Blood Cancer

What is blood cancer?

Blood cancers are different from most cancers. In most cancers, abnormal cells grow even though your body doesn’t need them forming a lump or mass called a tumor. However, blood cancer forms in the bone marrow, which is the thick, spongy liquid inside your bones. This is where new blood cells are made.

Overview

What are the blood cancer types?

Blood cancers include:

• Leukemia forms when white cells grow uncontrollably, mature improperly or chronically increase. Leukemias are also grouped based on how fast they grow.
• Acute leukemias: These grow fast and get worse very quickly.
• Chronic leukemias: These tend to be slow growing but may get worse over time.
• Lymphomas cause a dangerous increase in cells the bone marrow, lymph glands, liver and spleen. Lymphomas affect immunity, which increases the risk of infection.
• Multiple myeloma is the increase of plasma cells, which causes bone destruction. Patients end up with fractures and elevated calcium levels.

Symptoms

What are the signs and symptoms of blood cancer?

Signs of blood cancer vary depending on the type of disease.

Blood cancer symptoms include:

• Bleeding easily
• Blurred vision
• Bone pain
• Bruising easily
• Bruises that don’t heal
• Chest pain
• Dizziness
• Excessive sweating or night sweats
• Fatigue
• Fever or chills
• Frequent infections
• Frequent nose bleeds
• Headaches
• Loss of appetite
• Pale skin
• Shortness of breath
• Swollen lymph nodes in the groin, neck, stomach or underarm
• Tiny red patches under the skin
• Unexplained weight loss

Risk Factors

What causes blood cancer?

Anyone can get leukemia. Most people with leukemia don't know what caused it. Many have no risk factors. But here are some known risk factors for leukemia:

• Smoking: People who smoke are more likely to get acute myeloid leukemia (AML) than people who do not smoke.
• Exposure to certain chemicals: Being exposed to certain chemicals has been linked with some types of leukemia. For example, exposure to benzene is a risk factor for AML. It may also be a risk factor for acute lymphocytic leukemia (ALL). Benzene may be used in the rubber industry, oil refineries, chemical plants, and manufacturing. It is also in cigarette smoke, vehicle exhaust and certain cleaning products, art supplies and paints. Exposure to Agent Orange, an herbicide used in the Vietnam War, has been linked to an increased risk for chronic lymphocytic leukemia (CLL).
• Chemotherapy in the past: People who get certain chemotherapy medicines to treat other cancers are more likely to get AML or ALL later on. A person's risk for leukemia is higher for a number of years after the first cancer is treated. But this small increased risk of developing leukemia later on does not outweigh the need to use these medicines to treat the cancer.
• Radiation exposure: High doses of radiation raise a person's risk for AML, ALL and chronic myeloid leukemia. This exposure could be from an atomic bomb blast or a nuclear reactor accident. It could also be from radiation therapy used to treat another type of cancer.
• Rare congenital diseases: A small number of people are at greater risk for AML and ALL because they have certain rare diseases from the time they are born. For example, people with Down syndrome, ataxia-telangiectasia and Bloom syndrome have an increased risk of getting acute leukemias.
• Certain blood disorders: People who have certain blood diseases are more likely to get AML. These diseases include myelodysplastic syndromes.
• Family history: Most people who get leukemia don't have a family history of it. But people with a close relative (parent, sibling or child) who have AML or CLL may be at increased risk.
• Age: Most types of leukemia, especially chronic leukemias, become more common as people get older. But ALL is more common in children than in adults.
• Gender: Most types of leukemia are slightly more common in males than in females.

Prevention

How to prevent blood cancer

Anyone can get blood cancer. But you can help prevent getting cancer by keeping a healthy lifestyle.

• Avoid tobacco and alcohol
• Avoid cancer-causing agents and chemicals
• Eat a healthy diet
• Maintain a healthy weight
• Stay active – 30 minutes of activity five days a week
• Stay up to date on cancer screenings and vaccines
• Talk to your health care provider immediately if anything changes in your health

Diagnosis

How is blood cancer diagnosed?

