Blood Cancer 101: Symptoms, Types, Stages, Causes & Treatment

What is Blood Cancer?

Blood cancer, also known as haematologic cancer, is a type of cancer which occurs when there is abnormal growth of blood cells in the body. In blood cancer, the bone marrow, which is the spongy tissue inside bones where blood cells are made, is affected. There are three types of blood cells inside the bone marrow: red blood cells, which carry oxygen and carbon dioxide in the body; white blood cells, which fight infections as part of the immune system; and platelets which help form blood clots to seal an injury. Blood cancer affects these blood cells and prevents them from performing many of its functions.

Blood Cancer Types 

The three main types of blood cancers are: leukemia, lymphoma, and myeloma. 

1. Leukemia

This refers to cancer of white blood cells. Leukemia causes an abnormally swift rate of production of white blood cells in the bone marrow. These abnormal white blood cells then go on to destroy normal blood cells, which prevents the body from dealing with infections. Leukemia is determined in different types by the rate of growth (either acute or chronic), and which blood cells are affected. 

Acute leukemias: This form of leukemia occurs quickly and can escalate into heightened severity in a short period of time. There are two types of acute leukemias: acute myeloid leukemia (AML) and acute lymphocytic (lymphoblastic) leukemia (ALL). 

AML is the most common form of leukemia in adults, and impacts the blood and bone marrow. 

ALL can affect the blood marrow throughout the body, spreading to the liver, spleen, or lymph nodes. It is most common in children under the age of 15 years old, and is rare in adults. 

Chronic leukemias: Chronic leukemias are slow-growing, and advance slowly. There are three types of chronic leukemias:

Chronic lymphocytic leukemia (CLL) is a form of leukemia usually affects older adults, and accounts for a third of all leukemia diagnosis. Some forms of CLL begin slowly, with symptoms staying under the radar for years, while some forms of CLL grow swiftly.

Hairy cell leukemia (HCL) is a rare form of CLL and occurs most commonly in middle-aged or older people. It progresses slowly. 

Chronic myeloid leukemia (CML) is more common in adults than in children, and can progress from a slow progression to rapid growth. CML, unlike other leukemias, has been associated with an abnormal chromosome, known as the Philadelphia chromosome. It can spread to other parts of the body. 

2. Lymphoma

This refers to the cancer of the lymphatic system, and is the most common form of blood cancer in adults. An important part of the immune system, the lymphatic system consists of lymph nodes, which help in filtering out harmful substances from the body. Lymph nodes are typically affected in this form of cancer. Lymphoma affects a type of white blood cell called lymphocytes. Lymphocytes multiply abnormally and rapidly in the body, overwhelming the lymphatic system. There are two types of lymphoma, Hodgkin’s lymphoma, and non-Hodgkin lymphoma.

Hodgkin’s lymphoma is a slow growing variant of lymphoma, and typically affects individuals between the ages of 15 to 35 years old, or those over 55 years old.

Non-Hodgkin’s lymphoma is normally a fast growing kind of cancer, and usually affects those more than 60 years old. 

3. Myeloma

Myeloma is cancer of the plasma cells in the bone marrow. It is the second most common type of blood cancer and affects more than 100 patients in Singapore yearly. Plasma cells are a type of white blood cells that make antibodies to fight off infections. Myeloma affects the body’s immune system by creating too many plasma cells. This reduces the number of white and red blood cells produced, which leaves the body more prone to infections. This cancer is also known as multiple myeloma as it is found in many parts of the bone marrow. When the myeloma cells gather in the bone marrow, they can cause harm to the other parts of the body, like the kidneys.

Blood Cancer Causes and Risk Factors

All blood cancers are caused by mutations in DNA in the human body. Research has not found the cause for the changes to the DNA. However, it has found that a number of factors can affect how likely one is predisposed to develop certain types of blood cancer. These factors include age, gender, ethnicity, family history, radiation, chemical exposure, genetic conditions and more. 

Blood Cancer Symptoms 

Symptoms of blood cancer include the following: 

• Breathlessness 
• Unexplained weight loss 
• Development of lumps or swellings which were not previously present, especially in lymph nodes, the liver, and the spleen
• Heavy night sweats 
• Sudden high fever (38 degrees and above) 
• Persistent and recurrent infections
• Pain in bones, joints or abdominal areas 
• Sudden itch or rash on skin 
• Fatigue 
• Pale complexion 
• Bruising or bleeding without a reason 
• Anaemia, which is the lack of red blood cells in blood
• Bone pain, mostly in the back and the rib cage

It is important to note that not everyone will present with the same symptoms, and some people may have symptoms which are not listed here. 

Blood Cancer Diagnosis

Diagnosis of blood cancer typically starts with a doctor’s visit. 

The doctor will usually start off by collecting information, such as any known history of cancer in the individual’s family, and also the medical history of the individual. The doctor will then conduct several tests to examine further: 

Physical exam

The doctor will check for general signs of health, including feeling for any odd lumps or unusual occurrences in the body. 

