September is observed as Blood Cancer Awareness month all over the world. During this month, activists and stakeholders work to raise awareness about the disease and the efforts being taken to fight blood cancers including leukemia, lymphoma, myeloma and Hodgkin’s disease.
What is blood cancer?
The term blood cancer is a general description of various hematopoietic cancers. Our blood flows through blood vessels to supply all tissues in the body with nutrients. In the approximately 5 litres of blood circulating in our body there are billions of blood cells that carry out various vital functions. All blood cells originate from hematopoietic stem cells.
“Haematopoietic stem cells are known as mother cells and do not yet have a specific function. They are able to renew and differentiate into cells with a specific function, thus replacing cells that die. In bone marrow, blood stem cells divide and develop into progenitor cells. Through further division, the progenitor cells mature and transform into different types of blood cells and then enter the bloodstream,” says Dr Nitin Agarwal, HOD, Donor Request Management, DKMS BMST Foundation India.
Blood cancer is an abnormal proliferation (abnormal growth) of cells in the bone marrow especially white blood cells (WBC’s). Cancer cells flood the bloodstream and drive out healthy cells. As a result, the blood can no longer perform its basic tasks, such as transporting oxygen and protecting the body from infection.
Types of Blood Cancers
Leukemia
This cancer is found in the bone marrow and the bloodstream. “It is caused by abnormal rapid production of WBCs and high number of abnormal WBCs which cannot fight against infection, and they impair the bone marrow’s ability to produce red blood cells and platelets,” says Dr Jimmy Mirani, Consultant Onco Surgeon, Wockhardt Hospital, Mumbai Central.
Lymphoma
A type of blood cancer which affects the lymphatic system, which removes the risk excess fluids from body and generates immune cells. “Lymphocytes are blood cells which are used to fight against infections. These abnormal lymphocytes become lymphoma cells which multiply and get collected in the tissues,” adds Dr Mirani.
There are two types of lymphoma, namely, Hodgkin’s lymphoma and non-Hodgkin’s lymphoma.
Non-Hodgkin’s lymphoma:
It mainly impacts the B-cell or T-cell. “This type of lymphoma occurs more commonly than Hodgkin’s lymphoma. Can vary clinically and diagnostically into slow-growing ones to very aggressive types,” notes Dr. Amrita Chakrabarti, Consultant, Haemato-Oncology & Bone Marrow Transplant, Max Hospital, Shalimar Bagh.
Hodgkin’s lymphoma
This type of lymphoma affects the B cells. Broadly divided into classical Hodgkins and nodular lymphocyte predominant types. Occurs in the adolescence or elderly age group.
Myeloma
It is the cancer of plasma cells; WBCs which produce disease and infection fighting anti-bodies. Myeloma cells prevent the functions and productions of these antibodies leaving a week immune system.
Multiple myeloma
This starts in the bone marrow when plasma cells begin to grow uncontrollably. “As the cells grow, they compromise the immune system and impair the production and function of white and red blood cells causing bone disease, organ damage and anemia among other conditions,” adds Dr Agarwal.
Symptoms Of Blood Cancer
In most cases of blood cancer, the patient feels tired and weak. This happens because the number of red blood cells in the blood starts decreasing due to which there is a lack of blood in the person. “Some of the common symptoms of blood cancers are fever, severe fatigue, bleeding from gums or skin, back ache, or bone pains,” says Dr Pravas Mishra, Head Haematology/ Medical Oncology and BMT, Amrita Hospital, Faridabad.
Patients with myeloma might first present to an orthopaedical with a fracture originating from trivial trauma or to a nephrologist with a kidney dysfunction. Pain in bones and joints can be a symptom of not only arthritis but also blood cancer. Blood cancer is a disease in the bone marrow that is found in large amounts around the bones and joints.
“Patients might present with nodes in the neck or axilla or groin or swelling in any part of the body. However most often a patient with blood cancer might present with just a low haemoglobin. It is strongly advised not to ignore any anaemia,” warns Dr Mishra.
A person suffering from blood cancer is prone to repeated infections. When leukemia cells develop in the body, then complaints of infection can be seen in the patient’s mouth, throat, skin, lungs, etc.
People who have cancer tend to have an abnormally low weight. If the body weight is reduced without any obvious cause, then it can be seen as the primary symptom of cancer.
The abnormal formation of leukemia cells in the body prevents the bone marrow from forming healthy blood cells such as platelets. Due to its deficiency, more bleeding problems can be seen from the nose of the patient, during menstruation and gums.
Diagnosis of blood cancer
Blood cancer is diagnosed with the help of a wide range of diagnostic methods along clinical evaluation, such as blood tests, bone marrow tests, cytogenetic/karyotyping and molecular analysis, flow cytometry.
