Input: What is (are) Juvenile Myelomonocytic Leukemia ?

Output:
Key Points
                    - Juvenile myelomonocytic leukemia is a childhood disease in which too many myelocytes and monocytes (immature white blood cells) are made in the bone marrow.    - Signs and symptoms of juvenile myelomonocytic leukemia include fever, weight loss, and feeling very tired.    - Certain factors affect prognosis (chance of recovery) and treatment options.

                    Juvenile myelomonocytic leukemia is a childhood disease in which too many myelocytes and monocytes (immature white blood cells) are made in the bone marrow.
                    Juvenile myelomonocytic leukemia (JMML) is a rare childhood cancer that occurs more often in children younger than 2 years. Children who have neurofibromatosis type 1 and males have an increased risk of juvenile myelomonocytic leukemia.    In JMML, the body tells too many blood stem cells to become two types of white blood cells called myelocytes and monocytes. Some of these blood stem cells never become mature white blood cells. These immature white blood cells are called blasts. 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. </s>


Input: What are the symptoms of Juvenile Myelomonocytic Leukemia ?

Output: Signs and symptoms of juvenile myelomonocytic leukemia include fever, weight loss, and feeling very tired. These and other signs and symptoms may be caused by JMML or by other conditions. Check with your doctor if you have any of the following:         -  Fever for no known reason.    - Having infections, such as bronchitis or tonsillitis.    - Feeling very tired.    - Easy bruising or bleeding.    - Skin rash.    - Painless swelling of the lymph nodes in the neck, underarm, stomach, or groin.    - Pain or a feeling of fullness below the ribs. </s>


Input: What is the outlook for Juvenile Myelomonocytic Leukemia ?

Output: Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) and treatment options for JMML depend on the following:         - The age of the child at diagnosis.    - The number of platelets in the blood.    - The amount of a certain type of hemoglobin in red blood cells. </s>


Input: What are the treatments for Juvenile Myelomonocytic Leukemia ?

Output: Treatment of juvenile myelomonocytic leukemia (JMML) may include the following:         -  Combination chemotherapy.    -  Stem cell transplant.    -  13-cis-retinoic acid therapy.    - A clinical trial of a new treatment, such as targeted therapy.        Check the list of NCI-supported 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 doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website. </s>


Input: What is (are) Primary CNS Lymphoma ?

Output:
Key Points
                    - Primary central nervous system (CNS) lymphoma is a disease in which malignant (cancer) cells form in the lymph tissue of the brain and/or spinal cord.    - Having a weakened immune system may increase the risk of developing primary CNS lymphoma.     - Tests that examine the eyes, brain, and spinal cord are used to detect (find) and diagnose primary CNS lymphoma.    - Certain factors affect prognosis (chance of recovery) and treatment options.

                    Primary central nervous system (CNS) lymphoma is a disease in which malignant (cancer) cells form in the lymph tissue of the brain and/or spinal cord.
                    Lymphoma is a disease in which malignant (cancer) cells form in the lymph system. The lymph system is part of the immune system and is made up of the lymph, lymph vessels, lymph nodes, spleen, thymus, tonsils, and bone marrow. Lymphocytes (carried in the lymph) travel in and out of the central nervous system (CNS). It is thought that some of these lymphocytes become malignant and cause lymphoma to form in the CNS. Primary CNS lymphoma can start in the brain, spinal cord, or meninges (the layers that form the outer covering of the brain). Because the eye is so close to the brain, primary CNS lymphoma can also start in the eye (called ocular lymphoma). </s>


Input: Who is at risk for Primary CNS Lymphoma? ?

Output: Having a weakened immune system may increase the risk of developing primary CNS lymphoma. 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.    Primary CNS lymphoma may occur in patients who have acquired immunodeficiency syndrome (AIDS) or other disorders of the immune system or who have had a kidney transplant. For more information about lymphoma in patients with AIDS, see the PDQ summary on AIDS-Related Lymphoma Treatment. </s>


Input: How to diagnose Primary CNS Lymphoma ?

Output: Tests that examine the eyes, brain, and spinal cord are used to detect (find) and diagnose primary CNS lymphoma. 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.    -   Neurological exam : A series of questions and tests to check the brain, spinal cord, and nerve function. The exam checks a persons mental status, coordination, 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.    -   Slit-lamp eye exam : An exam that uses a special microscope with a bright, narrow slit of light to check the outside and inside of the eye.    -   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 brain and spinal cord. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so 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 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.     -   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 tumor cells. The sample may also be checked for the amounts of protein and glucose. A higher than normal amount of protein or lower than normal amount of glucose may be a sign of a tumor. This procedure is also called an LP or spinal tap.     -   Stereotactic biopsy : A biopsy procedure that uses a computer and a 3-dimensional (3-D) scanning device to find a tumor site and guide the removal of tissue so it can be viewed under a microscope to check for signs of cancer. The following tests may be done on the samples of tissue that are removed:                -  Flow cytometry : A laboratory test that measures the number of cells in a sample, the percentage of live cells in a sample, and certain characteristics of cells, such as size, shape, and the presence of tumor markers on the cell surface. The cells are stained with a light-sensitive 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 light-sensitive dye reacts to the light.      -  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.      -  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. Other tests, such as fluorescence in situ hybridization (FISH), may also be done to look for certain changes in the chromosomes.             -   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. </s>


Input: What is the outlook for Primary CNS Lymphoma ?

