What is Blood Cancer?
Blood cancer affects the blood cells. This type of cancer affects how the body produces blood cells and how well the cells function. A majority of blood cancers start in the bone marrow, the sponge-like, soft material in the centre of the bones. Stem cells in the bone marrow mature and develop into three types of cells; red blood cells, white blood cells and platelets. In a majority of blood cancers, the normal process of cell development is interrupted by an abnormal or uncontrolled growth of blood cells, interfering with optimal functioning and production of new blood cells.
Blood Cancer Types
There are three major blood cancer types, each with its subtypes. They can be as follows:
One of the most common types of blood cancer amongst children and teenagers, Leukemia is found in the blood and bone marrow. It is caused by the rapid production of white blood cells, which interferes with the ability of the bone marrow to produce red blood cells and platelets.
The types of Leukemia include:
1. Acute Leukemia
Acute lymphoblastic leukemia: ALL (Acute Lymphocytic Leukemia) is the most common type of cancer in children but can also affect adults. Also, children have a better chance of recovering from ALL as compared to adults.
Acute myeloid leukemia: Acute myeloid leukemia is a rare and aggressive cancer that, if left untreated, may be life-threatening. Typically, AML affects people of the age 60 and older. However, it can be seen in the younger population as well.
2. Chronic Leukemia
Chronic lymphocytic leukemia: CLL (Chronic Lymphocytic Leukemia) is the most common type of leukemia in adults. It happens when the healthy white blood cells (lymphocytes) in the bone marrow mutate into cancerous cells.
Chronic myeloid leukemia: Also known as chronic granulocytic leukemia, CML (Chronic Myeloid Leukemia) is a blood cancer that starts in the blood-forming myeloid cells or stem cells in the bone marrow.
Lymphoma is a blood cancer that affects the lymphatic system (produces immune cells and removes excess fluids from the body). Lymphocytes are a type of white blood cell that fights infection and abnormal lymphocytes become lymphoma cells. These lymphoma cells multiply and collect in the lymph nodes and tissues.
The types of lymphoma include:
1. Non-Hodgkin lymphoma: A blood cancer that develops from cells known as lymphocytes (a type of white blood cell that fights infections in the body) in the lymphatic system .
Follicular lymphoma: A slow growing blood cancer that may be found in the lymph nodes, bone marrow and other organs.
Waldenstrom macroglobulinemia: A rare type of non-Hodgkin lymphoma.
B-cell lymphoma: A common type of non-Hodgkin lymphoma in the lymphatic system. One can have this type of blood cancer for a considerable period of time before developing any symptoms.
Diffuse large B-cell lymphoma: DLBCL is the most common type of non-hodgkin lymphoma. Most often, it forms in the lymph nodes but can also start in other parts of the body. It tends to grow at a fast pace but also responds well to treatment.
2. Hodgkins lymphoma: A blood cancer that develops from lymphocytes in the lymphatic system. Hodgkins lymphoma is characterised by the presence of Reed-Sternberg cell (abnormal lymphocyte).
3. T-cell lymphoma: T-cell lymphoma is a group of rare blood cancers that affect the skin. A majority of cutaneous T-cell lymphomas grow at a very slow pace and are not life-threatening.
Myeloma affects the plasma cells. Plasma cells are white blood cells that generate antibodies and support the body’s immune system. Myeloma cells prevent the normal production of antibodies, leaving the body’s immunity weakened and susceptible to infection. Multiple myeloma cancer begins in the plasma cells and is the most common type of plasma cell disorder.
Symptoms of Blood Cancer
Signs of blood cancer vary based on the type of blood cancer. Here are a few common blood cancer symptoms:
Fatigue: A feeling of extreme tiredness and inability to manage daily life activities.
Persistent fever: A persistent fever is a sign that the body is fighting an infection or responding to abnormal cancer cells.
Drenching night sweats: This is a type of sweating that starts suddenly while sleeping at night.
Unusual bruising or bleeding: Unusual bruises that don’t heal after two weeks or unexpected bleeding that doesn’t stop.
Unexplained weight loss: Unexpected weight loss over a period of 3 to 6 months must be discussed with a healthcare provider.
An enlarged liver/spleen or a swollen lymph node: These symptoms can be signs of lymphoma or leukemia.
