Blood Cancer (Leukemia, Lymphoma, Myeloma)

Posted By: Pankaj Patel

Blood cancer is a form of cancer which attacks the blood, bone marrow, or lymphatic system. This group includes cancers of the bone marrow, blood, and lymphatic system, which includes lymph nodes, lymphatic vessels, tonsils, thymus, spleen, and digestive tract lymphoid tissue. Leukemia and myeloma, which start in the bone marrow, and lymphoma, which starts in the lymphatic system, are the most common types of blood cancer. What causes these cancers is not known.

There are three main groups of blood cancers:

1. Leukemia
2. Lymphoma
3. Multiple Myeloma

These malignancies have varying prognoses, depending on the patient and the specifics of the condition, but overall survival rates with blood cancer increased radically in the late 20th century with the development of advanced treatments. When caught early, blood cancer can be very manageable in some cases, which is one very good reason to make regular trips to the doctor a priority for people of all ages. In the case of leukemia, the cancer interferes with the body's ability to make blood. Leukemia attacks the bone marrow and the blood itself, causing fatigue, anemia, weakness, and bone pain. It is diagnosed with a blood test in which specific types of blood cells are counted. Treatment for leukemia usually includes chemotherapy and radiation to kill the cancer, and in some cases measures like bone marrow transplants may be required. There are several different types of leukemia, including chronic myelogenous leukemia, acute lymphoblastic leukemia, and hairy cell leukemia.

Leukemia:

Leukemia, a type of cancer found in your blood and bone marrow, is caused by the rapid production of abnormal white blood cells. The high number of abnormal white blood cells are not able to fight infection, and they impair the ability of the bone marrow to produce red blood cells and platelets.

There are four main types of leukemia (and several other less common types):

• Acute lymphocytic (or lymphblastic) leukemia ALL): The most common cancer in children, is highly curable with modern-day chemotherapy.
• Acute myelogenous leukemia (AML): Most commonly affects those over 60 years of age but can occur in younger people. Requires intensive chemotherapy and often an allogeneic stem-cell transplant (blood stem cells from another individual) to be cured. New strategies are desperately needed for older individuals who cannot tolerate the standard, intensive approach.
• CLL: Can be detected incidentally (example above) if not causing symptoms or when it presents aggressively with enlarged lymph nodes, a very high white blood cell count (the malignant lymphocytes), and profound fatigue. Those who have symptoms due to CLL require treatment, often a combination of chemotherapy and an immune therapy. Younger patients may require a stem-cell transplant for cure. Several newer therapies in the advanced stages of research (such as the drug PCI-32765) will likely revolutionize the treatment of this disease.
• Chronic Myelogenous Leukemia (CML): The treatment of this previously fatal form of leukemia was revolutionized by the development of the drug imatinib, followed by nilotinib and dasatinib. These pills, which are very well tolerated, drive the leukemia into remission in the vast majority of patients.

Lymphoma:

Lymphoma is a type of blood cancer that affects the lymphatic system, which removes excess fluids from your body and produces immune cells. Lymphocytes are a type of white blood cell that fight infection. Abnormal lymphocytes become lymphoma cells, which multiply and collect in your lymph nodes and other tissues. Over time, these cancerous cells impair your immune system.

There are two main types of lymphoma, Hodgkin’s and non-Hodgkin’s, which are distinguishable by their appearance under the microscope to a pathologist examining a lymph node biopsy (most commonly). Hodgkin’s and 85% of non-Hodgkin’s lymphoma (NHL) are caused by the abnormal proliferation of an immune cell called a B-lymphocyte; 15% of NHLs are of T-cell origin. There are only a few types of HL whereas there are over 30 types of NHL. A precise diagnosis may require a second opinion on the pathology specimen. Treatments may range from observation to well-tolerated immune therapies (such as rituximab, which has revolutionized the treatment of NHL) to intensive chemotherapy and even a stem-cell transplant (using the patient’s own stem cells, called an autologous transplant, or an allogeneic transplant, depending on the situation). The evaluation of a patient with lymphoma will also involve CAT scans and often a PET scan.

Multiple Myeloma:

Myeloma is a type of blood cancer that specifically targets your plasma cells. Plasma cells are white blood cells that produce disease- and infection-fighting antibodies in your body. Myeloma cells prevent the normal production of antibodies, leaving your body’s immune system weakened and susceptible to infection.

This very complicated blood cancer is caused by the overgrowth in the bone marrow of an immune cell called a plasma cell, which secretes a protein into the bloodstream, called an “M-protein,” that can be detected by a test called an immunoelectrophoresis. The malignant plasma cells can also burrow into the hard bones of the body to cause little holes called “lytic lesions” that can weaken the bones and cause them to fracture. A revolution in the treatment of this cancer has occurred in the last 10 years with the introduction of an autologous stem cell transplant and new drugs such as lenalidomide (Revlimid) and bortezomib (Velcade).