Output: Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) depends on the following:         - The patient's age and general health.     - The level of certain substances in the blood and cerebrospinal fluid (CSF).    - Where the tumor is in the central nervous system, eye, or both.    - Whether the patient has AIDS.         Treatment options depend on the following:          - The stage of the cancer.    - Where the tumor is in the central nervous system.    - The patient's age and general health.    - Whether the cancer has just been diagnosed or has recurred (come back).        Treatment of primary CNS lymphoma works best when the tumor has not spread outside the cerebrum (the largest part of the brain) and the patient is younger than 60 years, able to carry out most daily activities, and does not have AIDS or other diseases that weaken the immune system. </s>


Input: what research (or clinical trials) is being done for Primary CNS Lymphoma ?

Output:
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.     High-dose chemotherapy with stem cell transplant     High-dose 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 body's blood 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 therapy do. Monoclonal antibody therapy is one type of targeted therapy being studied in the treatment of primary CNS lymphoma.    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. Rituximab is a type of monoclonal antibody used to treat newly diagnosed primary CNS lymphoma in patients who do not have AIDS.

                    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>


Input: What are the treatments for Primary CNS Lymphoma ?

Output:
Key Points
                    - There are different types of treatment for patients with primary CNS lymphoma.     - Three standard treatments are used:         - Radiation therapy      - Chemotherapy      -  Steroid therapy        - New types of treatment are being tested in clinical trials.         - High-dose chemotherapy with stem cell transplant     - 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.    - Follow-up tests may be needed.

                    There are different types of treatment for patients with primary CNS lymphoma.
                    Different types of treatment are available for patients with primary central nervous system (CNS) lymphoma. 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.     Surgery is not used to treat primary CNS lymphoma.

                    Three standard treatments are used:
                    Radiation therapy      Radiation therapy is a cancer treatment that uses high-energy x-rays 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. Because primary CNS lymphoma spreads throughout the brain, external radiation therapy is given to the whole brain. This is called whole brain 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 whether the patient has primary CNS lymphoma and AIDS. External radiation therapy is used to treat primary CNS lymphoma.     High-dose radiation therapy to the brain can damage healthy tissue and cause disorders that can affect thinking, learning, problem solving, speech, reading, writing, and memory. Clinical trials have tested the use of chemotherapy alone or before radiation therapy to reduce the damage to healthy brain tissue that occurs with the use of radiation therapy.       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).     The way the chemotherapy is given depends on where the tumor is in the CNS or eye. Primary CNS lymphoma may be treated with systemic chemotherapy, intrathecal chemotherapy and/or intraventricular chemotherapy, in which anticancer drugs are placed into the ventricles (fluid -filled cavities) of the brain. If primary CNS lymphoma is found in the eye, anticancer drugs are injected directly into the vitreous humor (jelly-like substance) inside the eye.     A network of blood vessels and tissue, called the blood-brain barrier, protects the brain from harmful substances. This barrier can also keep anticancer drugs from reaching the brain. In order to treat CNS lymphoma, certain drugs may be used to make openings between cells in the blood-brain barrier. This is called blood-brain barrier disruption. Anticancer drugs infused into the bloodstream may then reach the brain.         Steroid therapy     Steroids are hormones made naturally in the body. They can also be made in a laboratory and used as drugs. Glucocorticoids are steroid drugs that have an anticancer effect in lymphomas.

                    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.     High-dose chemotherapy with stem cell transplant     High-dose 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 body's blood 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 therapy do. Monoclonal antibody therapy is one type of targeted therapy being studied in the treatment of primary CNS lymphoma.    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. Rituximab is a type of monoclonal antibody used to treat newly diagnosed primary CNS lymphoma in patients who do not have AIDS.

                    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.

                    Follow-up 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 follow-up tests or check-ups.

												            Treatment Options for Primary CNS Lymphoma

												                    Primary CNS Lymphoma Not Related to AIDS
												                    Treatment of primary central nervous system (CNS) lymphoma in patients who do not have AIDS may include the following:         -  Whole brain radiation therapy.    -  Chemotherapy.    - Chemotherapy followed by radiation therapy.    - Chemotherapy and targeted therapy (rituximab) followed by high-dose chemotherapy and stem cell transplant.    - A clinical trial of high-dose chemotherapy with stem cell transplant.    - A clinical trial of high-dose chemotherapy and targeted therapy (rituximab), with or without stem cell transplant or whole brain radiation therapy.

