How Radiotherapy and Chemotherapy effect the Blood Parameters of Cancer Patients


Master's Thesis, 2010

59 Pages, Grade: A


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Inhaltsverzeichnis

ABSTRACT

INTRODUCTION

1.1. What is cancer?
1.2. Terminology used in cancer:
1.3. Nomenclature of cancerous cells:
1.4. Types of cancer:
1.5. CAUSES:
1.6. SYMPTOMS:
1.8. ROLE OF NUTRITION IN CANCER:
1.9. TREATMENT

MATERIAL AND METHODS

2.1 Sample collection:
2.2 Anthropometric Measurement:
2.3 Physiological Measurement:
2.4. Blood sample collection:
2.5 Procedure:

RESULT & DISCUSSION

CONCLUSION

REFERENCES:

ABSTRACT

Cancer is an abnormal condition in which uncontrolled growth and proliferation of normal cells is occurs and the cells known as malignant cells.

Cancer causing agents are of three types’ 1.Radiant energy 2.Chemical compounds and 3.Viruses. The whole research work was conducted to investigate the effect of radiotherapy and chemotherapy in cancer patients by complete blood picture, anthropometric and physiological measurement. Complete blood picture include RBCs, Hb, MCV, MCHC, MCH, WBCs (Neutrophils, Lymphocytes, Eosinophils, Monocytes, Basophiles) and platelets. Anthropometric measurement include age, height, and weight. Physiological measurement includes systolic and diastolic blood pressure and pulse rate measurement. Comparison between control and cancer patient samples shows that RBCs have no significant difference in their levels but some cancer which treated with radiotherapy and chemotherapy may shows anemia. Hb comparison of control and shows difference in their levels. Hb decreases in cancer patients (due to diminished partial pressure of O2) but could be increases whit use of erythropoietin in cancer patients. An absolute indices (MCV, MCH, MCHC) decrease in cancerous patients. Chemotherapic treatment shows decrease in WBCs and platelets, it is also seen in leukemia, lymphoma, or multiple myolema. Neutropenia and thrombocytopenia also observed. Weight and height also decreased in cancer patients. Systolic and diastolic blood pressure is increases in cancer patients, and pulse rate is decreases in cancer patients.

INTRODUCTION

1.1. What is cancer?

Cancer is the uncontrolled growth of abnormal cells in the body. Cancerous cells are also called malignant cells. Treating cancer can be very complicated, and it is difficult for even the most educated patients to be sure they have the best care. Cells are the building blocks of living things. Cancer grows out of normal cells in the body. Normal cells multiply when the body needs them, and die when the body doesn't need them. Cancer appears to occur when the growth of cells in the body is out of control and cells divide too quickly. It can also occur when cells “forget” how to die.[1]

Cancer is a cellular tumour that unlike benign tumours cells, can metastasize and invade the surrounding and distant tissues.[2]

Cancer is derived from a Latin words meaning crab, it is presumed that the word cancer originated from the character of cancerous cell ‘e’ can originate and adhere and cause pain(like a crab)to any parts of body.[3]

Cancer cells are characterized by three properties, 1, diminished or unrestricted control of growth 2.invasion of local tissue and. 3.spread or metastasis to other parts of the body.

Agents causing cancer fall into three broad groups radiant energy, chemical compound and viruses.[4]

Cancer chemotherapy and radiation are used to damage or kill cancer cells. Some of the body’s normal cell including the blood cells, May also be damage by these treatments. The good news is that your body can repair damage normal cells.[5]

Nutritional deficiencies, hemolysis, bone marrow failure due to tumor involvement, myelofibrosis, or necrosis could not be synthematically investigated in present serial. [6] The use of erythropoietin (epo) in oncologic patients increases Hb levels that improves oxygenation its sensitivity to radiotherapy. [7]

1.2. Terminology used in cancer:

Neoplasia: Neoplasia means news growth and is characterized by unceasing abnormal and excessive proliferation of cells.

Neoplasm: The neoplasm (commonly called tumor) is defined as the abnormal mass of the tissue. The growth of ‘e’exceeds and is un co-ordinated with that of the normal tissue, and persists in the same excessive manners after the cessation of the stimuli ‘e’ evoked the change.

Oncology: The study of neoplasm (tumor) or cancerous cells is called oncology. When cancer is associated with a tumor then it is termed as malignant tumors or malignancy. The malignant tumors or cancer are destructive and dangerous.

Some important characteristics of cancerous cells or malignant Tumors:

- Differentiation of cancers or malignant tumor ranges from differention to undifferentiated.
- It invades and penetrates the surrounding tissues.
- It metastasizes to the regional lymph nodes and distant organs.
- Rate of growth of all cancer usually rapid except cancer of cervical ‘e’ grows slowly.
- Cancerous cells are non-encapsulated.
- The gross appearance of cancerous cells include regeneration, necrosis. Ulceration, hemorrhage is also more frequent.
- Clinically cancerous cells act as parasites and tend to kill the patient whenever it grows.
- Recurrence is common in malignant tumor. [8]

1.3. Nomenclature of cancerous cells :

Cancer are classified according to the tissue and cell type from which they originate.

- Those arising from epithelial cells are called carcinoma (karkino, crab, Greek). Nearly 90% of human cancers are carcinomas.
- Sarcomas are those derived from connective tissue or muscles cells (sarkos, flesh, oma, and tumor).

The enzymes secreted by malignant cells can hydrolyze the adhesive proteins, weakening the interaction of the cell with the substratum. [9]

1.4. Types of cancer:

There are many different kinds of cancers. Cancer can develop in almost any organ or tissue. [2]

Types of Cancer Classified by Body System:

Blood Cancer: The cells in the bone marrow that give rise to red blood cells, white blood cells, and platelets can sometimes become cancerous. These cancers are leukemia or lymphoma.

- Leukemia
- Lymphoma
- Multiple Myeloma
- Waldenstrom's Macroglobulinemia

Bone Cancer: Bone cancer is a relatively rare type of cancer that can affect both children and adults, but primarily affects children and teens. There are several types of bone cancer, but the most common types are:

- Ewing's Sarcoma
- Osteosarcoma

Brain Cancer: Brain tumors can be malignant (cancerous) or benign (non-cancerous). They affect both children and adults. Malignant brain tumors don't often spread beyond the brain. However, other types of cancer have the ability to spread to the brain. Types of brain cancer include:

- Adult Brain Tumor
- Brain Stem Glioma, Childhood
- Cerebellar Astrocytoma, Childhood
- Cerebral Astrocytoma/Malignant Glioma, Childhood
- Ependymoma, Childhood
- Medulloblastoma, Childhood
- Supratentorial Primitive Neuroectodermal Tumors and Pineoblastoma, Childhood
- Visual Pathway and Hypothalamic Glioma, Childhood

Breast Cancer: Breast cancer is a common type of cancer that affects women and much less commonly, men. More than 200,000 women are diagnosed with breast cancer in the United States each year. Types of breast cancer include, but are not limited to:

- Ductal carcinoma in situ
- Lobular carcinoma in situ
- Inflammatory breast cancer
- Paget's disease of the nipple
- Invasive types of breast cancer

Digestive/Gastrointestinal Cancers: This is a broad category of cancer that affects everything from the esophagus to the anus. Each type is specific and has its own symptoms, causes, and treatments.

- Anal Cancer
- Bile Duct Cancer, Extrahepatic
- Carcinoid Tumor, Gastrointestinal
- Colon Cancer
- Esophageal Cancer
- Gallbladder Cancer
- Liver Cancer, Adult Primary
- Liver Cancer, Childhood
- Pancreatic Cancer
- Rectal Cancer
- Small Intestine Cancer
- Stomach (Gastric) Cancer

Endocrine Cancers: The endocrine system is an instrumental part of the body that is responsible for glandular and hormonal activity. Thyroid cancer is the most common of the endocrine cancer types and generally, the least fatal.

- Adrenocortical Carcinoma
- Carcinoid Tumor, Gastrointestinal
- Islet Cell Carcinoma (Endocrine Pancreas)
- Parathyroid Cancer
- Pheochromocytoma
- Pituitary Tumor
- Thyroid Cancer

Eye Cancer: Like other organs in the human body, the eyes are vulnerable to cancer as well. Eye cancer can affect both children and adults.

- Melanoma, Intraocular
- Retinoblastoma

Genitourinary Cancers: These types of cancer affect the male genitalia and urinary tract.

- Bladder Cancer
- Kidney (Renal Cell) Cancer
- Penile Cancer
- Prostate Cancer
- Renal Pelvis and Ureter Cancer, Transitional Cell
- Testicular Cancer
- Urethral Cancer
- Wilms' Tumor and Other Childhood Kidney Tumors

Gynecologic Cancers: This group of cancer types affects the organs of the female reproductive system. Specialized oncologists called gynecologic oncologists are recommended for treating gynecologic cancer.