Symptoms of blood cancer

Blood cancer can produce a variety of symptoms, or none at all.

Common symptoms of blood cancer:

• Abdominal pain, especially in the upper abdomen
• Bone or joint pain
• Easy bleeding or bruising
• Enlarged liver and glands, such as the spleen and lymph nodes
• Fatigue
• Fever and chills
• Frequent infections
• Frequent urination
• Nausea, which may be described as feelings of wooziness, queasiness, retching, sea-sickness, car-sickness or upset stomach
• Night sweats
• Unexplained weight loss

Serious symptoms that might indicate a life-threatening condition

In some cases, blood cancer can be life threatening, especially if severe infections or uncontrollable bleeding occur. Seek immediate medical care if you, or someone you are with, have any of these life-threatening symptoms including:

• Bluish coloration of the lips or fingernails
• Change in level of consciousness or alertness, such as passing out or unresponsiveness
• Change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations and delusions
• Chest pain, chest tightness, chest pressure, palpitations
• High fever (higher than 101 degrees Fahrenheit)
• Rapid heart rate (tachycardia)
• Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing, wheezing
• Seizure
• Severe abdominal pain
• Uncontrolled or heavy bleeding

Causes of blood cancer

Although the specific cause of blood cancer is not known, a number of factors are associated with its development. Many blood cancers are more common among older adults. Some tend to run in families. Certain infections also appear to increase the risk of some blood cancers, as does a weakened immune system.

Risk factors for blood cancer

A number of factors increase the risk of developing blood cancer. Not all people with risk factors will get blood cancer. Risk factors for blood cancer include:

• Advanced age
• Certain types of infections
• Compromised immune system due to such conditions as HIV/AIDS, taking corticosteroids, or organ transplant
• Exposure to certain chemicals
• Exposure to radiation or certain types of chemotherapy
• Family history of blood cancer
• Personal history of certain blood disorders
• Personal history of certain genetic disorders
• Smoking

How to treat blood cancer?

The goal of blood cancer treatment is to permanently cure the cancer or to bring about a complete remission of the disease. Remission means that there is no longer any sign of the disease in the body, although it may recur or relapse later.

Some blood cancers grow slowly enough that delaying treatment may be an option. If the decision to delay treatment is made, close follow-up, called watchful waiting, is needed so that significant progression can be identified and treatments can be started when needed.

Common Treatments for blood cancer:

• Biological therapy to attack cancer cells
• Chemotherapy to attack cancer cells
• Participation in a clinical trial testing promising new treatments for blood cancers
• Radiation therapy to attack cancer cells
• Stem cell transplant to provide healthy stem cells that can make healthy blood cells
• Targeted therapy to attack cancer cells
• Watchful waiting to identify when to start treatment

Other treatments for blood cancer:

Other therapies may be added to help with your general state of health and any complications of the cancer or its treatment including:

• Anti-nausea medications if needed
• Antibiotics and other medications to reduce the likelihood of getting infections
• Blood transfusions to temporarily replace blood components (such as red blood cells or platelets)
• Dental care to manage oral symptoms of leukemia or chemotherapy
• Dietary counseling to help people with cancer maintain their strength and nutritional status
• Pain medications if needed to increase comfort
• Surgery to remove an enlarged spleen or to treat bone fractures
• Vaccinations to prevent diseases like the flu and pneumonia

Complementary treatments:

Some complementary treatments may help some people to better deal with blood cancer and its treatments. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for full medical care.

• Complementary treatments may include:
• Acupuncture
• Massage therapy
• Yoga

Hospice care:

In cases in which blood cancer has progressed to an advanced stage and has become unresponsive to treatment, the goal of treatment may shift away from curing the disease and focus on measures to keep a person comfortable and maximize the quality of life. Hospice care involves medically controlling pain and other symptoms while providing psychological and spiritual support as well as services to support the patient’s family.

Potential complications of blood cancer:

Complications of untreated or poorly controlled blood cancer can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of blood cancer include:

• Amyloidosis (rare immune-related disorder characterized by protein buildup in organs and tissues that can cause serious complications)
• Anemia (low red blood cell count)
• Broken bones
• Hypercalcemia (increased calcium in the blood)
• Hyperviscosity syndrome (thickened blood that is difficult for the heart to pump)
• Immune deficiency and frequent Infections
• Jaundice (yellowing of the skin and whites of the eyes)
• Kidney failure
• Peripheral neuropathy (disorder that causes dysfunction of nerves that lie outside your brain and spinal cord)
• Spread of cancer