What is Blood Cancer?

Blood cancer itself is not a single disease but an umbrella term for several types of cancers. As the word suggests, it means cancers relating to the blood, any cancer that affects the production and function of blood is classified as a blood cancer. Blood cells are produced in the hollow of our bones in a soft gel like tissue called bone marrow. The formation development and differentiation of blood cells happens here due to a process known as hematopoiesis.

Strictly speaking, there are two distinct types of blood cancers, depending on the type of blood cells affected by cancer:

• Leukemia- the cancer of the white blood cells
• Myeloma- the cancer of plasma cells

Leukemia:

Leukemia is caused by the rapid production of abnormal white blood cells due to which they cannot fight infections properly. This early production means crowding of the bone marrow, which impairs the ability of the bone marrow to produce red blood cells and platelets. It is classified as two types based on the progression of cancer- acute and chronic. The severe type spreads very fast and requires immediate treatment. Leukemia is divided further depending on the cells affected, myeloid, or lymphoid. So leukemia is of four types by the different combinations possible.

1. Acute Lymphocytic Leukemia (ALL)
2. Acute Myelogenous Leukemia (AML)
3. Chronic Lymphocytic Leukemia (CLL) and
4. Chronic Myelogenous Leukemia (CML)

Leukemia can occur in both adults and children, ALL followed by AML are the most common in children, whereas adults are more prone to AML and CML types.

Myeloma:

Cancer in plasma cells is called myeloma. Plasma cells are a type of white blood cell, which is responsible for producing antibodies in our body that help in the identification of infectious germs and foreign entities in the body. In myeloma, the plasma cells multiply and crowd the bone marrow, and that affects the blood cell production in the bone marrow. Myeloma can develop in any location where there is blood plasma, as it can occur at multiple places; it is also called multiple myeloma.

Myeloma cells continue to produce antibodies, too, only dysfunctional ones that can affect the functioning of the organs such as kidneys. The dysfunctional antibodies or proteins are called monoclonal proteins or M-proteins. Myeloma inhibits the body’s ability to fight infections causing frequent illness. Bone weakness or breaking of bones is also likely as the growing tumor erodes the bone structure.

Read risk factors, symptoms, diagnosis and treatment for Leukemia & Myeloma here.

What happens in Blood Cancer:

Cell division is a process fundamental to all life forms; it is essential for growth, and for replacing old and worn-out cells. Cancer is a condition where cells of a certain tissue start growing uncontrollably. The same happens in blood cancer too. Blood cancers, as is evident from the name, are the cancers of the blood cells.

Blood cells are of three main types- red blood cells, white blood cells, and platelets, which carry out different functions. The blood cells, in most of the cases, the white blood cells start multiplying rapidly. The consequences of this are twofold:

• The cancerous cells divide faster than the healthy cells, and as a result, they crowd the bone marrow. This implies a decrease in the production of healthy red blood cells and platelets.
• The cancerous cells which grow in numbers, do not function like they normally should. Meaning these cells do not support our body like they normally do.

Symptoms of Blood Cancer:

The symptoms of blood cancer may often be ignored or overlooked. This is because they are nonspecific and can be usually explained by flu or other common illnesses. But one must consult a doctor if any of the symptoms persist, and early diagnosis of blood cancer is essential for recovery.

The symptoms of blood cancer are because of the imbalance in the volumes of different types of blood cells. The manifestation of these symptoms depends on the type of blood cancer, the stage of cancer in the person, the progression (acute or chronic), and even differs from person to person.

• Anemia
• Thrombocytopenia
• Swelling of Lymph nodes
• Unexplained weight loss
• Swelling of liver or spleen
• Fever or infections
• Pain in the bone
• Night sweats

It is not possible to determine the exact reason why a person develops blood cancer. Research shows that certain factors could increase a person’s chance of developing this cancer. Risk factors are the identified characteristics that have higher probabilities of developing a cancer. There are many different types of blood cancers, while each has its own set of risk factors, there are a few common factors as well.