- Cervical Cancer
- Endometrial Cancer
- Gestational Trophoblastic Tumor
- Ovarian Cancer
- Uterine Sarcoma
- Vaginal Cancer
- Vulvar Cancer

Head and Neck Cancer: Most head and neck cancers affect moist mucosal surfaces of the head and neck, like the mouth, throat, and nose. Causes of head and neck cancer vary, but cigarette smoking plays a role. Current research suggests a strong HPV link in the development of some head and neck cancer.

- Hypopharyngeal Cancer
- Laryngeal Cancer
- Lip and Oral Cancer
- Metastatic Squamous Neck Cancer
- Nasopharyngeal Cancer
- Oropharyngeal Cancer
- Paranasal Sinus and Nasal Cavity Cancer
- Parathyroid Cancer
- Salivary Gland Cancer

Respiratory Cancers: Cigarette smoking is the primary cause for cancer affecting the respiratory system. Exposure to asbestos is also a factor.

- Lung Cancer, Non-Small Cell
- Lung Cancer, Small Cell
- Malignant Mesothelioma
- Thymoma and Thymic Carcinoma

Skin Cancers: Non-melanoma skin cancer is the most common type of cancer among men and women. Exposure to the UV rays of the sun is the primary cause for non-melanoma skin cancer and also melanoma.

- Cutaneous T-Cell Lymphoma
- Kaposi's Sarcoma
- Melanoma
- Merkel Cell Carcinoma
- Non-Melanoma Skin Cancer[10]

1.5. CAUSES:

Carcinogens : A carcinogen is any substance,or radiation that is an agent directly involved in the exacerbation of cancer or in the increase of its propagation. This may be due to the ability to damage the genome or to the disruption of cellular metabolic processes.Common examples of carcinogens are

- Alpha particles
- Gamma rays
- X- rays
- UV-rays
- Benzo[a] pyrene
- Nitrosamine
- Formaldehyde
- Vinyl chloride [11][12]
- Aflatoxin B1
- Hepatitis B virus
- Human papiloma virus
- Asbestos,
- Benzen
- Kepon[13]

1.6. SYMPTOMS :

Roughly, cancer symptoms can be divided into three groups:

- Local symptoms : unusual lumps or swelling (tumor), hemorrhage (bleeding), pain and/or ulceration. Compression of surrounding tissues may cause symptoms such as jaundice (yellowing the eyes and skin).
- Symptoms of metastasis (spreading) : enlarged lymph nodes, cough and hemoptysis, hepatomegaly (enlarged liver), bone pain, fracture of affected bones and neurological symptoms. Although advanced cancer may cause pain, it is often not the first symptom.
- Systemic symptoms : weight loss, poor appetite, fatigue and cachexia (wasting), excessive sweating (night sweats), anemia and specific paraneoplastic phenomena, i.e. specific conditions that are due to an active cancer, such as thrombosis or hormonal changes.[14]

1.7. DIAGNOSIS:

A cancer diagnosis is difficult to cope with. It is important, however, that discuss the type, size, and location of the cancer with doctor when he diagnosed it. He will also tell you about treatment options, along with their benefits and risks.

- Biopsy of the tumor
- Blood chemistries
- Bone marrow biopsy (for lymphoma or leukemia)
- Chest x-ray
- Complete blood count (CBC)
- CT scan

Most cancers are diagnosed by biopsy. Depending on the location of the tumor, the biopsy may be a simple procedure or a serious operation. Most patients with cancer have CT scans to determine the exact location and size of the tumor or tumors. [2]

1.8. ROLE OF NUTRITION IN CANCER:

Diet has a greater influence on some types of cancer than others. The strongest links are with some cancers of the gastrointestinal tract e.g. of the mouth, throat, stomach and large bowel (colon). Dietary factors may protect against or reduce the risk of cancer. For example, fruit and vegetables, consumed regularly, are thought to help reduce risk, whereas a low fiber intake or high alcohol intakes increase risk. Diet is only usually one of several factors involved. [15] It has been estimated that 30–40 percent of all cancers can be prevented by lifestyle and dietary measures alone.The consensus on diet and cancer is that obesity increases the risk of developing cancer.[16] First we will give you general guidelines, followed by in depth information of a diet to fight cancer. To begin, we must warn you that a dramatic change in your diet can dump dangerously large amounts of cellular waste into your blood stream, therefore you must detoxify your system before and during the initial stages of your diet.[17] Avoiding smoking, eating a balanced diet with plenty of fruit and vegetables and moderate amounts of red and processed meats, keeping body weight within the healthy range for height and keeping alcohol consumption to a moderate level, all help to reduce the risk of cancer.[15]

FRUITS:

Ten percent of your diet should be fruit. Eat fruit alone as a small meal or between meals, or at least one half hour before a meal, never after. Keep citrus fruit to a minimum. Citrus puts your body into an acidic state. If you are battling cancer, keep your citrus to a minimum. Get your vitamin C from supplements. [17] There is also moderate evidence that higher consumption of fruit can reduce lung cancer risk although the major risk factor is smoking. [15]

VEGETABLES:

A minimum of fifty percent of your diet should be veggies. Fresh vegetable juices are a must. The best cancer fighting juice is carrot juice. It is high in beta-carotene and high in alpha-carotene, an often ignored nutrient, though thought by many experts to be ten times more powerful than beta-carotene.[15][17] The Government’s Advisory Committee, COMA, concluded in 1998 that there is moderate evidence that higher vegetable consumption will reduce the risk of colon cancer. A vegetable is via the antioxidants. Vegetables are via the antioxidants fight against cancer. [15]

FATS AND OILS:

Most fats/oils should be kept to a minimum especially if they are human made or over processed (corn oil is deadly, margarine even more so), though you will want to get your allotment of Omega-3s. [17] Fats have probably been studied most thoroughly and produced the greatest association with cancer. [18] Avoid heating oils; heat causes oxidation and the release of free radicals. Mayonnaise and margarine are out. Avoid trans fatty (partially hydrogenated) oils as if they were the cause of your cancer. In 1989, the USDA found that fish oils reduce the production of the prostaglandin E2 which has a tendency to cause appetite loss. It is this appetite loss that brings on cachexia, the wasting syndrome that causes eventual death in cancer patients. [17]

SUGARS (CARBOHYDRATES):

The principles of carbohydrate in foods are sugar, cellulose and starch. There is a little role of carbohydrate pertaining to the cancer. [18] Cancer loves sugar and your liver hates it. Sugars put a terrible strain on your liver. The only recommended sweetener is Stevia. Stevia has been used for decades with no side effects. [17] In multiple studies diabetes has been linked with increased risk of colorectal cancer [19-21], endometrial cancer [22], and pancreatic cancer [20][23]. It is clear that severe dysregulation of glucose metabolism is a risk factor for cancer. Foods which contribute to hyperinsulinemia, such as refined sugar, foods containing refined sugar, and refined flour products should be avoided and eliminated from a cancer protective diet. [24]

LOW FIBER DIET:

Unrefined plant foods typically have an abundance of fiber. Dairy products, eggs, and meat all have this in common – they contain no fiber. Refined grain products also have most of the dietary fiber removed from them. So, a diet high in animal products and refined grains (a typical diet in the USA) is low in fiber. In prospective health studies low fiber was not found to be a risk for breast cancer. [24] A threshold of about 5 daily servings of vegetables was needed to reduce cancer risk and the effect was stronger among older subjects. [25] A high fiber/low fat diet is a cancer preventer and fighter. Fiber cleans your colon and combines with "stuck" fats to pass them on. It helps to lower cholesterol and tones your entire digestive track. The connection between low fiber intake and colon cancer has long been established. [17]

RED MEAT:

It has been suggested that a high consumption of red meat might be associated with increased risk of colon cancer. Components of cooked meat that have been suggested to cause this include heterocyclic amines, polycyclic aromatic hydrocarbons, nitrogenous residues and iron. Currently, the extent of any association remains unclear and it is unknown whether there is a link with red meat specifically or just with processed meat.[15] Meat, and the heterocyclic amines formed in cooking, have been correlated to breast cancer in a case-control study in Uruguay as well.[26]

ALCOHOL:

People who drink large amounts of alcohol have an increased risk of certain types of cancer, particularly liver cancer and cancers in the mouth and oesophagus. If such people also smoke, this makes the risk of cancer even greater. [15]

SELENIUM:

