Blood cancer

Types Of Blood Cancer

Based on whether it is an acute or chronic condition and the type of cells affected, blood cancer (leukemia) is divided into the following four types:

1. Acute lymphocytic leukemia (ALL)

• This is the most common type of leukemia that affects children but can affect adults too. 

• Acute lymphocytic leukemia occurs when the bone marrow produces an abnormal amount of white blood cells or leukocytes very rapidly. 
  
  

2. Acute myelogenous leukemia (AML)

• This is the most common type of acute blood cancer. 

• It is more common in adults (those between 40-60 years of age) and in men compared with women.

• In this type of blood cancer, the bone marrow produces an abnormal amount of immature white cells called myeloid blast cells that later divide into abnormal RBCs, WBCs, or platelets.
  
  

3. Chronic lymphocytic leukemia (CLL)

• This type of cancer is most commonly seen in people above the age of 55. 

• Children and adolescents are rarely affected by this type t and it is more common in men than women.

• This is a slowly progressive cancer where the bone marrow produces an abnormal amount of white blood cells over some time. 
  
  

4. Chronic myelogenous leukemia (CML)

• This leukemia is more common in older adults (most common in those over 65 years of age) and men.

• In this type, the body continues to produce abnormal myeloid cells that create the other blood cells.

Note: There are other rare types of leukemias such as hairy cell leukemia, multiple myeloma, myelomonocytic leukemia, granular lymphocytic leukemia, Burkitt's lymphoma, etc. 

Symptoms Of Blood Cancer

Certain chronic leukemias may not cause any noticeable symptoms at first, and symptoms may appear as the condition progresses. Acute types of blood cancer can cause aggressive symptoms, such as:

• Recurrent fever
• Recurrent infections
• Enlarged lymph nodes
• Joint pains
• Unintentional weight loss
• Fatigue, tiredness
• Abdominal pain due to enlarged spleen
• Easy bruising and bleeding
• Nosebleeds and bleeding gums. 
• Tiny red spots in the skin (called petechiae)
• Purplish patches in the skin
• Breathlessness
• Confusion
• Headaches

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Causes Of Blood Cancer

• Blood cancer is cancer that affects the bone marrow and blood cells. 

• The exact cause of why blood cancer occurs is not yet identified.

•  It is thought to occur when the blood cells undergo genetic mutations and behave abnormally.

• It starts when the DNA of a single cell in the bone marrow gets changed (mutation) and as a result, can’t develop, multiply, and function normally. 

• This rapid, out-of-control growth of abnormal cells takes place in the bone marrow and lymph nodes of the body. These abnormal cells then spill into the bloodstream.

• Also, abnormal and excessive production of the white blood cells or leukocytes causes overcrowding and clumping in the blood vessels. 

• These abnormal cells also reduce the count of other normal blood cells, such as red blood cells and platelets. 

• The white blood cells are responsible for fighting off infections and keeping the body’s immune system healthy. 

• With blood cancer, the abnormal white blood cells are unable to function properly, and thus the body becomes susceptible to infections. 

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Risk Factors For Blood Cancer

Certain factors can increase the risk of a person developing blood cancer. These include:

1. Family history

• There is a higher risk of developing leukemia if a close family member has suffered from leukemia.
  
  

2. Smoking

• Smoking tobacco products and cigarettes increase the risk of leukemia. 20% of all acute myeloid leukemia cases are linked to smoking.
  
  

3. Chemotherapy and radiation

• Chemotherapy or radiation for cancers like breast, ovarian, or Hodgkin's lymphoma can raise the risk of leukemia later in life.
  
  

4. Genetic syndromes

• Down’s syndrome, Fanconi’s anemia, Li Fraumeni syndrome, etc., are diseases caused due to genetic abnormalities and have been associated with a higher risk of leukemia.
  
  

5. Viral infections

• Exposure to certain viruses, such as the Epstein-Barr virus, human T-cell leukemia virus, etc., can increase the chances of leukemia.

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6. Exposure to carcinogens

Certain chemicals, such as benzene, are known carcinogens and increase the risk of leukemia.

Diagnosis Of Blood Cancer

The doctor conducts a thorough physical examination and reviews the history of symptoms, using various studies to diagnose and determine the subtype of blood cancer. These include:

1. Physical examination

Your doctor will look for physical signs of blood cancer such as pale skin from anemia, swelling of your lymph nodes, and enlargement of your liver and spleen.