												                    Primary CNS Lymphoma Related to AIDS
												                    Treatment of primary central nervous system (CNS) lymphoma in patients who do have AIDS may include the following:         -  Whole brain radiation therapy.    -  Chemotherapy followed by radiation therapy.        Treatment of primary CNS lymphoma is different in patients with AIDS because the treatment side effects may be more severe. (See the PDQ summary on AIDS-Related Lymphoma Treatment for more information).

												                    Primary Intraocular Lymphoma
												                    Treatment of primary intraocular lymphoma may include the following:         -  Chemotherapy (intraocular or systemic).    -  Whole brain radiation therapy.

												                    Recurrent Primary CNS Lymphoma
												                    Treatment of recurrent primary central nervous system (CNS) lymphoma may include the following:         -  Chemotherapy.    -  Radiation therapy (if not received in earlier treatment).    - A clinical trial of a new drug or treatment schedule. </s>


Input: What is (are) Ovarian Germ Cell Tumors ?

Output:
Key Points
                    - Ovarian germ cell tumor is a disease in which malignant (cancer) cells form in the germ (egg) cells of the ovary.     - Signs of ovarian germ cell tumor are swelling of the abdomen or vaginal bleeding after menopause.     - Tests that examine the ovaries, pelvic area, blood, and ovarian tissue are used to detect (find) and diagnose ovarian germ cell tumor.     - Certain factors affect prognosis (chance of recovery and treatment options).

                    Ovarian germ cell tumor is a disease in which malignant (cancer) cells form in the germ (egg) cells of the ovary.
                    Germ cell tumors begin in the reproductive cells (egg or sperm) of the body. Ovarian germ cell tumors usually occur in teenage girls or young women and most often affect just one ovary.    The ovaries are a pair of organs in the female reproductive system. They are in the pelvis, one on each side of the uterus (the hollow, pear-shaped organ where a fetus grows). Each ovary is about the size and shape of an almond. The ovaries make eggs and female hormones.      Ovarian germ cell tumor is a general name that is used to describe several different types of cancer. The most common ovarian germ cell tumor is called dysgerminoma. See the following PDQ summaries for information about other types of ovarian tumors:          -  Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer Treatment     -  Ovarian Low Malignant Potential Tumors Treatment </s>


Input: What are the symptoms of Ovarian Germ Cell Tumors ?

Output: Signs of ovarian germ cell tumor are swelling of the abdomen or vaginal bleeding after menopause. Ovarian germ cell tumors can be hard to diagnose (find) early. Often there are no symptoms in the early stages, but tumors may be found during regular gynecologic exams (checkups). Check with your doctor if you have either of the following:          - Swollen abdomen without weight gain in other parts of the body.     - Bleeding from the vagina after menopause (when you are no longer having menstrual periods). </s>


Input: How to diagnose Ovarian Germ Cell Tumors ?

Output: Tests that examine the ovaries, pelvic area, blood, and ovarian tissue are used to detect (find) and diagnose ovarian germ cell tumor. 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.    -   Pelvic exam : An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. A speculum is inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test of the cervix is usually done. The doctor or nurse also inserts one or two lubricated, gloved fingers of one hand into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.    -   Laparotomy : A surgical procedure in which an incision (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease. The size of the incision depends on the reason the laparotomy is being done. Sometimes organs are removed or tissue samples are taken and checked under a microscope for signs of disease.    -   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 x-ray 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.    -   Serum tumor marker test : A procedure in which a sample of blood is checked 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 alpha fetoprotein (AFP) or human chorionic gonadotropin (HCG) in the blood may be a sign of ovarian germ cell tumor. </s>


Input: What is the outlook for Ovarian Germ Cell Tumors ?

Output: Certain factors affect prognosis (chance of recovery and treatment options). The prognosis (chance of recovery) and treatment options depend on the following:         - The type of cancer.    -  The size of the tumor.    - The stage of cancer (whether it affects part of the ovary, involves the whole ovary, or has spread to other places in the body).    - The way the cancer cells look under a microscope.    - The patients general health.         Ovarian germ cell tumors are usually cured if found and treated early. </s>


Input: What are the stages of Ovarian Germ Cell Tumors ?

Output:
Key Points
                    - After ovarian germ cell tumor has been diagnosed, tests are done to find out if cancer cells have spread within the ovary 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 ovarian germ cell tumors:         - Stage I     - Stage II     - Stage III     - Stage IV

                    After ovarian germ cell tumor has been diagnosed, tests are done to find out if cancer cells have spread within the ovary or to other parts of the body.
                    The process used to find out whether cancer has spread within the ovary or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. Unless a doctor is sure the cancer has spread from the ovaries to other parts of the body, an operation called a laparotomy is done to see if the cancer has spread. The doctor must cut into the abdomen and carefully look at all the organs to see if they have cancer in them. The doctor will cut out small pieces of tissue so they can be checked under a microscope for signs of cancer. The doctor may also wash the abdominal cavity with fluid, which is also checked under a microscope to see if it has cancer cells in it. Usually the doctor will remove the cancer and other organs that have cancer in them during the laparotomy. It is important to know the stage in order to plan treatment.    Many of the tests used to diagnose ovarian germ cell tumor are also used for staging. The following tests and procedures may also be used for staging:          -   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).    -   Transvaginal ultrasound exam: A procedure used to examine the vagina, uterus, fallopian tubes, and bladder. An ultrasound transducer (probe) is inserted into the vagina and used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The doctor can identify tumors by looking at the sonogram.