Selenium is a mineral with anti-cancer properties. Many studies in the last several years have shown that selenium is a potent protective nutrient for some forms of cancer. [27] Selenium is present in the active site of many enzymes, including thioredoxin reductase, which catalyzes oxidation-reduction reactions. These reactions may encourage cancerous cells to under apoptosis. Selenium can decrease the rate of tumor growth. [28][29] both men and women were found to be protected by higher levels of selenium from colon cancer [30] and lung cancer.[31][32]

PROTECTIVE VITAMINS:

Vitamin B-12:

Vitamin B-12 has not been proven to be an anti-cancer agent, but there is some evidence indicating that it could be beneficial. The form of administered vitamin B-12 may be important. [33] So, there is evidence from laboratory studies, prospective cohort studies, and mechanistic studies showing that vitamin B-12 is an important nutrient for genetic stability, DNA repair, carcinogenesis, and cancer therapy. [34]

FOLIC ACID:

Folic acid is the dark green leafy vegetable vitamin. It has an integral role in DNA methylation and DNA synthesis. Folic acid works in conjunction with vitamin B-6 and vitamin B-12 in the single carbon methyl cycle. If insufficient folic acid is not available uracil is substituted for thymidine in DNA, which leads to DNA strand breakage. Many studies have found a significant reduction in colon, rectal, and breast cancer with higher intakes of folic acid and their related nutrients (vitamin B-6 and B-12). Alcohol is an antagonist of folate, so that drinking alcoholic beverages greatly magnifies the cancer risk of a low-folate diet. [34]

VITAMIN D:

Vitamin D is produced primarily from the exposure of the skin to sunshine. Even casual exposure of the face, hands, and arms in the summer generates a large amount of vitamin D. [35] The concentration of the active hormonal form of vitamin D is tightly regulated in the blood by the kidneys. This active hormonal form of vitamin D has the potent anti-cancer properties. It has been discovered that various types of normal and cancerous tissues. Several prospective studies of vitamin D and cancer have also shown a protective effect of vitamin D. [36]

ANTIOXIDANTS:

α- and β-Carotene and other Carotenoids: Carotenoids have been studied vigorously to see if these colorful compounds can decrease cancer risk. In ecological studies and early case-control studies it appeared that β -carotene was a cancer-protective agent. [37] Alpha-carotene has been found to be a stronger protective agent than its well-known isomer β -carotene. Studies tend to agree that overall intake of carotenoids is more protective than a high intake of a single carotenoid. So, a variety of fruits and vegetables is still a better anti-cancer strategy than just using a single vegetable high in a specific carotenoid. The richest source of α -carotene is carrots and carrot juice, with pumpkins and winter squash as a second most-dense source. [38][39]

VITAMIN C:

Vitamin C is correlated with overall good health and cancer prevention. [40] Use of vitamin C for cancer therapy was popularized by Linus Pauling. At high concentrations ascorbate is preferentially toxic to cancer cells. There is some evidence that large doses of vitamin C, either in multiple divided oral doses or intravenously, have beneficial effects in cancer therapy. [41][42]

OTHER ANTIOXIDANTS:

There are many more substances that will have some benefit for cancer therapy. Most of these substances are found in foods, but their effective doses for therapy are much higher than the normal concentration in the food. For example, grape seed extract contains proanthocyanidin, which shows anticarcinogenic properties. Also, green tea contains a flavanol, epigallocatechin-3-gallate (EGCG), which can inhibit metalloproteinases, among several possible other mechanisms. [43]

FOOD CARCINOGEN:

Carcinogens are substances which can start the process of cancer. Tobacco smoke contains carcinogens which cause lung cancer. Foods may also contain carcinogens. However, the risk from carcinogens in foods is low because if they are present at all, it is usually in very small amounts. Carcinogens in foods may be substances that occur naturally, they may be due to contamination, or they be formed during cooking or processing (e.g. in smoked foods or foods that have been blackened during cooking e.g. barbecuing). Aflatoxins are examples of carcinogens present in poorly stored foods. They are inked to mouldy produce, especially peanuts that are contaminated by the growth of moulds.[15]

GRAINS

Twenty percent of your diet should be whole grains. Avoid all refined, polished grains and flours and products made from them. Brown rice, kashi, millet, rye, buckwheat, barley, oats and oat bran’s, corn (on the cob or corn grits), and quinoa are recommended. [17]

1.9. TREATMENT

Treat=active ment=curative[44]

Cancer can develop at many different sites around the body, the general principles of treatment are the same. The chances of a cancer being curable are highest if it is detected by screening at a sufficiently early stage before it causes symptoms. . Cancer can be treated by surgery, chemotherapy, radiation therapy, immunotherapy, monoclonal antibody therapy or other methods. The choice of therapy depends upon the location and grade of the tumor and the stage of the disease, as well as the general state of the patient. A number of experimental cancer treatments are also under development. [45] In most cases, curative treatment involves the surgical removal of a tumour.Surgery Surgical removal of a tumour is the main treatment for most common solid tumours at an early stage. Mainly cancer chemotherapy and radiation therapy are used to damaged or kill cancer cells. Some of the body’s normal cells, including the blood cells, may also damaged by these treatments. Some medicines can also slow down the making of the blood cells [46].

1.9.1 Radiation therapy:

Radiation therapy is one of several treatments used to treat cancer by itself or in combination with other forms of treatment, most often surgery or chemotherapy. Radiation therapy is also called radiotherapy. [47] Radiation exposure to X-rays or gamma rays can kill cells or stop their growth. It can be effective in the treatment of cancerous growths, because malignant cells are more sensitive than normal body cells: the radiation can be applied to a particular area, whilst the rest of the body is shielded from it.

Historically, radiotherapy dates back to the discovery of X-rays by Röntgen in 1895 and of the radioactivity of substances such as uranium by Becquerel in 1896, leading to that of radium, identified in 1898 by Marie and Pierre Curie. [48] If your tumour is in a position which makes surgery too risky to perform, radiotherapy may be used as a first line of treatment, usually in combination with chemotherapy. For some people with low-grade gliomas, these treatments may be offered soon after diagnosis; for others it could be that their tumours are stable enough for years to pass by on the “watch and live” treatment plan of regular MRI scans before any radiotherapy is offered.[49]

Radiation therapy injures or destroys cells in the area being treated (the “target tissue”) by damaging their genetic material, making it impossible for these cells to continue to grow and divide. Although radiation damages both cancer cells and normal cells, most normal cells can recover from the effects of radiation and function properly. [50]

Goals of radiaton therapy:

1: The goal of radiation therapy is to damage as many cancer cells as possible, while, limiting harm to nearby healthy tissue.
2: We design methods to focus X-rays on specific tumors or regions of the body. [51]
3: the aim is to shrink a tumor and relieve symptoms. [50]

Types of radiation therapy:

There are different types of radiation and different ways to deliver the radiation. For example, certain types of radiation can penetrate more deeply into the body than can others. In addition, some types of radiation can be very finely controlled to treat only a small area (an inch of tissue, for example) without damaging nearby tissues and organs. Other types of radiation are better for treating larger areas. Radiation therapy may be used alone or in combination with other cancer treatments, such as chemotherapy or surgery. In some cases, a patient may receive more than one type of radiation therapy. [50]

Historically, the three main divisions of radiotherapy are external beam radiotherapy (EBRT or XBRT) or teletherapy, brachytherapy or sealed source radiotherapy, and systemic radioisotope therapy or unsealed source radiotherapy. The differences relate to the position of the radiation source; external is outside the body, brachytherapy uses sealed radioactive sources placed precisely in the area under treatment, and systemic radioisotopes are given by infusion or oral ingestion.[51] The type of radiation to be given depends on the type of cancer, its location, how far into the body the radiation will need to go, the patient's general health and medical history, whether the patient will have other types of cancer treatment, and other factors.[50]

1: External radiation therapy:

External radiation give through external beam radiation .[47] External beam radiation therapy comes from a machine that aims radiation at your cancer. The machine is large and may be noisy. It does not touch you, but rotates around you, sending radiation to your body from many directions.