Myths and facts about blood cancer
Myth: Blood cancer cannot be treated?
Fact: Once a patient is diagnosed with blood cancer, the first concern that comes to one’s mind – Is blood cancer curable?
Blood cancer is one type of cancer that has a high curability rate especially due to the advancement in the medical field, availability of newer, improved chemotherapy regimens, targeted therapy, and improved infection control measures. Timely diagnosis, especially early diagnosis, increases the chances of cure from blood cancer.
“Some of the other factors that impact the cure of blood cancer include the age of the patient, physical condition, presence of other comorbidities, stage of the disease, subtype of cancer, molecular factors, whether low grade/high grade, acute or chronic, the body parts that are affected and whether the disease is new onset or has come back after a previous cure.
You must understand that the cure or recovery from cancer is unpredictable,” adds Dr. Chakrabarti.
There are cases when the patient has recovered even in the later stages of blood cancer. On the other hand, there are recorded cases where the patient couldn’t recover even in the initial stages of blood cancer. So, it’s important to have realistic expectations and focus on following a healthy lifestyle with the advised treatment and measures. Early diagnosis and treatment play an important role in attaining cure.
Myth: All blood cancer patients need a bone marrow transplant
Fact: No, majority of patients suffering from blood cancers are treated without bone marrow transplant. A combination of chemotherapy, targeted therapy and immunotherapy is the best line of treatment.
Myth: Blood cancer occurs only in children?
Fact: No, blood cancers can occur in all age groups. All have a higher incidence in young children whereas Myeloid Leukaemia (MLL) is more frequently seen in senior citizens.
India is reeling under pressure of many misconceptions that exist amongst people about blood stem cell donation, its process and even its after-effects.
Myth: Once you donate blood stem cells, you will lose them forever.
Fact: Only a fraction of total stem cells is extracted during the process. Also, all the cells are naturally replenished within a few weeks
Myth: Donating stem cells is a really invasive and painful process
Fact: Blood stem cells are collected through peripheral blood stem cell collection (PBSC) which is completely safe and a non-surgical procedure. The process is similar to blood platelet donation that takes approximately three to four hours to complete and the donor can leave the collection center the same day.
Myth: Blood donation and a blood stem cell donation are same
Fact: “Unlike blood collection for transfusion, blood stem cells are collected only when there is a match between the donor and patient’s human leukocyte antigen (HLA) combination (tissue type). So, you could be potentially the only match and life saver for a person with blood cancer in need of a transplant,” adds Dr Nitin Agarwal. Blood stem cell donors donate only blood stem cells and the process is similar to a platelet donation.
Myth: Pregnant women can’t register
Fact: This is untrue, a woman can register even during her pregnancy.
Myth: Stem cell donation leaves prolonged side-effects
Fact: No, there are no major side effects post blood stem cell donation. A person may only experience minor flu like symptoms because of the GCSF injections given to him/her before the donation, to mobilize blood stem cells in your blood stream.
Myth: Piercing and/or tattoo is a restricting factor
Fact: Piercing or a tattoo doesn’t stop you from registering yourself to be a potential donor.
Myth: My blood stem cells can be stored
Fact: Your blood stem cells will not be stored. They last for around 72 hours and are delivered for the recipient straight to the hospital by a special courier. If the recipient’s body accepts them, the stem cells will start making healthy blood cells.
Myth: Joining a blood stem cell registry is no use. Most patients can find a stem cell donor within their own families
Fact: Per statistics, only 30% of blood disorder patients in need of a stem cell transplant are able to find a sibling match. About 70% of patients need an unrelated donor.
A registry like DKMS BMST Foundation India is a data bank of potential blood stem cell donors that houses details on thousands of committed blood stem cell donors. Any patient can benefit from this registry provided an HLA match.
Blood cancer treatment
Some of the blood cancer treatments include the following
Chemotherapy
This is the most important aspect of blood cancer treatment and involves using certain chemicals to kill the cancer-causing cells in the patient’s body. The prescribed drugs are given in a particular timeframe for the best possible improvement in the patient’s health. In some patients, a stem cell transplant is provided along with high dose chemotherapy.
Radiation therapy
Radiation therapy helps to destroy cancer cells with the help of specific high-energy beams to kill cancer cells in precise areas of the body. This treatment is much beneficial for patients with lymphoma
Bone marrow transplant
In this procedure, healthy stem cells are utilized to replace the cells affected by cancer. This helps the patients recover in the best possible manner. Can be autologous (where stem cells are taken from the patient’s own body) or allogenic (when a healthy donor gives stem cells to the patient.)
Targeted Therapy
Usually in the form of oral medications or pills. They are given alongside chemotherapy/ or radiotherapy and affect specific cancer cells and help in destroying them.
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