2. Laboratory tests

• Flow cytometry: It aids in the detection of antigens present on or inside the cells based on their specific characteristics. It also helps in monitoring the recurrence of the disease, assessing the extent of cancer, and checking the efficacy of ongoing treatment.

• Cytochemistry: It helps in the diagnosis of different types of acute blood cancers with the use of cytochemical stains.

• Complete blood count (CBC) : It is required to study the quantities and morphology of the different blood cells. 

• Peripheral smear examination: It is necessary to evaluate the blood cells in greater detail.

• Supportive tests like coagulation profile, kidney function test, liver function test, etc., may be essential to evaluate the overall health status.

3. Bone marrow studies & biopsy

• Bone marrow biopsy : This is a procedure in which a needle is used to withdraw a sample of the cancerous cells or tissue from the bone marrow. It helps in the diagnosis of abnormal cells such as those found in cancerous tumors or tumor markers.
  
  
• Bone marrow aspiration : It is a procedure in which a sample is drawn from the fluid portion of the bone marrow with the help of a fine needle. It checks for cancerous cells.
  
  
• Lymph node FNAC & biopsy : These are used to examine lesions or lumps inside the body observed by touch or during a scan to detect tumors in different parts of the body.

4. Imaging studies

• A PET CT scan (whole body) : It may be performed to check for signs of blood cancer in the body.
  
  
• CT Scan :  It not only helps to check for the presence of cancerous cells but also plays a vital role in the treatment of blood cancer such as bone marrow transplants.
  
  Note: Your doctor may order a chest X-ray or magnetic resonance imaging (MRI) scan if you have symptoms that indicate a complication of leukemia.

5. Lumbar puncture

A lumbar puncture (also called a spinal tap) may be ordered to see if cancer had spread to the spinal fluid surrounding the brain and spinal cord.

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Prevention Of Blood Cancer

Avoiding exposure to known risk factors such as benzene, radiation, smoking, etc., may reduce the chances of developing blood cancer.

Although cancer cannot be prevented, there are some simple and effective lifestyle changes that YOU can make now to ward off the cancer risk. Want to know how to reduce cancer risk? 
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Specialist To Visit

The diagnosis and treatment of blood cancer require a comprehensive approach. Specialists that can help include:

• Hematologist

• Hemato-oncologist

• Medical oncologist

• Pediatric oncologist 

• Bone marrow transplant specialist

A hematologist focuses on diagnosing and treating blood disorders, including blood cancers.

A hemato-oncologist specializes in managing both blood disorders and blood-related cancers.

A medical oncologist oversees cancer treatments such as chemotherapy, immunotherapy, and targeted therapies.

A pediatric oncologist treats cancers in children, including leukemia and other blood cancers.

A bone marrow transplant specialist performs transplants to replace damaged or diseased bone marrow with healthy stem cells.

Treatment Of Blood Cancer

Treatment of leukemia depends on the type of disease and the patient’s overall health condition. Majorly, the treatment approaches are as follows: 

1. Chemotherapy

The length of time for treatment can vary by regimen ranging from six months to indefinite treatment. These include drugs such as:

• Vincristine
• Daunorubicin
• Cytarabine
• Mercaptopurine
• Ifosfamide

2. Targeted therapy

With targeted therapy, drugs are given against a cancer cell-specific target. These targets of drugs are generally not present in normal dividing cells of our body. Examples of targeted therapy include:

• Monoclonal antibodies such as Inotuzumab, Gemtuzumab, Rituximab, Ofatumumab Obinutuzumab, and Alemtuzumab 
• Tyrosine kinase inhibitors such as Imatinib mesylate, Dasatinib, Nilotinib, Ponatinib, Ruxolitinib, and Fedratinib.
  
  

3. Immunotherapy

As the name suggests, immunotherapy works by helping the immune system work to fight cancer cells. This therapy uses substances that activate the body's immune system to work against the cancer cells:

• Pembrolizumab

• Atezolizumab
  
  

4. Radiation therapy

• This therapy uses radiation (high-energy rays similar to X-rays) to kill the cancer cells. 

• This treatment uses strong beams of energy to kill focus present in the body forming cancer cells (lymph nodes) or leukemia cells or stopping them from growing. 

• Radiation targets specific areas with cancer cells or can be applied to the whole body during a stem cell transplant..

• This therapy can also be used along with other treatment modalities such as chemotherapy and surgery. 
  
  

5. Stem cell transplant

• Also known as hematopoietic stem cell transplant or bone marrow transplant, this procedure replaces the cancerous blood-forming cells with new,  healthy hematopoietic cells. 

