treatment of Philadelphia chromosome positive childhood ALL during the remission induction, consolidation /intensification, and maintenance phases may include the following: Combination chemotherapy and targeted therapy with a tyrosine kinase inhibitor (imatinib mesylate) with or without a stem cell transplant using stem cells from a donor. Check the list of NCIsupported cancer clinical trials that are now accepting patients with Tcell childhood acute lymphoblastic leukemia and Philadelphia chromosome positive childhood precursor acute lymphoblastic leukemia. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website. Refractory Childhood Acute Lymphoblastic Leukemia There is no standard treatment for the treatment of refractory childhood acute lymphoblastic leukemia (ALL). Some of the treatments being studied in clinical trials for refractory childhood ALL include: Targeted therapy (blinatumomab or inotuzumab). Chimeric antigen receptor (CAR) Tcell therapy. Relapsed Childhood Acute Lymphoblastic Leukemia Standard treatment of relapsed childhood acute lymphoblastic leukemia (ALL) that comes back in the bone marrow may include the following: Combination chemotherapy. Chemotherapy with or without totalbody irradiation followed by a stem cell transplant, using stem cells from a donor. Standard treatment of relapsed childhood acute lymphoblastic leukemia (ALL) that comes back outside the bone marrow may include the following: Systemic chemotherapy and intrathecal chemotherapy with radiation therapy to the brain and/or spinal cord for cancer that comes back in the brain and spinal cord only. Combination chemotherapy and radiation therapy for cancer that comes back in the testicles only. Stem cell transplant for cancer that has recurred in the brain and/or spinal cord. Some of the treatments being studied in clinical trials for relapsed childhood ALL include: New anticancer drugs and new combination chemotherapy treatments. Combination chemotherapy and new kinds of targeted therapies (blinatumomab or inotuzumab). Chimeric antigen receptor (CAR) Tcell therapy. Check the list of NCIsupported cancer clinical trials that are now accepting patients with recurrent childhood acute lymphoblastic leukemia. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Childhood Rhabdomyosarcoma? ? [/INST] Certain genetic conditions increase the risk of childhood rhabdomyosarcoma. Anything that increases the risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesnt mean that you will not get cancer. Talk with your childs doctor if you think your child may be at risk. Risk factors for rhabdomyosarcoma include having the following inherited diseases: LiFraumeni syndrome. Pleuropulmonary blastoma. Neurofibromatosis type 1 (NF1). Costello syndrome. BeckwithWiedemann syndrome. Noonan syndrome. Children who had a high birth weight or were larger than expected at birth may have an increased risk of embryonal rhabdomyosarcoma. In most cases, the cause of rhabdomyosarcoma is not known.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Childhood Rhabdomyosarcoma ? [/INST] A sign of childhood rhabdomyosarcoma is a lump or swelling that keeps getting bigger. Signs and symptoms may be caused by childhood rhabdomyosarcoma or by other conditions. The signs and symptoms that occur depend on where the cancer forms. Check with your child's doctor if your child has any of the following: A lump or swelling that keeps getting bigger or does not go away. It may be painful. Bulging of the eye. Headache. Trouble urinating or having bowel movements. Blood in the urine. Bleeding in the nose, throat, vagina, or rectum.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Childhood Rhabdomyosarcoma ? [/INST] Diagnostic tests and a biopsy are used to detect (find) and diagnose childhood rhabdomyosarcoma. The diagnostic tests that are done depend in part on where the cancer forms. The following tests and procedures may be used: Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patients health habits and past illnesses and treatments will also be taken. Xray : An xray of the organs and bones inside the body, such as the chest. An xray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the abdomen, pelvis, or lymph nodes, taken from different angles. The pictures are made by a computer linked to an xray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas of the body, such as the skull, brain, and lymph nodes. This procedure is also called nuclear magnetic resonance imaging (NMRI). PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. Bone scan : A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner. Bone marrow aspiration and biopsy : The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone. Samples are removed from both hipbones. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer. Lumbar puncture : A procedure used to collect cerebrospinal fluid (CSF) from the spinal column. This is done by placing a needle between two bones in the spine and into the CSF around the spinal cord and removing a sample of the fluid. The sample of CSF is checked under a microscope for signs of cancer cells. This procedure is also called an LP or spinal tap. If these tests show there may be a rhabdomyosarcoma, a biopsy is done. A biopsy is the removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. Because treatment depends on the type of rhabdomyosarcoma, biopsy samples should be checked by a pathologist who has experience in diagnosing rhabdomyosarcoma. One of the following types of biopsies may be used: Fineneedle aspiration (FNA) biopsy : The removal of tissue or fluid using a thin needle. Core needle biopsy : The removal of tissue using a wide needle. This procedure may be guided using ultrasound, CT scan, or MRI. Open biopsy : The removal of tissue through an incision (cut) made in the skin. Sentinel lymph node biopsy : The removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. It is the first lymph node the cancer is likely to spread to from the tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes. The following tests may be done on the sample of tissue that is removed: Light microscopy: A laboratory test in which cells in a sample of tissue are viewed under regular and highpowered microscopes to look for certain changes in the cells. Immunohistochemistry : A test that uses antibodies to check for certain antigens in a sample of tissue. The antibody is usually linked to a radioactive substance or a dye that causes the tissue to light up under a microscope. This type of test may be used to tell the difference between different types of cancer. FISH (fluorescence in situ hybridization): A laboratory test used to look at genes or chromosomes in cells and tissues. Pieces of DNA that contain a fluorescent dye are made in the laboratory and added to cells or tissues on a glass slide. When these pieces of DNA attach to certain genes or areas of chromosomes on the slide, they light up when viewed under a microscope with a special light. This type of test is used to find certain gene changes. Reverse transcriptionpolymerase chain reaction (RTPCR) test: A laboratory test in which cells in a sample of tissue are studied using chemicals to look for certain changes in the structure or function of genes. Cytogenetic analysis : A laboratory test in which cells in a sample of tissue are viewed under a microscope to look for certain changes in the chromosomes.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is the outlook for Childhood Rhabdomyosarcoma ? [/INST] Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) and treatment options depend on the following: The patient's age. Where in the body the tumor started. The size of the tumor at the time of diagnosis. Whether the tumor has been completely removed by surgery. The type of rhabdomyosarcoma (embryonal, alveolar, or anaplastic). Whether there are certain changes in the genes. Whether the tumor had spread to other parts of the body at the time of diagnosis. Whether the tumor was in the lymph nodes at the time of diagnosis. Whether the tumor responds to chemotherapy and/or radiation therapy. For patients with recurrent cancer, prognosis and treatment also depend on the following: Where in the body the tumor recurred (came back). How much time passed between the end of cancer treatment and when the cancer recurred. Whether the tumor was treated with radiation therapy.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the stages of Childhood Rhabdomyosarcoma ? [/INST] After childhood rhabdomyosarcoma has been diagnosed, treatment is based in part on the stage of the cancer and sometimes it is based on whether all the cancer was removed by surgery. There are three ways that cancer spreads in the body. Cancer may spread from where it began to other parts of the body. Staging of childhood rhabdomyosarcoma is done in three parts. The staging system is based on the size of the tumor, where it is in the body, and whether it has spread to other parts of the body: Stage 1 Stage 2 Stage 3 Stage 4 The grouping system is based on whether the cancer has spread and whether all the cancer was removed by surgery: Group I Group II Group III Group IV The risk group is based on the staging system and the grouping system. Lowrisk childhood rhabdomyosarcoma Intermediaterisk childhood rhabdomyosarcoma Highrisk childhood rhabdomyosarcoma After childhood rhabdomyosarcoma has been diagnosed, treatment is based in part on the stage of the cancer and sometimes it is based on whether all the cancer was removed by surgery. The process used to find out if cancer has spread within the tissue or to other parts of the body is called staging. It is important to know the stage in order to plan treatment. The doctor will use results of the diagnostic tests to help find out the stage of the disease. Treatment for childhood rhabdomyosarcoma is based in part on the stage and sometimes on the amount of cancer that remains after surgery to remove the tumor. The pathologist will use a microscope to check the tissues removed during surgery, including tissue samples from the edges of the areas where the cancer was removed and the lymph nodes. This is done to see if all the cancer cells were taken out during the surgery. There are three ways that cancer spreads in the body. Cancer can spread through tissue, the lymph system, and the blood: Tissue. The cancer spreads from where it began by growing into nearby areas. Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body. Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body. Cancer may spread from where it began to other parts of the body. When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood. Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body. Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body. The metastatic tumor is the same type of cancer as the primary tumor. For example, if rhabdomyosarcoma spreads to the lung, the cancer cells in the lung are actually rhabdomyosarcoma cells. The disease is metastatic rhabdomyosarcoma, not lung cancer. Staging of childhood rhabdomyosarcoma is done in three parts. Childhood rhabdomyosarcoma is staged by using three different ways to describe the cancer: A staging system. A grouping system. A risk group. The staging system is based on the size of the tumor, where it is in the body, and whether it has spread to other parts of the body: Stage 1 In stage 1, the tumor is any size, may have spread to lymph nodes, and is found in only one of the following "favorable" sites: Eye or area around the eye. Head and neck (but not in the tissue next to the brain and spinal cord). Gallbladder and bile ducts. Ureters or urethra. Testes, ovary, vagina, or uterus. Rhabdomyosarcoma that forms in a "favorable" site has a better prognosis. If the site where cancer occurs is not one of the favorable sites listed above, it is said to be an "unfavorable" site. Stage 2 In stage 2, cancer is found in an "unfavorable" site (any one area not described as "favorable" in stage 1). The tumor is no larger than 5 centimeters and has not spread to lymph nodes. Stage 3 In stage 3, cancer is found in an "unfavorable" site (any one area not described as "favorable" in stage 1) and one of the following is true: The tumor is no larger than 5 centimeters and cancer has spread to nearby lymph nodes. The tumor is larger than 5 centimeters and cancer may have spread to nearby lymph nodes. Stage 4 In stage 4, the tumor may be any size and cancer may have spread to nearby lymph nodes. Cancer has spread to distant parts of the body, such as the lung, bone marrow, or bone. The grouping system is based on whether the cancer has spread and whether all the cancer was removed by surgery: Group I Cancer was found only in the place where it started and it was completely removed by surgery. Tissue was taken from the edges of where the tumor was removed. The tissue was checked under a microscope by a pathologist and no cancer cells were found. Group II Group II is divided into groups IIA, IIB, and IIC. IIA: Cancer was removed by surgery but cancer cells were seen when the tissue, taken from the edges of where the tumor was removed, was viewed under a microscope by a pathologist. IIB: Cancer had spread to nearby lymph nodes and the cancer and lymph nodes were removed by surgery. IIC: Cancer had spread to nearby lymph nodes, the cancer and lymph nodes were removed by surgery, and at least one of the following is true: Tissue taken from the edges of where the tumor was removed was checked under a microscope by a pathologist and cancer cells were seen. The furthest lymph node from the tumor that was removed was checked under a microscope by a pathologist and cancer cells were seen. Group III Cancer was partly removed by biopsy or surgery but there is tumor remaining that can be seen with the eye. Group IV Cancer had spread to distant parts of the body when the cancer was diagnosed. Cancer cells are found by an imaging test; or There are cancer cells in the fluid around the brain, spinal cord, or lungs, or in fluid in the abdomen; or tumors are found in those areas. The risk group is based on the staging system and the grouping system. The risk group describes the chance that rhabdomyosarcoma will recur (come back). Every child treated for rhabdomyosarcoma should receive chemotherapy to decrease the chance cancer will recur. The type of anticancer drug, dose, and the number of treatments given depends on whether the child has lowrisk, intermediaterisk, or highrisk rhabdomyosarcoma. The following risk groups are used: Lowrisk childhood rhabdomyosarcoma Lowrisk childhood rhabdomyosarcoma is one of the following: An embryonal tumor of any size that is found in a "favorable" site. There may be tumor remaining after surgery that can be seen with or without a microscope. The cancer may have spread to nearby lymph nodes. The following areas are "favorable" sites: Eye or area around the eye. Head or neck (but not in the tissue near the ear, nose, sinuses, or base of the skull). Gallbladder and bile ducts. Ureter or urethra. Testes, ovary, vagina, or uterus. An embryonal tumor of any size that is not found in a "favorable" site. There may be tumor remaining after surgery that can be seen only with a microscope. The cancer may have spread to nearby lymph nodes. Intermediaterisk childhood rhabdomyosarcoma Intermediaterisk childhood rhabdomyosarcoma is one of the following: An embryonal tumor of any size that is not found in one of the "favorable" sites listed above. There is tumor remaining after surgery, that can be seen with or without a microscope. The cancer may have spread to nearby lymph nodes. An alveolar tumor of any size in a "favorable" or "unfavorable" site. There may be tumor remaining after surgery that can be seen with or without a microscope. The cancer may have spread to nearby lymph nodes. Highrisk childhood rhabdomyosarcoma Highrisk childhood rhabdomyosarcoma may be the embryonal type or the alveolar type. It may have spread to nearby lymph nodes and has spread to one or more of the following: Other parts of the body that are not near where the tumor first formed. Fluid around the brain or spinal cord. Fluid in the lung or abdomen.