Cancers characterized by the overproduction of abnormal blood cells, leading to a shortage of healthy blood cells.
What are blood cancers?
Blood cancers are cancers that affect the production and function of blood cells. Most of these cancers start in the bone marrow, where blood cells are produced. When cancer develops, it disrupts the normal blood cell production process.
Blood cancers primarily affect three types of blood cells:
- Red blood cells: Carry oxygen throughout the body.
- White blood cells: Fight infection.
- Platelets: Help the blood clot.
In blood cancers, abnormal blood cells are produced in large numbers. These abnormal cells don't function properly and can crowd out healthy blood cells, leading to various complications. While the primary site of origin is often the bone marrow, blood cancers can also involve the lymphatic system (lymphomas) and other parts of the body.
The main types of blood cancers include leukemia, lymphoma, and myeloma. There are also related conditions like myelodysplastic syndromes (MDS) and myeloproliferative neoplasms (MPN).
AHN Hematological Oncology Center of Excellence
Our Hematological Oncology Center of Excellence includes physicians dedicated to malignant and benign disorders of the blood. We provide both inpatient and outpatient services and can offer treatment at AHN cancer institute sites throughout the region. The team also includes support from:
- Physician assistants
- Nurse practitioners
- Nurses
- Medical assistants
- Pharmacists
- Administrators
Why choose AHN for your blood cancer treatment?
AHN has a comprehensive cancer institute that likely encompasses a wide range of services specifically for blood cancers (also known as hematologic malignancies). At AHN, you can also expect:
- Specialized hematologists and oncologists: Our board-certified hematologists and oncologists specialize in the diagnosis and treatment of various blood cancers, such as leukemia, lymphoma, and myeloma.
- Multidisciplinary team approach: We use a multidisciplinary team approach, bringing together hematologists, oncologists, radiation oncologists, surgeons, pathologists, radiologists, nurses, and other specialists to provide coordinated care.
- Advanced diagnostic capabilities: AHN has state-of-the-art diagnostic tools, including advanced imaging (PET/CT, MRI), flow cytometry, cytogenetics, and molecular testing, to accurately diagnose and classify blood cancers. This is crucial for tailoring treatment.
- Wide range of treatment options: AHN could offer a comprehensive range of treatment options for blood cancers, including CAR T-cell therapy, stem cell therapy, and radiation therapy.
Blood cancer symptoms and signs
It’s important to remember that many of these symptoms and signs of blood cancer can be caused by other, non-serious health issues. If you are noticing worsening symptoms or concerning changes to your health, contact your doctor as soon as you can. Some common signs and symptoms of blood cancers include:
- Fatigue: Persistent tiredness or weakness that doesn't improve with rest. This is one of the most common symptoms across many blood cancers.
- Weakness: Feeling generally weak or lacking energy.
- Unexplained weight loss: Losing weight without trying.
- Fever or night sweats: Recurring fevers or excessive sweating, especially at night.
- Frequent infections: Getting infections more often than usual or having infections that are slow to heal.
- Easy bleeding or bruising: Bleeding or bruising more easily than normal, even from minor injuries. This can manifest as:
- Nosebleeds: Nosebleeds that occur more frequently than usual, last longer, or are difficult to stop.
- Bleeding gums: Gums that bleed easily, especially when brushing or flossing.
- Tiny red spots under the skin (petechiae): Small, pinpoint-sized red or purple spots that appear on the skin. They are usually flat and don't blanch (turn white) when pressed. Petechiae often occur in clusters.
- Larger bruises (ecchymoses): Bruises that are larger, more frequent, or appear with less trauma than usual. They may also be deeper in color (dark purple or black).
- Heavy menstrual periods: Menstrual periods that are abnormally heavy (soaking through pads or tampons more often than usual), prolonged (lasting longer than seven days), or involve passing large blood clots.
- Bone pain: Aching or tenderness in the bones, often in the ribs, spine, or long bones.
- Swollen lymph nodes: Enlarged lymph nodes, which may feel like lumps under the skin, particularly in the neck, armpits, or groin. They may or may not be painful.
- Abdominal discomfort or swelling: Discomfort or swelling in the abdomen, which may be caused by an enlarged spleen or liver.
- Headaches: Persistent or severe headaches.
- Skin rash or itching: Unexplained skin rashes or itching.
- Shortness of breath: Difficulty breathing or feeling short of breath, especially during activity.
Causes and risk factors
These are factors that make it more likely (but don't guarantee) that you might develop a blood cancer:
- Age: The risk of many blood cancers increases as you get older.
- Gender: Some blood cancers are more common in those assigned male at birth.
