Leukemia, lymphoma and myeloma

What are these diseases?

Blood cancers are diseases that disturb how blood cells are made and how they work. The three best-known groups are leukemia, lymphoma and myeloma. Unlike many cancers, blood cancers usually do not form a solid lump (a solid tumor).

• Leukemia is cancer of the blood and bone marrow. Abnormal white cells are made and take the place of healthy cells. The type depends on which blood cell has become cancerous and whether it grows fast or slowly.
• Lymphoma is cancer of lymphocytes, the white cells that work in the lymphatic system (lymph nodes and related tissues). It has two main groups: Hodgkin lymphoma and non-Hodgkin lymphoma.
• Myeloma is cancer of plasma cells, the cells that make antibodies.

One reassuring point: being referred to a blood specialist, or having an abnormal test, does not mean you have one of these diseases. An abnormal blood count has many other causes, and the doctor weighs it against the rest of the information.

What symptoms may it cause?

The symptoms depend on the type of disease, and most of them also appear in simpler conditions. Having them means they should be checked, not that the disease is certain.

• Acute leukemia (for example the acute myeloid type): unusual tiredness or weakness, paleness, shortness of breath, easy bruising or bleeding, frequent infections, fever, bone or joint pain, and swollen glands in the neck, armpit or groin. These symptoms usually appear over a few weeks.
• Lymphoma: the most common sign is a painless lump or swelling in the neck, armpit or groin. Fever, heavy night sweats, shortness of breath, itchy skin and sudden unexplained weight loss may also occur.
• Myeloma: bone pain (often in the back, hips, shoulders or ribs), unexplained tiredness, shortness of breath, muscle weakness, headache, strong thirst and frequent urination, and weight loss without dieting. Sometimes myeloma causes no symptoms at first and is found only through a blood test done for another reason.

A swollen gland is usually due to infections such as a cold or sore throat, and a blood or lymph cancer is an uncommon reason for it.

How is it diagnosed?

Diagnosis usually goes through several steps:

• Blood tests. The first step. They show the counts and the appearance of the blood cells.
• Biopsy. In lymphoma, part or all of a lymph node is removed, or a sample is taken with a thin needle. In leukemia and myeloma, a bone marrow sample is taken with a needle. These are done with local anesthetic or anesthesia.
• Imaging. Depending on the disease, a CT scan, MRI, PET scan or ultrasound may be needed.
• Further tests. Such as more blood tests and sometimes a check of the spinal fluid.

The results of these checks show the type of disease, the stage (how far it has spread) and whether it is fast or slow. This information decides the treatment. Not every patient needs all of these tests; the doctor will say which ones you need.

How is treatment planned?

The treatment plan depends on the type of disease, whether it is fast or slow, where it is, and your overall condition. The methods that may be used are: chemotherapy, targeted drugs, immunotherapy, radiotherapy, stem cell transplant and supportive care. This is a general list and does not mean all of them will be done. Which one suits you and where it is done is decided by the treatment team. In some cases radiotherapy or a transplant is carried out by a specialist in that field and you are referred.

A few points patients know less about:

• Not everyone is treated right away. In chronic lymphocytic leukemia it is said that treatment may not be needed at first and only regular follow-up is required. In slow-growing lymphomas too, if you have no symptoms, periodic tests may be done instead of early treatment. In myeloma as well, treatment does not always need to start at once.
• Some types need early treatment. In acute myeloid leukemia treatment usually has to start quickly.
• The goal of treatment is not always the same. In some diseases the goal is a cure, and in others it is to control the disease and its symptoms. For chronic lymphocytic leukemia, for example, it has no cure but can be kept under control with treatment. In myeloma too, the goal is often to limit the disease and its symptoms. Ask the doctor what the goal of treatment is in your case.
• Supportive care is part of treatment. Such as preventing infection, vaccines, blood or platelet transfusions and, in myeloma, medicines to protect the bones.

Follow-up and care at home

During and after treatment, regular tests and check-ups are needed, and imaging may also be done. If a symptom or side effect worries you between appointments, do not wait for the next one; contact the treatment team. Day-to-day advice (infection, food, side effects) is in the site’s “Patient guide”.

When to call

• A fever of 38 degrees or higher, especially during treatment: call the treatment team at once.
• Bleeding that will not stop, or bruises and tiny red spots on the skin without a reason.
• A swollen gland that has not shrunk after a week, is hard or does not move, or comes with night sweats and fever: see a doctor at the first opportunity.
• Emergency (115, Iran’s emergency number): sudden numbness or weakness in the arms or legs, being unable to stand or walk, sudden confusion, or losing control of urine or stool (in myeloma this may be a sign of pressure on the spinal cord and needs urgent treatment), and also severe shortness of breath.

For the full list of warning signs, see the guide “When should I call urgently?”. Every patient’s treatment plan is different; ask your doctor about your own situation.