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Childhood Rhabdomyosarcoma ? [/INST] New types of treatment are being tested in clinical trials. This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website. Highdose chemotherapy with stem cell transplant Highdose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells. Immunotherapy Immunotherapy is a treatment that uses the patients immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the bodys natural defenses against cancer. This type of cancer treatment is also called biologic therapy or biotherapy. There are different types of immunotherapy: Immune checkpoint inhibitor therapy uses the body's immune system to kill cancer cells. Two types of immune checkpoint inhibitors are being studied in the treatment of childhood rhabdomyosarcoma that has come back after treatment: CTLA4 is a protein on the surface of T cells that helps keep the bodys immune responses in check. When CTLA4 attaches to another protein called B7 on a cancer cell, it stops the T cell from killing the cancer cell. CTLA4 inhibitors attach to CTLA4 and allow the T cells to kill cancer cells. Ipilimumab is a type of CTLA4 inhibitor. PD1 is a protein on the surface of T cells that helps keep the bodys immune responses in check. When PD1 attaches to another protein called PDL1 on a cancer cell, it stops the T cell from killing the cancer cell. PD1 inhibitors attach to PDL1 and allow the T cells to kill cancer cells. Nivolumab and pembrolizumab are PD1 inhibitors. Vaccine therapy is a type of immunotherapy being studied to treat metastatic rhabdomyosarcoma. Targeted therapy Targeted therapy is a type of treatment that uses drugs or other substances to attack cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation do. There are different types of targeted therapy: mTOR inhibitors stop the protein that helps cells divide and survive. Sirolimus is a type of mTOR inhibitor therapy being studied in the treatment of recurrent rhabdomyosarcoma. Tyrosine kinase inhibitors are smallmolecule drugs that go through the cell membrane and work inside cancer cells to block signals that cancer cells need to grow and divide. MK1775 is a tyrosine kinase inhibitor being studied in the treatment of recurrent rhabdomyosarcoma. Antibodydrug conjugates are made up of a monoclonal antibody attached to a drug. The monoclonal antibody binds to specific proteins or receptors found on certain cells, including cancer cells. The drug enters these cells and kills them without harming other cells. Lorvotuzumab mertansine is an antibodydrug conjugate being studied in the treatment of recurrent rhabdomyosarcoma. Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Childhood Rhabdomyosarcoma ? [/INST] There are different types of treatment for patients with childhood rhabdomyosarcoma. Children with rhabdomyosarcoma should have their treatment planned by a team of health care providers who are experts in treating cancer in children. Treatment for childhood rhabdomyosarcoma may cause side effects. Three types of standard treatment are used: Surgery Radiation therapy Chemotherapy New types of treatment are being tested in clinical trials. Highdose chemotherapy with stem cell transplant Immunotherapy Targeted therapy Patients may want to think about taking part in a clinical trial. Patients can enter clinical trials before, during, or after starting their cancer treatment. Followup tests may be needed. There are different types of treatment for patients with childhood rhabdomyosarcoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment. Children with rhabdomyosarcoma should have their treatment planned by a team of health care providers who are experts in treating cancer in children. Because rhabdomyosarcoma can form in many different parts of the body, many different kinds of treatments are used. Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other health care providers who are experts in treating children with rhabdomyosarcoma and who specialize in certain areas of medicine. These may include the following specialists: Pediatrician. Pediatric surgeon. Radiation oncologist. Pediatric hematologist. Pediatric radiologist. Pediatric nurse specialist. Geneticist or cancer genetics risk counselor. Social worker. Rehabilitation specialist. Treatment for childhood rhabdomyosarcoma may cause side effects. For information about side effects that begin during treatment for cancer, see our Side Effects page. Side effects from cancer treatment that begin after treatment and continue for months or years are called late effects. Late effects of cancer treatment for rhabdomyosarcoma may include: Physical problems. Changes in mood, feelings, thinking, learning, or memory. Second cancers (new types of cancer). Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information.) Three types of standard treatment are used: Surgery Surgery (removing the cancer in an operation) is used to treat childhood rhabdomyosarcoma. A type of surgery called wide local excision is often done. A wide local excision is the removal of tumor and some of the tissue around it, including the lymph nodes. A second surgery may be needed to remove all the cancer. Whether surgery is done and the type of surgery done depends on the following: Where in the body the tumor started. The effect the surgery will have on the way the child will look. The effect the surgery will have on the child's important body functions. How the tumor responded to chemotherapy or radiation therapy that may have been given first. In most children with rhabdomyosarcoma, it is not possible to remove all of the tumor by surgery. Rhabdomyosarcoma can form in many different places in the body and the surgery will be different for each site. Surgery to treat rhabdomyosarcoma of the eye or genital areas is usually a biopsy. Chemotherapy, and sometimes radiation therapy, may be given before surgery to shrink large tumors. Even if the doctor removes all the cancer that can be seen at the time of the surgery, patients will be given chemotherapy after surgery to kill any cancer cells that are left. Radiation therapy may also be given. Treatment given after the surgery to lower the risk that the cancer will come back, is called adjuvant therapy. Radiation therapy Radiation therapy is a cancer treatment that uses highenergy xrays or other types of radiation to kill cancer cells or stop them from growing. There are two types of radiation therapy: External radiation therapy uses a machine outside the body to send radiation toward the cancer. Certain ways of giving radiation therapy can help keep radiation from damaging nearby healthy tissue. These types of external radiation therapy include the following: Conformal radiation therapy: Conformal radiation therapy is a type of external radiation therapy that uses a computer to make a 3dimensional (3D) picture of the tumor and shapes the radiation beams to fit the tumor. This allows a high dose of radiation to reach the tumor and causes less damage to nearby healthy tissue. Intensitymodulated radiation therapy (IMRT): IMRT is a type of 3dimensional (3D) radiation therapy that uses a computer to make pictures of the size and shape of the tumor. Thin beams of radiation of different intensities (strengths) are aimed at the tumor from many angles. Volumetrical modulated arc therapy (VMAT): VMAT is type of 3D radiation therapy that uses a computer to make pictures of the size and shape of the tumor. The radiation machine moves in a circle around the patient once during treatment and sends thin beams of radiation of different intensities (strengths) at the tumor. Treatment with VMAT is delivered faster than treatment with IMRT. Stereotactic body radiation therapy: Stereotactic body radiation therapy is a type of external radiation therapy. Special equipment is used to place the patient in the same position for each radiation treatment. Once a day for several days, a radiation machine aims a larger than usual dose of radiation directly at the tumor. By having the patient in the same position for each treatment, there is less damage to nearby healthy tissue. This procedure is also called stereotactic externalbeam radiation therapy and stereotaxic radiation therapy. Proton beam radiation therapy: Protonbeam therapy is a type of highenergy, external radiation therapy. A radiation therapy machine aims streams of protons (tiny, invisible, positivelycharged particles) at the cancer cells to kill them. This type of treatment causes less damage to nearby healthy tissue. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. It is used to treat cancer in areas such as the vagina, vulva, uterus, bladder, prostate, head, or neck. Internal radiation therapy is also called brachytherapy, internal radiation, implant radiation, or interstitial radiation therapy. The type and amount of radiation therapy and when it is given depends on the age of the child, the type of rhabdomyosarcoma, where in the body the tumor started, how much tumor remained after surgery, and whether there is tumor in the nearby lymph nodes. External radiation therapy is usually used to treat childhood rhabdomyosarcoma but in certain cases internal radiation therapy is used. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Chemotherapy may also be given to shrink the tumor before surgery in order to save as much healthy tissue as possible. This is called neoadjuvant chemotherapy. Every child treated for rhabdomyosarcoma should receive systemic chemotherapy to decrease the chance the cancer will recur. The type of anticancer drug, dose, and the number of treatments given depends on whether the child has lowrisk, intermediaterisk, or highrisk rhabdomyosarcoma. See Drugs Approved for Rhabdomyosarcoma for more information. Followup tests may be needed. Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the cancer has recurred (come back). These tests are sometimes called followup tests or checkups. Treatment Options for Childhood Rhabdomyosarcoma Previously Untreated Childhood Rhabdomyosarcoma The treatment of childhood rhabdomyosarcoma often includes surgery, radiation therapy, and chemotherapy. The order that these treatments are given depends on where in the body the tumor started, the size of the tumor, the type of tumor, and whether the tumor has spread to lymph nodes or other parts of the body. See the Treatment Option Overview section of this summary for more information about surgery, radiation therapy, and chemotherapy used to treat children with rhabdomyosarcoma. Rhabdomyosarcoma of the brain and head and neck For tumors of the brain: Treatment may include surgery to remove the tumor, radiation therapy, and chemotherapy. For tumors of the head and neck that are in or near the eye: Treatment may include chemotherapy and radiation therapy. If the tumor remains or comes back after treatment with chemotherapy and radiation therapy, surgery to remove the eye and some tissues around the eye may be needed. For tumors of the head and neck that are near the ear, nose, sinuses, or base of the skull but not in or near the eye: Treatment may include radiation therapy and chemotherapy. For tumors of the head and neck that are not in or near the eye and not near the ear, nose, sinuses, or base of the skull: Treatment may include chemotherapy, radiation therapy, and surgery to remove the tumor. For tumors of the head and neck that cannot be removed by surgery: Treatment may include chemotherapy and radiation therapy including stereotactic body radiation therapy. For tumors of the larynx (voice box): Treatment may include chemotherapy and radiation therapy. Surgery to remove the larynx is usually not done, so that the voice is not harmed. Rhabdomyosarcoma of the arms or legs Chemotherapy followed by surgery to remove the tumor. If the tumor was not completely removed, a second surgery to remove the tumor may be done. Radiation therapy may also be given. For tumors of the hand or foot, radiation therapy and chemotherapy may be given. The tumor may not be removed because it would affect the function of the hand or foot. Lymph node dissection (one or more lymph nodes are removed and a sample of tissue is checked under a microscope for signs of cancer). For tumors in the arms, lymph nodes near the tumor and in the armpit area are removed. For tumors in the legs, lymph nodes near the tumor and in the groin area are removed. Rhabdomyosarcoma of the chest, abdomen, or pelvis For tumors in the chest or abdomen (including the chest wall or abdominal wall): Surgery (wide local excision) may be done. If the tumor is large, chemotherapy and radiation therapy are given to shrink the tumor before surgery. For tumors of the pelvis: Surgery (wide local excision) may be done. If the tumor is large, chemotherapy is given to shrink the tumor before surgery. Radiation therapy may be given after surgery. For tumors of the diaphragm: A biopsy of the tumor is followed by chemotherapy and radiation therapy to shrink the tumor. Surgery may be done later to remove any remaining cancer cells. For tumors of the gallbladder or bile ducts: A biopsy of the tumor is followed by chemotherapy and radiation therapy. For tumors of the muscles or tissues around the anus or between the vulva and the anus or the scrotum and the anus: Surgery is done to remove as much of the tumor as possible and some nearby lymph nodes, followed by chemotherapy and radiation therapy. Rhabdomyosarcoma of the kidney For tumors of the kidney: Surgery to remove as much of the tumor as possible. Chemotherapy and radiation therapy may also be given. Rhabdomyosarcoma of the bladder and prostate For tumors that are only at the top of the bladder: Surgery (wide local excision) is done. For tumors of the prostate or bladder (other than the top of the bladder): Chemotherapy and radiation therapy are given first to shrink the tumor. If cancer cells remain after chemotherapy and radiation therapy, the tumor is removed by surgery. Surgery may include removal of the prostate, part of the bladder, or pelvic exenteration without removal of the rectum. (This may include removal of the lower colon and bladder. In girls, the cervix, vagina, ovaries, and nearby lymph nodes may be removed). Chemotherapy is given first to shrink the tumor. Surgery to remove the tumor, but not the bladder or prostate, is done. Internal or external radiation therapy may be given after surgery. Rhabdomyosarcoma of the area near the testicles Surgery to remove the testicle and spermatic cord. The lymph nodes in the back of the abdomen may be checked for cancer, especially if the lymph nodes are large or the child is 10 years or older. Radiation therapy may be given if the tumor cannot be completely removed by surgery. Rhabdomyosarcoma of the vulva, vagina, uterus, cervix, or ovary For tumors of the vulva and vagina: Treatment may include chemotherapy followed by surgery to remove the tumor. Internal or external radiation therapy may be given after surgery. For tumors of the uterus: Treatment may include chemotherapy with or without radiation therapy. Sometimes surgery may be needed to remove any remaining cancer cells. For tumors of the cervix: Treatment may include chemotherapy followed by surgery to remove any remaining tumor. For tumors of the ovary: Treatment may include chemotherapy followed by surgery to remove any remaining tumor. Metastatic rhabdomyosarcoma Treatment, such as chemotherapy, radiation therapy, or surgery to remove the tumor, is given to the site where the tumor first formed. If the cancer has spread to the brain, spinal cord, or lungs, radiation therapy may also be given to the sites where the cancer has spread. The following treatment is being studied for metastatic rhabdomyosarcoma: A clinical trial of immunotherapy (vaccine therapy). Check the list of NCIsupported cancer clinical trials that are now accepting patients with previously untreated childhood rhabdomyosarcoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website. Recurrent Childhood Rhabdomyosarcoma Treatment options for recurrent childhood rhabdomyosarcoma are based on many factors, including where in the body the cancer has come back, what type of treatment the child had before, and the needs of the child. Treatment of recurrent rhabdomyosarcoma may include one or more of the following: Surgery. Radiation therapy. Chemotherapy. A clinical trial of highdose chemotherapy followed by stem cell transplant using the patient's own stem cells. A clinical trial of targeted therapy or immunotherapy (sirolimus, lorvotuzumab, ipilimumab, nivolumab, or pembrolizumab). A clinical trial of targeted therapy with a tyrosine kinase inhibitor (MK1775) and chemotherapy. Check the list of NCIsupported cancer clinical trials that are now accepting patients with recurrent childhood rhabdomyosarcoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI website. New types of treatment are being tested in clinical trials. This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website. Highdose chemotherapy with stem cell transplant Highdose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells. Immunotherapy Immunotherapy is a treatment that uses the patients immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the bodys natural defenses against cancer. This type of cancer treatment is also called biologic therapy or biotherapy. There are different types of immunotherapy: Immune checkpoint inhibitor therapy uses the body's immune system to kill cancer cells. Two types of immune checkpoint inhibitors are being studied in the treatment of childhood rhabdomyosarcoma that has come back after treatment: CTLA4 is a protein on the surface of T cells that helps keep the bodys immune responses in check. When CTLA4 attaches to another protein called B7 on a cancer cell, it stops the T cell from killing the cancer cell. CTLA4 inhibitors attach to CTLA4 and allow the T cells to kill cancer cells. Ipilimumab is a type of CTLA4 inhibitor. PD1 is a protein on the surface of T cells that helps keep the bodys immune responses in check. When PD1 attaches to another protein called PDL1 on a cancer cell, it stops the T cell from killing the cancer cell. PD1 inhibitors attach to PDL1 and allow the T cells to kill cancer cells. Nivolumab and pembrolizumab are PD1 inhibitors. Vaccine therapy is a type of immunotherapy being studied to treat metastatic rhabdomyosarcoma. Targeted therapy Targeted therapy is a type of treatment that uses drugs or other substances to attack cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation do. There are different types of targeted therapy: mTOR inhibitors stop the protein that helps cells divide and survive. Sirolimus is a type of mTOR inhibitor therapy being studied in the treatment of recurrent rhabdomyosarcoma. Tyrosine kinase inhibitors are smallmolecule drugs that go through the cell membrane and work inside cancer cells to block signals that cancer cells need to grow and divide. MK1775 is a tyrosine kinase inhibitor being studied in the treatment of recurrent rhabdomyosarcoma. Antibodydrug conjugates are made up of a monoclonal antibody attached to a drug. The monoclonal antibody binds to specific proteins or receptors found on certain cells, including cancer cells. The drug enters these cells and kills them without harming other cells. Lorvotuzumab mertansine is an antibodydrug conjugate being studied in the treatment of recurrent rhabdomyosarcoma. Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Childhood Vascular Tumors ? [/INST] Childhood vascular tumors form from cells that make blood vessels or lymph vessels. Tests are used to detect (find) and diagnose childhood vascular tumors. Childhood vascular tumors may be classified into four groups. Benign tumors Intermediate (locally aggressive) tumors Intermediate (rarely metastasizing) tumors Malignant tumors Childhood vascular tumors form from cells that make blood vessels or lymph vessels. Vascular tumors can form from abnormal blood vessel or lymph vessel cells anywhere in the body. They may be benign (not cancer) or malignant (cancer). There are many types of vascular tumors. The most common type of childhood vascular tumor is hemangioma, which is a benign tumor that usually goes away on its own. Because malignant vascular tumors are rare in children, there is not a lot of information about what treatment works best. Childhood vascular tumors may be classified into four groups. Benign tumors Benign tumors are not cancer. This summary has information about the following benign vascular tumors: Infantile hemangioma. Congenital hemangioma. Benign vascular tumors of the liver. Spindle cell hemangioma. Epithelioid hemangioma. Pyogenic granuloma (lobular capillary hemangioma). Angiofibroma. Juvenile nasopharyngeal angiofibroma. Intermediate (locally aggressive) tumors Intermediate tumors that are locally aggressive often spread to the area around the tumor. This summary has information about the following locally aggressive vascular tumors: Kaposiform hemangioendothelioma and tufted angioma. Intermediate (rarely metastasizing) tumors Intermediate (rarely metastasizing) tumors sometimes spread to other parts of the body. This summary has information about the following vascular tumors that rarely metastasize: Retiform hemangioendothelioma. Papillary intralymphatic angioendothelioma. Composite hemangioendothelioma. Kaposi sarcoma. Malignant tumors Malignant tumors are cancer. This summary has information about the following malignant vascular tumors: Epithelioid hemangioendothelioma. Angiosarcoma of soft tissue. Benign Tumors Infantile Hemangioma Infantile hemangiomas are the most common type of benign vascular tumor in children. An infantile hemangioma may also be called a "strawberry mark." Immature cells that are meant to form blood vessels form a tumor instead. These tumors are not usually seen at birth but appear when the infant is 3 to 6 weeks old. Most hemangiomas get bigger for about 5 months, then stop growing and slowly fade away completely during the next several years. It is rare for them to come back. Hemangiomas may be on the skin, in the tissue below the skin, and/or in an organ. They are usually on the head and neck but can be anywhere on or in the body. Hemangiomas may appear as a single lesion, one or more lesions spread over a larger area of the body, or multiple lesions in more than one part of the body. Lesions that are spread over a larger area of the body or multiple lesions are more likely to cause problems. Risk Factors Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get the disease; not having risk factors doesnt mean that you will not get the disease. Talk with your child's doctor if you think your child may be at risk. Infantile hemangiomas are more common in the following: Girls. Whites. Premature babies. Twins, triplets, or other multiple births. Babies of mothers who are older at time of the pregnancy or who have problems with the placenta during pregnancy. Other risk factors for infantile hemangiomas include the following: Having certain syndromes. PHACE syndrome: A syndrome in which the hemangioma spreads across a large area of the body (usually the head or face). Other health problems involving the large blood vessels, heart, eyes, and/or brain may also occur. LUMBAR/PELVIS/SACRAL syndrome: A syndrome in which the hemangioma spreads across a large area of the lower back. Other health problems that affect the urinary system, genitals, rectum, anus, brain, spinal cord, and nerve function may also occur. Having more than one hemangioma or an airway hemangioma increases the risk of having other health problems. Multiple hemangiomas: Having more than five hemangiomas on the skin is a sign that there may be hemangiomas in an organ, most commonly the liver. Heart, muscle, and thyroid gland problems can also occur. Airway hemangiomas: Hemangiomas in the airway usually occur along with a large, beardshaped area of hemangioma on the face (from the ears, around the mouth, lower chin, and front of neck). It is important for airway hemangiomas to be treated before the child has trouble breathing. Signs and Symptoms Infantile hemangiomas may cause any of the following signs and symptoms. Check with your childs doctor if your child has any of the following: Skin lesions: An area of spidery veins or lightened or discolored skin may appear before the hemangioma does. Hemangiomas occur as firm, warm, bright redblue lesions on the skin. Lesions that form ulcers are also painful. Later, as the hemangiomas go away, they begin fading in the center before flattening and losing color. Lesions below the skin: Lesions that grow under the skin in the fat may appear blue or purple. If the lesions are deep enough under the skin surface, they may not be seen. Lesions in an organ: There may be no signs that hemangiomas have formed on an organ. Although most infantile hemangiomas are nothing to worry about, if your child develops any lumps or red or blue marks on the skin check with your child's doctor. He or she can recommend a specialist if needed. Diagnostic Tests A physical exam and history are usually all that are needed to diagnose infantile hemangiomas. If there is something about the tumor that looks unusual, a biopsy may be done. If the hemangioma is deeper inside the body with no change to the skin, or the lesions are spread across a large area of the body, an ultrasound or MRI may be done. See the General Information section for a description of these tests and procedures. If the hemangiomas are part of a syndrome, more tests may be done such as an echocardiogram, magnetic resonance angiogram, and eye exam. Treatment Most hemangiomas fade and shrink without treatment. If the hemangioma is large or causing other health problems, treatment may include the following: Propranolol or other betablocker therapy. Steroid therapy, before betablocker therapy is begun or when betablockers cannot be used. Pulsed dye laser surgery, for hemangiomas that have ulcers or have not gone away. Surgery (excision) for hemangiomas that have ulcers, cause vision problems, or have not gone away. Topical betablocker therapy for hemangiomas that are in one area of the skin. Combined therapy, such as propranolol and steroid therapy or propranolol and topical betablocker therapy. Congenital Hemangioma Congenital hemangioma is a benign vascular tumor that begins forming before birth and is fully formed when the baby is born. They're usually on the skin but can be in another organ. There are three types of congenital hemangiomas: Rapidly Involuting Congenital Hemangioma: These tumors go away on their own 12 to 15 months after birth. They can form ulcers, bleed, and cause temporary heart and blood clotting problems. The skin may look a little different even after the hemangiomas go away. Partial Involuting Congenital Hemangioma: These tumors do not go away completely. NonInvoluting Congenital Hemangioma: These tumors never go away on their own. Diagnostic Tests See the General Information section for a description of tests and procedures used to diagnose congenital hemangioma. Treatment Treatment of rapidly involuting congenital hemangioma and partial involuting congenital hemangioma may include the following: Observation only. Treatment of noninvoluting congenital hemangioma may include the following: Surgery to remove the tumor depending on where it is and whether it is causing symptoms. Benign Vascular Tumors of the Liver Benign vascular tumors of the liver may be focal (a single lesion in one area of the liver), multifocal (multiple lesions in one area of the liver), or diffuse (multiple lesions in more than one area of the liver). The liver has many functions, including filtering blood and making proteins needed for blood clotting. Sometimes, blood that normally flows through the liver is blocked or slowed by the tumor. This sends blood directly to the heart without going through the liver and is called a liver shunt. This can cause heart failure and problems with blood clotting. Focal Tumors Focal tumors are usually rapidly involuting congenital hemangiomas or noninvoluting congenital hemangiomas. Diagnostic Tests See the General Information section for a description of tests and procedures used to diagnose focal benign vascular tumors. Treatment Treatment of focal tumors of the liver depends on whether symptoms occur and may include the following: Observation. Drugs to manage symptoms, including heart failure and blood clotting problems. Embolization of the liver to manage symptoms, including heart failure. Multifocal and Diffuse Tumors Multifocal and diffuse tumors of the liver are usually infantile hemangiomas. Diffuse tumors of the liver can cause serious effects, including problems with the thyroid gland and heart. The liver can enlarge, press on other organs, and cause more symptoms. Diagnostic Tests See the General Information section for a description of tests and procedures used to diagnose multifocal or diffuse benign vascular tumors. Treatment Treatment of multifocal and diffuse liver tumors may include the following: Observation for multifocal tumors of the liver that do not cause symptoms. Betablocker therapy (propranolol). Chemotherapy. Steroid therapy. Total hepatectomy and liver transplant, when the tumors do not respond to drug therapy. This is only done when the tumors have spread widely in the liver and more than one organ has failed. If a vascular tumor of the liver does not respond to standard treatments, a biopsy may be done to see if the tumor has become malignant. Spindle Cell Hemangioma Spindle cell hemangiomas contain cells called spindle cells. Under a microscope, spindle cells look long and slender. Risk Factors Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get the disease; not having risk factors doesnt mean that you will not get the disease. Talk with your child's doctor if you think your child may be at risk. Spindle cell hemangiomas are likely to occur in children with the following syndromes: Maffucci syndrome, which affects cartilage and skin. KlippelTrenaunay syndrome, which affects blood vessels, soft tissues, and bones. Signs Spindle cell hemangiomas appear on or under the skin. They are painful redbrown or bluish lesions that usually appear on the arms or legs. They can begin as one lesion and develop into more lesions over years. Diagnostic Tests See the General Information section for a description of tests and procedures used to diagnose spindle cell hemangioma. Treatment There is no standard treatment for spindle cell hemangiomas. Treatment may include the following: Surgery to remove the tumor. Spindle cell hemangiomas may come back after surgery. Epithelioid Hemangioma Epithelioid hemangiomas usually form on or in the skin, especially the head, but can occur in other areas, such as bone. Signs and Symptoms Epithelioid hemangiomas are sometimes caused by injury. On the skin, they may appear as firm pink to red bumps and may be itchy. Epithelioid hemangioma of the bone may cause swelling, pain, and weakened bone in the affected area. Diagnostic Tests See the General Information section for a description of tests and procedures used to diagnose epithelioid hemangioma. Treatment There is no standard treatment for epithelioid hemangiomas. Treatment may include the following: Surgery (curettage or resection). Sclerotherapy. Radiation therapy in rare cases. Epithelioid hemangiomas often come back after treatment. Pyogenic Granuloma Pyogenic granuloma is also called lobular capillary hemangioma. It is most common in older children and young adults but may occur at any age. The lesions are sometimes caused by injury or from the use of certain medicines, including birth control pills and retinoids. They may also form for no known reason inside capillaries (the smallest blood vessels) or other places on the body. Usually there is only one lesion, but sometimes multiple lesions occur in the same area or the lesions may spread to other areas of the body. Signs Pyogenic granulomas are raised, bright red lesions that may be small or large and smooth or bumpy. They grow quickly over weeks to months and may bleed a lot. Diagnostic Tests See the General Information section for a description of tests and procedures used to diagnose pyogenic granuloma. Treatment Some pyogenic granulomas go away without treatment. Other pyogenic granulomas need treatment that may include the following: Surgery (excision or curettage) to remove the lesion. Laser photocoagulation. Pyogenic granulomas often come back after treatment. Angiofibroma Angiofibromas are rare. They are benign skin lesions that usually occur with a condition called tuberous sclerosis (an inherited disorder that causes skin lesions, seizures, and mental disabilities). Signs Angiofibromas appear as red bumps on the face. Diagnostic Tests See the General Information section for a description of tests and procedures used to diagnose angiofibroma. Treatment Treatment of angiofibromas may include the following: Surgery (excision) to remove the tumor. Laser therapy. Targeted therapy (sirolimus). Juvenile Nasopharyngeal Angiofibroma Juvenile nasopharyngeal angiofibromas are benign tumors but they can invade nearby tissue. They begin in the nasal cavity and may spread to the nasopharynx, the paranasal sinuses, the bone around the eyes, and sometimes to the brain. Diagnostic Tests See the General Information section for a description of tests and procedures used to diagnose juvenile nasopharyngeal angiofibroma. Treatment Treatment of juvenile nasopharyngeal angiofibromas may include the following: Surgery (excision) to remove the tumor. Radiation therapy. Chemotherapy. Immunotherapy (interferon). Targeted therapy (sirolimus). Intermediate Tumors that Spread Locally Kaposiform Hemangioendothelioma and Tufted Angioma Kaposiform hemangioendotheliomas and tufted angiomas are blood vessel tumors that occur in infants or during early childhood. These tumors can cause KasabachMerritt phenomenon, a condition in which the blood is not able to clot and serious bleeding may occur. In KasabachMerritt phenomenon the tumor traps and destroys platelets (bloodclotting cells). Then there aren't enough platelets in the blood when needed to stop bleeding. This type of vascular tumor is not related to Kaposi sarcoma. Signs and Symptoms Kaposiform hemangioendotheliomas and tufted angiomas usually occur on the skin of the arms and legs, but may also form in deeper tissues, such as muscle or bone. Signs and symptoms