Chemical exposure:

The most common and dangerous chemical which can cause blood cancer is benzene. Exposure to heavy factory smoke and chemicals, formaldehyde etc., can also lead to blood cancer. Air is the medium through which people are exposed to these chemicals and breathing intoxicated air makes the person more vulnerable to blood cancer. Certain drugs used in treating cancer, especially those of chemotherapy can increase a person’s risk of developing blood cancer too.

Radiation exposure:

Blood cancer can also happen because of exposure to radiation. Radiation of certain wavelength can destroy the DNA and can cause cancer. Higher the dose of radiation, greater the risk of developing blood cancer. Exposure to radiation as a part of radiotherapy to cure cancers and to imaging tests can increase the risk of developing blood cancer. Also, exposure to radiation in the environment will have an impact in developing the disease. The most dangerous instance that has happened in this case was the atomic bomb blast in Japan. The exposure to heavy radiation in this region post the atomic blast has caused blood cancer in many people.

Chronic inflammation:

Inflammation is generally a normal physiological response of the body to any injury caused to tissue. The process starts when the damaged tissue release chemicals, that cause the cells to divide and grow which helps in rebuilding the tissue. This helps in speed recovery of the injury. The inflammatory procedure ends when the injury is healed. Infections that do subside cause chronic inflammations. Abnormal immune reactions to normal tissues or obesity can also lead to inflammations.

Chronic inflammation can cause DNA damage and lead to cancer. It is important to determine why and where the inflammation has occurred and which type of inflammation it is. This information contributes to the detection and diagnosis of blood cancer. The contribution of the inflammation and its causes to physiological process (such as wound healing) also plays a vital role in detecting cancer.

Genetics:

There are some symptoms which are inherited syndromes. These syndromes directly impact higher possibilities of developing cancer. They include Fanconi anemia, Bloom syndrome, ataxia-telangiectasia, down syndrome and a few more.

• Fanconi Anemia: 

Fanconi anemia is an inherited disease which leads to bone marrow failure. FA restricts the bone marrow from making new blood cells for the normal functioning of the body. It also causes the bone marrow to make faulty blood cells and can lead to blood cancer.

• Bloom syndrome:

Bloom syndrome is a very rare genetic disorder characterized by small dilated blood vessels over the nose and cheeks, and deficiencies which cause many types of blood cancers.

• Down syndrome:

People, especially children with Down syndrome have a higher risk of inheriting blood cancer. Here, patients having abnormalities that affect the production of blood cells. They then develop blood cancer because of these abnormalities. These people have an extra section of DNA known as chromosome 21 and hence an extra copy of Erg Gene.

• Ataxia-telangiectasia (AT) :

AT is a very rare inherited disease which generally affects the nervous system and the circulatory system. Mutations in specific areas of the DNA cause AT due to an alteration in a specific gene known as ATM. The condition occurs when a person inherits two non-working copies of a gene. A person who inherits only one non-working gene copy is a carrier. This gene is an ability to produce enzymes, which can restrict cell growth and promote cell death.

• Smoking:

This is one of the most crucial risk factors for blood cancer. The wide belief is that smoking causes lung or mouth cancer only, but it is one of the major contributors for blood cancer too. The tobacco can severely damage or change the DNA of blood cells which leads abnormal growth and malfunctioning of the cell causing blood cancer. It can also reduces the body’s immunity, making the body more prone to attacks. Continuing to smoke in spite of having cancer leads to an enormous growth in the cancerous cells.