                    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 tumor as the primary tumor. For example, if an ovarian germ cell tumor spreads to the liver, the tumor cells in the liver are actually cancerous ovarian germ cells. The disease is metastatic ovarian germ cell tumor, not liver cancer.

                    The following stages are used for ovarian germ cell tumors:
                    Stage I     In stage I, cancer is found in one or both ovaries. Stage I is divided into stage IA, stage IB, and stage IC.            -  Stage IA: Cancer is found inside a single ovary.     -  Stage IB: Cancer is found inside both ovaries.     -  Stage IC: Cancer is found inside one or both ovaries and one of the following is true:                   - cancer is also found on the outside surface of one or both ovaries; or       - the capsule (outer covering) of the ovary has ruptured (broken open); or       - cancer cells are found in the fluid of the peritoneal cavity (the body cavity that contains most of the organs in the abdomen) or in washings of the peritoneum (tissue lining the peritoneal cavity).                           Stage II      In stage II, cancer is found in one or both ovaries and has spread into other areas of the pelvis. Stage II is divided into stage IIA, stage IIB, and stage IIC.             -  Stage IIA: Cancer has spread to the uterus and/or fallopian tubes (the long slender tubes through which eggs pass from the ovaries to the uterus).     -  Stage IIB: Cancer has spread to other tissue within the pelvis.      -  Stage IIC: Cancer is found inside one or both ovaries and has spread to the uterus and/or fallopian tubes, or to other tissue within the pelvis. Also, one of the following is true:                  - cancer is found on the outside surface of one or both ovaries; or       - the capsule (outer covering) of the ovary has ruptured (broken open); or       - cancer cells are found in the fluid of the peritoneal cavity (the body cavity that contains most of the organs in the abdomen) or in washings of the peritoneum (tissue lining the peritoneal cavity).                          Stage III     In stage III, cancer is found in one or both ovaries and has spread outside the pelvis to other parts of the abdomen and/or nearby lymph nodes. Stage III is divided into stage IIIA, stage IIIB, and stage IIIC.             -  Stage IIIA: The tumor is found in the pelvis only, but cancer cells that can be seen only with a microscope have spread to the surface of the peritoneum (tissue that lines the abdominal wall and covers most of the organs in the abdomen), the small intestines, or the tissue that connects the small intestines to the wall of the abdomen.     -  Stage IIIB: Cancer has spread to the peritoneum and the cancer in the peritoneum is 2 centimeters or smaller.      -  Stage IIIC: Cancer has spread to the peritoneum and the cancer in the peritoneum is larger than 2 centimeters and/or cancer has spread to lymph nodes in the abdomen.           Cancer that has spread to the surface of the liver is also considered stage III ovarian cancer.       Stage IV     In stage IV, cancer has spread beyond the abdomen to other parts of the body, such as the lungs or tissue inside the liver.    Cancer cells in the fluid around the lungs is also considered stage IV ovarian cancer. </s>


Input: What are the treatments for Ovarian Germ Cell Tumors ?

Output:
Key Points
                    - There are different types of treatment for patients with ovarian germ cell tumors.     - Four types of standard treatment are used:          - Surgery     - Observation     - Chemotherapy      - Radiation therapy         - New types of treatment are being tested in clinical trials.         - High-dose chemotherapy with bone marrow transplant     - New treatment options         - 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.    - Follow-up tests may be needed.

                    There are different types of treatment for patients with ovarian germ cell tumors.
                    Different types of treatment are available for patients with ovarian germ cell tumor. 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 is the most common treatment of ovarian germ cell tumor. A doctor may take out the cancer using one of the following types of surgery.             -  Unilateral salpingo-oophorectomy: A surgical procedure to remove one ovary and one fallopian tube.      -  Total hysterectomy: A surgical procedure to remove the uterus, including the cervix. If the uterus and cervix are taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision (cut) in the abdomen using a laparoscope, the operation is called a total laparoscopic hysterectomy.     -  Bilateral salpingo-oophorectomy: A surgical procedure to remove both ovaries and both fallopian tubes.     -  Tumor debulking: A surgical procedure in which as much of the tumor as possible is removed. Some tumors cannot be completely removed.            Even if the doctor removes all the cancer that can be seen at the time of the operation, some patients may be offered 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.    After chemotherapy for an ovarian germ cell tumor, a second-look laparotomy may be done. This is similar to the laparotomy that is done to find out the stage of the cancer. Second-look laparotomy is a surgical procedure to find out if tumor cells are left after primary treatment. During this procedure, the doctor will take samples of lymph nodes and other tissues in the abdomen to see if any cancer is left. This procedure is not done for dysgerminomas.       Observation     Observation is closely watching a patients condition without giving any treatment unless signs or symptoms appear or change.        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 treatment using more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated.    See Drugs Approved for Ovarian, Fallopian Tube, or Primary Peritoneal Cancer for more information.       Radiation therapy     Radiation therapy is a cancer treatment that uses high-energy x-rays 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 ovarian germ cell tumors.