may include the following: Firm, painful areas of skin that look bruised. Purple or brownishred areas of skin. Easy bruising. Bleeding more than the usual amount from mucous membranes, wounds, and other tissues. Anemia (weakness, feeling tired, or looking pale). Diagnostic Tests See the General Information section for a description of tests and procedures used to diagnose kaposiform hemangioendothelioma. If a physical exam and MRI clearly show the tumor is a kaposiform hemangioendothelioma or a tufted angioma, a biopsy may not be needed. A biopsy is not always done because serious bleeding can occur. Treatment Treatment of kaposiform hemangioendotheliomas and tufted angiomas depends on the child's symptoms. Infection, delay in treatment, and surgery can cause bleeding that is lifethreatening. Kaposiform hemangioendotheliomas and tufted angiomas are best treated by a vascular anomaly specialist. Treatment and supportive care to manage bleeding may include the following: Steroid therapy which may be followed by chemotherapy. Nonsteroidal antiinflammatory drugs (NSAID), such as aspirin. Immunotherapy (interferon). Antifibrinolytic therapy to improve blood clotting. Chemotherapy with one or more anticancer drugs. Betablocker therapy (propranolol). Surgery (excision) to remove the tumor, with or without embolization. Targeted therapy (sirolimus). A clinical trial of targeted therapy (sirolimus) and steroid therapy. Even with treatment, these tumors do not fully go away and can come back. Longterm effects include chronic pain, heart failure, bone problems, and lymphedema (the build up of lymph fluid in tissues). Intermediate Tumors that Rarely Spread Retiform Hemangioendothelioma Retiform hemangioendotheliomas are slow growing, flat tumors that occur in young adults and sometimes children. These tumors usually occur on or under the skin of the arms, legs, and trunk. These tumors often come back after treatment, but they usually do not spread to other parts of the body. Diagnostic Tests See the General Information section for a description of tests and procedures used to diagnose retiform hemangioendothelioma. Treatment Treatment of retiform hemangioendotheliomas may include the following: Surgery (excision) to remove the tumor. Follow up will include monitoring to see if the tumor comes back. Radiation therapy and chemotherapy when surgery cannot be done or when the tumor has come back. Papillary Intralymphatic Angioendothelioma Papillary intralymphatic angioendotheliomas are also called Dabska tumors. These tumors form in or under the skin anywhere on the body. The tumors contain channels that look like lymph vessels. Lymph nodes are sometimes affected. Signs Papillary intralymphatic angioendotheliomas may appear as firm, raised, purplish bumps, which may be small or large. These tumors grow slowly over time. Diagnostic Tests See the General Information section for a description of tests and procedures used to diagnose papillary intralymphatic angioendothelioma. Treatment Treatment of papillary intralymphatic angioendotheliomas may include the following: Surgery (excision) to remove the tumor. Composite Hemangioendothelioma Composite hemangioendotheliomas have features of both benign and malignant vascular tumors. These tumors usually occur on or under the skin on the arms or legs. They may also occur on the head, neck, or chest. Composite hemangioendotheliomas are not likely to metastasize (spread) but they may come back in the same place. When the tumors metastasize, they usually spread to nearby lymph nodes. Diagnostic Tests See the General Information section for a description of tests and procedures used to diagnose composite hemangioendothelioma and find out whether the tumor has spread. Treatment Treatment of composite hemangioendotheliomas may include the following: Surgery to remove the tumor. Radiation therapy and chemotherapy for tumors that have spread. Kaposi Sarcoma Kaposi sarcoma is a cancer that causes lesions to grow in the skin; the mucous membranes lining the mouth, nose, and throat; lymph nodes; or other organs. It is caused by the Kaposi sarcoma herpes virus (KSHV). In the United States, it usually occurs in people who have a weak immune system caused by AIDS or by drugs used in organ transplants. It is very rare in children and can be caused by HIV infection and rare immune system disorders. Signs Signs in children may include the following: Lesions in the skin, mouth, or throat. Skin lesions are red, purple, or brown and change from flat, to raised, to scaly areas called plaques, to nodules. Swollen lymph nodes. Diagnostic Tests See the General Information section for a description of tests and procedures used to diagnose Kaposi sarcoma. Treatment Treatment of Kaposi sarcoma may include the following: Chemotherapy. See the PDQ summary on Kaposi Sarcoma Treatment for information about Kaposi sarcoma in adults. Malignant Tumors Epithelioid Hemangioendothelioma Epithelioid hemangioendotheliomas can occur in children, but are most common in adults between 30 and 50 years of age. They usually occur in the liver, lung, or in bone. They may be either fast growing or slow growing. In about a third of cases, the tumor spreads to other parts of the body very quickly. Signs and Symptoms Signs and symptoms depend on where the tumor is: On the skin, the tumors can be raised and rounded or flat, redbrown patches that feel warm. In the lung, there may be no early symptoms. Signs and symptoms that occur may include: Chest pain. Spitting up blood. Anemia (weakness, feeling tired, or looking pale). Trouble breathing (from scarred lung tissue). In bone, the tumors can cause breaks. Diagnostic Tests Epithelioid hemangioendotheliomas in the liver are found with CT scans and MRI scans. See the General Information section for a description of these tests and procedures used to diagnose epithelioid hemangioendothelioma and find out whether the tumor has spread. Xrays may also be done. Treatment Treatment of slowgrowing epithelioid hemangioendotheliomas includes the following: Observation. Treatment of fastgrowing epithelioid hemangioendotheliomas may include the following: Surgery to remove the tumor when possible. Immunotherapy (interferon) and targeted therapy (thalidomide, sorafenib, pazopanib, sirolimus) for tumors that are likely to spread. Chemotherapy. Total hepatectomy and liver transplant when the tumor is in the liver. Angiosarcoma of the Soft Tissue Angiosarcomas are fastgrowing tumors that form in blood vessels or lymph vessels in any part of the body, usually in soft tissue. Most angiosarcomas are in or near the skin. Those in deeper soft tissue can form in the liver, spleen, and lung. These tumors are very rare in children. Children sometimes have more than one tumor in the skin and/or liver. Risk Factors Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get the disease; not having risk factors doesnt mean that you will not get the disease. Talk with your child's doctor if you think your child may be at risk. Risk factors for angiosarcomas include the following: Being exposed to radiation. Chronic (longterm) lymphedema, a condition in which extra lymph fluid builds up in tissues and causes swelling. Having a benign vascular tumor. A benign tumor, such as a hemangioma, may become an angiosarcoma but this rare. Signs Signs of angiosarcoma depend on where the tumor is and may include the following: Red patches on the skin that bleed easily. Purple tumors. Diagnostic Tests See the General Information section for a description of tests and procedures used to diagnose angiosarcoma and find out whether the tumor has spread. Treatment Treatment of angiosarcoma may include the following: Surgery to completely remove the tumor. A combination of surgery, chemotherapy, and radiation therapy for angiosarcomas that have spread. Targeted therapy (bevacizumab) and chemotherapy for angiosarcomas that began as infantile hemangiomas. A clinical trial of targeted therapy, radiation therapy, and surgery with or without chemotherapy.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Childhood Vascular Tumors ? [/INST] Tests are used to detect (find) and diagnose childhood vascular tumors. The following tests and procedures may be used: Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps, lesions, or anything else that seems unusual. A history of the patients health habits and past illnesses and treatments will also be taken. Ultrasound exam: A procedure in which highenergy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later. CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an xray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). Biopsy : The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. A biopsy is not always needed to diagnose a vascular tumor.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Childhood Vascular Tumors ? [/INST] There are different types of treatment for childhood vascular tumors. Children with childhood vascular tumors should have their treatment planned by a team of health care providers who are experts in treating cancer in children. Some treatments cause side effects months or years after treatment has ended. Eleven types of standard treatment are used: Betablocker therapy Surgery Photocoagulation Embolization Chemotherapy Sclerotherapy Radiation therapy Targeted therapy Immunotherapy Other drug therapy Observation New types of treatment are being tested in clinical trials. Patients may want to think about taking part in a clinical trial. Patients can enter clinical trials before, during, or after starting their cancer treatment. Followup tests may be needed. There are different types of treatment for childhood vascular tumors. Different types of treatment are available for children with vascular tumors. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Because vascular tumors in children are rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment. Children with childhood vascular tumors should have their treatment planned by a team of health care providers who are experts in treating cancer in children. Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other pediatric health care providers who are experts in treating children with cancer and who specialize in certain areas of medicine. These may include the following specialists: Pediatric vascular anomaly specialist (expert in treating children with vascular tumors). Pediatric surgeon. Orthopedic surgeon. Radiation oncologist. Pediatric nurse specialist. Rehabilitation specialist. Psychologist. Social worker. Some treatments cause side effects months or years after treatment has ended. Some treatments, such as chemotherapy and radiation therapy, cause side effects that continue or appear months or years after treatment has ended. These are called late effects. Late effects of treatment may include: Physical problems. Changes in mood, feelings, thinking, learning, or memory. Second cancers (new types of cancer). Some late effects may be treated or controlled. It is important to talk with your child's doctors about the possible late effects caused by some treatments. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information). Eleven types of standard treatment are used: Betablocker therapy Betablockers are drugs that decrease blood pressure and heart rate. When used in patients with vascular tumors, betablockers may help shrink the tumors. Betablocker therapy may be given by vein (IV), by mouth, or placed on the skin (topical). The way the betablocker therapy is given depends on the type of vascular tumor and where the tumor first formed. The betablocker propranolol is usually the first treatment for hemangiomas. Infants treated with IV propranolol may need to have their treatment started in a hospital. Propranolol is also used to treat benign vascular tumor of liver and kaposiform hemangioendothelioma. Other betablockers used to treat vascular tumors include atenolol, nadolol, and timolol. Infantile hemangioma may also be treated with propranolol and steroid therapy or propranolol and topical betablocker therapy. See the drug information summary on Propranolol Hydrochloride for more information. Surgery The following types of surgery may be used to remove many types of vascular tumors: Excision: Surgery to remove the entire tumor and some of the healthy tissue around it. Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a skin lesion such as a tumor. Surgery with a pulsed dye laser may be used for some hemangiomas. This type of laser uses a beam of light that targets blood vessels in the skin. The light is changed into heat and the blood vessels are destroyed without damaging nearby skin. Total hepatectomy and liver transplant: A surgical procedure to remove the entire liver followed by a transplant of a healthy liver from a donor. Curettage: A procedure in which abnormal tissue is removed using a small, spoonshaped instrument called a curette. The type of surgery used depends on the type of vascular tumor and where the tumor formed in the body. For malignant tumors, even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the tumor will come back, is called adjuvant therapy. Photocoagulation Photocoagulation is the use of an intense beam of light, such as a laser, to seal off blood vessels or destroy tissue. It is used to treat pyogenic granuloma. Embolization Embolization is a procedure that uses particles, such as tiny gelatin sponges or beads, to block blood vessels in the liver. It may be used to treat some benign vascular tumors of the liver and kaposiform hemangioendothelioma. Chemotherapy Chemotherapy is a treatment that uses drugs to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach tumor cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect tumor cells in those areas (regional chemotherapy). Chemotherapy for hemangiomas may also be given topically (applied to the skin in a cream or lotion). The way the chemotherapy is given depends on the type of the vascular tumor being treated. Sclerotherapy Sclerotherapy is a treatment used to destroy the blood vessel with the tumor. A liquid is injected into the blood vessel, causing it to scar and break down. Over time, the destroyed blood vessel is absorbed into normal tissue. The blood flows through nearby healthy veins instead. Sclerotherapy is used in the treatment of epithelioid hemangioma. Radiation therapy Radiation therapy is a treatment that uses highenergy xrays or other types of radiation to kill tumor cells or keep them from growing. There are two types of radiation therapy: External radiation therapy uses a machine outside the body to send radiation toward the tumor. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the tumor. The way the radiation therapy is given depends on the type of the vascular tumor being treated. External radiation is used to treat some vascular tumors. Targeted therapy Targeted therapy is a type of treatment that uses drugs or other substances to attack specific tumor cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do. Angiogenesis inhibitors are a type of targeted therapy. Angiogenesis inhibitors are drugs that stop cells from dividing and prevent the growth of new blood vessels that tumors need to grow. The targeted therapy drugs thalidomide, sorafenib, pazopanib, sirolimus, and bevacizumab are angiogenesis inhibitors used to treat childhood vascular tumors. Immunotherapy Immunotherapy is a treatment that uses the patients immune system to fight disease. Substances made by the body or made in a laboratory are used to boost, direct, or restore the bodys natural defenses against disease. Interferon is a type of immunotherapy used to treat childhood vascular tumors. It interferes with the division of tumor cells and can slow tumor growth. It is used in the treatment of juvenile nasopharyngeal angiofibroma, kaposiform hemangioendothelioma, and epithelioid hemangioendothelioma. Other drug therapy Other drugs used to treat childhood vascular tumors or manage their effects include the following: Steroid therapy: Steroids are hormones made naturally in the body. They can also be made in a laboratory and used as drugs. Steroid drugs help shrink some vascular tumors. Nonsteroidal antiinflammatory drugs (NSAIDs): NSAIDs are commonly used to decrease fever, swelling, pain, and redness. Examples of NSAIDs are aspirin, ibuprofen, and naproxen. In the treatment of vascular tumors, NSAIDs can increase the flow of blood through the tumors and decrease the chance that an unwanted blood clot will form. Antifibrinolytic therapy: These drugs help the blood clot in patients who have KasabachMerritt syndrome. Fibrin is the main protein in a blood clot that helps stop bleeding and heal wounds. Some vascular tumors cause fibrin to break down and the patient's blood does not clot normally, causing uncontrolled bleeding. Antifibrinolytics help prevent the breakdown of fibrin. Observation Observation is closely monitoring a patients condition without giving any treatment until signs or symptoms appear or change. New types of treatment are being tested in clinical trials. Information about clinical trials is available from the NCI website. Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the research process. Clinical trials are done to find out if new treatments are safe and effective or better than the standard treatment. Many of today's standard treatments are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way disease will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose tumors have not gotten better. There are also clinical trials that test new ways to stop tumors from recurring (coming back) or reduce the side effects of treatment. Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials. Followup tests may be needed. Some of the tests that were done to diagnose the vascular tumor may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the tumor has recurred (come back). These tests are sometimes called followup tests or checkups.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Childhood Vascular Tumors ? [/INST] New types of treatment are being tested in clinical trials. Information about clinical trials is available from the NCI website. Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the research process. Clinical trials are done to find out if new treatments are safe and effective or better than the standard treatment. Many of today's standard treatments are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way disease will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose tumors have not gotten better. There are also clinical trials that test new ways to stop tumors from recurring (coming back) or reduce the side effects of treatment. Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Chronic Myelogenous Leukemia ? [/INST] Chronic myelogenous leukemia is a disease in which the bone marrow makes too many white blood cells. Leukemia may affect red blood cells, white blood cells, and platelets. Signs and symptoms of chronic myelogenous leukemia include fever, night sweats, and tiredness. Most people with CML have a gene mutation (change) called the Philadelphia chromosome. Tests that examine the blood and bone marrow are used to detect (find) and diagnose chronic myelogenous leukemia. Certain factors affect prognosis (chance of recovery) and treatment options. Chronic myelogenous leukemia is a disease in which the bone marrow makes too many white blood cells. Chronic myelogenous leukemia (also called CML or chronic granulocytic leukemia) is a slowly progressing blood and bone marrow disease that usually occurs during or after middle age, and rarely occurs in children. Leukemia may affect red blood cells, white blood cells, and platelets. Normally, the bone marrow makes blood stem cells (immature cells) that become mature blood cells over time. A blood stem cell may become a myeloid stem cell or a lymphoid stem cell. A lymphoid stem cell becomes a white blood cell. A myeloid stem cell becomes one of three types of mature blood cells: Red blood cells that carry oxygen and other substances to all tissues of the body. Platelets that form blood clots to stop bleeding. Granulocytes (white blood cells) that fight infection and disease. In CML, too many blood stem cells become a type of white blood cell called granulocytes. These granulocytes are abnormal and do not become healthy white blood cells. They are also called leukemia cells. The leukemia cells can build up in the blood and bone marrow so there is less room for healthy white blood cells, red blood cells, and platelets. When this happens, infection, anemia, or easy bleeding may occur. This summary is about chronic myelogenous leukemia. See the following PDQ summaries for more information about leukemia: Adult Acute Lymphoblastic Leukemia Treatment Childhood Acute Lymphoblastic Leukemia Treatment Adult Acute Myeloid Leukemia Treatment Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies Treatment Chronic Lymphocytic Leukemia Treatment Hairy Cell Leukemia Treatment</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Chronic Myelogenous Leukemia ? [/INST] Signs and symptoms of chronic myelogenous leukemia include fever, night sweats, and tiredness. These and other signs and symptoms may be caused by CML or by other conditions. Check with your doctor if you have any of the following: Feeling very tired. Weight loss for no known reason. Night sweats. Fever. Pain or a feeling of fullness below the ribs on the left side. Sometimes CML does not cause any symptoms at all.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the genetic changes related to Chronic Myelogenous Leukemia ? [/INST] Most people with CML have a gene mutation (change) called the Philadelphia chromosome. Every cell in the body contains DNA (genetic material) that determines how the cell looks and acts. DNA is contained inside chromosomes. In CML, part of the DNA from one chromosome moves to another chromosome. This change is called the Philadelphia chromosome. It results in the bone marrow making an enzyme, called tyrosine kinase, that causes too many stem cells to become white blood cells (granulocytes or blasts). The Philadelphia chromosome is not passed from parent to child.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Chronic Myelogenous Leukemia ? [/INST] Tests that examine the blood and bone marrow are used to detect (find) and diagnose chronic myelogenous leukemia.. The following tests and procedures may be used: Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease such as an enlarged spleen. A history of the patients health habits and past illnesses and treatments will also be taken. Complete blood count (CBC) with differential : A procedure in which a sample of blood is drawn and checked for the following: The number of red blood cells and platelets. The number and type of white blood cells. The amount of hemoglobin (the protein that carries oxygen) in the red blood cells. The portion of the blood sample made up of red blood cells. Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease. Bone marrow aspiration and biopsy : The removal of bone marrow, blood, and a small piece of bone by inserting a needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for abnormal cells. One of the following tests may be done on the samples of blood or bone marrow tissue that are removed: Cytogenetic analysis: A test in which cells in a sample of blood or bone marrow are viewed under a microscope to look for certain changes in the chromosomes, such as the Philadelphia chromosome. FISH (fluorescence in situ hybridization): A laboratory technique used to look at genes or chromosomes in cells and tissues. Pieces of DNA that contain a fluorescent dye are made in the laboratory and added to cells or tissues on a glass slide. When these pieces of DNA bind to specific genes or areas of chromosomes on the slide, they light up when viewed under a microscope with a special light. Reverse transcriptionpolymerase chain reaction (RTPCR): A laboratory test in which cells in a sample of tissue are studied using chemicals to look for certain changes in the structure or function of genes.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is the outlook for Chronic Myelogenous Leukemia ? [/INST] Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) and treatment options depend on the following: The patients age. The phase of CML. The amount of blasts in the blood or bone marrow. The size of the spleen at diagnosis. The patients general health.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the stages of Chronic Myelogenous Leukemia ? [/INST] After chronic myelogenous leukemia has been diagnosed, tests are done to find out if the cancer has spread. Chronic myelogenous leukemia has 3 phases. Chronic phase Accelerated phase Blastic phase After chronic myelogenous leukemia has been diagnosed, tests are done to find out if the cancer has spread. Staging is the process used to find out how far the cancer has spread. There is no standard staging system for chronic myelogenous leukemia (CML). Instead, the disease is classified by phase: chronic phase, accelerated phase, or blastic phase. It is important to know the phase in order to plan treatment. The information from tests and procedures done to detect (find) and diagnose chronic myelogenous leukemia is also used to plan treatment. Chronic myelogenous leukemia has 3 phases. As the amount of blast cells increases in the blood and bone marrow, there is less room for healthy white blood cells, red blood cells, and platelets. This may result in infections, anemia, and easy bleeding, as well as bone pain and pain or a feeling of fullness below the ribs on the left side. The number of blast cells in the blood and bone marrow and the severity of signs or symptoms determine the phase of the disease. Chronic phase In chronic phase CML, fewer than 10% of the cells in the blood and bone marrow are blast cells. Accelerated phase In accelerated phase CML, 10% to 19% of the cells in the blood and bone marrow are blast cells. Blastic phase In blastic phase CML, 20% or more of the cells in the blood or bone marrow are blast cells. When tiredness, fever, and an enlarged spleen occur during the blastic phase, it is called blast crisis.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Chronic Myelogenous Leukemia ? [/INST] New types of treatment are being tested in clinical trials. Information about clinical trials is available from the NCI website. Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Chronic Myelogenous Leukemia ? [/INST] There are different types of treatment for patients with chronic myelogenous leukemia. Six types of standard treatment are used: Targeted therapy Chemotherapy Biologic therapy Highdose chemotherapy with stem cell transplant Donor lymphocyte infusion (DLI) Surgery New types of treatment are being tested in clinical trials. Patients may want to think about taking part in a clinical trial. Patients can enter clinical trials before, during, or after starting their cancer treatment. Followup tests may be needed. There are different types of treatment for patients with chronic myelogenous leukemia. Different types of treatment are available for patients with chronic myelogenous leukemia (CML). Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information about new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment. Six types of standard treatment are used: Targeted therapy Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Tyrosine kinase inhibitors are targeted therapy drugs used to treat chronic myelogenous leukemia. Imatinib mesylate, nilotinib, dasatinib, and ponatinib are tyrosine kinase inhibitors that are used to treat CML. See Drugs Approved for Chronic Myelogenous Leukemia for more information. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated. See Drugs Approved for Chronic Myelogenous Leukemia for more information. Biologic therapy Biologic therapy is a treatment that uses the patients immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the bodys natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy. See Drugs Approved for Chronic Myelogenous Leukemia for more information. Highdose chemotherapy with stem cell transplant Highdose chemotherapy with stem cell transplant is a method of giving high doses of chemotherapy and replacing bloodforming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the bodys blood cells. See Drugs Approved for Chronic Myelogenous Leukemia for more information. Donor lymphocyte infusion (DLI) Donor lymphocyte infusion (DLI) is a cancer treatment that may be used after stem cell transplant. Lymphocytes (a type of white blood cell) from the stem cell transplant donor are removed from the donors blood and may be frozen for storage. The donors lymphocytes are thawed if they were frozen and then given to the patient through one or more infusions. The lymphocytes see the patients cancer cells as not belonging to the body and attack them. Surgery Splenectomy is surgery to remove the spleen. New types of treatment are being tested in clinical trials. Information about clinical trials is available from the NCI website. Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials. Followup tests may be needed. Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called followup tests or checkups. Treatment Options for Chronic Myelogenous Leukemia Chronic Phase Chronic Myelogenous Leukemia Treatment of chronic phase chronic myelogenous leukemia may include the following: Targeted therapy with a tyrosine kinase inhibitor. Highdose chemotherapy with donor stem cell transplant. Chemotherapy. Splenectomy. A clinical trial of lowerdose chemotherapy with donor stem cell transplant. A clinical trial of a new treatment. Check the list of NCIsupported cancer clinical trials that are now accepting patients with chronic phase chronic myelogenous leukemia. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website. Accelerated Phase Chronic Myelogenous Leukemia Treatment of accelerated phase chronic myelogenous leukemia may include the following: Donor stem cell transplant. Targeted therapy with a tyrosine kinase inhibitor. Tyrosine kinase inhibitor therapy followed by a donor stem cell transplant. Biologic therapy (interferon) with or without chemotherapy. Highdose chemotherapy. Chemotherapy. Transfusion therapy to replace red blood cells, platelets, and sometimes white blood cells, to relieve symptoms and improve quality of life. A clinical trial of a new treatment. Check the list of NCIsupported cancer clinical trials that are now accepting patients with accelerated phase chronic myelogenous leukemia. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website. Blastic Phase Chronic Myelogenous Leukemia Treatment of blastic phase chronic myelogenous leukemia may include the following: Targeted therapy with a tyrosine kinase inhibitor. Chemotherapy using one or more drugs. Highdose chemotherapy. Donor stem cell transplant. Chemotherapy as palliative therapy to relieve symptoms and improve quality of life. A clinical trial of a new treatment. Check the list of NCIsupported cancer clinical trials that are now accepting patients with blastic phase chronic myelogenous leukemia. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website. Relapsed Chronic Myelogenous Leukemia Treatment of relapsed chronic myelogenous leukemia may include the following: Targeted therapy with a tyrosine kinase inhibitor. Donor stem cell transplant. Chemotherapy. Donor lymphocyte infusion. Biologic therapy (interferon). A clinical trial of new types or higher doses of targeted therapy or donor stem cell transplant. Check the list of NCIsupported cancer clinical trials that are now accepting patients with relapsing chronic myelogenous leukemia. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Bile Duct Cancer (Cholangiocarcinoma) ? [/INST] Bile duct cancer is a rare disease in which malignant (cancer) cells form in the bile ducts. Having colitis or certain liver diseases can increase the risk of bile duct cancer. Signs of bile duct cancer include jaundice and pain in the abdomen. Tests that examine the bile ducts and nearby organs are used to detect (find), diagnose, and stage bile duct cancer. Different procedures may be used to obtain a sample of tissue and diagnose bile duct cancer. Certain factors affect prognosis (chance of recovery) and treatment options. Bile duct cancer is a rare disease in which malignant (cancer) cells form in the bile ducts. A network of tubes, called ducts, connects the liver, gallbladder, and small intestine. This network begins in the liver where many small ducts collect bile (a fluid made by the liver to break down fats during digestion). The small ducts come together to form the right and left hepatic ducts, which lead out of the liver. The two ducts join outside the liver and form the common hepatic duct. The cystic duct connects the gallbladder to the common hepatic duct. Bile from the liver passes through the hepatic ducts, common hepatic duct, and cystic duct and is stored in the gallbladder. When food is being digested, bile stored in the gallbladder is released and passes through the cystic duct to the common bile duct and into the small intestine. Bile duct cancer is also called cholangiocarcinoma. There are two types of bile duct cancer: Intrahepatic bile duct cancer : This type of cancer forms in the bile ducts inside the liver. Only a small number of bile duct cancers are intrahepatic. Intrahepatic bile duct cancers are also called intrahepatic cholangiocarcinomas. Extrahepatic bile duct cancer : The extrahepatic bile duct is made up of the hilum region and the distal region. Cancer can form in either region: Perihilar bile duct cancer: This type of cancer is found in the hilum region, the area where the right and left bile ducts exit the liver and join to form the common hepatic duct. Perihilar bile duct cancer is also called a Klatskin tumor or perihilar cholangiocarcinoma. Distal extrahepatic bile duct cancer: This type of cancer is found in the distal region. The distal region is made up of the common bile duct which passes through the pancreas and ends in the small intestine. Distal extrahepatic bile duct cancer is also called extrahepatic cholangiocarcinoma.