• These healthy cells are taken from the patient (before exposure to chemotherapy or radiation therapy) or from a donor’s blood or bone marrow and are infused into the patient's blood. Healthy hematopoietic cells grow and multiply forming new bone marrow and blood cells that develop into all the different types of cells your body needs (red blood cells, white blood cells, and platelets). 
  
  

6. Supportive care

Supportive care is required for patients to help stimulate the production of blood cells, combat infections, and manage side effects, such as nausea, vomiting, etc.

• Antiemetic drugs provide relief from nausea and vomiting (ondansetron, palonosetron). 

• Recombinant human erythropoietin alpha preparations help produce red blood cells and help treat anemia due to leukemia or post-chemotherapy.

• Various antibiotics and antiviral medications are used to prevent and treat infections.
  . 

7. Chimeric antigen receptor (CAR) T-cell treatment

• This is a new form of therapy where the patient’s own T-lymphocyte cells are harvested and engineered in the laboratory to make them capable of fighting the leukemia cells. 

• These cells are then reinserted into the body.

Living With Blood Cancer

With advancements in treatment, many leukemia patients enjoy long, healthy lives, though the journey can be emotionally challenging. Open communication, lifestyle adjustments, and support from loved ones or professionals can help manage anxiety and maintain positivity. Here are some helpful tips:

1. Learn about your diagnosis

• Don’t be afraid to ask your healthcare team about anything you don’t understand. 

• It is best to ask your doctor about your health and condition rather than search online or depend on other people for help.
  
  

2. Join a support group

• A support group can keep you cheered up since the other participants will have their insights into cancer treatment. 

• You can even find inspiration from the other members, or strategies for coping with pain or other side effects of treatment.
  
  

3. Pursue a passion or hobby

• Engage yourself in the hobbies which have given you pleasure in the past. It could be reading, writing, dancing, travelling, etc.
  
  

4. Make sleep a priority

• Sleep can be elusive when you’re feeling anxious or depressed, or even just exhausted from your cancer treatment. 

• But a lack of sleep can make you feel even more anxious or despairing. 

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Home-care For Blood Cancer

People with blood cancer suffer from chronic fatigue and are at risk of getting recurrent infections. Also, the chemotherapy sessions bring about various side effects. There are a few things you can do to care for yourself or a loved one suffering from blood cancer:

1. Eat right

• Eat fresh home-cooked meals and drink plenty of water or energy drinks daily.
  
  

2. Try home remedies

• Nausea, and vomiting due to chemotherapy can be managed with medications or home remedies like sucking on peppermint lozenges.
  
  

3. Keep infections at bay

• Follow good hand hygiene

• Avoid crowded places and unhygienic places

• Wear a surgical mask when visiting the hospital.
  
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4. Be active

• Engage in light physical activity as it will help boost energy levels and help with symptoms of chronic fatigue.

Complications Of Blood Cancer

In the terminal stages, the patient sleeps through most of the day and has reduced appetite, extreme muscle wasting, feeble heartbeat, etc.

It may also cause other complications, such as:

• Recurrent and serious bacterial or fungal infections.

• Tumor lysis syndrome is a side effect of chemotherapy where the tumor cells die quickly and result in dangerously high levels of metabolites, harming the kidneys.

• Disseminated intravascular coagulation is a condition in which the blood clots abnormally and leads to thrombosis or hemorrhage.

• Leukemia survivors are at a higher risk of getting other types of cancers as well.

Cancer often shows subtle signs, making early detection crucial for effective treatment, better outcomes, and reduced complications in health and well-being.
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Alternative Therapies For Leukemia

Alternative therapies can be used to provide symptomatic relief for patients with blood cancer. These include:

1. Yoga and exercise

• Yoga and exercise can help boost energy levels and combat chronic fatigue. 

• Breathing exercises can help with relaxation. 

• It can also induce feelings of positivity and help deal with the diagnosis.

Learn more about other health benefits of yoga.
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2. Massage

Foot and body massages can help with relaxation and provide symptomatic relief.

3. Aromatherapy

• Aromatherapy is the use of certain scents to induce relaxation of the mind and body. 

• It promotes a feeling of calmness and positivity.
  
  

4. Acupressure and acupuncture

• Acupressure and acupuncture techniques also help combat pain, fatigue, and other symptoms.
  
  

5. Meditation

• Meditation techniques like focused breathing, positive imagery, etc. help deal with stress and anxiety post-diagnosis. 

• It helps increase mental strength and willpower, which is essential to fight such grave diseases.