• Diet:

Today, more than 50% of the world’s population do not follow a nutritious diet, a few foods, however, increase the risk of cancer. They are as follows:

• Processed meat
• Microwave popcorn
• Aerated drinks
• Diet food and beverages
• Refined flour
• Refined sugars
• Dirty fruits and vegetables
• Farmed salmon
• Hydrogenated oils

Stage refers to the extent of cancer. For anyone diagnosed with cancer, making an educated treatment decision is significant and it begins by identifying the stage or progression of blood cancer. One of the most important factors, however, that help you to identify the correct treatment option is to be sure of the stage of blood cancer. Most of the cancers are staged based on their size and spread of tumors. But unlike other cancers, blood cancer occurs within the bone marrow, within the developing blood cells and this makes it a unique case, where staging occurs differently. The stages of leukemia are hence categorized by the blood cell counts and accumulation of these cells within other organs like liver, spleen etc. To analyze and determine these stages, doctors often order X-Rays, lab tests, and other screening procedures for diagnosis of blood cancer.

Chronic Lymphocytic Leukemia Staging:

Staging is crucial factor to decide the course of treatment of cancer. Usually blood cancers are staged on the basis of size of tumour and its spreading, but that approach does not work for leukemias as these are the cancers in the bone marrow and formation of cancerous tumour is rare for these. Different leukemias have different staging systems too. CLL has two staging systems- Rai and Binet, the former being more common in the US and the latter preferred in Europe.

Rai staging system:

This system divides the cancer into five stages and three factors determine the stage of CLL- whether or not the lymph nodes, spleen etc are enlarged, the total number of lymphocytes in the blood and if anemia or other disorder is present. The stages are Rai Stage 0 to Rai Stage IV.

Binet staging system:

This system differs from the one above as it takes into account how many types of lymphoid tissues are affected. The stages are commonly called clinical stages:

• Clinical stage A
• Clinical stage B
• Clinical stage C

Stage A is marked by less than 3 organs affected by CLL, Stage B more than three organs affected and Stage C is marked by presence of anemia and/or thrombocytopenia. Read more about Chronic Lymphocytic Leukemia.

Multiple Myeloma Stages:

There are two major conventions of staging myeloma and both of them give three stages of the disease but take different factors into consideration. They are:

International Staging System: In this, the stages are marked by the levels of albumin and microglobulin in the blood. This system is based on more than 10,000 cancer cases.
Durie-Salmon Staging: This system marks the stages depending on several factors- level of cancerous cells, damaged caused to the bone, levels of M protein, calcium levels in the blood, albumin and hemoglobin levels. Also, there is further classification based on whether or not there is kidney damage (Group A indicating normal kidney function, B indicating abnormality, for example: Stage IA)

Types Of Stages In Multiple Myeloma:

There are several classification based on several factors- the stage of myeloma, the symptoms shown by the patient, the presence of symptoms itself, etc. Here are a few to indicate the terminology surrounding the types of myeloma.

1. Asymptomatic and symptomatic:

As the name suggests, in asymptomatic, the patient shows no symptoms in terms of damaging the body. The cancer can be stable at this stage or advance further into symptomatic myeloma. Asymptomatic is also called smoldering or indolent myeloma. Symptomatic myeloma is active and shows significant damage to the organs

1. Hyperdiploid and Hypodiploid:

Another type of classification, based on the chromosome number in the myeloma cells. Hyperdiploid indicates that myeloma cells have more chromosomes than normal and there are less chromosomes in hypodiploid myeloma when compared to normal. Hyperdiploid is less aggressive than hypodiploid.

Read more about Multiple Myeloma

Blood cancer is a disorder that affects the blood and the bone marrow. In majority of the cases, the development of red blood cells is restricted while in cancer there is an uncontrolled division of cells, These cancer cells interrupt the functioning of the normal cells and the cells cannot defend against foreign bodies or form a clot to stop bleeding. Immediately after the patient recognizes the symptoms, an attempt for earlier diagnosis needs to be made. Depending upon the different stages of blood cancer, age and tolerance levels of the patient towards the treatment and side effects, the oncologist has to decide the treatment.

