BLOOD CANCER

Overview

Blood Cancer is essentially a set of malignancies that wrecks havoc with the patient’s health and wellbeing, and if untreated, often leading to fatality. However, the good news is that blood cancer treatment is readily available and evolving rapidly. As the treatment methods are coming of age, the remission and survival rates are showing an upward curve. In the recent medical breakthroughs, researchers have identified specific gene mutations that can be targeted for safe and efficient recovery, provided the treatment is undertaken in the initial phase.

Rajiv Gandhi Cancer Institute & Research Centre, a premier cancer hospital in Delhi NCR, India, has a proven record when it comes to providing blood cancer treatment and personalized care. From conventional methods like chemo and radiotherapy to stem cells and bone marrow transplantations, we specialize in it all. It is pertinent to stat here that Rajiv Gandhi Cancer Institute & Research Centre has a separate department of hemato-oncology with a dedicated team of doctors specialized in treatment of blood cancers and blood disorders and in bone marrow/ hematopoietic stem cell transplant.

Going a step ahead, we have taken the prerogative to promote awareness about cancer amongst masses. After all, awareness is the first line of defense against diseases. Accordingly, we have put up a concise guide to blood cancer, covering all its key aspects, such as causes, types, symptoms and signs, and stages. So, read on and stay informed.

What is Blood Cancer?

A cancer arising from any of blood cell is called a blood cancer and can affect any organ of the body. Blood cancer is usually associated with impaired production of normal blood components and/ or dysfunction of blood components in bone marrow and lymphatic system of body, resulting in poor immunity, and sometimes low platelet counts and low hemoglobin leading to higher infection risk, bleeding tendencies and weakness or fatigue. There can be lymph node enlargement visible in form of nodules around neck or other organs.

Types of Blood Cancer:

Acute leukemia

Acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) are aggressive blood cancers and are rapidly fatal if untreated. There are several subclasses of ALL and AML depending on their cytogenetic and molecular patterns. Diagnosis of acute leukemia mostly depends upon bone marrow examination which include microscopic examination and flow cytometry as well as cytogenetic / molecular testing. We have effective treatment regimes for such deadly diseases. Treatment of acute leukemia consists of intensive chemotherapies. A bone marrow / hematopoietic stem cell transplantation is also recommended where appropriate for certain high risk cases of acute leukemia. With appropriate treatment, there are good probability of cure and a long term survival even in these aggressive diseases.

Lymphomas

These are cancers arising from lymphocytes which are very important component of blood and lymphatic system and instrumental in proving immunity against infections. A lymphoma can arise in any body organ from brain to skin but usually it affects lymph nodes around neck chest and abdomen or having an increase in abnormal lymphocytes in blood. Lymphomas are a large group of cancers with varying behavior, while some of lymphomas are slow growing, there are others which are very aggressive and rapidly fatal if untreated. A biopsy from affected organ or lymph node is important to come to precise diagnosis and then to decide on therapy. Usually, lymphomas are treated with moderately intensive chemotherapy and immunotherapy. An Autologous stem cell transplant is usually recommended for certain high risk lymphomas or relapsed lymphomas (recurrence of lymphoma after chemotherapy). Some very high risk lymphomas are also treated with Allogeneic bone marrow/ hematopoietic stem cell transplantation.

Chronic lymphocytic leukemia (CLL)

CLL is closely related to lymphoma and is actually a type of slow lymphoma which chiefly affect blood and bone marrow and sometimes involve lymph nodes, liver, spleen and other organs too. Diagnosis of CLL depends on flow cytometry of a blood sample and sometimes a biopsy from affected lymph nodes too is advised. In very early stages of CLL, usually no treatment is required and we need to keep a close watch on patients physical health and blood reports. While in advanced stage of CLL, the treatment consists of chemo and immunotherapies or molecularly targeted therapy. With recent developments in understanding of biology and CLL, molecularly targeted therapies like Ibrutinib / Acalabrutinib are preferred in certain high risk patients or patients with higher age and poor physical performance status. With currently available therapies, even elderly and frail patients of CLL can be treated with orally available targeted therapies.

Myeloma/ Multiple Myeloma

Myeloma or Multiple Myeloma are same things and is a cancer arising from plasma cells. Plasma cells too are very important component of body’s immune system and reside in bone marrow. Myeloma can cause widespread damage in body including bone weakness or fractures, kidney dysfunction, infections and anemia. Diagnosis of Myeloma depends upon bone marrow tests or a biopsy from affected tissue apart from several blood tests. Treatment of Myeloma consists of chemotherapy or certain targeted immunotherapies and Autologous bone marrow/ hematopoietic stem cell transplantation. With appropriate therapy, a significant number of patients can achieve good disease control and lead a near normal life.

Chronic myeloid leukemia (CML)

CML is a fairly common disease amongst blood cancers. This is a slow cancer to start with but it may change or transform into an aggressive blood cancer. Now we have targeted therapy to treat CML and most of such patients can lead a normal life free of disease. Currently available targeted therapies in India are Glivac (Imatinib) and its generics, Tasigna (Nilotinib), Dasatinib and Bosutinib. Other than that, Ponatinib is a third generation TKI and is recommended for certain high risk patients with CML and who failed to respond to other medicines. An Allogeneic bone marrow/ hematopoietic stem cell transplantation is treatment for patients who do not respond to medicines mentioned above.

Myelodysplastic Syndrome

This is a malignant disease (cancer) of bone marrow characterized by failure of marrow to produce blood components and potentially to transform into acute myeloid leukemia (AML). The disease MDS is treated with help of chemotherapy and Allogeneic bone marrow / hematopoietic stem cell transplantation in certain high risk patients.

Others

Other less common blood cancers are Chronic myelo-monocytic leukemia (CMML), primary myelofibrosis (PMF) and other myeloproliferative neoplasms (MPNs) like polycythemia vera, essential thrombocytosis, and other rare blood cancers are treated with appropriated chemotherapy/ targeted therapy and Allogeneic bone marrow/ hematopoietic stem cell transplantation.

Stages of Blood Cancer:

Not all blood cancers have stages. Lymphoma commonly have 4 stages depending on their extent or spread in the body while myeloma has three stages depending on biochemical and molecular profile of cancer. Leukemia can not be divided into stages but have different system of their classification into various risk groups.

Symptoms of Blood Cancer

Headaches, gum swellings
Bone pains, bone fractures without much injury or trauma
leeding symptoms- purpura and ecchymoses (red-black spots or patches over skin), gum bleeds. Heavy menses with too much blood flow. Blurring of vision due to intra ocular bleeds. Internal bleeds in intestines or brain which can be life threatening.