External beam radiation therapy is a local treatment, meaning that the radiation is aimed only at a specific part of your body. For example, if you have lung cancer, you will get radiation to your chest only and not the rest of your body. [52] External beam therapy is administered just like a normal X-ray. The radiation used for external beam radiation treatments comes from special machines, such as linear accelerators, cobalt machines, or orthovoltage x-ray machines. They deliver intense treatments with pinpoint accuracy. [47]

External beam radiation therapy is the safe delivery of high-energy X-rays to your cancer. [10] External radiation therapy is used to treat most types of cancer, including cancer of the bladder, brain, breast, cervix, larynx, lung, prostate, and vagina. [50]

1. Three-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver precise doses of radiation to the lung tumor.
2: Intensity modulated radiation therapy (IMRT) is a specialized form of 3D-CRT that modifies the radiation by varying the intensity of each radiation beam. [53]
3: Stereotactic Radiotherapy is a type of external beam radiotherapy that focuses high doses of radiation within the body, and claims to be much more accurate than other methods of radiation therapy . Cyberknife, Gamma Knife and Novalis Tx are three current technologies.[16]
4: Prophylactic cranial irradiation (PCI) is external radiation given to the brain when the primary cancer (for example, small cell lung cancer) has a high risk of spreading to the brain.
5: Intraoperative radiation therapy (IORT) is a form of external radiation that is given during surgery. IORT is used to treat localized cancers that cannot be completely removed or that have a high risk of recurring (coming back) in nearby tissues. [50]

Sources of external radiation:

1: Gamma rays (denoted as γ) are electromagnetic radiation of high energy (very short wavelength).Gamma-rays can kill living cells, a fact which medicine uses to its advantage, using gamma-rays to kill cancerous cells. Despite their cancer-causing properties, gamma rays are also used to treat some types of cancer . In the procedure called gamma-knife surgery, multiple concentrated beams of gamma rays are directed on the growth in order to kill the cancerous cells. The beams are aimed from different angles to concentrate the radiation on the growth while minimizing damage to the surrounding tissues. [54]
2: X-rays are created by machines called linear accelerators. Depending on the amount of energy the x-rays have, they can be used to destroy cancer cells on the surface of the body (lower energy) or deeper into tissues and organs (higher energy). Compared with other types of radiation, x-rays can deliver radiation to a relatively large area.
3: Particle beams use fast-moving subatomic particles instead of photons. This type of radiation may be called particle beam radiation therapy or particulate radiation. Particle beams are created by accelerators. Unlike x-rays and gamma rays, some particle beams can penetrate only a short distance into tissue. Therefore, they are often used to treat cancers located on the surface of or just below the skin.
4: Proton beam therapy is a type of particle beam radiation therapy. Proton beam therapy is also being used in clinical trials for intraocular melanoma (melanoma that begins in the eye), retinoblastoma (an eye cancer that most often occurs in children under age 5), rhabdomyosarcoma (a tumor of the muscle tissue), some cancers of the head and neck, and cancers of the prostate, brain, and lung.[50]

2: Internal radiation therapy Or Brachytherapy :

Uses radiation that is placed very close to or inside the tumor. The radiation source is usually sealed in a small holder called an implant. Implants may be in the form of thin wires, plastic tubes called catheters, ribbons, capsules, or seeds. The implant is put directly into the body. Internal radiation therapy may require a hospital stay. Internal radiation therapy involves placing radioactive substances such as cesium, iridium, and iodine near or into cancerous cells within the body.

Internal radiation is usually delivered in one of two ways, each of which is described below. Both methods use sealed implants. [47][50]

1: Interstitial radiation therapy is inserted into tissue at or near the tumor site. It is used to treat tumors of the head and neck, prostate, cervix, ovary, breast, and perianal and pelvic regions.
2:Intracavitary or intraluminal radiation therapy is inserted into the body with an applicator. It is commonly used in the treatment of uterine cancer. Researchers are also studying these types of internal radiation therapy for other cancers, including breast, bronchial, cervical, gallbladder, oral, rectal, tracheal, uterine, and vaginal.
3: Systemic radiation therapy uses radioactive materials such as iodine 131 and strontium 89. The materials may be taken by mouth or injected into the body. [47]

Sources of internal radiation therapy:

The energy (source of radiation) used in internal radiation comes from the radioactive isotope in radioactive iodine (iodine 125 or iodine 131), and from strontium 89, phosphorous, palladium, cesium, iridium, phosphate, or cobalt. Other sources are being investigated. [47][50]

Biological effect of radiation on cancer tissue:

Direct effect:

The radiations damages DNA molecules. No effects are visible immediately. But the damaged is observed during the next mitosis. Since new DNA can not be synthesized, cells die at the attempt of the next division, chromosome breakage is often notice.

Indirect effect:

Damage to local blood supply cuts off the nutrition and the causes local necrosis and cell death. Partially damaged cells are also destroyed by the immunologically systems. [55]

Effect of radiation therapy on blood cells:

Bone marrow and lymphoid tissues are highly radio-sensitive because of the higher rate of cell division on these organs. Leukopenia and thrombocytopenia is an accepted side effects of radiotherapy. Periodic check of blood counts is down during radiotherapy, and if the blood count are drastically lowered, [WBCs count below 2,000/cu mm and platelets count below 80,000], the therapy is temporarily stopped till recovery is affected. [16] The destruction of the highly radiosensitive lymphocytes by radiotherapy could decrease the cell-mediated response to cancer and increased metastases. [56]

Side effects of radiotherapy:

Side effects are different for everyone. Some patients feel fine during treatment while others may feel uncomfortable. [53] Side effects vary among treatment plans. Only a physician will be able to provide side effect expectations because it really does vary among treatment. [57]

The side effects depend on how much of your brain is being treated or if the spinal canal has to be treated as well. Most side effects are quite mild and all efforts are made to minimise them. However, some are inevitable. [49]

Early side-effects:

- Hair loss: You will lose your hair in the area irradiated. Hair starts to fall out between the second and third weeks of treatment and will usually have grown back to its maximum extent by 3-6 months
- Skin changes: You may notice some skin changes in the area being treated. After about 3 weeks it may redden and become itchy and darkened, as sunburn does.[49][53]
- Tiredness: Most people will feel tired and a little sleepy towards the end of their course of radiotherapy.[49]
- Nausea: Very rarely people feel sick.[49][53]
- Weight: You may find that your weight has increased, especially if you have been on steroid tablets.[49]
- Blood count: Cancer-related causes of low blood cell counts.[49,58]

Later side-effects:

There are some side-effects that can develop many months or years after the radiotherapy. If, the pituitary gland or the hypothalamus receives a high radiotherapy dose, regulation of some of the hormones can be upset. This may lead to a loss of periods, or sexual function and sometimes an under active thyroid. However all of these can be treated by hormone replacements. Most people are concerned about the effect of radiotherapy on their intelligence. [59]

1.9.2. Chemo therapy:

Chemotherapy, also called chemo, is medicines used to treat cancer. These medicines destroy cancer cells, keep them from growing and spreading, shrink the size of a tumor or relieve cancer symptoms. [60] It is well known that reducing the chemotherapy dose reduces the response rate and does not cure cancer .[61] The term, 'Chemotherapy,' is a general one used in association with any treatment involving the use of chemical agents to stop cancer cell growth. Chemotherapy may eliminate cancerous cells at sites which are at great distances from the original site of cancer development. Because of this, chemotherapy is considered to be a form of systemic treatment. Greater than half of all persons who have been diagnosed with cancer receive chemotherapy. Chemotherapy assists in treating millions of people successfully, helping them to enjoy full and productive live. [45]

Goal of Chemotherapy

- keep the cancer from spreading
- slow the cancer's growth
- kill cancer cells that may have spread to other parts of the body from the original tumor relieve symptoms caused by cancer.[62]

How does chemotherapy work?

Chemotherapy involves taking drugs that kills cells that are dividing rapidly such as cancer cells. The most common way of having chemotherapy is by injection into a vein (intravenously or IV), but sometimes chemotherapy drugs are taken as tablets. IV treatment involves the drug being administered through a vein in the hand or arm. Some women have chemotherapy that is a combination of tablets and IV. Chemotherapy drugs are absorbed into the blood and travel through the body finding and destroying the remaining cancer cells. [63]

How is chemotherapy given?

Chemotherapy may be given in many ways.

