Blood cancer is cancer in white blood cells (WBCs). The blood has plasma (the liquid part), red blood cells, WBCs and platelets. Plasma transports the waste material, nutrients, proteins and other molecules that help in temperature control and fluid balance in the body. The red blood cells help in transporting oxygen to different organs in the body from the lungs. The WBCs have an immunity-providing function; the role of platelets is to prevent bleeding by forming blood clots.
WBCs regularly die and are regenerated. When suffering from blood cancer, the bone marrow produces abnormal WBCs, leading to cancer.
Blood cancer is of the following types:
- Leukaemia: A type of blood cancer that affects WBCs. Leukaemia is the most common blood cancer that takes place in children below the age of 15 years. In cancer, abnormal WBCs fail to protect the body against infections as they are unable to perform their functions. It either develops slowly (chronic) or fast (acute).
- Lymphoma: This cancer affects the lymphatic system, which contains lymph nodes that are small structures that help in providing immunity against harmful substances. Generally, cancer affects the lymph nodes. This is the most common blood cancer in adults. This cancer develops on a type of WBC known as lymphocytes. The most well-studied type is Hodgkin’s lymphoma, while the others are known as non-Hodgkin’s lymphoma.
- Myeloma: This cancer acts on the lymphocytes, resulting in abnormal protein production. The myeloma lowers the body’s immunity and leads to infections occurring often along with kidney damage.
The leukaemia stages are listed below:
- Stage 0: No symptoms with a high WBC count
- Stage I: Enlarged lymph nodes with high WBCs count
- Stage II: Anaemia with high WBC count, with or without enlarged lymph nodes
- Stage III: Anaemia with high WBC cell count with an enlarged spleen or liver and may have an enlarged lymph node
- Stage IV: High WBC count, low platelet count, and enlarged lymph nodes with an enlarged liver and may have anaemia
The stages of lymphoma are listed below:
- Stage I: One lymph node or lymphoid organ is affected
- Stage IE: One part of one organ outside the lymphatic system is affected
- Stage II: Two or more lymph nodes are affected on the same side of the diaphragm (a muscle that separates the abdomen and chest)
- Stage IIE: Cancer has spread to an organ next to a lymph node
- Stage III: Lymph nodes on both sides of the diaphragm are affected, or lymph nodes above the diaphragm and the spleen are affected
- Stage IV: At least one organ, such as the lungs, liver or bone marrow, is affected
The stages of multiple myeloma are listed below:
- Stage I: Albumin levels should be at least 3.5 g/dL and serum beta-2 microglobulin below 3.5 mg/L and lactic acid dehydrogenase level is normal, and cytogenetics (study of chromosomes of the bone marrow) are not high risk
- Stage II: Not stage I or stage III
- Stage III: Serum beta-2 microglobulin is at least 5.5 mg/dL and cytogenetics are high risk and/or lactic acid dehydrogenase levels are high.
Depending on the blood cancer type, the symptoms may vary. Some common symptoms of blood cancer include:
- Pain in the bone and joint
- Weight loss
- Swelling of the lymph nodes, spleen and liver
Having any of these symptoms does not indicate that you definitely have blood cancer. You should consult the doctor for accurate diagnosis.
CAUSES AND RISK FACTORS
The exact cause of cancer is unclear; however, certain factors increase the risk of developing cancers.
Some risk factors of leukaemia include:
- Exposure to high levels of radiation
- Long-term exposure to cancer-causing chemicals such as benzene
- History of chemotherapy or radiation therapy
- Rare genetic disorders, such as Down’s syndrome, Bloom syndrome and Fanconi anaemia
- Myelodysplastic syndrome (bone marrow failure disorder)
- Family history
Some risk factors of Hodgkin’s lymphoma include:
- Family history
- Epstein-Barr virus infection
- Human immunodeficiency virus (HIV) infection
- Autoimmune disorders
- Immunosuppression because of organ transplant
Some risk factors of non-Hodgkin’s lymphoma are listed below:
- Autoimmune disorders, including lupus, rheumatoid arthritis, and Sjögren syndrome
- People that are on immunosuppressants such as people that have had an organ transplant
- People with human immunodeficiency virus (HIV) infections
- Bacterial and viral infections, including infections because of Helicobacter pylori, Epstein-Barr virus, hepatitis C virus and Chlamydia psittacosis
- Cigarette smoking
- Eczema and psoriasis
- Coeliac disease
- Working with textiles and electricals
- Drugs, including digoxin, phenytoin, and chemotherapy drugs
- Organic chemicals, including hair dye, solvents, pesticides and wood preservatives
- Radiation exposure
Some risk factors of multiple myeloma include:
- Gender: Males are at a higher risk than women to develop multiple myeloma
- Age: Most cases of multiple myeloma occur in older populations, with maximum cases diagnosed in the above 65 years population.