- Family history: If someone in your family has had a blood cancer, your risk might be slightly higher, but most blood cancers aren't directly passed down in families.
- Genetic conditions: Certain genetic conditions you're born with can increase your risk.
- Previous cancer treatment: Chemotherapy or radiation for a previous cancer can, in rare cases, increase your risk of developing a blood cancer later on.
- Immune system problems: Having a weakened immune system can increase your risk of certain lymphomas.
- Lifestyle factors: Smoking Increases the risk of acute myeloid leukemia (AML).
- Obesity: Obesity may be linked to a slightly higher risk of some blood cancers.
Blood cancer screening and diagnosis
Unlike some cancers (such as breast or colon), there are generally no routine screening tests recommended for the general population to detect blood cancers early. This is because effective and reliable screening tests for most blood cancers are not yet available. In certain cases, individuals with a family history of specific blood cancers or those with certain genetic conditions may undergo more frequent monitoring or testing. However, this is determined on a case-by-case basis by a health care professional. The diagnosis of blood cancer typically involves a combination of multiple approaches.
Medical history and physical exam
The doctor will ask about your symptoms, medical history, and family history of cancer. A physical exam will be performed to check for signs of blood cancer, such as swollen lymph nodes, enlarged spleen or liver, or pale skin.
Blood tests
The specific blood tests ordered will depend on the suspected type of blood cancer and the individual's clinical situation. Blood tests are just one part of the diagnostic process for blood cancers. Bone marrow biopsies, imaging studies, and other tests are also often necessary. Blood tests for blood cancers include:
- Complete blood count (CBC): Measures the number of red blood cells, white blood cells, and platelets in your blood. Abnormal counts can be an early sign of blood cancer.
- Peripheral blood smear: A sample of blood is examined under a microscope to look for abnormal cells.
- Blood chemistry tests: These assess kidney and liver function, which can be affected by blood cancers.
- Lactate dehydrogenase (LDH): Elevated levels may indicate tissue damage, which can occur in blood cancers.
- Uric acid: Elevated levels may indicate increased cell turnover, which can occur in blood cancers.
Bone marrow aspiration and biopsy
A sample of bone marrow is removed from the hip bone (usually) for examination. The bone marrow sample is examined under a microscope to look for abnormal cells, and tests such as flow cytometry, cytogenetics, and molecular testing may be performed. This crucial test for diagnosing most blood cancers includes:
- Aspiration: A liquid sample of bone marrow is extracted.
- Biopsy: A small piece of bone and marrow is removed.
Lymph node biopsy
If swollen lymph nodes are present, a biopsy may be performed to examine the tissue for signs of lymphoma. The entire lymph node (excisional biopsy) or a small piece of the lymph node (incisional biopsy) may be removed.
Imaging tests
The choice of imaging depends on the type of blood cancer suspected or diagnosed, as well as the individual's symptoms and clinical situation, and includes:
- X-rays: Can help detect bone damage in myeloma or lymphoma.
- CT scans: Provide detailed images of internal organs and can help detect enlarged lymph nodes or other abnormalities.
- MRI scans: Can be used to assess bone marrow involvement and detect tumors in soft tissues.
- PET scans: Can help detect areas of increased metabolic activity, which may indicate cancer. Often used in lymphoma.
Flow cytometry
A technique used to identify and count specific types of cells in the blood or bone marrow based on their surface markers.Helps to diagnose and classify leukemia and lymphoma.
Cytogenetic and molecular testing
These tests analyze the chromosomes and genes of blood cells to identify abnormalities that can help diagnose and classify blood cancers. Examples include karyotyping, fluorescent in situ hybridization (FISH), and polymerase chain reaction (PCR).
Types and stages of blood cancer
Understanding the types and stages of blood cancer can help you feel empowered and informed when it comes to your care options at AHN. Different types and stages require different treatment approaches. Knowing this allows patients to actively participate in choosing the best course of action.
Leukemia
Leukemia, or cancers of the blood and bone marrow, are characterized by the uncontrolled production of abnormal blood cells. Different types of leukemia are classified based on the type of blood cell affected (lymphoid or myeloid) and the rate of progression (acute or chronic) including:
- Acute leukemias: Fast-growing leukemias that require immediate treatment.
- Acute lymphoblastic leukemia (ALL): Affects immature lymphocytes.
- Acute myeloid leukemia (AML): Affects immature myeloid cells.
- Chronic leukemias: Slow-growing leukemias that may not require immediate treatment.
- Chronic lymphocytic leukemia (CLL): Affects mature lymphocytes.
- Chronic myeloid leukemia (CML): Affects myeloid cells; associated with the Philadelphia chromosome.