- Injection. The chemotherapy is given by a shot in a muscle in your arm, thigh, or hip or right under the skin in the fatty part of your arm, leg, or belly.
- Intra-arterial (IA). The chemotherapy goes directly into the artery that is feeding the cancer.
- Intraperitoneal (IP). The chemotherapy goes directly into the peritoneal cavity (the area that contains organs such as your intestines, stomach, liver, and ovaries).
- Intravenous (IV). The chemotherapy goes directly into a vein.
- Topically. The chemotherapy comes in a cream that you rub onto your skin.
- Orally. The chemotherapy comes in pills, capsules, or liquids that you swallow. [63]

Cancer Chemotherapy -- Effectiveness by Disease:

1. Curative

- Acute Lymphocytic Leukemia, Hodgkin’s Disease, Diffuse Histiocytic Lymphoma, Burkitt’s Lymphoma
- Testicular Cancer, Choriocarcinoma
- Wilms’ Tumor, Ewing’s Sarcoma, Embryonal Rhabdomyosarcoma

2. Probably Curative

- Acute Myelogenous Leukemia
- Small Cell Lung Cancer, Breast Cancer, Osteogenic Sarcoma

3. Major Therapeutic Benefit (Short of Cure)

- Head and Neck Cancer, Cervical Cancer, Metastatic Breast Cancer, Ovarian Cancer
- Soft Tissue Sarcoma
- Nodular Lymphomas, Chronic Leukemia’s
- Insulinomas

4. Limited Effectiveness

- Lung Cancer
- GI Cancer
- Prostate Cancer
- Melanoma. [64]

Types of chemotherapy:

It’s rather confusing and pointless most of the time to go through all the types of chemotherapy, but there are people who find such a list both informative and useful. It includes alkylating agents’ chemotherapy, alkaloid-based treatment, anti-tumor antibiotics, antimetabolites, topoisomerase inhibitors, antineoplastics and so on. [65]

1: Antimetabolites

Mechanisms

- incorporation of nucleotide analog in DNA or RNA, resulting in abnormal nucleic acids
- inhibition of certain enzymes involved in nucleotide biosynthesis.[64] These drugs either purine or either pyramidin[65]

Examples:

1: Pyrimidines Uracil: 5-fluorouracil (5-fluoro-2’-deoxyuridine) Thymine: 3’-azido-3’-deoxythymidine Cytosine: Cytosine arabinoside; 5-azacytidine
2: Purines Adenine: 6-mercaptopurine Guanine: 6-thioguanine
3: Antifols (Methotrexate):competitive inhibition of dihydrofolate reductase, necessary for generation of methyl donors required for thymidine synthesis.[64][65]

Toxicity (general)

- interfere with replication of all rapidly proliferating cells
- bone marrow --- myelosuppression
- GI mucosa ---- diarrhea, stomatitis Toxicity (specific)
- 6-mercaptopurine --- cholestatic jaundice
- Methotrexate renal – high doses may block tubules and cause acute renal failure hepatic
- usually seen with chronic daily administration of low doses (i.e., psoriasis treatment) CNS
- encephalopathy in patients given prior irradiation.[64]

2: Plant Alkaloids:

Vincristine,vinblastin,taxanes.All are plant alkaloids cause mitotic arrest by poisoning the spindles.Mitotic spindles are vital for cell division.[65]

Toxicity

- neurotoxicity
- paresthesias
- constipation
- decreased deep tendon reflexes
- myelosuppression.[64]

3:Alkalyting agents:

Mechanisms

- base alkylation resulting in DNA cross-linking
- single strand breaks
- double strand breaks and strand misreading.[64]

Examples:

- Nitrogen Mustard
- Cyclophosphamide
- Nitrosoureas
- Cis-platinum
- Busulfan ,melaphalen.[64][65]

Toxicities (general)

- Myelosuppression
- Stomatitis
- Nausea/vomiting
- Alopecia
- Impaired ovulation and spermatogenesis
- Mutagenesis and carcinogenesis. [64]

4: Antibiotics

Mechanism

cause linking of double strands of DNA and prevent replication.

Examples

Adriamycin,bleomycin,epirubicin.[65]

5:Anthracyclines :

Mechanisms

- Intercalate between strands of DNA double helix
- Formation of drug free radicals
- Inhibition of topoisomerase II

Examples:

- Daunorubicin
- Doxorubicin (Adriamycin)

Toxicities

- Myelosuppression
- Stomatitis
- Cardiotoxicity (irreversible, dose-related) .[64]

6:L-Asparginas (E. Coli,erwentia)

Mechanisms

- l-asparaginase converts asparagine to aspartate and NH3. Normal cells can reverse this process to form asparagine.
- Drug has activity in acute lymphocytic leukemia. Lymphoblasts lack asparagine synthetase and die without preformed asparagine in plasma.

Toxicity

- Hypersensitivity (urticaria, anaphylaxis)
- Pancreatitis
- Hepatotoxicity .[64]

7: Podophyllotoxin:

Mechanism

This is a plant derived compound that is used to produce certain drugs. They prevent the cell from entering the S phase of the cell cycle.

Examples

Etoposide and Teniposide. [65]

8: Corticosteroids:

Mechanisms

- Unclear –induce apoptosis of lymphoblasts and effective in lymphoid malignancies
- Work via nuclear receptors

Examples

- Prednisone
- Dexamethasone Toxicity
- Typical steroid toxicity –relatively modest in this context. [64]

9: Patinum compounds Mechanism

They are alkylatig agents and they forms cross-linkage adducts thus bloking DNA replication.

Examples

- Cisplatin,
- Carboplastin.[65]

10: Anthracyclines Mechanisms

- Intercalate between strands of DNA double helix
- Formation of drug free radicals
- Inhibition of topoisomerase II

Examples:

- Daunorubicin
- Doxorubicin (Adriamycin) Toxicities
- Myelosuppression
- Stomatitis
- Cardiotoxicity (irreversible, dose-related). [64]

Side effects of chemotherapy:

Chemo can destroy or slow down the growth of normal cells, including cells of the hair, mouth, digestive system, and blood stream. [59] Chemotherapy is designed to kill fast-growing cancer cells. But it can also affect healthy cells that grow quickly. These include cells that line your mouth and intestines, cells in your bone marrow that make blood cells, and cells that make your hair grow. Chemotherapy causes side effects when it harms these healthy cells.[63] By understanding the most common chemotherapy side effects—and by taking action to protect against possible outcomes—the chance of experiencing some serious side effects may be decreased [66]

Nausea and Vomiting:

It is quite common to feel nausea when having chemotherapy. Nausea can last for a few hours to a few days. Chemotherapy can also make some women vomit. The good news is that nausea and vomiting can usually be controlled with drugs call anti-emetics.

Fatigue:

Feeling tired is one of the main side effects of chemotherapy, and can last 3-6 months after your treatment is finished. Fatigue can also be due to anemia, which means that there are fewer red blood cells in your blood. [62][63]

Hair Loss

Hair loss from chemotherapy can range from mild thinning of the hair to total hair loss (including body hair).

Not all chemotherapy drugs cause hair loss. If you do lose some hair it will usually grow back within weeks.

Diarrhea and constipation:

This can be from the chemotherapy drugs, or from being less active or eating less due to nausea. Some anti-nausea drugs can also cause constipation. [59][62][63]

Weight gain or loss:

Some having chemotherapy lose their appetite and lose weight, while other put on weight.

Depression:

Some feel depressed, sad or teary before, during and after chemotherapy treatment. Some sadness or depression is normal.

Anxiety:

Some feel anxious, worried, nervous or distressed before, during and after treatment. Some anxiety is normal. [62]

Anemia:

Anemia can make you feel short of breath, weak, dizzy, faint, or very tired.

Some types of chemotherapy cause anemia because they make it harder for bone marrow to produce new red blood cells. [63][66]

Appetite Changes:

Chemotherapy can cause appetite changes. You may lose your appetite because of nausea (feeling like you are going to throw up), mouth and throat problems that make it painful to eat, or drugs that cause you to lose your taste for food. [63]

Bleeding:

Platelets are cells that make your blood clot when you bleed. Chemotherapy can lower the number of platelets because it affects your bone marrow’s ability to make them. A low platelet count is called thrombocytopenia. This condition may cause bruises (even when you have not been hit or have not bumped into anything), bleeding from your nose or in your mouth, or a rash of tiny, red dots. [59][63]64]

Infection:

Some types of chemotherapy make it harder for your bone marrow to produce new white blood cells. White blood cells help your body fight infection. Therefore, it is important to avoid infections, since chemotherapy decreases the number of your white blood cells.[59][63][66]

Infertility:

Some types of chemotherapy can cause infertility. [63]

Mouth and Throat Changes:

Some types of chemotherapy harm fast-growing cells, such as those that line your mouth, throat, and lips. This can affect your teeth, gums, the lining of your mouth, and the glands that make saliva. Most mouth problems go away a few days after chemotherapy is over.

Pain:

Some types of chemotherapy cause painful side effects. These include burning, numbness, and tingling. [59][63]

Other Side effects of chemotherapy:

- Skin or nail changes or reactions
- Menopausal symptoms (temporary or permanent)
- Sexual difficulties
- Nerve and muscle problems
- Swelling in the arms and legs.

The following side effects of chemotherapy are rare but can be quite serious (medical advice should be sought if any of the following occur):

- Bleeding or bruising
- Kidney or bladder problems
- Heart problems
- Bone marrow problems. [67]

MATERIAL AND METHODS

Present work was conducted to investigate the effect of radiotherapy and chemotherapy in cancer patient. In which we carried biochemical analysis (RBC’s, WBC’s, platelets, Hb, MCV, MCH, MCHC, TLC, neutrophils, basophils, eosinophils ,lymphocyte and monocyte), physiological and anthropometric measurements.

