Blood cancer

What is blood cancer?

Cancer that begins in blood-forming tissue, such as the bone marrow, or in the cells of the immune system. Examples of hematologic cancer are leukemia, lymphoma and multiple myeloma.

Leukemia

Leukemia is cancer of the blood cells. Most blood cells form in the bone marrow. In leukemia, cancerous blood cells form and crowd out the healthy blood cells in the bone marrow.

Lymphoma

Lymphoma is cancer that begins in cells of the immune system. There are two basic categories of lymphomas. One kind is Hodgkin lymphoma, which is marked by the presence of a type of cell called the Reed-Sternberg cell. The other category is non-Hodgkin lymphomas, which includes a large, diverse group of cancers of immune system cells. Non-Hodgkin lymphomas can be further divided into cancers that have an indolent (slow growing) course and those that have an aggressive (fast growing) course.

Myeloma

Myeloma is cancer that begins in the bone marrow. It is a cancer of plasma cells, which are a type of white blood cells (also called plasma B cells). It has several forms, including multiple myeloma, the most common form. More than 90% of people with myeloma have this type which affects several different areas of the body.

Other forms are:

Plasmacytoma, where only one site of myeloma cells evident in the body, such as a tumor in the bone, skin, muscle, or lung
Localized myeloma, which is found in one site with exposure to neighboring sites
Extramedullary myeloma, which involves tissue other than the marrow, such as the skin, muscles or lungs

Doctors also divide myeloma into groups that describe how rapidly or slowly the disease is progressing:

Asymptomatic or smoldering myeloma progresses slowly and has no symptoms even though the patient has the disease.
symptomatic myeloma has related symptoms such as anemia, kidney damage and bone disease.

What are the risk factors for blood cancer?

Leukemia

There is currently no known way to prevent most types of leukemia, especially among children. Smoking is the most significant avoidable risk factor among adults. Also, avoiding chemicals linked with leukemia, such as benzene, may lower the risk of developing leukemia.

Both children and adults are at higher risk of developing acute leukemia if they:

Have been treated previously for cancer with radiation and chemotherapy
Are taking immune suppressing drugs
Have certain genetic conditions such as Down’s Syndrome

Lymphoma

Risk factors for both Hodgkin lymphoma and NHL include:

Being male
Having a weakened immune system
Being infected with human immunodeficiency virus (HIV) or Epstein-Barr virus

Infection with Helicobacter pylori or human T-cell leukemia/lymphoma virus type 1 (HTLV-1) increases the risk for certain types of NHL.

The risk of NHL increases with age, whereas the risk of Hodgkin lymphoma is higher in both early adulthood and later life.

Myeloma

Doctors don’t know why some cells become myeloma cells and others don’t. For most people who have myeloma, there are no obvious reasons why they developed the disease.

Some factors that may increase the risk of developing myeloma include:

Being over age 50
Being a male
Being African American
Being obese
Having a history of MGUS (monoclonal gammopathy of unknown significance)
Exposure to radiation or certain types of pesticides, fertilizers and Agent Orange

What are the symptoms of blood cancer?

Leukemia

Fever, chills and other flu-like symptoms
Weakness and fatigue
Frequent infections
Loss of appetite
Weight loss
Swollen or tender lymph nodes, liver or spleen
Easy bleeding or bruising
Tiny red spots under the skin
Swollen or bleeding gums
Sweating, especially at night
Bone or joint pain
Anemia

Lymphoma

Enlarged lymph nodes
Swollen abdomen (belly)
Feeling full after only a small amount of food
Chest pain or pressure
Shortness of breath or cough
Fever
Weight loss
Night sweats
Fatigue (extreme tiredness)
Low red blood cell counts (anemia)

Myeloma

Bone problems (pain, weakness or fracture)
Low blood counts (Shortages of red blood cells, white blood cells, and blood platelets)
High blood levels of calcium
Nervous system symptoms
Nerve damage (weakness and numbness)
Hyperviscosity (blood is unable to freely flow through the arteries)
Kidney problems

How is blood cancer diagnosed?

Leukemia

Leukemia is either acute or chronic. Acute leukemia is a fast-growing cancer that usually gets worse quickly. Chronic leukemia is a slower-growing cancer that gets worse slowly over time. The treatment and prognosis for leukemia depend on the type of blood cell affected and whether the leukemia is acute or chronic.

Your healthcare provider may do one or more of the following procedures to determine if you have leukemia:

Complete medical history
Physical exam
Blood tests
Imaging tests such as X-rays, ultrasound, CT scan, MRI, bone scan
Bone marrow biopsy
Surgical lymph node biopsy
Lumbar puncture

Lymphoma

Complete medical history
Physical exam
Blood tests
Imaging tests such as X-rays, ultrasound, CT scan, MRI, bone scan
Lymph node biopsy
Lab tests on biopsy samples to classify the type of lymphoma

Myeloma

Lab tests on blood and/or urine
X–rays of the bones
Bone marrow biopsy

How is blood cancer treated?

Some of the treatments for these disorders include chemotherapy, apheresis, and in some hematologic malignancies, stem cell transplant. In addition, therapeutic apheresis procedures are adjunctive treatment for patients with hematological, neuromuscular, renal, rheumatological and autoimmune disorders.

Leukemia

The main type of treatment for leukemia is chemotherapy. This may be used alone or in combination with:

Bone marrow transplants
Radiation therapy
Interferon therapy (immunotherapy)
Surgery-splenectomy (removal of the spleen)

The treatment plan chosen is based on the type of leukemia, the patient’s age, white blood cell count, genetics of the cancer, and whether or not there was a preleukemic condition or a previously treated cancer.

Lymphoma

Standard treatments for both types of lymphoma are chemotherapy, radiation therapy, and stem cell transplant. Additional standard therapies include surgery for Hodgkin lymphoma and targeted therapy, plasmapheresis, watchful waiting and biological therapy for NHL.