- Obesity: The risk increases if a person has obesity.
- Family history: The chances are higher if someone in the family has multiple myeloma.
- Other plasma cell diseases: A person has a higher risk of developing multiple myeloma if they have another plasma cell disorder such as monoclonal gammopathy of undetermined significance.
Blood cancers cannot be prevented; however, certain risk factors can be avoided, including:
- Stopping smoking.
- Minimising exposure to industrial chemicals and pesticides.
- Avoiding any behaviour that could lead to HIV such as sharing needles or having unprotected sex.
- Maintaining a healthy weight, staying active and eating healthy.
The diagnosis of leukaemia can be made based on the following tests:
- Complete blood count
- Complete metabolic panel
- Liver function tests
- Coagulation panel
- Peripheral blood smear
- Bone marrow biopsy
The diagnosis for Hodgkin’s lymphoma can be made based on the following:
- Laboratory tests, including complete blood count, erythrocyte sediment rate, complete metabolic panel, HIV, hepatitis B virus and hepatitis C virus
- Biopsy of lymph node or suspected organ
- Diagnostic scans, including chest X-ray, PET scan and CT scan of the chest, abdomen and pelvis
The diagnostic tests for non-Hodgkin’s lymphoma include the following:
- Complete blood count
- Serum chemistry tests
- Imaging tests, including computed tomography (CT) of the pelvis, abdomen, chest and neck, magnetic imaging resonance (MRI) of the brain and spinal cord and positron emission tomography (PET) scan and a testicular ultrasound
- Tissue or lymph node biopsy
- Lumbar puncture (a procedure to remove some of the cerebrospinal fluid and send for testing)
- Bone marrow biopsy
The diagnosis for multiple myeloma can be made based on the following tests:
- Complete blood count
- Peripheral blood smear
- Differential blood count
- Biochemistry panel, including renal function test, liver function test, creatinine, calcium, albumin, lactate dehydrogenase and electrolyte test
- 24-h urine for monoclonal protein levels
- Bone marrow biopsy
- X-ray, MRI of the thoracic and lumbar spine and pelvis, CT scan, PET scan
Some conditions that can have similar symptoms such as leukaemia include:
- Copper deficiency
- Autoimmune conditions, including lupus
- Vitamin B12 and vitamin B9 deficiencies
- Viral infections, such as Epstein-Barr virus, HIV or cytomegalovirus infection
Some conditions that have symptoms such as Hodgkin’s lymphoma include:
- Non-Hodgkin’s lymphoma
- Peripheral T cell lymphoma
- Diffuse large B cell lymphoma
- Infectious mononucleosis
Some conditions that can have similar symptoms to non-Hodgkin’s lymphoma are listed below:
- Epstein-Barr virus infection
- Hodgkin’s lymphoma
- Obstruction of the intestine
- Metastasis of the primary tumour such as soft tissue carcinoma and nasopharyngeal carcinoma
Some conditions that can have symptoms similar to multiple myeloma include:
- Waldenstrom’s macroglobulinemia
- Monoclonal gammopathy of undetermined significance
- Smoldering multiple myeloma
Depending on the type of blood cancer and its stage, the treatment varies. Some of the most common cancer treatments include:
- Chemotherapy: Usage of extremely potent drugs that can prevent new cancer cells from growing while killing old cancer cells is known as chemotherapy. It may either be intravenously or orally given. Either one or more may be required depending on how complicated the cancer case is.