2.1 Sample collection:

Eighty samples were collected. Out of them forty were cancer patients and forty are normal subjects. Cancer patient were selected from Nuclear Institute of Medicine and Radiotherapy (NIMRA), Jamshoro.The age group of samples as well as control was between 25-50 years.

2.2 Anthropometric Measurement:

The field of anthropometry encompasses a variety of human body measurements, such as weight, height, and size, including circumferences, lengths, breadths, and skinfold thicknesses. Anthropometry is a key component of nutrition status assessment in children and adults.

Anthropometric data for children reflect general health status, dietary adequacy, and growth and development over time. In adults, body measurement data are used to evaluate health and dietary status, disease risk, and body composition changes that occur over the adult lifespan. [68]

We carried two types of anthropometric measurement, height and weight. Height done by tap measurement and weight is measured by bathroom scale or weight machine. [69]

2.3 Physiological Measurement:

In physiological measurement we measure the blood pressure and pulse rate of control and patients.

Blood pressure:

Blood pressure measurement is the non-invasive measurement of the pressure exerted by the circulating blood on the walls of the body's arteries. The non-invasive blood pressure is taken using a sphygmomanometer, a hand bulb pump, and a cuff. [70]

How blood pressure checked?

1. A soft arm cuff is wrapped around the upper arm. A hand bulb pumps air into the cuff, gently squeezing the arm and temporarily interrupting the flow of blood. The pressure gauge reaches a peak.
2. Then the cuff is slowly deflated, letting blood flow again. As the cuff deflates and the pressure gauge gradually decreases, the return of the blood flow through the main artery in arm can be heard using a stethoscope.
3. The reading on the pressure gauge when the pulse is first heard is systolic pressure (the peak pressure as the heart contracts).The reading when the pulse can first no longer be heard is diastolic pressure (the lowest pressure as the heart relaxes between beats).[71]

Pulse rate:

Pulse rate is the rate at which heart beats. Your pulse is usually called heart rate, which is the number of times heart beats each minute (bpm). However, the rhythm and strength of the heartbeat can also be noted, as well as whether the blood vessel feels hard or soft. Changes in heart rate or rhythm, a weak pulse, or a hard blood vessel may be caused by heart disease or another problem.[72]

How pulse rate checked?

1. First step to taking and checking for a normal rate is to locate the individuals wrist.
2. Then placing first 3 fingers (pointer+middle+ring) just below the crease (where hand and wrist meet just under the thumb) press until can feel the radial pulse.
3. Counting pulse rate is a simple way to find out how fast heart is beating. [73]

2.4. Blood sample collection:

Blood is typically drawn from a vein, usually from the inside of the elbow or the back of the hand. The site is cleaned with germ-killing medicine (antiseptic). The health care provider wraps an elastic band around the upper arm to apply pressure to the area and make the vein swell with blood.

Next, the health care provider gently inserts a needle into the vein. The blood collects into an airtight vial or tube attached to the needle. The elastic band is removed from their arm.

Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding.[74]

2.5 Procedure:

2.5.1 Hematological analyzer:

Complete blood count test were carried on Hematological analyzer (Medononic 620).This instrument is a fully automated hematology analyzer designed to measure up to 20 parameters using whole blood from an open inlet, closed tubes, micro pipettes 20 microlitre or pre-diluted blood.

The instrument employs the electronic impedance principle for cell counting and sizing, and colorimetric method for measuring hemoglobin. A microprocessor is used to measure the parameters and to size the cells. During the count the processor checking the analyzing process for any irregularities. Size distributions are printed for all populations (RBC, PLT, and WBC).

The instrument has as standard a parallel and a serial out put, which is user programmable. For a built-in selectable program the user can choose between different print formats.

The instrument is fully automatic, which means that, the system is always powered on and performs automatically perform check-and cleaning cycle to minimize user maintenance. [75]

2.5.2 Measuring principle:

1. RBC, WBC, and PLT concentration detection:

- Detection is accomplished using the electronic impedance principle and occurs in the orifice of transducer.
- The blood is diluted to 1:400(WBC & HBG) and 1:40000(RBC & PLT) through a precise shear system .The shear valve “cut” a very reproducible volume(25microlitre)from the aspired blood and dilute with an equal precise volume of diluents (or lyzer) to achieve the final dilution rate.
- Two separate measuring chamber and transducer are used, one for RBC/PLT and one for WBC/HGB analysis. This excludes any possibility of cross contamination between the lyzer and the RBC/PLT dilution.
- A pressure is applied on top of the diluted sample and the diluted sample is pressed through an orifice (operature) of 80 micrometer diameter .Each side of orifice is equipped with a platinum electrode current and an electrical current is applied between the electrode.
- When a cell is drawn into a constant current, flowing from electrode through the orifice to a second electrode, the electrical conductivity is change s. This generates an equivalent voltage pulse.
- The amplitude of the pulse is directly proportional to the volume of the represented cell. The number of pulses corresponds to the number of cells detected.
- The PLT, RBC, and WBC parameters are measured on a precise aliquot of the sample. The amount of sample measured is determined by the volume of a precise glass column; called a metering tube. Two optical detectors are used to start and stop detection.
- The start detector is activated by the flow of the isotonic diluent through the metering tube. As the meniscus passes the optical path it causes a voltage change that activates the count and sizing circuitry of the system.
- As the isotonic diluent continues to flow upward into the metering tube it passes the stop detector .This action stop the count an analyzing process and the parameters and distribution curves are displayed. Due to this principle, the CA instruments perform absolute counts related to fixed volumes.
- The instrument used a lower discriminator level at approx. 2.5 fl. All cells over this level are analyzed and counts are stored.
- The reproducibility is directly related to the total number of cells entering the orifice. The higher the concentration, the better the reproducibility. The instrument has a dilution ratio for RBC of 1:40,000 and the CV will therefore be less than 1% for sample with an RBC number within the normal range. [75]

Normal ranges:

- RBC’s = 4.5-5.9million/cmm (Male)

=3.8-5.8 million/cmm (Female)

- WBC’s = 4000-11000/cmm (Adult)

=6000-18000/cmm (Children)

- Platelets =1, 50,000-4, 50,000/cmm

2. Sizing RBC, WBC and PLT:

- The sizing is done in a matrix with the volume on the horizontal (x) axis and the number of the cells on the vertical(y) axis. [75]

3. WBC differentials:

- The instrument utilizes a so-called mathematical differential, where the curves are analyzed within the software and 3 separate curves are built through a curve fitting method.
- Hence, the software of the instrument is building an artificial matching distribution around the main populations. To do so, after the analyzing process, the instrument find two main modes (=peaks) within the total distribution. Then matching of the 2 main population takes place including extrapolation to the base line. The remaining area that was not covered by the 2 main population is now classified as being the MID cell area which mainly consist of the Monocyte. A third population is now calculated, representing this area. [73]

Normal ranges:

- Neutrophiles = 50-70%
- Eosinophiles = 01-06%
- Basophiles = 00-01%
- Lymphocytes = 25-45%
- Monocytes = 02-10%

4. MCV (Mean Cell Volume RBCs):

- The MCV parameter is derived from the RBC’s distribution curve. As distribution curve has a maximum volume range of 250fl, the maximum channel also contains clumps of cells that are large then this volume. Therefore this channel is excluded from the MCV calculation. The MCV calculated from the volume position of the discriminating to 249fl.
- In general, RBC count that are lower than 0.60 (displayed value) do not give a MCV/HCT value due to low statistical significance. [75]

Normal ranges:

- MCV = 76-96 fl

6. HGB (Hemoglobin Concentration):

- The hemoglobin is determined from the same dilution as the WBC. For each sample a blank is measured as a reference; this means that any drift in reagent and cuvette-absorption or lamp is eliminated. The photometer system consists of a tungsten lamp, a cuvette with a length of 15 mm and a filter at a wave length of 535 nm (band width 20nm). [75]

Normal ranges:

- Hemoglobin =13-18g/dl (Male)

=11.5-16.5g/dl (Female)

7. MCH (Mean Cell Hemoglobin):

- The MCH is a calculated value and is defined as HGB/RBC giving the mean HG B concentration in each red cell. [75]

Normal range:

- MCH = 27-32 pg

8. MCHC (Mean Cell Hemoglobin Concentration)

- The MCHC is a calculated value and it is defined as HGB/HCT.
- The MCHC is calculated from 3 measured parameters and therefore an excellent instrument stability check. MCHC =HGB/HCT HGB/ (MCV X RBC). [75]

Normal range:

- MCHC = 30-35 g/dl

RESULT & DISCUSSION

Table: 3.1 Statistical Comparison Of RBC’s & Hb In Control & cancer Patients.