Bone pain: Leukemia and myeloma can cause tender spots in the bone or bone pain.
Blood Cancer Stages
Identifying the stages of blood cancer provides important information about the progression of the condition and helps doctors determine the most appropriate line of treatment. Blood cancer stages are divided on the basis of metastasis. They can be described as follows:
Leukemia Staging
There is no staging for leukemia. It is often risk stratified based on genetic markers. This approach helps determine the specific subtypes of leukemia, predict prognosis and tailor treatments. For example, chronic myeloid leukemia (CML) and acute lymphoblastic leukemia (ALL) are both stages of leukemia that do not have traditional stages like I, II, III, and IV.
Chronic lymphocytic leukemia
Staged using the RAI system which considers three main factors: lymphocyte count in the blood, low blood platelet count, the degree of liver, spleen or lymph node enlargement and the presence of anaemia.
Chronic myeloid leukemia
Staged based on the percentage of abnormal blood cells detected in the blood and bone marrow tests. This can be both early stage or advanced stage.
Note: The stages of leukemia alone cannot predict a patient’s treatment outcomes with any degree of uncertainty. Also, there is a range of outcomes for patients diagnosed with the same stage of leukemia.
Lymphoma Staging
The lymphatic system is spread throughout the body, so it is common for lymphoma to be diagnosed at an advanced stage. Lymphoma staging is divided into two parts; early stage and advanced stage lymphoma, with two stages within each classification.
Lymphoma Staging in Adults
Staging of lymphoma in adults is the same for Hodgkins lymphoma and non-Hodgkin lymphoma. The main stages of lymphoma in adults are numbered 1 to 4.
Stage I: Indicates lymphoma in only one group of lymph nodes (glands).
Stage IE: Indicates that lymphoma originated in a single body organ outside the lymphatic system (for example, the liver).
Note: The letter E used to describe the lymphoma stages refers to “extranodal” (lymphoma that started in a body organ that is not a part of the lymphatic system).
Stage II: Indicates lymphoma in two or more groups of lymph nodes or the same side of diaphragm.
Stage IIE: Indicates that lymphoma originated in a body organ outside the lymphatic system and in one or more groups of lymph nodes.
Stage III: Indicates there are lymph nodes containing lymphoma on both the sides of the diaphragm.
Stage IV: It is the most advanced stage of lymphoma involving multiple organs.
Multiple Myeloma Staging
The stage of myeloma indicates how it is affecting the patient and how it might develop. Staging is based on certain biochemical parameters like albumin, beta 2 microglobulin, LDH and high risk cytogenetics.
Blood Cancer Diagnosis
A healthcare provider may begin the diagnosis of blood cancer by discussing symptoms and medical history. The tests used to diagnose blood cancer include:
Complete blood count (CBC)
This test measures and counts the blood cells. For example, if a healthcare provider suspects leukemia, they’ll look for high or low white blood cell counts and lower than normal platelet and red blood cell count.
Blood chemistry test
This test measures biomolecules or electrolytes in the blood. In some cases, a doctor may order specific blood tests for cancer to learn more about the condition. These tests may include CBC (Complete Blood Count), tumor marker blood tests, blood protein tests and CTC (circulating tumor cell tests).
Computed Tomography (CT) scan
This test uses a series of X-rays and computed technology to create 3-D images of soft tissues and bones. If a doctor suspects myeloma, a CT scan may be recommended to detect bone damage.
Magnetic Resonance Imaging (MRI) scan
An MRI scan helps detect signs of leukemia, myeloma and lymphoma complications affecting the spine.
Positron Emission Tomography (PET) scan
This test produces images of organs and tissues to identify signs of myeloma or lymphoma.
Bone marrow biopsies
A bone marrow biopsy analyses the percentage of normal and abnormal blood cells in the bone marrow. This type of biopsy may also test the bone marrow for changes in DNA that can potentially drive cancer growth.
Lymph Node Biopsy
Lymphadenectomy, also known as lymph node dissection is a surgical procedure in which the lymph nodes are dissected and a sample of tissue is analysed for malignancy under the microscope. It is performed as part of the surgical management of blood cancers.
Blood cell examination
A blood cell examination examines changes in the appearance of blood cells. For example, a doctor may order a peripheral smear test to detect signs of lymphoma or leukemia.