- Other leukemias:
- Hairy cell leukemia: A rare, slow-growing leukemia that affects B lymphocytes.
- Acute promyelocytic leukemia (APL): A subtype of AML.
- Myelomonocytic leukemia: A type of AML that affects both myeloid and monocytic cells.
Lymphoma
Cancers that begin in the lymphatic system, affecting lymphocytes (a type of white blood cell) are also called lymphoma.They are divided into Hodgkin lymphoma and non-Hodgkin lymphoma:
- Hodgkin lymphoma (HL): Characterized by the presence of Reed-Sternberg cells.
- Classical Hodgkin lymphoma: The most common type.
- Nodular lymphocyte-predominant Hodgkin lymphoma: A less common type.
- Non-Hodgkin lymphoma (NHL): A diverse group of lymphomas that are not Hodgkin lymphoma.
- B-Cell lymphomas: Affect B lymphocytes.
- Diffuse large B-Cell lymphoma (DLBCL): An aggressive lymphoma.
- Follicular lymphoma: A slow-growing lymphoma.
- Mantle cell lymphoma: A relatively rare and typically aggressive type of B-cell NHL.
- Marginal zone lymphoma: A group of slow-growing (indolent) B-cell non-NHL that arise from B lymphocytes in the marginal zone of lymphoid tissue.
- Burkitt lymphoma: A very aggressive lymphoma.
- T-Cell lymphomas: Affect T lymphocytes.
- Peripheral T-Cell lymphomas (PTCL): A group of aggressive lymphomas.
- Anaplastic large cell lymphoma (ALCL): A type of T-cell non-NHL. It is characterized by the presence of large, abnormal lymphocytes called "anaplastic" cells that express the CD30 protein.
Myeloma
Myelomas are cancers that affect plasma cells, a type of white blood cell that produces antibodies. Types include:
- Multiple myeloma: Plasma cells become cancerous and accumulate in the bone marrow, producing abnormal antibodies.
- Waldenström macroglobulinemia: A rare type of lymphoma where abnormal B cells produce large amounts of IgM antibodies.
- Plasma cell leukemia: A rare and aggressive form of myeloma where plasma cells are found in high numbers in the peripheral blood.
- Solitary plasmacytoma: A single tumor of plasma cells, typically in bone or soft tissue.
Myelodysplastic Syndromes (MDS)
A group of disorders in which the bone marrow doesn't produce enough healthy blood cells. MDS can progress to AML.Classification: Based on the types of blood cells affected and the percentage of blast cells in the bone marrow.
Myeloproliferative Neoplasms (MPN)
A group of disorders characterized by the overproduction of blood cells in the bone marrow. Subtypes include:
- Polycythemia vera (PV): Overproduction of red blood cells.
- Essential thrombocythemia (ET): Overproduction of platelets.
- Primary myelofibrosis (PMF): Scarring of the bone marrow, leading to impaired blood cell production.
- Chronic neutrophilic leukemia (CNL): Overproduction of neutrophils.
- Chronic eosinophilic leukemia (CEL): Overproduction of eosinophils.
Staging blood cancer is complex and varies depending on the specific type of blood cancer. Unlike solid tumors, blood cancers (leukemia, lymphoma, myeloma) don't always form tumors that can be easily measured and staged using a simple system like Stage 1, 2, 3, or 4. Instead, staging and risk assessment consider a combination of factors. These factors take into consideration the patient’s overall health, the type of blood cancer, blood count, lymph node and organ involvement, and many more factors. Your AHN care team will work with you to provide a specific prognosis for you.
Blood cancer treatment
The specific treatment approach for blood cancer depends on the type of cancer, its stage, the patient's age and overall health, and other individual factors. Your AHN blood cancer specialist and care team will develop a treatment plan that is personalized to your specific needs. Treatment can often include one or a combination of these approaches:
- Chemotherapy: Uses drugs to kill cancer cells or stop them from growing. It's often the main treatment for many types of leukemia and lymphoma. Chemotherapy drugs can be given orally (as pills), intravenously (through a vein), or directly into the cerebrospinal fluid.
- Targeted therapy: These drugs target specific molecules involved in cancer cell growth and survival, without harming normal cells as much as chemotherapy. It can be used alone or in combination with chemotherapy. Common therapies include Tyrosine kinase inhibitors (TKIs) for chronic myeloid leukemia (CML), monoclonal antibodies for lymphoma.
- Immunotherapy: This uses your own immune system recognize and attack cancer cells. It can be used alone or in combination with other treatments. Targeted therapy options include immune checkpoint inhibitors, CAR T-cell therapy.