                    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.     High-dose chemotherapy with bone marrow transplant     High-dose chemotherapy with bone marrow transplant is a method of giving very high doses of chemotherapy and replacing blood -forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the 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.       New treatment options      Combination chemotherapy (the use of more than one anticancer drug) is being tested in clinical trials.

                    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.

                    Follow-up 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 follow-up tests or check-ups.

		            Treatment Options By Stage

		                    Stage I Ovarian Germ Cell Tumors
		                    Treatment depends on whether the tumor is a dysgerminoma or another type of ovarian germ cell tumor.    Treatment of dysgerminoma may include the following:          -  Unilateral salpingo-oophorectomy with or without lymphangiography or CT scan.     - Unilateral salpingo-oophorectomy followed by observation.     - Unilateral salpingo-oophorectomy followed by radiation therapy.    - Unilateral salpingo-oophorectomy followed by chemotherapy.        Treatment of other ovarian germ cell tumors may be either:          - unilateral salpingo-oophorectomy followed by careful observation; or    - unilateral salpingo-oophorectomy, sometimes followed by combination chemotherapy.        Check the list of NCI-supported cancer clinical trials that are now accepting patients with stage I ovarian germ cell tumor. 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 Ovarian Germ Cell Tumors
		                    Treatment depends on whether the tumor is a dysgerminoma or another type of ovarian germ cell tumor.    Treatment of dysgerminoma may be either:          - total abdominal hysterectomy and bilateral salpingo-oophorectomy followed by radiation therapy or combination chemotherapy; or     -  unilateral salpingo-oophorectomy followed by chemotherapy.         Treatment of other ovarian germ cell tumors may include the following:          - Unilateral salpingo-oophorectomy followed by combination chemotherapy.     -  Second-look laparotomy (surgery done after primary treatment to see if tumor cells remain).    - A clinical trial of a new treatment.        Check the list of NCI-supported cancer clinical trials that are now accepting patients with stage II ovarian germ cell tumor. 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 Ovarian Germ Cell Tumors
		                    Treatment depends on whether the tumor is a dysgerminoma or another type of ovarian germ cell tumor.    Treatment of dysgerminoma may include the following:         - Total abdominal hysterectomy and bilateral salpingo-oophorectomy, with removal of as much of the cancer in the pelvis and abdomen as possible.    -  Unilateral salpingo-oophorectomy followed by chemotherapy.         Treatment of other ovarian germ cell tumors may include the following:          - Total abdominal hysterectomy and bilateral salpingo-oophorectomy, with removal of as much of the cancer in the pelvis and abdomen as possible. Chemotherapy will be given before and/or after surgery.     - Unilateral salpingo-oophorectomy followed by chemotherapy.     -  Second-look laparotomy (surgery done after primary treatment to see if tumor cells remain).    - A clinical trial of a new treatment.         Check the list of NCI-supported cancer clinical trials that are now accepting patients with stage III ovarian germ cell tumor. 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 Ovarian Germ Cell Tumors
		                    Treatment depends on whether the tumor is a dysgerminoma or another type of ovarian germ cell tumor.    Treatment of dysgerminoma may include the following:          - Total abdominal hysterectomy and bilateral salpingo-oophorectomy followed by chemotherapy, with removal of as much of the cancer in the pelvis and abdomen as possible.     -  Unilateral salpingo-oophorectomy followed by chemotherapy.         Treatment of other ovarian germ cell tumors may include the following:          - Total abdominal hysterectomy and bilateral salpingo-oophorectomy, with removal of as much of the cancer in the pelvis and abdomen as possible. Chemotherapy will be given before and/or after surgery.     - Unilateral salpingo-oophorectomy followed by chemotherapy.    -  Second-look laparotomy (surgery done after primary treatment to see if tumor cells remain).    - A clinical trial of a new treatment.         Check the list of NCI-supported cancer clinical trials that are now accepting patients with stage IV ovarian germ cell tumor. 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>


Input: what research (or clinical trials) is being done for Ovarian Germ Cell Tumors ?

Output:
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.     High-dose chemotherapy with bone marrow transplant     High-dose chemotherapy with bone marrow transplant is a method of giving very high doses of chemotherapy and replacing blood -forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the 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.       New treatment options      Combination chemotherapy (the use of more than one anticancer drug) is being tested in clinical trials.

                    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>


Input: What is (are) Adult Acute Lymphoblastic Leukemia ?