Blood tests

A sample of blood from the person will be taken, and sent to a lab for further testing. There are several types of blood tests, including: 

• Complete blood count (CBC): The individual’s blood will be tested for a complete blood count. The number of white blood cells, red blood cells and platelets present in the blood will be assessed and determined. 
• Peripheral blood smear: This test is usually run as a follow-up, if there are abnormal results found on the CBC. The smear will help to check on abnormalities present, and the appearance of the red blood cells, white blood cells, and platelets. 
• Blood chemistry: This is used to measure a person’s health status. 

Blood clotting tests

This helps to measure if blood is clotting normally, as clotting is a function of the platelets and proteins in blood. Some blood cancers can reduce the number of platelets and cause frequent bruising or bleeding. Blood clotting tests can help determine if the bruising and bleeding is due to cancer, or due to another cause

Urine Tests

Myelomas can affect kidney functioning. Urine tests are used to determine the function of the kidneys and assess their health, in the case of suspected myeloma. 

Biopsy

A biopsy is when a small piece of tissue from the body is removed for further examination of the presence of cancer cells. The doctor may suggest taking a tissue sample from the bone marrow (known as a bone marrow biopsy), or taking a fluid sample from the bone marrow (known as bone marrow aspiration).  

X-rays

This may be used more specifically for myeloma; it helps to identify lesions in the bones caused by myeloma. Also, it can detect weakened bone areas or fractures that may need surgery. 

Magnetic Resonance Imaging (MRI)

This procedure uses a magnetic field, radio waves, and the computer to help make detailed pictures of areas inside the body. It can be used to find areas where the bone is damaged. This can be used to assist in confirming the presence and spread of myeloma.

Blood Cancer Treatment

Treatment for blood cancer depends on the type of blood cancer, stage of the cancer, how quick the cancer is growing and spreading to other parts of the body, genetic mutations that might be present in the cancer cells, and age and overall health of the person with cancer. Here are some treatment options to consider. 

Watchful waiting

Watchful waiting is recommended in certain cases of blood cancer. This is usually done when the person is not experiencing symptoms from their disease and the blood cancer is slow-growing. The person’s health is closely monitored, and no treatment is administered, except for treatment for infections. Doctors will monitor the person for any changes in conditions and symptoms, such as fatigue, weight loss, or an enlarged spleen. 

Chemotherapy

This form of medication is injected into the body or taken in the form of a pill. It has anti-cancer drugs which help to kill and stop the production of cancer cells, though it can affect other cells in the body as well.

Targeted therapies

This form of treatment is most often used for leukemia treatment. Drugs that specifically kill malignant blood cells are used. These drugs do not damage or harm normal cells. Targeted therapy drugs block the growth of cancer cells rather than kill the cancer cells, so they are usually used in conjunction with chemotherapy to treat blood cancer. 

Radiation therapy

High-energy rays are used to kill cancer cells. Radiation therapy can be used to treat bone pain from the growth of blood cancer cells in the bone marrow. It could also be used before a stem cell transplant

Surgery

Surgery is used to remove affected lymph nodes to treat certain kinds of blood cancers. In some cases, a person with blood cancer may have surgery to remove an enlarged spleen, which can press on other organs like the stomach, causing discomfort. 

Immunotherapy

The immune system of the body is activated to specifically kill cancer cells in this form of treatment. 

Stem cell transplantation

After chemotherapy, healthy stem cells are infused into the body to restore bone marrow and help continue healthy blood production to destroy malignant blood cells. Chemotherapy, while effective in destroying cancer cells, often damages healthy blood cells as well. These stem cells are immature cells which can grow into new blood cells, and are gathered from the person with cancer before chemotherapy starts, or given by a donor. 

For many diagnosed with blood cancer, the aim of treatment would be to cure the cancer and completely remove any signs of cancer in the body. This is called a complete remission. However, it is possible for someone to have a partial remission, and this occurs when there are a small number of cancer cells left in the body. 

Some blood cancers are chronic and do not have a cure, but are managed with ongoing treatment. For many people, blood cancer does not reduce their lifespan, and regular medication and treatments can help in stabilising their condition. If the cancer becomes more aggressive, more intensive treatment may be needed to control the cancer.

How to Prevent Blood Cancer

To prevent blood cancer, reducing exposure to factors increasing the risk for getting blood cancer, and also adopting healthy lifestyle habits can aid in prevention of blood cancer. Some tips are to: 

• Avoid exposure to radiation, chemicals like pesticides or benzene. 
• Avoid smoking, or tobacco in any form. 
• Stay active and keep fit by getting regular exercise. 
• Eat a healthy diet rich with vitamins and antioxidants. 

Blood Cancer Support Group & Resources

The Leukemia and Lymphoma Foundation was set up in September 2002 as a charitable organization in Singapore. Its aim is to assist persons with leukemia or lymphoma with financial aid for treatment, and also to improve the quality of life of this group of people through social activities and counselling support. 

There is also a Multiple Myeloma Support Group at the National University Cancer Institute (NUCI). Their aim is to reach out to multiple myeloma patients as well as their caregivers, across Singapore, and is not exclusive to individuals seeking treatment at the NUCI. It hopes to provide a platform for current patients and their caregivers to share personal experiences, and seek advice and emotional support from each other.

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