Blood Cancers (Hematologic)
Blood cancers occur in cells of the immune system or in bone marrow where red blood cells are made. 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.
There are three major blood cancers:
There are four types of leukemia which is found in your blood and bone marrow, caused by the rapid production of abnormal white blood cells. The high number of abnormal white blood cells cannot fight infection, and they impair the ability of the bone marrow to produce needed red blood cells and platelets.
This type of blood cancer targets your plasma cells. Plasma cells are white blood cells that produce disease- and infection-fighting antibodies in your body. Myeloma cells prevent the normal production of antibodies, leaving your body's immune system weakened and susceptible to infection.
This affects your body’s lymphatic system, which removes excess fluids from your throughout your body and produces immune cells. Lymphocytes are a type of white blood cell that fight infection. Abnormal lymphocytes become malignant lymphoma cells, which multiply and collect in your lymph nodes and other tissues. Over time, these cancerous cells impair your immune system.
There are two forms of lymphoma, Hodgkin and Non-Hodgkin. They behave, spread and respond to treatment differently, and affect different white blood cells. Doctors who examine these cancerous cells under a microscope look for an abnormal cell called a Reed-Sternberg, then make their classification as follows:
Hodgkin Lymphoma (HL)
Hodgkin lymphoma has the Reed-Sternberg cell and is named after discoverer of the disease. Thanks to recent advances in the fight against this disease, more than 75 percent of newly diagnosed cases are curable. The disease is more common among teenagers and young adults (10 to 15 percent of cases), as well as those over 55. It’s further broken down into types (classical is the most common) and subtypes.
Non-Hodgkin Lymphoma (NHL)
Non-Hodgkin lymphoma does not have the Reed-Sternberg cell. The disease is further broken down based by the specific type of white blood cell involved and other characteristics (85 percent of cases involve B cells while 15 percent occur in T cells).
The types affecting children and adults are often very different. Also, some types grow slowly and don’t need immediate treatment, while others require treatment right away. These three main types affecting children and teens grow quickly:
- lymphoblastic lymphoma
- Burkitt lymphoma (small non-cleaved cell lymphoma)
- large cell lymphoma
Blood Cancer Symptoms
- fever or night sweats
- easy bruising or bleeding
- petechiae (flat, pinpoint, dark-red spots under the skin caused by bleeding)
- weakness, fatigue or pale appearance
- unexplained weight loss or loss of appetite
- shortness of breath (adults)
- bone or joint pain (ALL)
- painless lumps in the neck, underarm, stomach or groin (ALL)
- pain or feeling of fullness below the ribs (ALL)
- getting many infections (ALL)
Multiple myeloma does not always cause symptoms, but people who have it may experience:
- bone pain, especially in the back or ribs
- bones that break easily
- unexplained fevers
- frequent infections
- unusual bruising or bleeding
- trouble breathing
- arm or leg weakness
- too much calcium in the blood (hypercalcemia), which can cause:
- Appetite loss
- Nausea or vomiting
- Feeling thirsty
- Frequent urination
- Muscle weakness
- Confusion or trouble thinking
- unexplained fever
- painless lymph node swelling in the neck, underarm, groin, chest or stomach
- unexplained weight loss
- night sweats
- itchy skin
- unexplained pain in the chest, abdomen or bones (adult NHL)
- trouble breathing (pediatric NHL)
- coughing (pediatric NHL)
- trouble swallowing (pediatric NHL)
- painless testicle lump or swelling (pediatric NHL)
Other conditions can cause similar symptoms. If you have any of these symptoms, it’s important to see your MedStar Health doctor to determine a cause and treatment if needed.
Blood Cancer Risks
While we don’t know what causes most types of leukemia, there are some risk factors that can increase your chances of developing the disease.
Acute Lymphoblastic Leukemia (ALL):
Children have the highest risk for developing acute lymphoblastic leukemia (ALL), usually before age 5. Two-thirds of cases are in children and teens. Risk then declines slowly until the mid-20s, levels off and slowly rises again after 50.
In adults, ALL is more common in whites than African Americans.
Past treatment with chemotherapy or radiation can increase your risk.
While ALL itself does not seem to run in families, there are certain inherited genetic syndromes that can raise the risk of developing the disease:
- Down syndrome
- Klinefelter syndrome
- Fanconi anemia
- Bloom syndrome
Acute Myeloid Leukemia Risks (ALL):
AML rarely strikes before 45, with 66 the average patient age.
Smoking can increase your risk, as can exposure to smoke.
Past treatment with chemotherapy or radiation can increase your risk, as can previous treatment for childhood ALL.
Benzene exposure can increase your risk.
You may face a greater risk if you have a history of blood disorders such as aplastic anemia or myelodysplastic syndrome.
Certain genetic disorders can increase your risk including:
- Down syndrome
- Fanconi anemia
- Neurofibromatosis type 1 (NF1)
- Noonan syndrome
- Shwachman-Diamond syndrome
Chronic Lymphoblastic Leukemia Risks (CLL):
CLL is rarely seen before age 40, with 72 the average age at diagnosis.
A family history of CLL or lymph system cancer increases your risk.
You may have a higher risk if you are Jewish and your family came from Russia or Eastern Europe.
Chronic Myeloid Leukemia Risks (CML):
The only known risk factor for CML is age. It mainly affects adults, with 64 the average age at diagnosis.
We don’t know what causes most cases of multiple myeloma, and most cases develop in patients with no known risk factors. But risk factors that have been identified include:
Almost everyone who is diagnosed is over 45, and most are over 65.
African-Americans are twice as likely to get the disease as whites.
You face a higher risk if you have a personal history of other plasma cell disorders, such as plasmacytoma (a single tumor rather than several) or monoclonal gammopathy of undetermined significance
Radiation and Chemical Exposure
So far, studies have found an association — but no strong connection — between multiple myeloma, radiation or chemicals and certain occupations, such as working in agriculture, petroleum, leather or cosmetology.
While we don’t know what causes most cases of lymphoma, there are risk factors that can increase your chances of developing the disease.
Hodgkin Lymphoma Risks
The disease is more common from 15 to 40 (especially in the 20s), and again after 55.
The risk is higher if you are infected with human immunodeficiency virus (HIV) or mononucleosis (mono), caused by the Epstein-Barr virus (EBV)
While most patients do not have a family history of the disease, having a close relative (parent or sibling) with it can increase your risk.
Certain inherited immune system diseases can raise your risk.
Non-Hodgkin Lymphoma Risks
While some types of the disease are more common in younger people, most cases occur in people over 60.
The risk is higher among men overall, but certain types are more common in women.
Whites are more likely than African-Americans and Asian-Americans to develop the disease.
Exposure to certain chemicals increases risk.
Suppressed Immune System
Taking immunosuppressant drugs after an organ transplant raises risk.
Medical conditions that can increase risk include:
- an inherited immune disorder like hypogammaglobulinemia or Wiskott-Aldrich syndrome
- any autoimmune disease like rheumatoid arthritis, Sjogren’s Syndrome, lupus, or psoriasis
-human T-lymphotrophic virus type I (HTLV-1)
-Epstein-Barr virus (EBV)
-infections that chronically stimulate the immune system