Blood Cancers

Blood cancers affect the production and function of your blood cells. Most of these cancers start in your bone marrow where blood is produced. Stem cells in your bone marrow mature and develop into three types of blood cells: red blood cells, white blood cells, or platelets. In most blood cancers, the normal blood cell development process is interrupted by uncontrolled growth of an abnormal type of blood cell. These abnormal blood cells, or cancerous cells, prevent your blood from performing many of its functions, like fighting off infections or preventing serious bleeding.

Types of Blood Cancer

Blood cancers affect blood cells and bone marrow — the spongy tissue inside your bones where blood cells are made. These cancers change the way blood cells behave and how well they work. 

You have three types of blood cells:

• White blood cells fight infection as part of your immune system.
• Red blood cells carry oxygen to your body’s tissues and organs and bring carbon dioxide to your lungs so you can breathe it out.
• Platelets help your blood clot when you’re injured.

There are three major types of blood cancer:

• Leukemia
• Lymphoma
• Myeloma

These cancers cause your bone marrow and lymphatic system to make blood cells that don’t work as well as they should. They all affect different types of white blood cells, and they act in different ways.

Leukemia

People who have leukemia make a lot of white blood cells that can’t fight infections. Leukemia is divided into four types based on the kind of white blood cell it affects and whether it grows quickly (acute) or slowly (chronic).

Acute lymphocytic leukemia (ALL). This starts with white blood cells called lymphocytes in bone marrow. People with ALL make too many lymphocytes that crowd out healthy white blood cells. ALL can advance quickly if it’s not treated.

It’s the most common type of childhood cancer. Children ages 3 to 5 are most likely to get it, but adults over age 75 can get ALL, too.

You’re more likely to get it if you:

• Have a brother or sister with ALL
• Were treated with chemotherapy or radiation for another type of cancer in the past
• Have been near a lot of radiation
• Have Down syndrome or another genetic disorder

Acute myeloid leukemia (AML). This starts in myeloid cells, which normally grow into white blood cells, red blood cells, and platelets. AML lowers the number of healthy blood cells in all three types. This form of leukemia grows quickly.

AML mainly affects people over age 65. It’s more common in men than women.

You’re chances of getting it are higher if you:

• Have been treated with chemotherapy or radiation for cancer
• Have been around toxic chemicals like benzene
• Smoke
• Have a blood disorder like myelodysplasia or polycythemia vera, or a genetic disorder like Down syndrome

Chronic lymphocytic leukemia (CLL). This is the most common type of leukemia in adults. Like ALL, it starts from lymphocytes in bone marrow, but it grows more slowly. Many people with CLL don’t show any symptoms until years after the cancer starts.

CLL mainly affects people in their 70s or older. A family history of blood cancer can raise your odds of it, as can spending a lot of time around chemicals like weedkillers or insecticides.

Chronic myeloid leukemia (CML). This blood cancer starts in myeloid cells, like AML. But the abnormal cells grow slowly.

CML is slightly more common in men than in women. It usually affects adults, but kids can sometimes get it, too. You’re more likely to get it if you’ve been around high amounts of radiation.

Lymphoma

This is a cancer of the lymph system. This network of vessels includes your lymph nodes, spleen, and thymus gland. The vessels store and carry white blood cells to help your body fight infections.

Lymphomas start in white blood cells called lymphocytes. There are two main types of lymphoma:

• Hodgkin’s lymphoma starts in immune cells called B lymphocytes, or B cells. These cells make proteins called antibodies that fight off germs. People with Hodgkin’s lymphoma have large lymphocytes called Reed-Sternberg cells in their lymph nodes.
• Non-Hodgkin’s lymphoma starts in B cells or in another type of immune cell called a T cell. Non-Hodgkin’s lymphoma is more common than Hodgkin’s lymphoma.

Both types are divided into a few subtypes. The subtypes are based on where in the body the cancer started and how it behaves.

People who have weak immune systems are more likely to get lymphoma. Infection with the Epstein-Barr virus, HIV, or Helicobacter pylori (H. pylori) bacteria also raises your chances.

Lymphoma is most often diagnosed in people ages 15 to 35 and over age 50.

Myeloma

This is a cancer of the plasma cells in bone marrow. Plasma cells are a type of white blood cell that makes antibodies.

Myeloma cells spread through the bone marrow. They can damage your bones and crowd out healthy blood cells. These cells also make antibodies that can’t fight off infections.

This cancer is often called multiple myeloma because it’s found in many parts of your bone marrow.

Men over age 50 are most likely to get it, and African-Americans have higher odds of it than other people.

Your chances are also higher if you:

• Have close relatives with myeloma
• Are obese
• Have spent a lot of time around radiation

Blood cancer symptoms

Some common blood cancer symptoms include:

• Fever, chills
• Persistent fatigue, weakness
• Loss of appetite, nausea
• Unexplained weight loss
• Night sweats
• Bone/joint pain
• Abdominal discomfort
• Headaches
• Shortness of breath
• Frequent infections
• Itchy skin or skin rash
• Swollen lymph nodes in the neck, underarms or groin

Blood cancer tests and diagnosis

People find out that they have blood cancer in a variety of ways. Many people go to their GP with symptoms and are sent for blood tests to get more information, before being sent to hospital for further tests. Others have a routine blood test for something else entirely, and the results lead to them being sent to see a specialist. Some people with acute blood cancers become very unwell very quickly and will have tests in hospital that show that they have blood cancer.