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Bile Duct Cancer (Cholangiocarcinoma)? ? [/INST] Having colitis or certain liver diseases can increase the risk of bile duct cancer. Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for bile duct cancer include the following conditions: Primary sclerosing cholangitis (a progressive disease in which the bile ducts become blocked by inflammation and scarring). Chronic ulcerative colitis. Cysts in the bile ducts (cysts block the flow of bile and can cause swollen bile ducts, inflammation, and infection). Infection with a Chinese liver fluke parasite.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Bile Duct Cancer (Cholangiocarcinoma) ? [/INST] Signs of bile duct cancer include jaundice and pain in the abdomen. These and other signs and symptoms may be caused by bile duct cancer or by other conditions. Check with your doctor if you have any of the following: Jaundice (yellowing of the skin or whites of the eyes). Dark urine. Clay colored stool. Pain in the abdomen. Fever. Itchy skin. Nausea and vomiting. Weight loss for an unknown reason.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Bile Duct Cancer (Cholangiocarcinoma) ? [/INST] Tests that examine the bile ducts and nearby organs are used to detect (find), diagnose, and stage bile duct cancer. Procedures that make pictures of the bile ducts and the nearby area help diagnose bile duct cancer and show how far the cancer has spread. The process used to find out if cancer cells have spread within and around the bile ducts or to distant parts of the body is called staging. In order to plan treatment, it is important to know if the bile duct cancer can be removed by surgery. Tests and procedures to detect, diagnose, and stage bile duct cancer are usually done at the same time. The following tests and procedures may be used: Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patients health habits and past illnesses and treatments will also be taken. Liver function tests : A procedure in which a blood sample is checked to measure the amounts of bilirubin and alkaline phosphatase released into the blood by the liver. A higher than normal amount of these substances can be a sign of liver disease that may be caused by bile duct cancer. Laboratory tests : Medical procedures that test samples of tissue, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time. Carcinoembryonic antigen (CEA) and CA 199 tumor marker test : A procedure in which a sample of blood, urine, or tissue is checked to measure the amounts of certain substances made by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the body. These are called tumor markers. Higher than normal levels of carcinoembryonic antigen (CEA) and CA 199 may mean there is bile duct cancer. Ultrasound exam : A procedure in which highenergy sound waves (ultrasound) are bounced off internal tissues or organs, such as the abdomen, and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later. CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the abdomen, taken from different angles. The pictures are made by a computer linked to an xray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). MRCP (magnetic resonance cholangiopancreatography): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body such as the liver, bile ducts, gallbladder, pancreas, and pancreatic duct. Different procedures may be used to obtain a sample of tissue and diagnose bile duct cancer. Cells and tissues are removed during a biopsy so they can be viewed under a microscope by a pathologist to check for signs of cancer. Different procedures may be used to obtain the sample of cells and tissue. The type of procedure used depends on whether the patient is well enough to have surgery. Types of biopsy procedures include the following: Laparoscopy : A surgical procedure to look at the organs inside the abdomen, such as the bile ducts and liver, to check for signs of cancer. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to perform procedures such as taking tissue samples to be checked for signs of cancer. Percutaneous transhepatic cholangiography (PTC): A procedure used to xray the liver and bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an xray is taken. A sample of tissue is removed and checked for signs of cancer. If the bile duct is blocked, a thin, flexible tube called a stent may be left in the liver to drain bile into the small intestine or a collection bag outside the body. This procedure may be used when a patient cannot have surgery. Endoscopic retrograde cholangiopancreatography (ERCP): A procedure used to xray the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes bile duct cancer causes these ducts to narrow and block or slow the flow of bile, causing jaundice. An endoscope is passed through the mouth and stomach and into the small intestine. Dye is injected through the endoscope (thin, tubelike instrument with a light and a lens for viewing) into the bile ducts and an xray is taken. A sample of tissue is removed and checked for signs of cancer. If the bile duct is blocked, a thin tube may be inserted into the duct to unblock it. This tube (or stent) may be left in place to keep the duct open. This procedure may be used when a patient cannot have surgery.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is the outlook for Bile Duct Cancer (Cholangiocarcinoma) ? [/INST] Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) and treatment options depend on the following: Whether the cancer is in the upper or lower part of the bile duct system. The stage of the cancer (whether it affects only the bile ducts or has spread to the liver, lymph nodes, or other places in the body). Whether the cancer has spread to nearby nerves or veins. Whether the cancer can be completely removed by surgery. Whether the patient has other conditions, such as primary sclerosing cholangitis. Whether the level of CA 199 is higher than normal. Whether the cancer has just been diagnosed or has recurred (come back). Treatment options may also depend on the symptoms caused by the cancer. Bile duct cancer is usually found after it has spread and can rarely be completely removed by surgery. Palliative therapy may relieve symptoms and improve the patient's quality of life.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Bile Duct Cancer (Cholangiocarcinoma) ? [/INST] New types of treatment are being tested in clinical trials. This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website. Liver transplant In a liver transplant, the entire liver is removed and replaced with a healthy donated liver. A liver transplant may be done in patients with perihilar bile duct cancer. If the patient has to wait for a donated liver, other treatment is given as needed. Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the stages of Bile Duct Cancer (Cholangiocarcinoma) ? [/INST] The results of diagnostic and staging tests are used to find out if cancer cells have spread. There are three ways that cancer spreads in the body. Cancer may spread from where it began to other parts of the body. Stages are used to describe the different types of bile duct cancer. Intrahepatic bile duct cancer Perihilar bile duct cancer Distal extrahepatic bile duct cancer The following groups are used to plan treatment: Resectable (localized) bile duct cancer Unresectable, metastatic, or recurrent bile duct cancer The results of diagnostic and staging tests are used to find out if cancer cells have spread. The process used to find out if cancer has spread to other parts of the body is called staging. For bile duct cancer, the information gathered from tests and procedures is used to plan treatment, including whether the tumor can be removed by surgery. There are three ways that cancer spreads in the body. Cancer can spread through tissue, the lymph system, and the blood: Tissue. The cancer spreads from where it began by growing into nearby areas. Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body. Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body. Cancer may spread from where it began to other parts of the body. When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood. Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body. Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body. The metastatic tumor is the same type of cancer as the primary tumor. For example, if bile duct cancer spreads to the liver, the cancer cells in the liver are actually bile duct cancer cells. The disease is metastatic bile duct cancer, not liver cancer. Stages are used to describe the different types of bile duct cancer. Intrahepatic bile duct cancer Stage 0: Abnormal cells are found in the innermost layer of tissue lining the intrahepatic bile duct. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ. Stage I: There is one tumor that has spread into the intrahepatic bile duct and it has not spread into any blood vessels. Stage II: There is one tumor that has spread through the wall of the bile duct and into a blood vessel, or there are multiple tumors that may have spread into a blood vessel. Stage III: The tumor has spread through the tissue that lines the abdominal wall or has spread to organs or tissues near the liver such as the duodenum, colon, and stomach. Stage IV: Stage IV is divided into stage IVA and stage IVB. Stage IVA: The cancer has spread along the outside of the intrahepatic bile ducts or the cancer has spread to nearby lymph nodes. Stage IVB: The cancer has spread to organs in other parts of the body. Perihilar bile duct cancer Stage 0: Abnormal cells are found in the innermost layer of tissue lining the perihilar bile duct. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ. Stage I: Cancer has formed in the innermost layer of the wall of the perihilar bile duct and has spread into the muscle layer or fibrous tissue layer of the wall. Stage II: Cancer has spread through the wall of the perihilar bile duct to nearby fatty tissue or to the liver. Stage III: Stage III is divided into stage IIIA and stage IIIB. Stage IIIA: Cancer has spread to branches on one side of the hepatic artery or of the portal vein. Stage IIIB: Cancer has spread to nearby lymph nodes. Cancer may have spread into the wall of the perihilar bile duct or through the wall to nearby fatty tissue, the liver, or to branches on one side of the hepatic artery or of the portal vein. Stage IV: Stage IV is divided into stage IVA and stage IVB. Stage IVA: Cancer has spread to one or more of the following: the main part of the portal vein and/or common hepatic artery; the branches of the portal vein and/or common hepatic artery on both sides; the right hepatic duct and the left branch of the hepatic artery or of the portal vein; the left hepatic duct and the right branch of the hepatic artery or of the portal vein. Cancer may have spread to nearby lymph nodes. Stage IVB: Cancer has spread to lymph nodes in more distant parts of the abdomen, or to organs in other parts of the body. Distal extrahepatic bile duct cancer Stage 0: Abnormal cells are found in the innermost layer of tissue lining the distal extrahepatic bile duct. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ. Stage I: Stage I is divided into stage IA and stage IB. Stage IA: Cancer has formed and is found in the distal extrahepatic bile duct wall only. Stage IB: Cancer has formed and has spread through the wall of the distal extrahepatic bile duct but has not spread to nearby organs. Stage II: Stage II is divided into stage IIA and stage IIB. Stage IIA: Cancer has spread from the distal extrahepatic bile duct to the gallbladder, pancreas, duodenum, or other nearby organs. Stage IIB: Cancer has spread from the distal extrahepatic bile duct to nearby lymph nodes. Cancer may have spread through the wall of the duct or to nearby organs. Stage III: Cancer has spread to the large vessels that carry blood to the organs in the abdomen. Cancer may have spread to nearby lymph nodes. Stage IV: Cancer has spread to organs in distant parts of the body. The following groups are used to plan treatment: Resectable (localized) bile duct cancer The cancer is in an area, such as the lower part of the common bile duct or perihilar area, where it can be removed completely by surgery. Unresectable, metastatic, or recurrent bile duct cancer Unresectable cancer cannot be removed completely by surgery. Most patients with bile duct cancer cannot have their cancer completely removed by surgery. Metastasis is the spread of cancer from the primary site (place where it started) to other places in the body. Metastatic bile duct cancer may have spread to the liver, other parts of the abdominal cavity, or to distant parts of the body. Recurrent bile duct cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the bile ducts, liver, or gallbladder. Less often, it may come back in distant parts of the body.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Bile Duct Cancer (Cholangiocarcinoma) ? [/INST] There are different types of treatment for patients with bile duct cancer. Three types of standard treatment are used: Surgery Radiation therapy Chemotherapy New types of treatment are being tested in clinical trials. Liver transplant Patients may want to think about taking part in a clinical trial. Patients can enter clinical trials before, during, or after starting their cancer treatment. Followup tests may be needed. There are different types of treatment for patients with bile duct cancer. Different types of treatments are available for patients with bile duct cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment. Three types of standard treatment are used: Surgery The following types of surgery are used to treat bile duct cancer: Removal of the bile duct: A surgical procedure to remove part of the bile duct if the tumor is small and in the bile duct only. Lymph nodes are removed and tissue from the lymph nodes is viewed under a microscope to see if there is cancer. Partial hepatectomy: A surgical procedure in which the part of the liver where cancer is found is removed. The part removed may be a wedge of tissue, an entire lobe, or a larger part of the liver, along with some normal tissue around it. Whipple procedure: A surgical procedure in which the head of the pancreas, the gallbladder, part of the stomach, part of the small intestine, and the bile duct are removed. Enough of the pancreas is left to make digestive juices and insulin. Even if the doctor removes all the cancer that can be seen at the time of the operation, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy. It is not yet known whether chemotherapy or radiation therapy given after surgery helps keep the cancer from coming back. The following types of palliative surgery may be done to relieve symptoms caused by a blocked bile duct and improve quality of life: Biliary bypass: A surgical procedure in which the part of the bile duct before the blockage is connected with part of the bile duct that is past the blockage or to the small intestine. This allows bile to flow to the gallbladder or small intestine. Stent placement: A surgical procedure in which a stent (a thin, flexible tube or metal tube) is placed in the bile duct to open it and allow bile to flow into the small intestine or through a catheter that goes to a collection bag outside of the body. Percutaneous transhepatic biliary drainage: A procedure used to xray the liver and bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an xray is taken. If the bile duct is blocked, a thin, flexible tube called a stent may be left in the liver to drain bile into the small intestine or a collection bag outside the body. Radiation therapy Radiation therapy is a cancer treatment that uses highenergy xrays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy: External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. External and internal radiation therapy are used to treat bile duct cancer. It is not yet known whether external radiation therapy helps in the treatment of resectable bile duct cancer. In unresectable, metastatic, or recurrent bile duct cancer, new ways to improve the effect of external radiation therapy on cancer cells are being studied: Hyperthermia therapy: A treatment in which body tissue is exposed to high temperatures to make cancer cells more sensitive to the effects of radiation therapy and certain anticancer drugs. Radiosensitizers: Drugs that make cancer cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more cancer cells. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Systemic chemotherapy is used to treat unresectable, metastatic, or recurrent bile duct cancer. It is not yet known whether systemic chemotherapy helps in the treatment of resectable bile duct cancer. In unresectable, metastatic, or recurrent bile duct cancer, intraarterial embolization is being studied. It is a procedure in which the blood supply to a tumor is blocked after anticancer drugs are given in blood vessels near the tumor. Sometimes, the anticancer drugs are attached to small beads that are injected into an artery that feeds the tumor. The beads block blood flow to the tumor as they release the drug. This allows a higher amount of drug to reach the tumor for a longer period of time, which may kill more cancer cells. New types of treatment are being tested in clinical trials. This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website. Liver transplant In a liver transplant, the entire liver is removed and replaced with a healthy donated liver. A liver transplant may be done in patients with perihilar bile duct cancer. If the patient has to wait for a donated liver, other treatment is given as needed. Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials. Followup tests may be needed. Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called followup tests or checkups. Treatment Options for Bile Duct Cancer Intrahepatic Bile Duct Cancer Resectable Intrahepatic Bile Duct Cancer Treatment of resectable intrahepatic bile duct cancer may include: Surgery to remove the cancer, which may include partial hepatectomy. Embolization may be done before surgery. Surgery followed by chemotherapy and/or radiation therapy. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage I intrahepatic bile duct cancer and stage II intrahepatic bile duct cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website. Unresectable, Recurrent, or Metastatic Intrahepatic Bile Duct Cancer Treatment of unresectable, recurrent, or metastatic intrahepatic bile duct cancer may include the following: Stent placement as palliative treatment to relieve symptoms and improve quality of life. External or internal radiation therapy as palliative treatment to relieve symptoms and improve the quality of life. Chemotherapy. A clinical trial of external radiation therapy combined with hyperthermia therapy, radiosensitizer drugs, or chemotherapy. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage III intrahepatic bile duct cancer, stage IV intrahepatic bile duct cancer and recurrent intrahepatic bile duct cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website. Perihilar Bile Duct Cancer Resectable Perihilar Bile Duct Cancer Treatment of resectable perihilar bile duct cancer may include the following: Surgery to remove the cancer, which may include partial hepatectomy. Stent placement or percutaneous transhepatic biliary drainage as palliative therapy, to relieve jaundice and other symptoms and improve the quality of life. Surgery followed by radiation therapy and/or chemotherapy. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage I perihilar bile duct cancer and stage II perihilar bile duct cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website. Unresectable, Recurrent, or Metastatic Perihilar Bile Duct Cancer Treatment of unresectable, recurrent, or metastatic perihilar bile duct cancer may include the following: Stent placement or biliary bypass as palliative treatment to relieve symptoms and improve the quality of life. External or internal radiation therapy as palliative treatment to relieve symptoms and improve the quality of life. Chemotherapy. A clinical trial of external radiation therapy combined with hyperthermia therapy, radiosensitizer drugs, or chemotherapy. A clinical trial of chemotherapy and radiation therapy followed by a liver transplant. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage III perihilar bile duct cancer, stage IV perihilar bile duct cancer and recurrent perihilar bile duct cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website. Distal Extrahepatic Bile Duct Cancer Resectable Distal Extrahepatic Bile Duct Cancer Treatment of resectable distal extrahepatic bile duct cancer may include the following: Surgery to remove the cancer, which may include a Whipple procedure. Stent placement or percutaneous transhepatic biliary drainage as palliative therapy, to relieve jaundice and other symptoms and improve the quality of life. Surgery followed by radiation therapy and/or chemotherapy. Check the list of NCIsupported cancer clinical trials that are now accepting patients with localized extrahepatic bile duct cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website. Unresectable, Recurrent, or Metastatic Distal Extrahepatic Bile Duct Cancer Treatment of unresectable, recurrent, or metastatic distal extrahepatic bile duct cancer may include the following: Stent placement or biliary bypass as palliative treatment to relieve symptoms and improve the quality of life. External or internal radiation therapy as palliative treatment to relieve symptoms and improve the quality of life. Chemotherapy. A clinical trial of external radiation therapy combined with hyperthermia therapy, radiosensitizer drugs, or chemotherapy. Check the list of NCIsupported cancer clinical trials that are now accepting patients with unresectable extrahepatic bile duct cancer, recurrent extrahepatic bile duct cancer and metastatic extrahepatic bile duct cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>Who is at risk for Testicular Cancer? ? [/INST] Health history can affect the risk of testicular cancer. Anything that increases the chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesnt mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors for testicular cancer include: Having had an undescended testicle. Having had abnormal development of the testicles. Having a personal history of testicular cancer. Having a family history of testicular cancer (especially in a father or brother). Being white. Treatment for testicular cancer can cause infertility. Certain treatments for testicular cancer can cause infertility that may be permanent. Patients who may wish to have children should consider sperm banking before having treatment. Sperm banking is the process of freezing sperm and storing it for later use.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the stages of Testicular Cancer ? [/INST] After testicular cancer has been diagnosed, tests are done to find out if cancer cells have spread within the testicles or to other parts of the body. There are three ways that cancer spreads in the body. Cancer may spread from where it began to other parts of the body. The following stages are used for testicular cancer: Stage 0 (Testicular Intraepithelial Neoplasia) Stage I Stage II Stage III After testicular cancer has been diagnosed, tests are done to find out if cancer cells have spread within the testicles or to other parts of the body. The process used to find out if cancer has spread within the testicles or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process: Chest xray : An xray of the organs and bones inside the chest. An xray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an xray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). Abdominal lymph node dissection : A surgical procedure in which lymph nodes in the abdomen are removed and a sample of tissue is checked under a microscope for signs of cancer. This procedure is also called lymphadenectomy. For patients with nonseminoma, removing the lymph nodes may help stop the spread of disease. Cancer cells in the lymph nodes of seminoma patients can be treated with radiation therapy. Serum tumor marker test : A procedure in which a sample of blood is examined to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called tumor markers. The following 3 tumor markers are used in staging testicular cancer: Alphafetoprotein (AFP) Betahuman chorionic gonadotropin (hCG). Lactate dehydrogenase (LDH). Tumor marker levels are measured again, after inguinal orchiectomy and biopsy, in order to determine the stage of the cancer. This helps to show if all of the cancer has been removed or if more treatment is needed. Tumor marker levels are also measured during followup as a way of checking if the cancer has come back. There are three ways that cancer spreads in the body. Cancer can spread through tissue, the lymph system, and the blood: Tissue. The cancer spreads from where it began by growing into nearby areas. Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body. Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body. Cancer may spread from where it began to other parts of the body. When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood. Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body. Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body. The metastatic tumor is the same type of cancer as the primary tumor. For example, if testicular cancer spreads to the lung, the cancer cells in the lung are actually testicular cancer cells. The disease is metastatic testicular cancer, not lung cancer. The following stages are used for testicular cancer: Stage 0 (Testicular Intraepithelial Neoplasia) In stage 0, abnormal cells are found in the tiny tubules where the sperm cells begin to develop. These abnormal cells may become cancer and spread into nearby normal tissue. All tumor marker levels are normal. Stage 0 is also called testicular intraepithelial neoplasia and testicular intratubular germ cell neoplasia. Stage I In stage I, cancer has formed. Stage I is divided into stage IA, stage IB, and stage IS and is determined after an inguinal orchiectomy is done. In stage IA, cancer is in the testicle and epididymis and may have spread to the inner layer of the membrane surrounding the testicle. All tumor marker levels are normal. In stage IB, cancer: is in the testicle and the epididymis and has spread to the blood vessels or lymph vessels in the testicle; or has spread to the outer layer of the membrane surrounding the testicle; or is in the spermatic cord or the scrotum and may be in the blood vessels or lymph vessels of the testicle. All tumor marker levels are normal. In stage IS, cancer is found anywhere within the testicle, spermatic cord, or the scrotum and either: all tumor marker levels are slightly above normal; or one or more tumor marker levels are moderately above normal or high. Stage II Stage II is divided into stage IIA, stage IIB, and stage IIC and is determined after an inguinal orchiectomy is done. In stage IIA, cancer: is anywhere within the testicle, spermatic cord, or scrotum; and has spread to up to 5 lymph nodes in the abdomen, none larger than 2 centimeters. All tumor marker levels are normal or slightly above normal. In stage IIB, cancer is anywhere within the testicle, spermatic cord, or scrotum; and either: has spread to up to 5 lymph nodes in the abdomen; at least one of the lymph nodes is larger than 2 centimeters, but none are larger than 5 centimeters; or has spread to more than 5 lymph nodes; the lymph nodes are not larger than 5 centimeters. All tumor marker levels are normal or slightly above normal. In stage IIC, cancer: is anywhere within the testicle, spermatic cord, or scrotum; and has spread to a lymph node in the abdomen that is larger than 5 centimeters. All tumor marker levels are normal or slightly above normal. Stage III Stage III is divided into stage IIIA, stage IIIB, and stage IIIC and is determined after an inguinal orchiectomy is done. In stage IIIA, cancer: is anywhere within the testicle, spermatic cord, or scrotum; and may have spread to one or more lymph nodes in the abdomen; and has spread to distant lymph nodes or to the lungs. Tumor marker levels may range from normal to slightly above normal. In stage IIIB, cancer: is anywhere within the testicle, spermatic cord, or scrotum; and may have spread to one or more lymph nodes in the abdomen, to distant lymph nodes, or to the lungs. The level of one or more tumor markers is moderately above normal. In stage IIIC, cancer: is anywhere within the testicle, spermatic cord, or scrotum; and may have spread to one or more lymph nodes in the abdomen, to distant lymph nodes, or to the lungs. The level of one or more tumor markers is high. or Cancer: is anywhere within the testicle, spermatic cord, or scrotum; and may have spread to one or more lymph nodes in the abdomen; and has not spread to distant lymph nodes or the lung but has spread to other parts of the body. Tumor marker levels may range from normal to high.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Testicular Cancer ? [/INST] There are different types of treatment for patients with testicular cancer. Testicular tumors are divided into 3 groups, based on how well the tumors are expected to respond to treatment. Good Prognosis Intermediate Prognosis Poor Prognosis Five types of standard treatment are used: Surgery Radiation therapy Chemotherapy Surveillance Highdose chemotherapy with stem cell transplant New types of treatment are being tested in clinical trials. Patients may want to think about taking part in a clinical trial. Patients can enter clinical trials before, during, or after starting their cancer treatment. Followup tests may be needed. There are different types of treatment for patients with testicular cancer. Different types of treatments are available for patients with testicular cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment. Testicular tumors are divided into 3 groups, based on how well the tumors are expected to respond to treatment. Good Prognosis For nonseminoma, all of the following must be true: The tumor is found only in the testicle or in the retroperitoneum (area outside or behind the abdominal wall); and The tumor has not spread to organs other than the lungs; and The levels of all the tumor markers are slightly above normal. For seminoma, all of the following must be true: The tumor has not spread to organs other than the lungs; and The level of alphafetoprotein (AFP) is normal. Betahuman chorionic gonadotropin (hCG) and lactate dehydrogenase (LDH) may be at any level. Intermediate Prognosis For nonseminoma, all of the following must be true: The tumor is found in one testicle only or in the retroperitoneum (area outside or behind the abdominal wall); and The tumor has not spread to organs other than the lungs; and The level of any one of the tumor markers is more than slightly above normal. For seminoma, all of the following must be true: The tumor has spread to organs other than the lungs; and The level of AFP is normal. hCG and LDH may be at any level. Poor Prognosis For nonseminoma, at least one of the following must be true: The tumor is in the center of the chest between the lungs; or The tumor has spread to organs other than the lungs; or The level of any one of the tumor markers is high. There is no poor prognosis grouping for seminoma testicular tumors. Five types of standard treatment are used: Surgery Surgery to remove the testicle (inguinal orchiectomy) and some of the lymph nodes may be done at diagnosis and staging. (See the General Information and Stages sections of this summary.) Tumors that have spread to other places in the body may be partly or entirely removed by surgery. Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy. Radiation therapy Radiation therapy is a cancer treatment that uses highenergy xrays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy: External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is used to treat testicular cancer. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated. See Drugs Approved for Testicular Cancer for more information. Surveillance Surveillance is closely following a patient's condition without giving any treatment unless there are changes in test results. It is used to find early signs that the cancer has recurred (come back). In surveillance, patients are given certain exams and tests on a regular schedule. Highdose chemotherapy with stem cell transplant Highdose chemotherapy with stem cell transplant is a method of giving high doses of chemotherapy and replacing blood forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the bodys blood cells. See Drugs Approved for Testicular Cancer for more information. New types of treatment are being tested in clinical trials. Information about clinical trials is available from the NCI website. Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials. Followup tests may be needed. Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called followup tests or checkups. Men who have had testicular cancer have an increased risk of developing cancer in the other testicle. A patient is advised to regularly check the other testicle and report any unusual symptoms to a doctor right away. Longterm clinical exams are very important. The patient will probably have checkups frequently during the first year after surgery and less often after that. Treatment Options by Stage Stage 0 (Testicular Intraepithelial Neoplasia) Treatment of stage 0 may include the following: Radiation therapy. Surveillance. Surgery to remove the testicle. Check the list of NCIsupported cancer clinical trials that are now accepting patients with testicular cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website. Stage I Testicular Cancer Treatment of stage I testicular cancer depends on whether the cancer is a seminoma or a nonseminoma. Treatment of seminoma may include the following: Surgery to remove the testicle, followed by surveillance. For patients who want active treatment rather than surveillance, treatment may include: Surgery to remove the testicle, followed by chemotherapy. Treatment of nonseminoma may include the following: Surgery to remove the testicle, with longterm followup. Surgery to remove the testicle and lymph nodes in the abdomen, with longterm followup. Surgery followed by chemotherapy for patients at high risk of recurrence, with longterm followup. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage I testicular cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website. Stage II Testicular Cancer Treatment of stage II testicular cancer depends on whether the cancer is a seminoma or a nonseminoma. Treatment of seminoma may include the following: When the tumor is 5 centimeters or smaller: Surgery to remove the testicle, followed by radiation therapy to lymph nodes in the abdomen and pelvis. Combination chemotherapy. Surgery to remove the testicle and lymph nodes in the abdomen. When the tumor is larger than 5 centimeters: Surgery to remove the testicle, followed by combination chemotherapy or radiation therapy to lymph nodes in the abdomen and pelvis, with longterm followup. Treatment of nonseminoma may include the following: Surgery to remove the testicle and lymph nodes, with longterm followup. Surgery to remove the testicle and lymph nodes, followed by combination chemotherapy and longterm followup. Surgery to remove the testicle, followed by combination chemotherapy and a second surgery if cancer remains, with longterm followup. Combination chemotherapy before surgery to remove the testicle, for cancer that has spread and is thought to be lifethreatening. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage II testicular cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website. Stage III Testicular Cancer Treatment of stage III testicular cancer depends on whether the cancer is a seminoma or a nonseminoma. Treatment of seminoma may include the following: Surgery to remove the testicle, followed by combination chemotherapy. If there are tumors remaining after chemotherapy, treatment may be one of the following: Surveillance with no treatment unless tumors grow. Surveillance for tumors smaller than 3 centimeters and surgery to remove tumors larger than 3 centimeters. A PET scan two months after chemotherapy and surgery to remove tumors that show up with cancer on the scan. A clinical trial of chemotherapy. Treatment of nonseminoma may include the following: Surgery to remove the testicle, followed by combination chemotherapy. Combination chemotherapy followed by surgery to remove the testicle and all remaining tumors. Additional chemotherapy may be given if the tumor tissue removed contains cancer cells that are growing or if followup tests show that cancer is progressing. Combination chemotherapy before surgery to remove the testicle, for cancer that has spread and is thought to be lifethreatening. A clinical trial of chemotherapy. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage III testicular cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Testicular Cancer ? [/INST] New types of treatment are being tested in clinical trials. Information about clinical trials is available from the NCI website. Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Chronic Myelogenous Leukemia ? [/INST] Chronic myelogenous leukemia is a disease in which too many white blood cells are made in the bone marrow. See the PDQ summary on Chronic Myelogenous Leukemia Treatment for information on diagnosis, staging, and treatment.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Chronic Myelogenous Leukemia ? [/INST] See the PDQ summary about Chronic Myelogenous Leukemia Treatment for information.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is (are) Thymoma and Thymic Carcinoma ? [/INST] Thymoma and thymic carcinoma are diseases in which malignant (cancer) cells form on the outside surface of the thymus. Thymoma is linked with myasthenia gravis and other autoimmune diseases. Signs and symptoms of thymoma and thymic carcinoma include a cough and chest pain. Tests that examine the thymus are used to detect (find) thymoma or thymic carcinoma. Thymoma and thymic carcinoma are usually diagnosed, staged, and treated during surgery. Certain factors affect prognosis (chance of recovery) and treatment options. Thymoma and thymic carcinoma are diseases in which malignant (cancer) cells form on the outside surface of the thymus. The thymus, a small organ that lies in the upper chest under the breastbone, is part of the lymph system. It makes white blood cells, called lymphocytes, that protect the body against infections. There are different types of tumors of the thymus. Thymomas and thymic carcinomas are rare tumors of the cells that are on the outside surface of the thymus. The tumor cells in a thymoma look similar to the normal cells of the thymus, grow slowly, and rarely spread beyond the thymus. On the other hand, the tumor cells in a thymic carcinoma look very different from the normal cells of the thymus, grow more quickly, and have usually spread to other parts of the body when the cancer is found. Thymic carcinoma is more difficult to treat than thymoma. For information on thymoma and thymic carcinoma in children, see the PDQ summary on Unusual Cancers of Childhood Treatment. Thymoma is linked with myasthenia gravis and other autoimmune diseases. People with thymoma often have autoimmune diseases as well. These diseases cause the immune system to attack healthy tissue and organs. They include: Myasthenia gravis. Acquired pure red cell aplasia. Hypogammaglobulinemia. Polymyositis. Lupus erythematosus. Rheumatoid arthritis. Thyroiditis. Sjgren syndrome.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the symptoms of Thymoma and Thymic Carcinoma ? [/INST] Signs and symptoms of thymoma and thymic carcinoma include a cough and chest pain. Thymoma and thymic carcinoma may not cause early signs or symptoms. The cancer may be found during a routine chest xray. Signs and symptoms may be caused by thymoma, thymic carcinoma, or other conditions. Check with your doctor if you have any of the following: A cough that doesn't go away. Chest pain. Trouble breathing.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>How to diagnose Thymoma and Thymic Carcinoma ? [/INST] Tests that examine the thymus are used to detect (find) thymoma or thymic carcinoma. The following tests and procedures may be used: Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patients health habits and past illnesses and treatments will also be taken. Chest xray: An xray of the organs and bones inside the chest. An xray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest, taken from different angles. The pictures are made by a computer linked to an xray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the chest. This procedure is also called nuclear magnetic resonance imaging (NMRI). PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. Thymoma and thymic carcinoma are usually diagnosed, staged, and treated during surgery. A biopsy of the tumor is done to diagnose the disease. The biopsy may be done before or during surgery (a mediastinoscopy or mediastinotomy), using a thin needle to remove a sample of cells. This is called a fineneedle aspiration (FNA) biopsy. Sometimes a wide needle is used to remove a sample of cells and this is called a core biopsy. A pathologist will view the sample under a microscope to check for cancer. If thymoma or thymic carcinoma is diagnosed, the pathologist will determine the type of cancer cell in the tumor. There may be more than one type of cancer cell in a thymoma. The surgeon will decide if all or part of the tumor can be removed by surgery. In some cases, lymph nodes and other tissues may be removed as well.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What is the outlook for Thymoma and Thymic Carcinoma ? [/INST] Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) and treatment options depend on the following: The stage of the cancer. The type of cancer cell. Whether the tumor can be removed completely by surgery. The patient's general health. Whether the cancer has just been diagnosed or has recurred (come back).</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the stages of Thymoma and Thymic Carcinoma ? [/INST] Tests done to detect thymoma or thymic carcinoma are also used to stage the disease. There are three ways that cancer spreads in the body. Cancer may spread from where it began to other parts of the body. The following stages are used for thymoma: Stage I Stage II Stage III Stage IV Thymic carcinomas have usually spread to other parts of the body when diagnosed. Tests done to detect thymoma or thymic carcinoma are also used to stage the disease. Staging is the process used to find out if cancer has spread from the thymus to other parts of the body. The findings made during surgery and the results of tests and procedures are used to determine the stage of the disease. It is important to know the stage in order to plan treatment. There are three ways that cancer spreads in the body. Cancer can spread through tissue, the lymph system, and the blood: Tissue. The cancer spreads from where it began by growing into nearby areas. Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body. Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body. Cancer may spread from where it began to other parts of the body. When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood. Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body. Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body. The metastatic tumor is the same type of cancer as the primary tumor. For example, if thymic carcinoma spreads to the bone, the cancer cells in the bone are actually thymic carcinoma cells. The disease is metastatic thymic carcinoma, not bone cancer. The following stages are used for thymoma: Stage I In stage I, cancer is found only within the thymus. All cancer cells are inside the capsule (sac) that surrounds the thymus. Stage II In stage II, cancer has spread through the capsule and into the fat around the thymus or into the lining of the chest cavity. Stage III In stage III, cancer has spread to nearby organs in the chest, including the lung, the sac around the heart, or large blood vessels that carry blood to the heart. Stage IV Stage IV is divided into stage IVA and stage IVB, depending on where the cancer has spread. In stage IVA, cancer has spread widely around the lungs and heart. In stage IVB, cancer has spread to the blood or lymph system. Thymic carcinomas have usually spread to other parts of the body when diagnosed. The staging system used for thymomas is sometimes used for thymic carcinomas.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>what research (or clinical trials) is being done for Thymoma and Thymic Carcinoma ? [/INST] New types of treatment are being tested in clinical trials. This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website. Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.</s>

<s>[INST] <<SYS>>You are MediTalk, a Cool Medical Assitant Voice Bot. You helps the people by answering their medical related questions in many language. Don't answer the question which are not medical related and Don't make up the answer if you don't know. Make sure the answer is in four to five sentences<</SYS>>What are the treatments for Thymoma and Thymic Carcinoma ? [/INST] There are different types of treatment for patients with thymoma and thymic carcinoma. Four types of standard treatment are used: Surgery Radiation therapy Chemotherapy Hormone therapy New types of treatment are being tested in clinical trials. Patients may want to think about taking part in a clinical trial. Patients can enter clinical trials before, during, or after starting their cancer treatment. Followup tests may be needed. There are different types of treatment for patients with thymoma and thymic carcinoma. Different types of treatments are available for patients with thymoma and thymic carcinoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment. Four types of standard treatment are used: Surgery Surgery to remove the tumor is the most common treatment of thymoma. Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy. Radiation therapy Radiation therapy is a cancer treatment that uses highenergy xrays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy: External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is used to treat thymoma and thymic carcinoma. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated. Chemotherapy may be used to shrink the tumor before surgery or radiation therapy. This is called neoadjuvant chemotherapy. Hormone therapy Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy is used to reduce the production of hormones or block them from working. Hormone therapy with drugs called corticosteroids may be used to treat thymoma or thymic carcinoma. New types of treatment are being tested in clinical trials. This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website. Patients may want to think about taking part in a clinical trial. For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment. Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment. Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials. Followup tests may be needed. Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called followup tests or checkups. Treatment Options for Thymoma and Thymic Carcinoma Stage I and Stage II Thymoma Treatment of stage I thymoma is surgery. Treatment of stage II thymoma is surgery followed by radiation therapy. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage I thymoma and stage II thymoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website. Stage III and Stage IV Thymoma Treatment of stage III and stage IV thymoma that may be completely removed by surgery includes the following: Surgery with or without radiation therapy. Neoadjuvant chemotherapy followed by surgery with or without radiation therapy. A clinical trial of anticancer drugs in new combinations or doses. A clinical trial of new ways of giving radiation therapy. Treatment of stage III and stage IV thymoma that cannot be completely removed by surgery includes the following: Neoadjuvant chemotherapy followed by surgery and/or radiation therapy. Radiation therapy. Chemotherapy. A clinical trial of anticancer drugs in new combinations or doses. A clinical trial of new ways of giving radiation therapy. Check the list of NCIsupported cancer clinical trials that are now accepting patients with stage III thymoma and stage IV thymoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website. Thymic Carcinoma Treatment of thymic carcinoma that may be completely removed by surgery includes the following: Surgery with or without radiation therapy. A clinical trial of anticancer drugs in new combinations or doses. A clinical trial of new ways of giving radiation therapy. Treatment of thymic carcinoma that cannot be completely removed by surgery includes the following: Radiation therapy. Chemotherapy with or without surgery to remove part of the tumor and/or radiation therapy. Chemotherapy with radiation therapy. Chemotherapy. A clinical trial of anticancer drugs in new combinations or doses. A clinical trial of new ways of giving radiation therapy. Check the list of NCIsupported cancer clinical trials that are now accepting patients with thymic carcinoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website. Recurrent Thymoma and Thymic Carcinoma Treatment of recurrent thymoma and thymic carcinoma may include the following: Surgery with or without radiation therapy. Radiation therapy. Hormone therapy. Chemotherapy. A clinical trial of anticancer drugs in new combinations or doses. A clinical trial of new ways of giving radiation therapy. Check the list of NCIsupported cancer clinical trials that are now accepting patients with recurrent thymoma and thymic carcinoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.</s>