Integrative Medicine Blog

A Beginner’s Guide to Blood Cancer

Heidi S. Puc M.D., FACP, ABIHM Saturday, September 10, 2016
Blood cancer

An overview about Blood Cancer.

Well here we are in September already, on the threshold of autumn! September is also the month for “Blood Cancer Awareness”. The term “blood cancer” encompasses many different types of malignancies that can originate from our blood system including leukemias, lymphomas, and multiple myeloma. Leukemias (both acute and chronic forms) are cancers that affect the body’s immature white blood cells, which are mainly found in the bone marrow. Lymphomas are cancers that arise from lymphocytes (a type of white blood cell) that can be present not only in the bone marrow but also in lymph nodes throughout the body and the spleen. Multiple myeloma is a disease originating in cells called plasma cells, located in the bone marrow.

The major types of leukemias are acute myelogenous (AML), acute lymphocytic (ALL), chronic myelogenous (CML), and chronic lymphocytic (CLL), but there are further subclassifications of these types. There are also some disorders related to leukemias that could originate from the bone marrow including myelodysplasias (MDS) and myeloproliferative disorders (MPD). The underlying problem in most of these disorders involves the “crowding out” of normal, healthy bone marrow cells by cancerous stem cells or “progenitor cells”, and the result, depending on the disorder, could be either elevated or low white and red blood cells, or platelets. There is usually immune dysfunction that happens as these cancerous cells can no longer perform their normal immune supportive functions. The acute leukemias grow quickly and suddenly and are immediately life-threatening, whereas the chronic leukemias grow more slowly and are usually not urgently life-threatening.

Lymphomas usually start in the lymph nodes or lymphatic tissue, and are divided into two major groups, known as Hodgkin’s Disease/Lymphoma and non-Hodgkin’s lymphoma. They are further subdivided into B-cell type (more common) and T-cell type (less common). Lymphomas can spread into sites such as the bone marrow, hard bone (cortex), organs (liver, intestines) and brain/spinal fluid, and others.

Multiple myeloma originates in the bone marrow from abnormal B lymphocytes called plasma cells, and these cells no longer produce healthy immune system proteins. These plasma cells can also grow in various parts of the body in large clumps, known as plasmacytomas. The development of multiple myeloma can occur slowly and some patients present to their doctor with early or moderate signs of it’s growth (with either Monoclonal Gammopathy, known as MGUS, or smoldering myeloma). Multiple myeloma can cause destruction of bone cortex and can lead to high blood calcium levels as well as kidney damage.

The signs and symptoms a person may develop with these disorders include some or all of the following, depending on the specific disorder: fatigue, abnormal bleeding or bruising, frequent viral or bacterial infections, bone pain, fever, chills, weight loss, night sweats, swollen lymph nodes, abdominal pain from enlarged liver or spleen, weakness, loss of appetite, skin itching, flulike symptoms, or mouth sores.

The exact causes of these blood cancers is not always clear, but genetic predisposition and exposure to certain environmental factors such as benzene chemicals, excess radiation exposure, pesticides, or viruses may play a role. It is known that infection with HIV increases the risk for non-Hodgkin’s lymphoma by as much as 100 times. Epstein-Barr virus can also increase risk for non-Hodgkin’s lymphoma. Leukemias, lymphomas, myelodysplasias, and myeloproliferative disorders may also occur secondarily after prior treatment of another malignancy with certain chemotherapies or radiation.

Patients suspected to have any of these disorders are referred to a hematologist/oncologist and have a variety of tests performed to confirm the diagnosis and to assess the severity and stage of disease. They will have a history and physical exam, further blood tests, urine tests, possible scans such as chest x-ray, CT, PET, or MRI scans or skeletal x-rays, possible bone marrow biopsy, lymph node biopsy, or spinal tap.

Treatment for the particular blood cancer will depend on the type, as will the urgency of treatment. Acute leukemias, and some lymphomas are immediately life threatening and would require urgent hospital admission and treatment with chemotherapy and/or radiation. Eventually a bone marrow or stem cell transplant may be needed to attempt cure. Other blood cancers can be treated on an outpatient basis with chemotherapy and/or radiation, and referral for bone marrow or stem cell transplant may be needed if remission or cure has not been achieved. All of these blood cancers have differing chemotherapy drugs or regimens that are considered standard, and clinical trials or investigational therapies may be offered. Some of these blood cancers are curable, while others are not curable but treatable, and cure rates may depend on severity of disease and age and general health of the patient.

I hope this overview of blood cancers has raised your awareness of these disorders! Much progress has been made in the treatment of blood cancers through knowledge and research; please be generous in supporting these efforts in your local communities as well as nationally.

Happy Autumn!