- Radiation therapy: Using high doses of radiation to kill and shrink tumors, radiation therapy is used to treat localized lymphomas or to relieve symptoms, such as bone pain.
- Stem cell transplantation (bone marrow transplantation): Damaged or diseased bone marrow is replaced with healthy stem cells. It's used to treat certain types of leukemia, lymphoma, and multiple myeloma.
- Surgery: Surgery has a limited role in treating hematologic cancers. It can be used for diagnostic purposes (e.g., lymph node biopsy), to remove the spleen (splenectomy) in certain cases, or to treat complications.
- Supportive care: Supportive care aims to manage the side effects of treatment and improve the patient's quality of life. This can include medications to prevent nausea, antibiotics to treat infections, and blood transfusions to treat anemia or thrombocytopenia.
Blood cancer FAQs
You likely have questions — and maybe concerns — if you are facing a blood cancer diagnosis. That’s completely normal, and your AHN care team is here to help. They will be your go-to resource and are here to talk with you about any questions or concerns you may have. If you need a place to start, we’ve complied some frequently asked questions that may help you start to form your own questions to bring to your team.
Is blood cancer curable?
The curability of blood cancer depends on several factors, including the specific type of cancer, its stage, the patient's age and overall health, and the treatment approach. Some types of blood cancer are highly curable, while others are more challenging to treat and may require ongoing management.
What is a cancerous level of white blood cells?
There isn't a single "cancerous level" of white blood cells (WBC). Normal WBC counts vary, and what's considered abnormal depends on the specific type of blood cancer suspected. In some leukemias, WBC counts can be extremely high, while in other blood cancers, they may be normal or even low. A doctor will evaluate WBC counts in the context of other blood test results and symptoms to determine if cancer is present.
How is blood cancer diagnosed?
Blood cancer diagnosis typically involves a combination of the following:
- Physical exam: A doctor will check for signs of blood cancer, such as swollen lymph nodes, enlarged spleen or liver, or paleness.
- Blood tests: A complete blood count (CBC) can reveal abnormalities in red blood cells, white blood cells, and platelets. A blood smear can help identify abnormal cells under a microscope.
- Bone marrow biopsy: A sample of bone marrow is taken and examined under a microscope to look for cancerous cells.
- Imaging tests: X-rays, CT scans, or MRIs may be used to look for tumors or other abnormalities in the body.
- Lymph node biopsy: If lymph nodes are swollen, a biopsy may be performed to check for cancer cells.
What are the three main types of blood cancer?
The three main types of blood cancer are:
- Leukemia: Cancer of the blood and bone marrow, characterized by the overproduction of abnormal white blood cells.
- Lymphoma: Cancer of the lymphatic system, which includes the lymph nodes, spleen, and thymus gland.
- Myeloma: Cancer of the plasma cells, a type of white blood cell that produces antibodies.
What are the seven warning signs of blood cancer?
While these symptoms can be caused by other conditions, it's important to see a doctor if you experience any of the following, especially if they are persistent or unexplained:
- Unexplained weight loss
- Fever or night sweats
- Fatigue or weakness
- Bone pain or tenderness
- Swollen lymph nodes
- Enlarged liver or spleen
- Easy bleeding or bruising
What is the life expectancy of a person with blood cancer?
Life expectancy for people with blood cancer varies widely depending on the type of cancer, stage at diagnosis, genetic factors, treatment received, and overall health. Some blood cancers have high survival rates with treatment, while others are more aggressive and have a poorer prognosis. It is crucial to discuss this question with the patient's oncologist, as they can provide the most accurate and personalized information.
Does cancer show up in routine blood work?
Sometimes, yes. A routine complete blood count (CBC) can sometimes detect abnormalities that suggest blood cancer, such as unusual white blood cell counts, low red blood cell counts (anemia), or low platelet counts. However, a normal CBC does not always rule out cancer, and further testing may be needed if symptoms are present or if there is a high suspicion of cancer.
Contact us
Call the Division of Hematology and Cellular Therapy at 412-578-4484 or (412) 578-HOPE (412) 578-4673 to make an appointment with a hematologist. Patients needing immediate care are usually admitted to AHN West Penn Hospital and care is coordinated from there. Patients are otherwise seen in the outpatient office in the Mellon Pavilion. Once scheduled, our staff will instruct you on what is needed so that our doctors get access to your medical records.
Second opinions
If you have cancer, you have a team of oncology specialists ready to review your medical records and offer you a second opinion. After completing their review, they’ll talk with you about your goals to determine a course of treatment that’s right for you. To get started, fill out our Second Opinion Request form. A nurse navigator will contact you within the next 24 to 48 hours to discuss next steps and schedule.