Output:
Key Points
                    - Adult acute lymphoblastic leukemia (ALL) is a type of cancer in which the bone marrow makes too many lymphocytes (a type of white blood cell).    - Leukemia may affect red blood cells, white blood cells, and platelets.    - Previous chemotherapy and exposure to radiation may increase the risk of developing ALL.    - Signs and symptoms of adult ALL include fever, feeling tired, and easy bruising or bleeding.     - Tests that examine the blood and bone marrow are used to detect (find) and diagnose adult ALL.    - Certain factors affect prognosis (chance of recovery) and treatment options.

                    Adult acute lymphoblastic leukemia (ALL) is a type of cancer in which the bone marrow makes too many lymphocytes (a type of white blood cell).
                    Adult acute lymphoblastic leukemia (ALL; also called 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.

                    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 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.         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 ALL, too many stem cells become lymphoblasts, B lymphocytes, or T lymphocytes. These cells are also called leukemia cells. These leukemia cells are not able to fight infection very well. 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 cause infection, anemia, and easy bleeding. The cancer can also spread to the central nervous system (brain and spinal cord).     This summary is about adult acute lymphoblastic leukemia. See the following PDQ summaries for information about other types of leukemia:          -  Childhood Acute Lymphoblastic Leukemia Treatment.    -  Adult Acute Myeloid Leukemia Treatment.    -  Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies Treatment.    -  Chronic Lymphocytic Leukemia Treatment.    -  Chronic Myelogenous Leukemia Treatment.    -  Hairy Cell Leukemia Treatment. </s>


Input: What are the symptoms of Adult Acute Lymphoblastic Leukemia ?

Output: Signs and symptoms of adult ALL include fever, feeling tired, and easy bruising or bleeding. The early signs and symptoms of ALL may be like the flu or other common diseases. Check with your doctor if you have any of the following:         - Weakness or feeling tired.    -  Fever or night sweats.    - Easy bruising or bleeding.    -  Petechiae (flat, pinpoint spots under the skin, caused by bleeding).    - Shortness of breath.    - Weight loss or loss of appetite.    - Pain in the bones or stomach.    - Pain or feeling of fullness below the ribs.    - Painless lumps in the neck, underarm, stomach, or groin.    - Having many infections.        These and other signs and symptoms may be caused by adult acute lymphoblastic leukemia or by other conditions. </s>


Input: How to diagnose Adult Acute Lymphoblastic Leukemia ?

Output: Tests that examine the blood and bone marrow are used to detect (find) and diagnose adult ALL. 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 infection 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 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.    -   Peripheral blood smear : A procedure in which a sample of blood is checked for blast cells, the number and kinds of white blood cells, the number of platelets, and changes in the shape of blood cells.    -   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. A pathologist views the bone marrow, blood, and bone under a microscope to look for abnormal cells. The following tests may be done on the samples of blood or bone marrow tissue that are removed:               -  Cytogenetic analysis:  A laboratory test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out if there are 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 process used to identify cells, based on the types of antigens or markers on the surface of the cell. This process is used to diagnose the subtype of ALL by comparing the cancer cells to normal cells of the immune system. For example, a cytochemistry study may test the cells in a sample of tissue using chemicals (dyes) to look for certain changes in the sample. A chemical may cause a color change in one type of leukemia cell but not in another type of leukemia cell. </s>


Input: What is the outlook for Adult Acute Lymphoblastic Leukemia ?

Output: Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery) and treatment options depend on the following:         - The age of the patient.    - Whether the cancer has spread to the brain or spinal cord.    - Whether there are certain changes in the genes, including the Philadelphia chromosome.    - Whether the cancer has been treated before or has recurred (come back). </s>


Input: Who is at risk for Adult Acute Lymphoblastic Leukemia? ?

Output: Previous chemotherapy and exposure to radiation may increase the risk of developing 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 doctor if you think you may be at risk. Possible risk factors for ALL include the following:         - Being male.    - Being white.    - Being older than 70.    - Past treatment with chemotherapy or radiation therapy.    - Being exposed to high levels of radiation in the environment (such as nuclear radiation).    - Having certain genetic disorders, such as Down syndrome. </s>


Input: What are the stages of Adult Acute Lymphoblastic Leukemia ?

Output:
Key Points
                    - Once adult ALL has been diagnosed, tests are done to find out if the cancer has spread to the central nervous system (brain and spinal cord) or to other parts of the body.    - There is no standard staging system for adult ALL.

                    Once adult ALL has been diagnosed, tests are done to find out if the cancer has spread to the central nervous system (brain and spinal cord) or to other parts of the body.
                    The extent or spread of cancer is usually described as stages. It is important to know whether the leukemia has spread outside the blood and bone marrow in order to plan treatment. The following tests and procedures may be used to determine if the leukemia has spread:          -   Chest x-ray : An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.    -   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.    -   CT scan (CAT scan): A procedure that makes a series of detailed pictures of the abdomen, taken from different angles. The pictures are made by a computer linked to an x-ray 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).