However you find out, the time around your diagnosis can feel very uncertain. The information in this section is designed to help you understand and feel reassured about the tests and processes involved with getting a diagnosis for blood cancer and monitoring you during and beyond treatment.

What tests will I need?

You might need a number of tests to work out if you have blood cancer and what type of cancer you have (confirm your diagnosis). Once you’ve started treatment you’ll have regular tests to see how you’re doing. 

The most common types of tests for blood cancer are blood tests and biopsies, but you may also need scans to monitor your symptoms or see how well your treatment is working.

The tests you’ll have will depend on your symptoms and what type of blood cancer you have (or is suspected). To see which tests you can expect for specific conditions, use the menu to choose a particular type of blood cancer. Everyone is different and symptoms vary between people, so even people with the same condition may not have all the same tests.It’s important to remember that many tests – and particularly blood tests – can also be used to diagnose a wide range of health conditions. If you’ve been sent for any of these tests, this doesn’t necessarily mean that your doctor thinks you have blood cancer.

Blood tests

Blood tests can be used to help diagnose and monitor blood cancer. There are lots of different tests that can be done using a blood sample.

What does a blood test involve?

You might have a blood test at your doctor’s surgery, or you may need to visit the blood clinic at the hospital.

• Blood will be taken from your vein using a thin needle and syringe. It might be a bit uncomfortable as the needle goes in but it’s usually over quite quickly.
• If you’re in hospital and have a PICC line, blood samples might be taken from there instead.
• Once it’s been taken, your blood sample will be sent off to the lab.
• Your doctor should tell you when you can expect the results.

Common blood tests for diagnosis and monitoring

Full blood count (FBC)

This test measures the number of each type of cell in your blood: red cells, white cells and platelets. In the lab, a machine will very accurately count the blood cells in your sample. If the count is too high or too low, a small drop of your blood is smeared onto a slide and a doctor or senior scientist will look at it under a microscope.

Infection screening / virology testing

It’s important for your healthcare team to have a good understanding of your general health before you start treatment, so you’re likely to have some tests for conditions such as HIV, hepatitis B and C. This is because if you are infected (or have been infected) with these viruses your doctor may need to treat them while your cancer is being treated

Liver function tests

If you need chemotherapy you’ll have a series of liver function tests. Many drugs are broken down in the liver. If your liver isn’t working normally, it might be necessary to adjust the dosage of your medication.

Peripheral blood film

This test is used to look at your red blood cells, white blood cells and platelets and check they are the right size and shape and see whether they are healthy.

Urea and electrolytes

This test checks how well your kidneys are working. This helps your healthcare team work out your drug doses and checks for any damage the cancer or treatment has caused.

Other tests

Some flow cytometry (immunophenotyping) and cytogenetic testing can also be done using a sample from a blood test.

Bone marrow biopsies

A bone marrow biopsy allows doctors to take a small sample of your bone marrow. They can then look at this under a microscope and see whether there are any abnormal cells.

There are two types of bone marrow biopsy:

• aspirate, which takes the liquid bone marrow,
• trephine, which takes the spongy bone marrow along with some of the bone.

Bone marrow biopsies can be used to diagnose blood cancer, see how it has affected your body, and check how well a treatment is working.

People with some types of blood cancer (or suspected blood cancer) may need to have one or more biopsies, although not everyone will need one.

What happens during a bone marrow biopsy?

• You’ll lie on your side and a small needle will be used to give some local anaesthetic (only numbing a specific area of the body) into the skin around the back of your hip bone.
• Using an aspirate (a larger needle that’s inserted into the bone), a small amount of bone marrow is sucked out from your hip bone; this procedure is called a bone marrow aspirate.
• A piece of bone may also be taken using a different needle, and this is called a trephine.

Taking the sample is usually quite quick, but it may feel painful while it’s being done. For this reason, you may be offered medication to help with the pain (such as gas and air or some tablets to make you feel more relaxed – sedatives), although most people manage without this.

You won’t get your results immediately. Your doctors will need prepare the bone marrow samples and then look at them under a microscope or pass them through a machine called a flow cytometer.

Lymph node biopsies

A lymph node biopsy is a small operation that takes a sample of a lymph node (gland) affected by cancer. It’s most often used to confirm that you have lymphoma but it can also be used to diagnose some other types of blood cancer.

What happens during the test?

The procedure is done at the hospital, often under a local anaesthetic. Occasionally a general anaesthetic is needed, meaning you’ll sleep through it.

You might have one whole lymph node removed – an excision biopsy. Or you might have just the core of lymph node removed under local anaesthetic with the help of an ultrasound or CT scan. This is called a core biopsy or incisional biopsy.

This sample is then examined under the microscope in a laboratory.

Scans explained

Scans can be used to help diagnose some types of blood cancer such as lymphoma. For most other types of blood cancer they aren’t routine, but they can be used to check out symptoms such as a swollen spleen.