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Table 3.1, shows the mean values, of RBCs and Hb of normal and cancer patients. Mean RBCs of normal and cancer patients was 4.5+0.5 and 4.4+0.7 respectively, t –test value is 0.11 and for all probability of RBC’s is0.9. Which indicates that the RBC’s have no significant difference in their levels. Some cancer treatments, especially chemotherapy and radiation therapy, may cause a decrease in your body’s RBCs. This condition is known as anemia. Blood loss, either from surgery or from specific cancers, can also cause or worsen anemia. [76]

The mean Hb of normal and cancer patient was 12.6+1.1 and 11.08+1.1; t-test value is 1.9 and p-value of Hb is 0.1. This indicates that Hb has significant difference in their level which is slightly low in cancer patients. Several experimental studies have shown that low levels of hemoglobin (Hb) correlate with diminished partial oxygen pressure (pO2) in the tumor. [77- 80]

Many studies have shown that the use of erythropoietin (EPO) in oncologic patients increases Hb levels. [81-86].

Table.3.2 Statistical Comparison Of Absolute Indices In Control & cancer Patient.

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Table-3.2, shows the mean value of MCV, MCH and MCHC of normal and cancer patients. Mean value of MCV for normal and cancer patient was 81.7+6.7 and 78.1+9.7 and t-test is 0.5 and for all probability of MCV is 0.6.which shows that the MCV value of cancer patients is slightly low than normal.

And the mean value of MCH for normal and cancer patient was 27.9+5.6 and 25.6+3.5 .And the t-value is 0.4 and p-value of MCH is 0.7.this indicates that MCH is also low in cancer patient then normal.

While mean value of MCHC for normal person and cancer patient was 35.0+2.3 and 32.7+0.8.While t-test value is 0.1 and p-value of MCHC is 0.9.It is also low in cancer patients.

Table: 3.3 Statistical Comparison of WBC’s In Control & cancer Patient.

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Table-3.3, shows the mean values, t-values and p-values of TLC, Neutrophil, Lymphocytes, Eosinophils, Monocytes and Basophils of normal persons and cancer patients. Mean value of TLC for normal persons and cancer patients was 9490+4279.4 and 8332.5+3644.9, the t-value is 0.78 and p-value of TLC is 0.5.which indicates that TLC level is low in cancer patient.

The mean value of neutrophils for normal and cancer patients was 70.6+11.6 and 52.8+26.3,t-value is 0.26 and p-value of neutrophils was 0.8.It also shows that the neutrophil is low in cancer patients. These cancers and cancer treatments may cause a condition called neutropenia, an abnormally low level of neutrophils. [76]

The mean value of lymphocytes for normal and cancer patients is 26.6+11.3 and 23.6+13.7, and t-test value is 0.97 and p-value of lymphocytes is 0.4.This shows that the lymphocyte is low in cancer patient.

Natural killer cell activity is significantly reduced in patients with cancers of head and neck, gastric, lung, and breast as compared with healthy individuals. [77]

The mean value of eosinophil for normal and cancer patients is 1.07+0.6 and 2.7+0.7, and t-test value is 10.35 and p-value of eosinophils was 0.001.It shows the significant difference in their levels.

The mean value of monocytes for normal and cancer patients is 1.7+0.8 and 2.9+0.7,and t-test value is 6.75 and p-value of monocytes is 0.001.It indicates the significant difference in their levels.

And the mean value of basophils for normal and in cancer patients is normal value and 1.47+0.5,and t-value is 16.37 and p-value of basophils is 0.001.This indicates the significant difference in normal and cancer patient. Some cancer treatments, especially chemotherapy, may cause a decrease in your body’s WBCs. Cancers that affect the blood and bone marrow, such as leukemia, lymphoma, or multiple myeloma, can cause a decrease in the WBC count. [78]

Table: 3.4 Statistical Comparison Of Anthropometric Measurement In Control & cancer Patients.

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Table-3.4, shows the mean values, t-values and p-values of Age, Height and Weight of normal persons and cancer patients. Mean value of age for normal and cancer patients was 33.3+5.8 and 40.3+7.9, and mean value of height for normal and cancer patients was 159.0+7.0 and 155.9+7.2.This shows that cancer patients has low height then normal. While mean value of weight for normal and cancer patients was 58.8+6.7 and 56.0+11.9.It also indicates that the cancer patient has low weight then normal.

Table: 3.5 Statistical Comparison Of Physiological Measurement In Control & cancer Patients.

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Table-3.5 shows the mean values, t-values, and p-values of Systolic blood pressure, Diastolic blood pressure and Pulse rate of normal persons and cancer patients. Mean value of systolic blood pressure of normal persons and cancer patients was 120.9+8.5 and 122.3+6.09.And the t-test value is 0.8 and p-value of systolic blood pressure is 0.4,this indicates that the systolic pressure is high in cancer patient.

The mean value of diastolic blood pressure for normal and cancer patients was 76.5+5.5 and 82.5+5.3. And t-test value is 4.8 and p-value of diastolic pressure is 0.001.which indicates that cancer patients have significant difference in their levels.

While the mean value of pulse rate for normal persons and cancer patients was 78.7+6.9 and 73.5+2.8.and t-test value and p-value of pulse rate was 0.2 and 0.8.

Table: 3.6 Statistical Comparison of Platelet Count In Control & cancer Patients.

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Table 3.6, shows the mean value; t-value and p-value of platelets for normal persons and cancer patients were 231487.5+100712.9 and 31705+145624.823. The t-value and p-value of platelets was 0.000004487 and 0.9.This indicates that mean value of platelets was lower in cancer patients as compared to normal persons.

Some cancer treatments, such as chemotherapy or radiation therapy, may cause a decrease in platelets, which may result in a condition called thrombocytopenia. Cancers that involve the bone marrow directly, such as leukemia, lymphoma, or multiple myeloma, can also cause a decrease in the production of platelets. [76]

Table: 3.7 Statistical Comparison Of RBC’s & Hb In Control & cancer Patients.

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Table-3.7, shows the mean value, t-values, and p-values of RBCs and Hb for female control samples and female patient samples. Mean value of RBCs for female control samples and female patients samples was 2.2+0.49 and 4.5+1.09, and the t-test value and p-value of RBC’s is 9.2 and 0.001 respectively, which indicates that the RBC’s is low in cancer patients.

The mean value of Hb for female control samples and female patients samples is 12.03+0.8 and 11.3+1.7. While t-value and p-value of Hb was 0.54 and 0.6.This also shows that Hb is slightly low in cancer patients.

Table: 3.8 Statistical Comparison Of Absolute Indices In Control & cancer Patients.

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Table-3.8, shows the mean values, t-values, and p-values of MCV, MCH and MCHC for female control samples and female patient samples. Mean value of MCV for female control samples and female patient samples is 80.525+6.435 and 72.9+6.19, and the t-value and p-value of MCV was 0.66 and o.5 respectively, which indicates that MCV is low in cancer patients.

The mean value of MCH for female control sample and female patient samples was 28.625+3.843 and 25.3214+3.193., and the t-value and p-value of MCH was 3.39 and 0.001.It is also low in cancer patients.

While mean value of MCHC for female control samples and female patient samples was 35.2+2.3 and 32.6+0.8.While t-value and p-value of MCHC were 0.31 and 0.7.This shows that MCHC is also low in cancer patients.

Table: 3.9 Statistical Comparison Of WBC’s In Control & cancer Patients. (Female)

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Table-3.9 shows the mean values, t-values, and p-values of TLC, Neutrophils, Lymphocytes, Eosinophils, Monocytes, and Basophils for female control samples and female patients samples. Mean value of TLC for female control samples and female patient samples was 9608.3+3925.6 and 8328.5+3762.1, the t-test value and p-value of TLC was 1.17 and 0.3.This shows that TLC is lower in cancer patients than normal.

The mean value of neutrophils for female control samples and female patient samples is 69.7+12.7 and 50.9+28.3, and t-test value and p-value of neutrophils was 0.34 and 0.7.This is also low in cancer patients.

The mean value of lymphocytes for female control samples and female patient samples is 27.5+12.4and 21.9+13.7, t-test value and p-value of lymphocytes is 0.01 and 0.9.which indicates that lymphocytes are also low in cancer patients.

The mean value of eosinophils for female control samples and female patient samples is 1.08 +0.6 and 2.8+0.7,and t-test value and p-value of eosinophils is 8.4 and 0.00.These are also high in cancer patients.

The mean value of monocytes for female control samples and patient samples is 1.6 +0.9 and 2.9+0.6 and t-test value and p-value of monocytes is 5.7 and 0.001.Monocytes are also high in cancer patients.