                    There is no standard staging system for adult ALL.
                    The disease is described as untreated, in remission, or recurrent.    Untreated adult ALL    The ALL is newly diagnosed and has not been treated except to relieve signs and symptoms such as fever, bleeding, or pain.          - The complete blood count is abnormal.    - More than 5% of the cells in the bone marrow are blasts (leukemia cells).    - There are signs and symptoms of leukemia.         Adult ALL in remission    The ALL has been treated.         - The complete blood count is normal.    - 5% or fewer of the cells in the bone marrow are blasts (leukemia cells).    - There are no signs or symptoms of leukemia other than in the bone marrow. </s>


Input: What are the treatments for Adult Acute Lymphoblastic Leukemia ?

Output:
Key Points
                    - There are different types of treatment for patients with adult ALL.     - The treatment of adult ALL usually has two phases.    - Four types of standard treatment are used:          - Chemotherapy      - Radiation therapy      - Chemotherapy with stem cell transplant     - Targeted therapy         - 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.    - Patients with ALL may have late effects after treatment.    - Follow-up tests may be needed.

                    There are different types of treatment for patients with adult ALL.
                    Different types of treatment are available for patients with adult 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. 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.

                    The treatment of adult ALL usually has two phases.
                    The treatment of adult ALL is done in phases:         -  Remission 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.    -  Post-remission therapy: This is the second phase of treatment. It begins once the leukemia is in remission. The goal of post-remission therapy is to kill any remaining leukemia cells that may not be active but could begin to regrow and cause a relapse. This phase is also called remission continuation therapy.        Treatment called central nervous system (CNS) sanctuary therapy is usually given during each 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. Systemic chemotherapy given in high doses, intrathecal chemotherapy, and radiation therapy to the brain are able to reach leukemia cells in the CNS. They are given to kill the leukemia cells and lessen the chance the leukemia will recur (come back). CNS sanctuary therapy is also called CNS prophylaxis.

                    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 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 and stage of the cancer being treated.    Intrathecal chemotherapy may be used to treat adult ALL that has spread, or may spread, to the brain and spinal cord. When used to lessen the chance leukemia cells will spread to the brain and spinal cord, it is called central nervous system (CNS) sanctuary therapy or CNS prophylaxis.        See Drugs Approved for Acute Lymphoblastic Leukemia for more information.       Radiation therapy      Radiation therapy is a cancer treatment that uses high-energy x-rays 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. External radiation therapy may be used to treat adult ALL that has spread, or may spread, to the brain and spinal cord. When used this way, it is called central nervous system (CNS) sanctuary therapy or CNS prophylaxis. External radiation therapy may also be used as palliative therapy to relieve symptoms and improve quality of life.       Chemotherapy with stem cell transplant     Stem cell transplant is a method of giving 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.    See Drugs Approved for Acute Lymphoblastic Leukemia for more information.        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.    Targeted therapy drugs called tyrosine kinase inhibitors are used to treat some types of adult ALL. These drugs block the enzyme, tyrosine kinase, that causes stem cells to develop into more white blood cells (blasts) than the body needs. Three of the drugs used are imatinib mesylate (Gleevec), dasatinib, and nilotinib.    See Drugs Approved for Acute Lymphoblastic Leukemia for more information.

                    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 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.

                    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.

                    Patients with ALL may have late effects after treatment.
                    Side effects from cancer treatment that begin during or after treatment and continue for months or years are called late effects. Late effects of treatment for ALL may include the risk of second cancers (new types of cancer). Regular follow-up exams are very important for long-term survivors.

                    Follow-up 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 follow-up tests or check-ups.

														            Treatment Options for Adult Acute Lymphoblastic Leukemia

														                    Untreated Adult Acute Lymphoblastic Leukemia
														                    Standard treatment of adult acute lymphoblastic leukemia (ALL) during the remission induction phase includes the following:         -  Combination chemotherapy.    -  Tyrosine kinase inhibitor therapy with imatinib mesylate, in certain patients. Some of these patients will also have combination chemotherapy.    -  Supportive care including antibiotics and red blood cell and platelet transfusions.    -  CNS prophylaxis therapy including chemotherapy (intrathecal and/or systemic) with or without radiation therapy to the brain.        Check the list of NCI-supported cancer clinical trials that are now accepting patients with untreated adult 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 doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.

														                    Adult Acute Lymphoblastic Leukemia in Remission
														                    Standard treatment of adult ALL during the post-remission phase includes the following:          -  Chemotherapy.    -  Tyrosine kinase inhibitor therapy.    -  Chemotherapy with stem cell transplant.    -  CNS prophylaxis  therapy including chemotherapy (intrathecal and/or systemic) with or without radiation therapy to the brain.        Check the list of NCI-supported cancer clinical trials that are now accepting patients with adult acute lymphoblastic 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 doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website.

