1. What are “blood cancers” (also known as “liquid tumors” or “hematologic malignancies?)”
Blood cancers are a complex family of diseases that affect how your blood cells are made and function. Most, but not all, of these cancers begin in your bone marrow where blood is produced. The effect of the blood cancer will depend on which type of cancer is present and which blood cells are affected.
2. What are the different types of blood cancers?
The most common types of blood cancers are: leukemia, lymphoma, and multiple myeloma. (Other types of blood cancers known as myelodysplastic syndromes and myeloproliferative syndromes are less common and will not be discussed in this article.)
Leukemia is the type of cancer found in your bone marrow caused by rapid production of abnormal white blood cells. The high number of abnormal white blood cells impairs the ability of the unaffected bone marrow to produce normal white cells as well as red cells and platelets. The abnormality in the white blood cells also makes patients more susceptible to infection.
Lymphoma is the type of blood cancer that affects the lymphatic system – the system that removes excess fluids from your body and produces immune cells. Lymphocytes, the type of the white blood cells that fight infection, are involved with the lymphatic system. Abnormal lymphocytes become cancerous by becoming lymphoma cells which can then multiply and grow in your lymph nodes and other lymphatic organs such as the spleen. Over time, these cancerous cells impair your immune system.
Multiple myeloma is a cancer of a specific type of white blood cell known as a plasma cell. Plasma cells are white blood cells that produce antibodies in your body that fight disease and infection. Myeloma cells prevent the normal production of antibodies leaving your body’s immune system impaired and susceptible to infection.
3. What are the typical symptoms of blood cancers and how do these symptoms differ from those of non-hematologic malignancies?
Symptoms of blood cancers arise primarily because of the accumulation of abnormal cells in different parts of the body including organs such as the lymph glands, liver, spleen or even the brain, as well as invasion of the bone marrow with impairment of the normal bone marrow functioning. These symptoms include swelling, pain or loss of function of an infected organ and are similar to those seen with non-hematologic malignancies.
Anemia is a deficiency of red blood cells or of hemoglobin in the blood. Anemia presents with symptoms such as weakness, fatigue, a pale appearance or shortness of breath and is confirmed by blood tests. Blood cancers cause anemia by impairing the production of red blood cells which normally occurs in the bone marrow.
Leukopenia is a decrease in the number of white blood cells. Similar to anemia, blood cancers cause leukopenia by preventing the normal manufacture of white blood cells by the bone marrow. Leukopenia will reduce your body’s ability to fight infection and make you predisposed to infections that in normal circumstances would not be life threatening.
Thrombocytopenia is an abnormality where platelets, the cells which prevent bleeding, are decreased in number. Blood cancers are associated with thrombocytopenia, and the resultant impairment of platelet production leads to a proclivity for abnormal bleeding and bruising.
Hematologic malignancies, by replacing normal bone marrow, can therefore result in symptoms by causing anemia, leukopenia, and thrombocytopenia. Since most non-hematologic malignancies do not involve the bone marrow, these symptoms are therefore, for the most part, unique to blood cancers and usually are not common symptoms of non-hematologic malignancies.
4. How are blood cancers diagnosed and what diagnostic testing is specific or more common to the diagnosis of blood cancers?
Blood cancers are often diagnosed through a biopsy of the suspected affected tissue such as a biopsy of a lymph node. Another common diagnostic procedure used in patients with blood cancers that is not used in patients with most other malignancies is a bone marrow exam. A bone marrow exam consists of obtaining both a liquid part of the bone marrow and a solid part of the bone marrow in procedures known as a bone marrow aspirate and biopsy respectfully. This is a procedure primarily performed by a specialist physician, known as a hematologist/oncologist, who then sends the bone marrow specimens for appropriate pathologic testing to either establish or refute a diagnosis of a blood cancer or assess for bone marrow involvement in a blood cancer that has already been diagnosed by biopsy elsewhere. Contrary to popular belief, a bone marrow exam is a very easy test for the doctor to carry out and with modern local anesthetic techniques does not usually result in undue pain or discomfort to the patient.
A PET/CT scan, a radiographic study looking at both functional activity as well as structure of various parts of the body, is another commonly utilized diagnostic test for blood cancers. This same radiographic study is also frequently employed in other non-hematologic malignancies. The results of this radiographic study help to assess the extent of a cancer in a process called staging.
Specific blood tests depending upon the type of malignancy may also be performed. One of the most important examinations that your hematologist/oncologist may need to do is an examination of a peripheral blood smear looking for abnormalities consistent with involvement of the blood by a blood cancer.
5. What are some of the ways that blood cancers can be treated?
Blood cancers can be treated in a number of different fashions because of the numerous specific diseases they encompass. These include chemotherapy (treatment by chemical substance), immunotherapy (treatment with substances that produce an immune response or are antibodies against the cancer itself), and targeted therapy (treatment that uses drugs designed to “target” cancer cells without affecting normal cells.) The exact type of treatment will depend on whether the blood cancer is a leukemia, lymphoma, or multiple myeloma. The advantageous aspect of blood cancers is that they are imminently more treatable than most solid tumor malignancies and can often be treated with a combination of pills and intravenous medications without the need for surgery and, in many cases, without the need for radiation. Some malignancies, for example chronic myeloid leukemia, can be treated for many years with a simple daily oral medication.
6. Are any blood cancers curable?
Absolutely. Blood cancers are one of the first type of malignancies for which curability was demonstrated. The majority of patients who have Hodgkin’s lymphoma and a type of Non-Hodgkin’s lymphoma known as diffuse large B-cell lymphoma, are cured with standard techniques. Some of these malignancies, such as chronic myeloid leukemia and multiple myeloma, that are treatable but not curable can often be put into long term remission, even if a total cure is not possible. The prognosis for all blood cancers continues to improve because this is one of the family of malignancies in which numerous new drugs have been discovered over the past ten years and the landscape for treatment has never looked more promising than it does right now.
7. How are blood cancers uniquely managed at New Jersey Cancer Care?
New Jersey Cancer Care is a community hospital where patients can receive all of their care. Communication among a patient’s caregivers is facilitated because of the established relationship between the doctors who care for them and the relationships among those physicians as well.
One of the many advantages of a patient receiving care for their blood cancers at New Jersey Cancer Care is our affiliation with the John Theurer Cancer Center (JTCC). The physicians at each hospital have an ongoing relationship in caring for patients jointly enabling smoother, more cohesive care for the patient while still enabling the patient to receive their care close to home at New Jersey Cancer Care.
There are various reasons why blood cancers are often comanaged by the JTCC along with the hematologist/oncologists at New Jersey Cancer Care. These include a patient who does not respond to standard therapy, a patient with a blood cancer that presents in an atypical fashion, or a patient whose diagnosis is in question. Complicated blood cancers are also often comanaged in consultation with the hematologic malignancy team at JTCC to allow us to have access to clinical trials and state of the art pathologic review. This association between the specialist teams in certain malignancies such as lymphoma, leukemia and myeloma at JTCC and New Jersey Cancer Care oncologists provides patients with a team of physicians who optimize the patient’s care.
The New Jersey Cancer Care patients with blood cancers thus enjoy the best of both worlds: access to tertiary care center expertise at JTCC while receiving the convenience and warmth of their neighborhood hospital. This, along with the recent improved prognosis for this family of diseases , makes New Jersey Cancer Care the ideal site for treatment of our community patients with blood cancers.