And the mean value of basophils for female control samples and female patient samples is normal value and 1.4+0.5. And t-test value and p-value of basophils was 13.1 and 0.001.

Table: 3.10. Statistical Comparison Of Anthropometric Measurement In Control & cancer Patients. (Female)

Abbildung in dieser Leseprobe nicht enthalten

Table-3.10, shows the mean values, t-test values, and p-values of age, height and weight for female control samples and female patient samples. Mean value of age for female control samples and female patient samples was 32.3+4.6 and 40.2+7.3, mean value of height for female control samples and female patient samples was 154.3+3.7 and 153.4+4.6. Hight is similar in cancer patients and normals. While mean value of weight for female control samples and female patient samples was 56.1+6.3 and 56.8 +13.4.which indicates that weight have no significant difference in cancer than normal.

Table: 3.11 Statistical Comparison Of Physiological Measurement In Control & cancer Patients. (Female)

Abbildung in dieser Leseprobe nicht enthalten

Table-3.11, shows the mean values, t-test values, and p-values of systolic blood pressure, diastolic blood pressure and pulse rate for female control samples and female patients samples. Mean value of systolic blood pressure for female control samples and female patients samples is 117.7+8.5 and 120.5+5.6, the t-value and p-value of systolic blood pressure was 1.3 and 0.2, The mean value of diastolic blood pressure for female control samples and female patient samples was 74.5+5.9 and 81.4+4.4, and t-value and p-value of diastolic pressure was 4.6 and 0.001. This shows that systolic and diastolic blood pressures were higher in female cancer patients as compared to normal females.

While mean value of pulse rate for female control samples and female patients samples was 77.2+7.0 and 72.3+1.9.While t-value and p-value of pulse rate was 0.2 and 0.8.This indicates that the pulse rate is lower in female cancer patients as compared to normal females.

Table: 3.12. Statistical Comparison Of Platelet Count In Control & Patients. (Female)

Abbildung in dieser Leseprobe nicht enthalten

Table-3.12, shows the mean value, t-test value, and p-value of platelets count for female control samples and female patient samples is 239791.66+88474.5 and 117238.9.2857+10517.2.The t-value and p-value of platelets is 1429658.952 and 0.001. The t-value and p-value of platelets was 1429658.9 and 0.001.This shows that mean value of platelets was lower in female cancer patients as compared to normal females.

Table: 3.13 Statistical Comparison Of RBC’s & Hb In Male Control & Patients. (Male)

Abbildung in dieser Leseprobe nicht enthalten

Table -3.13, shows the mean values, t-test values, and p-values of RBCs and Hb for male control samples and male patients samples. Mean value of RBCc for male control samples and male patient samples is 4.7256+0.386 and 4.3616+0.8347, and the t-value and p-value of RBC’s was 1.35 and 0.2 respectively, which indicates that RBC’s are low in cancer patients.

And mean value of Hb for male control sample and male patient samples is 13.5+1.00314 and 10.5+3.5.while t-test value and p-value of Hb was 0.32 and 0.7.This shows that Hb is low in cancer patients.

Table: 3.14 Statistical Comparison Of Absolute Indices In Control & Patients. (Male)

Abbildung in dieser Leseprobe nicht enthalten

Table-3.14, shows the mean values, t-test values, and p-values of MCV, MCH, and MCHC. Mean values of MCV for male control sample and male patient samples are 77.5+5.7 and 80.1+12.0, the t-value and p-value of MCV was 0.02 and 0.9 respectively, which indicates that MCV is low in cancer patients.

The mean value of MCH for male control samples and male patients sample is 27.0+7.6 and 26.4+4.2. And the t-value and p-value of MCH was 5 and 0.001.This shows that MCH is low in cancer patients.

While mean value of MCHC for male control samples and male patients sample is 34.7+2.4 and 33.0+0.8.While t-test value and p-value of MCHC was 0.43 and 0.7.MCHC were lower in male cancer patients as compared to normal males.

Table: 3.15 Statistical Comparision Of WBC’s In Control & Patients. (Male)

Abbildung in dieser Leseprobe nicht enthalten

Table-3.15, shows the mean values, t-values, and p-values of TLC, Neutrophils, Lymphocytes, Eosinophils, Monocytes, and Basophils for male control samples and male patients samples. Mean value of TLC for male control samples and male patient samples is 9312.5+4891.8 and 8341.6+3515.7. The t-test value and p-value of TLC is 2 and 0.05, which shows that TLC is lower in cancer patients.

The mean value of neutrophils for male control samples and male patient samples is 71.8+10.1 and 57.3+21.0, t-test value and p-value of neutrophils was 0.4 and 0.7, and this shows that neutrophils are also low in cancer patients.

The mean value of lymphocytes for male control samples and male patient samples was 25.25+9.6 and 27.8+13.6, t-test value and p-value of lymphocytes was 0.3 and 0.7.This shows lymphocytes are also low in cancer patients.

The mean value of eosinophils for male control samples and male patient samples was 1.06+0.6 and 2.6+0.7, t-test value and p-value of eosinophils was 5.4 and 0.001, which indicates that eosinophils are increase in cancer patients.

The mean value of monocytes for male control samples and male patient samples was 1.8+0.8 and 3+0.9, t-test value and p-value of monocytes was 3.4 and 0.001.This shows that monocyte are increase in cancer patients.

And the mean value of basophils for male control samples and male patient samples was normal value normal value and 1.5+0.6. and t-test value and p-value of basophils was 9.06 and 0.001.

Table: 3.16. Statistical Comparison Of Anthropometric Measurement In Control & Patients. (Male)

Abbildung in dieser Leseprobe nicht enthalten

Table-3.16, shows the mean values, t-values, and t-values of age, height and weight for male control samples and male patients samples. Mean value of age for male control sample and male patients samples was 34.8+7.2 and 40.5+9.4, and mean value of height for male control samples and male patients samples was 166.0+4.5 and 161.7+9.0.Which indicates that height is low in cancer patients than in normal.

While mean value of weight for male control sample and male patient samples is 62.9375+5.3 and 54.33+7.8.which indicates that weight is low in cancer patients than normal.

Table: 3.17 Statistical Comparison Of Physiological Measurement In Control & Patients. (Male)

Abbildung in dieser Leseprobe nicht enthalten

Table-3.17, shows the mean values, t-test values, and p-values of systolic blood pressure, diastolic blood pressure and pulse rate. Mean value of systolic blood pressure for male control sample and male patient sample was 125.7+5.9 and 126.6+4.9.The t-value and p-value of systolic blood pressure was 0.24 and 0.8.

And mean value of diastolic blood pressure for male control sample and male patients sample is 79.5+3.2 and 85+6.3.This shows that systolic and diastolic blood pressures is higher in male cancer patients as compared to normal males.

While mean value of pulse rate for male control sample and male patients samples was 81.06+6.5 and 76.3+2.8. While t-value and p-value of pulse rate was 0.74 and 0.5. This shows pulse rate was lower in male cancer patients as compared to normal males.

Table: 3.18 Statistical Comparison Of Platelet Count In Control & Patients. (Male)

Abbildung in dieser Leseprobe nicht enthalten

Table-3.18, shows the mean values, t-test values, and p-values of platelets count for male control samples and male patients samples is 219031.2+118716.8 and 130608.3+78443.3.The t-value and p-value for platelet count was 4200.86 and 0.001.

This shows that mean value of platelets was higher in male cancer patients as compared to normal males.

CONCLUSION

The survey work was carried out to see the effect of radiotherapy and chemotherapy on the blood of cancer patients.

The result makes clear that the weight of cancerous patients was decline than the average persons and the height of cancerous patients was bringing down as compared to normal.

The Blood pressure of cancer patients (Systolic and Diastolic) was raise and pulse rate was decreases than the normal.

The results indicates that RBC had no significant difference but Hb had low value as compared to normal value due to devalue of oxygen pressure In tumor and WBC ( neutrophils and lymphocytes) decrease in cancer patients .

Eosinophils , monocytes and basophils had greater value as compared to normal.

MCV, MCH and MCHC had turn down values than standard value.

The out come provide evidence for Platelets had low value the normal.

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Title
How Radiotherapy and Chemotherapy effect the Blood Parameters of Cancer Patients
College
University of Sindh  (Biochemistry)
Grade
A
Author
Year
2010
Pages
59
Catalog Number
V538057
ISBN (eBook)
9783346137418
ISBN (Book)
9783346137425
Language
English
Keywords
radiotherapy, chemotherapy, blood, parameters, cancer, patients
Quote paper
Muhammad Younis (Author), 2010, How Radiotherapy and Chemotherapy effect the Blood Parameters of Cancer Patients, Munich, GRIN Verlag, https://www.grin.com/document/538057

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