														                    Recurrent Adult Acute Lymphoblastic Leukemia
														                    Standard treatment of recurrent adult ALL may include the following:         -  Combination chemotherapy followed by stem cell transplant.     - Low-dose radiation therapy as palliative care to relieve symptoms and improve the quality of life.    -  Tyrosine kinase inhibitor therapy with dasatinib for certain patients.        Some of the treatments being studied in clinical trials for recurrent adult ALL include the following:         - A clinical trial of stem cell transplant using the patient's stem cells.    - A clinical trial of biologic therapy.    - A clinical trial of new anticancer drugs.        Check the list of NCI-supported cancer clinical trials that are now accepting patients with recurrent adult 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 doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI website. </s>


Input: What is (are) Oral Cavity and Oropharyngeal Cancer ?

Output:
Key Points
                    - Oral cavity and oropharyngeal cancer are diseases in which malignant (cancer) cells form in the mouth and throat.    - The number of new cases of oral cavity and oropharyngeal cancer and the number of deaths from oral cavity and oropharyngeal cancer varies by race and gender.    - Different factors increase or decrease the risk of oral cavity and oropharyngeal cancer.

                    Oral cavity and oropharyngeal cancer are diseases in which malignant (cancer) cells form in the mouth and throat.
                    Oral cavity cancer forms in any of these tissues of the oral cavity:         - The front two thirds of the tongue.    - The gingiva (gums).    - The buccal mucosa (the lining of the inside of the cheeks).    - The floor (bottom) of the mouth under the tongue.    - The hard palate (the front of the roof of the mouth).    - The retromolar trigone (the small area behind the wisdom teeth).          Oropharyngeal cancer forms in any of these tissues of the oropharynx:         - The middle part of the pharynx (throat) behind the mouth.    - The back one third of the tongue.    - The soft palate (the back of the roof of the mouth).    - The side and back walls of the throat.    - The tonsils.          Most oral cavity and oropharyngeal cancers start in squamous cells, the thin, flat cells that line the lips, oral cavity, and oropharynx. Cancer that forms in squamous cells is called squamous cell carcinoma.   See the following PDQ summaries for more information about the screening, diagnosis, and treatment of oral cavity and oropharyngeal cancer:         -  Oral Cavity and Oropharyngeal Cancer Prevention     -  Lip and Oral Cavity Cancer Treatment     -  Oropharyngeal Cancer Treatment

                    The number of new cases of oral cavity and oropharyngeal cancer and the number of deaths from oral cavity and oropharyngeal cancer varies by race and gender.
                    Over the past ten years, the number of new cases and deaths from oral cavity and oropharyngeal cancer slightly increased in white men and women. The number slightly decreased among black men and women.   Oral cavity and oropharyngeal cancer is more common in men than in women. Although oral cavity and oropharyngeal cancer may occur in adults of any age, it occurs most often in those aged 55 to 64 years.   France, Brazil, and parts of Asia have much higher rates of oral cavity and oropharyngeal cancer than most other countries.    The number of new cases of oropharyngeal cancer caused by certain types of human papillomavirus (HPV) infection has increased. One kind of HPV, called HPV 16, is often passed from one person to another during sexual activity. </s>


Input: Who is at risk for Oral Cavity and Oropharyngeal Cancer? ?

Output: The number of new cases of oral cavity and oropharyngeal cancer and the number of deaths from oral cavity and oropharyngeal cancer varies by race and gender. Over the past ten years, the number of new cases and deaths from oral cavity and oropharyngeal cancer slightly increased in white men and women. The number slightly decreased among black men and women.   Oral cavity and oropharyngeal cancer is more common in men than in women. Although oral cavity and oropharyngeal cancer may occur in adults of any age, it occurs most often in those aged 55 to 64 years.   France, Brazil, and parts of Asia have much higher rates of oral cavity and oropharyngeal cancer than most other countries.    The number of new cases of oropharyngeal cancer caused by certain types of human papillomavirus (HPV) infection has increased. One kind of HPV, called HPV 16, is often passed from one person to another during sexual activity. </s>


Input: Who is at risk for Oral Cavity and Oropharyngeal Cancer? ?

Output: Different factors increase or decrease the risk of oral cavity and oropharyngeal 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 oral cavity and oropharyngeal cancer, see the PDQ summary on Oral Cavity and Oropharyngeal Cancer Prevention. </s>


Input: What is (are) Chronic Myelogenous Leukemia ?

Output:
Key Points
                    - 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>


Input: What are the symptoms of Chronic Myelogenous Leukemia ?

Output: 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>


Input: What are the genetic changes related to Chronic Myelogenous Leukemia ?

Output: 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>


Input: How to diagnose Chronic Myelogenous Leukemia ?

Output: 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>


Input: What is the outlook for Chronic Myelogenous Leukemia ?

Output: 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>


Input: What are the stages of Chronic Myelogenous Leukemia ?

Output:
Key Points
                    - 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>


Input: what research (or clinical trials) is being done for Chronic Myelogenous Leukemia ?

Output:
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>