You may have one or more of these tests:

• Blood tests: These are often the first tests done. Blood is taken from your arm or hand with a small needle. The blood is then sent to a lab and tested.
• Bone marrow aspiration and biopsy: This procedure is done by taking out small amounts of bone marrow. Bone marrow samples are usually taken from the back of the hip bone. First, the aspiration is done. An area over the back of your hip is numbed. A long, hollow needle is then put through your skin and into your hip bone. A syringe is used to pull out a small amount of liquid bone marrow. You may have some brief pain when the marrow is removed. A bone marrow biopsy is usually done right after the aspiration. A small piece of bone and marrow is removed with a slightly larger needle that's pushed down into the bone. The biopsy may also cause some brief pain. The bone marrow is then checked for leukemia cells and tested.
• Spinal tap: This procedure is done to look for leukemia cells in your spinal fluid. It's done by putting a thin needle in the space between two bones of your spine to take out a small amount of fluid. Numbing medicine is used to make it more comfortable for you.

How blood or bone marrow is tested?

The tests done on blood or bone marrow samples may include:

• Complete blood count (CBC): This is often the first test done. It measures the numbers of different types of cells in your blood.
• Immunophenotyping: These tests are done on blood, bone marrow or both. They measure the types and amounts of proteins called antigens on or in the leukemia cells. It takes a few days to get the results of these tests.
• Cytogenetics: For this test, cells are grown in a lab for a week or more. The chromosomes inside the cells are then stained with special dyes and viewed with a microscope. Major changes in the chromosomes can often be seen with this test. But smaller changes may not be visible.
• Fluorescence in situ hybridization (FISH): This test is used to find abnormal changes in the chromosomes and genes of leukemia cells. The cells in the sample are stained with fluorescent dyes that will only attach to certain parts of chromosomes. The cells are then viewed with a microscope using a special light. This test can find some abnormal chromosome and gene changes that can't be seen with standard cytogenetic testing. It's also a quicker test.
• Polymerase chain reaction (PCR): This is a very sensitive test that can find and measure some genetic mutations and chromosomal changes that are too small to be seen with a microscope. PCR testing increases or amplifies the amount of genetic material in a sample so that it can be easier to find. This test can find small levels of genetic or chromosomal changes that other tests can’t find. This test may be done on bone marrow or a blood sample.

Finding the gene changes can help decide your treatment. For instance, about one out of four people with blood cancer have the Philadelphia chromosome in their leukemia cells. This chromosome contains the abnormal gene BCR-ABL1 that helps the leukemia cells grow. Those leukemia cells can be treated with medicines that target cells with this gene change.

Treatment

How is blood cancer treated?

• Chemotherapy: Chemotherapy is the main way to treat blood cancers. The goal is to kill the cancer cells quickly and put the cancer into remission. Remission means there are no signs of cancer in your body.
• Radiation therapy: This type of treatment uses high-energy X-rays to kill cancer cells. It may be used to kill or prevent the spread of cancer in your central nervous system (brain and spine). It may be used as part of a stem cell transplant. In rare cases, it may be done to shrink a tumor that's affecting a certain part of your body.
• Stem cell transplant with high-dose chemotherapy: If the normal doses of chemotherapy don't work, you may need very high doses of chemo. These high doses can damage the stem cells in your bone marrow. Blood stem cells are the "starter" cells for new blood cells. Sometimes, high-dose chemotherapy is used to kill all your stem cells. Then you're given stem cells from a volunteer donor. Over time, they go into your bone marrow and restore your body's ability to make blood cells. This is called a stem cell transplant.
• Targeted therapy: These medicines target certain abnormal proteins on cancer cells. They're taken daily as pills. The success rate of targeted therapy for chronic myeloid leukemia, for example, has been so good that we see better results without chemotherapy in these patients.
• Immunotherapy with antibodies: These medicines are manmade substances that are like the ones your immune system makes. They help your immune system find and kill lymphoma cells. Immunotherapy medicines can also be attached to a radioactive molecule, called radioimmunotherapy. The immunotherapy medicine then binds the radiation right to the lymphoma cell. This limits radiation damage to other cells.

What is the blood cancer survival rate?

Survival rates vary depending on the type of blood cancer. Leukemia has a five-year survival rate of about 65%, myeloma has a five-year survival rate of about 55% and lymphomas have a five-year survival rate between 90-95%. The survival rate continues to increase as more research is done.

Is blood cancer curable?

Catching it early can make blood cancer more easily curable.