Blood Cancer Treatment
Treatment Therapies for Blood Cancer
Blood cancer treatment therapies can be as follows:
Chemotherapy
This treatment uses anticancer drugs designed to destroy cancer cells. Some blood cancers may also be treated with a combination of stem cell transplantation, radiation therapy, and chemotherapy.
Radiation therapy
In this type of treatment therapy, high energy X-rays or other radiations are used to destroy cancer cells. Radiation therapy for blood cancer treatment can be part of a larger treatment plan used along with immunotherapy and chemotherapy to ease symptoms of blood cancer. The most commonly used radiation therapy for blood cancers is EBRT (external beam radiation therapy). Radio-immunotherapy may also be used to treat some blood cancers.
Targeted therapy
Targeted therapy aims to interfere with the growth of cancer cells. Different types of blood cancers have different targets and patients may undergo tests to determine genes, proteins and other factors in the cancer cells. Based on these tests, the most appropriate treatment is chosen. Targeted therapy can be a standalone treatment or may be combined with chemotherapy. Targeted therapies may include tyrosine kinase inhibitors (TKIs), T-cell therapy and monoclonal antibodies.
Blood cancer bone marrow transplant (stem cell transplantation)
During a blood marrow transplant, healthy stem cells may be infused into the patient’s body. The aim of this type of treatment is to resume the production of healthy blood cells. Stem cell transplantation is often used after radiation therapy or chemotherapy to consolidate treatment and prevent relapse.
Immunotherapy
During immunotherapy, patients are given medicines to boost the immune system and successfully recognize and destroy cancer cells. Different types of immunotherapy include T cell therapy, donor lymphocyte infusion, cytokine treatment, radio-immunotherapy and monoclonal antibody treatment.
Supportive therapies
Supportive therapies such as antibiotics, growth factors, blood transfusions may be used to manage symptoms and side effects of blood cancer treatment and support the overall well-being of the patient. The goal of this type of blood cancer treatment is to manage symptoms, achieve remission and improve quality of life.
Surgical Treatment for Blood Cancer
Splenectomy
The spleen plays an essential role in the immune system, filtering blood and fighting infections. Splenectomy is a surgical procedure employed to remove spleen and treat certain blood cancers and other blood disorders. It can be performed via robotic-assisted or open laparoscopic techniques.
Conclusion
Blood cancer is one of the most aggressive and most treatable types of cancer. Blood cancer cure rates are higher than 80% in most leukemias and lymphomas and many other types of blood cancers like myeloma can be controlled with medications. With the introduction of new therapies like immunotherapy and CAR-T, the treatment outcomes have improved even more. Furthermore, it is important to recognise symptoms and start treatment at an early stage to improve outcomes.
FAQs
Is blood cancer curable?
Yes, blood cancer can be cured. Most often, the goal of blood cancer treatment is curing the condition. In situations where curing cancer isn’t possible, there are several treatments that put some blood cancers into remission. Remission means that the treatments used eliminate the signs and symptoms for a long time.
How to prevent blood cancer?
Even though the cause of many blood cancers is unknown, here are a few ways to reduce the risk of blood cancers:
Avoid excessive exposure to radiation, chemicals such as benzene or pesticides and to tobacco or smoking in any form. Additionally, healthy lifestyle behaviours, such as staying active and eating a balanced diet can help reduce the risk of developing a variety of cancers.
Which blood cancer is the most dangerous?
AML (Acute myeloid leukemia) is one of the most dangerous types of blood cancer and can be life-threatening if left untreated.
Is blood cancer genetic?
In some cases, blood cancers like leukemia, lymphoma and multiple myeloma are related to inherited genetic factors. Among these, the genes responsible for inherited forms of acute leukemia are the best characterised.
What are the causes of blood cancer?
Blood cancer is caused by mutations (changes) in the DNA within the blood cells. This causes the blood cells to grow abnormally. In a majority of cases, these mutations are linked to factors that can’t be controlled. When a cancer is diagnosed in the blood, it is usually due to an abnormal and excessive reproduction of WBCs (white blood cells).
Can blood cancer be detected early?
A majority of blood cancers don’t show up in routine blood tests. However, specialised blood tests can help detect cancers at an early stage. For example, the Galleri test can help diagnose over 50 different types of cancers. Early diagnosis of blood cancer can lead to more effective treatment. 