- Stem cell therapy/Bone marrow transplant: Young stem cells are implanted in the body. These stem cells will produce new and healthy cells. The stem cells can be harvested from different organs, including umbilical cord cells, bone marrow and blood cells.
- Radiation therapy: This may be given through either stem cells or medicines. This kills multiple cancer cells together. This may be given before stem cell therapy.
- Cancer surgery: If surgery is required, the affected lymph nodes may be required. This is commonly prescribed for lymphoma.
- Targeted therapy: This therapy will act specifically targeting the cancer cells without affecting the normal cells around them. This is commonly prescribed for leukaemia.
- Immunotherapy: This is a specific treatment that makes the immune system fight and destroys cancer cells.
Lifestyle changes after you get diagnosed with blood cancer will help you keep yourself healthy to withstand the treatment, keep your immune system strong and make you emotionally healthy.
Some changes to make include:
- Quit smoking. This will improve immunity to fight cancer.
- Reduce the risk of getting an infection by avoiding crowded spaces, washing your hands regularly and regularly cleaning high-contact surfaces.
- Exercise regularly. This will help in improving stamina and keeping a positive outlook.
- Eat healthy. The food will provide energy and improve the overall mood.
- Make time for rest. The most common complaint for people is feeling tired. The day should be planned in such a manner as to allocate time for rest.
PROGNOSIS AND COMPLICATIONS
The leukaemia prognosis develops on different factors, including comorbidities, age and type of leukaemia. There has been an improvement in the five-year survival rate of ~26% in the past few years.
The prognosis of Hodgkin’s lymphoma depends on different factors, including the stage of cancer. The five-year survival rate of stage IV Hodgkin’s lymphoma is ~60%, while it is much higher in stage I and II at ~90%.
The five-year survival rate of people with non-Hodgkin’s lymphoma is ~72%. Depending on the type of non-Hodgkin’s lymphoma, the survival rate differs.
Concomitant diseases can affect the survival rates in older patients with multiple myeloma. In younger patients, concomitant diseases are considerably lower. The five-year survival rate for people with multiple myeloma is ~35%.
Some complications of leukaemia include:
- Tumour lysis syndrome (the destruction of tumour cells causes the tumour cell contents to release into the blood, and the kidneys cannot excrete them at the same rate, causing an excess of uric acid, potassium and phosphorus in the blood)
- Disseminated intravascular coagulation (a bleeding disorder)
Certain complications of Hodgkin’s lymphoma include:
- Cardiac disease, including coronary artery disease, diseases in the heart valve and inflammation of the membrane surrounding the heart
- Secondary cancer with the most common cancer as lung cancer
- Other cancers, including thyroid cancer, breast cancer and pancreatic cancer
Certain complications of non-Hodgkin’s lymphoma include:
- Obstruction of the major blood vessel that transports blood to the heart for pumping
- Compression of the spinal cord or brain
- Improper functioning of the liver
- Very high WBC count in the blood
- Compression of the heart because of fluid accumulation in the surrounding membrane
- Decrease in the number of neutrocytes (a type of WBC) with symptoms of an infection such as fever
- Rise of uric acid, creatinine, phosphate and potassium in the blood
- Rise in the Ca levels
- Airway, ureter or intestinal obstruction
- Blood clot in the vein
Certain complications of multiple myeloma include:
- Increased Ca concentration in the blood
- Skeletal damage
- Kidney failure
- Blood clotting
- Hyperviscosity syndrome (bleeding through the nose, blurred vision, seizure and heart failure)
In addition to conventional medicines, herbal medicine has been extensively used for cancer. The benefit of these medicines is questionable; however, certain patients have claimed to find relief with the same.
These treatments generally help the person feel like they are in control of their disease.
Certain herbs that are mentioned in Ayurveda for leukaemia are listed below:
- Gugulu (Commiphora wightii)
- Vantrapush (Podophyllum hexeandrum)
- Vanpalandu (Urginea indica)
- Bhallatak (Semecarpus anacardium)
- Sandpuspa (Lochnera rosea)
Consult your doctor before taking any herbal drugs as certain herbal drugs can affect your cancer therapy:
- St John’s wort
- Kava kava
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