Types of scan

CT scan

A CT (computed tomography) scan is a type of X-ray. A CT scan is not a routine test done for blood cancers, but there may be specific reasons it needs to be done, such as if you have a swollen liver or spleen.

You’ll lie on a table that moves into a cylindrical tunnel while pictures are taken. You may need to have a dye injected into one of your veins, to help get a better image. You need to stay very still for this test, so children under five may have medication to help them sleep through it.

MRI scan

MRI (magnetic resonance imaging) shows up soft tissues (non-bony parts) and uses radio waves rather than X-rays. An MRI is not a routine test done for blood cancers, but there may be specific reasons it needs to be done.

You’ll be asked to lie on a table, which will move you through the scanner. You may need to have an injection of some dye. You need to stay very still for this test so children under five may have medication to help them sleep through it.

PET scan

A PET (positron emission tomography) scan is similar to an MRI, but you’re injected with a radioactive sugar. The levels of radiation used are very small and won’t harm you or anyone nearby. This test may be done if you have swollen lymph nodes. It may also be done to compare your results after treatment.

You need to stay very still for this test so children under five may have medication to help them sleep through it.

X-rays

This scan provides very good images of the denser tissues in the body, such as bone. You’ll lie on a table while scans are taken. Your doctors may use an X-ray when you’re first diagnosed, to check for infection or chest problems. People with myeloma may have a series of X-rays – this is sometimes called a skeletal survey.

Ultrasound scans

Ultrasound scans can be used to give more information about your condition. For example, it could be used to measure the size of your spleen, which is often enlarged if you have lymphoma. Ultrasound is also used to help see lymph nodes during a biopsy.

A small handheld device will be moved over the part of your body being scanned. It shouldn’t be painful or uncomfortable. 

Staging, classification and risk scoring

Once it’s confirmed what type of blood cancer you have, your team will do a number of tests to check your general health, find out how far your condition is developed, and work out your likely outlook (prognosis).

All of this information helps them work out which treatment will be most appropriate for you.

These tests could include:

• Blood tests – to check your health such as how your heart, liver, kidneys and thyroid are working and check for any specific health problems such as hepatitis that might affect which treatments you can receive.
• Scans – (particularly if you have lymphoma) to see how developed the cancer is.
• Chromosomal tests – these help doctors work out which type of treatment might work best for you.

You might hear this process called:

• Staging – which means the process of testing to see how far the cancer has spread or grown.
• Classification – which means sorting your condition into a particular group – this can be useful as cancers in different groups/classifications respond differently to treatment.
• Stratification or risk scoring – which means finding out how ‘high risk’ you are that your cancer will develop – this can be useful when deciding which type of treatment you should have.

Cytogenetic testing

Every kind of cancer, including blood cancer, changes the chromosomes (genes) in the affected cells. (These gene faults are not the same thing as genes passed through families.)

The study of these gene changes is called cytogenetics or molecular genetics.

Cytogenetic testing is also known as cytogenetics, genetic testing, molecular testing, karyotyping, chromosomal abnormality or FISH testing.

Why are these tests done?

The purpose of these tests is to look for gene changes that indicate what type of blood cancer you have. Knowing if you have particular genetic changes can help doctors:

• decide on what treatment you’ll have – this is because some genetic changes mean you’ll be more or less likely to respond to certain types of treatment, and 
• have a better idea of your likely outlook (prognosis) – people with some genetic changes may be expected to have a different prognosis.

How is the test done?

Cytogenetic tests are usually done on cells from your blood or from your bone marrow before you start any treatment. These cells can come from a sample from a blood test or bone marrow biopsy.

Your cells will be sent to a laboratory where they will be grown over a number of days and then viewed under a microscope. The cells may be treated to make the chromosomes show up and help identify any unusual changes.

The results of the test will be sent back to your specialist doctor.

Immunophenotyping (flow cytometry)

Immunophenotyping (also called immunophenotype analysis or flow cytometry) is a way of looking at the pattern of proteins on your cells. It’s used to see if there are any unusual cells in your blood and, if so, how many there are.  

This test can confirm a diagnosis of some types of blood cancer, help your specialist work out exactly which type of blood cancer you have, and give your healthcare team a clearer picture of your outlook.

How does it work?

You’ll have a bone marrow biopsy or a blood test. Then in the laboratory, a sample of your cells will be combined with a particular type of antibody (a protein made by your white blood cells to fight infection), which will stick to the surface of abnormal cells, but not to a normal cell. As the cells pass through a machine, the results are plotted on a graph, showing how many abnormal cells are in the sample, and what type they are.

The test is very sensitive – even if there are only a small number of abnormal cells in the sample, it will see them.

Finding the right support and information

You should have been given the names and contact details of your consultant, clinical nurse specialist and other members of your healthcare team. It’s worth taking some time to think about what information you want to know, and when and how you want to receive this.

Your team should be on hand to answer any questions you might have and work with you to make decisions about your treatment. If you don’t have the contact details of a key worker of clinical nurse specialist, do not hesitate to ask for these from your consultant.

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