A few most common symptoms that can be observed easily are:

• Anemia: When the red blood cells in a person’s body do not function normally or there is a decrease in the count of blood cells, it manifests as anemia. Anemia leads to shortness of breath, dizziness, chest pain, pale skin and feeling weak.
• Poor clotting: A decrease in the platelet count can lead to poor clotting, as platelet cells help in clotting wounds. This can lead to unusual bruising, bleeding gums and heavy periods.
• Infections: Frequent repetition of infections also should not be ignored. This repetition depicts the weakening of the white blood cells.

If any of these symptoms are observed, consulting a doctor immediately is advised.
The doctor may then examine your health condition for a few days and then suggest tests to determine if it’s cancer or not.

The most common tests used to diagnose blood cancer are:

Complete blood count

This blood test measures the concentration of various types of blood cells-red blood cells, white blood cells and platelet cell count, in the given sample. Any abnormalities in the blood cells or their concentration can be determined using this test. Bone marrow biopsy may help in confirming this diagnosis.

1. White blood cells: These cells protect the body from dangerous foreign bodies, virus and infections, that could harm the body. Higher or lower white blood cell count than the normal value may imply that the person has blood cancer.

2. Red blood cells: These cells carry oxygen throughout the body and decrease in the count of RBCs or the content of hemoglobin (the red pigment in RBC) is called anemia. This can happen not just in case of blood cancer though, some anticancer treatments like chemotherapy and radiotherapy can cause a decrease in the red blood cell count. Post blood loss during any surgery or treatment is generally followed by blood transfusion.

3. Platelets: Platelets help in blood clotting. Blood cancer or other cancers that have spread to the bone marrow lead to a decrease in the platelet count. Anticancer treatments can also lead to a decrease in the concentration of the platelets. In case of severe loss of platelets, platelet transfusion may be required.

Bone marrow biopsy/aspiration

Removal of bone marrow sample for testing is called bone marrow biopsy or aspiration, the difference being the follows:

• Bone marrow aspiration: Extracting a liquid bone marrow sample.
• Bone marrow biopsy: Removing a small amount of bone marrow tissue.

It is used to determine if the cancer is affecting the bone marrow, the type of blood cancer, the stage or severity of the disease. Changes in blood cells that are not detected in complete blood count can be detected using this test.

Both the tests are performed at the same time under medical surveillance. The main purpose of this test is to confirm blood cancers and bone marrow disorders, detect any DNA abnormalities in the sample. Post anticancer treatments, this is used to check the progress of the treatment and evaluate the patient’s tolerance.

Lymph Node biopsy

Blood cancer affects the blood cells which in turn means that the immune system completely gets affected. The lymphatic system is responsible for the human immunity. It includes tonsils, spleen and lymph nodes. The lymph nodes are present in hundreds in the body which contain white blood cells to fight infections.
In lymph node biopsy, a small cut is made and the node is taken, and the cut is closed by stitches. This gives information about the blood cancer, its type, stage and spreading.

Spinal tap

It is also referred as lumbar puncture. A fine needle is inserted in the space between between the bones in the lower back and cerebrospinal fluid is extracted from the spine. This fluid is examined under a microscope to see if the blood cancer has spread to the spinal cord.

Flow cytometry

This test determines the blood and bone marrow cells to analyze a change in the white blood cell count that could cause cancer. An instrument known as flow cytometer is used to measure the number and percentage of cells and their characteristics. This test also helps to detect the residual levels of cancer post treatment. The results are also useful for measuring the amount of DNA in the blood cells.

Karyotype test

This test maps the 46 human chromosomes of a cell to determine the changes in the chromosomes and their arrangement. G-banding is the method used for this test. A stain called Giemsa is used to make the banding pattern of chromosome pairs easier to see. This test looks for abnormalities in the size, shape, number and arrangement of the blood cells or bone marrow cells. This test can help the doctor prescribe the medications and plan the treatment.

Treatment of Recurrent Blood Cancer