About blood cancers About leukaemia and blood cancers Treating blood cancers Treating Blood Cancer Once diagnosed, your healthcare team can describe your treatment options, the expected results of each option, and possible side effects. Because cancer treatments often damage healthy cells and tissues, side effects are common. The treatment that’s right for you depends mainly on the type of blood cancer, your age, and your general health. People with blood cancer have many treatment options, and you may receive more than one type of treatment. Treatment options may include: Watchful waiting supportive care Chemotherapy Targeted therapy Radiation therapy Stem cell transplant Your healthcare team may include the following specialists: Haematologist: A haematologist is a doctor who specialises in treating blood disorders. Clinical nurse specialist: They are your key point of contact for your healthcare team. You and your carers can ask questions about blood cancer and your care and have support from your clinical nurse specialist when you’re first diagnosed and throughout your treatment and beyond. Their continuous support, care and knowledge at every step makes a clinical nurse specialist a key member of your multidisciplinary team. You should be given the names and contact details of your consultant, clinical nurse specialist and other members of your healthcare team. Don’t be afraid to ask your healthcare team any questions you might have about your treatment and the other available options. Questions you may want to ask your doctor about treatment What are my treatment options? Which do you recommend for me? Why? What are the potential benefits of each kind of treatment? What are the risks and potential side effects of each treatment? How can side effects be managed? What can I do to prepare for treatment? Will I need to stay in the hospital? If so, for how long? How will treatment affect my normal activities? Would a clinical trial be right for me? Clinical Trials For anyone thinking about cancer treatment, a clinical trial may be an option. Clinical trials involve testing new drugs or combinations of drugs in people diagnosed with blood cancer. Like all other treatment options, a clinical trial can have possible benefits and risks. By looking closely at all options, including clinical trials, you are taking an active role in a decision that affects your life. Even if you don’t benefit directly from the treatment being studied, you may still make an important contribution by helping doctors learn more about blood cancer and how to control it. If you’re interested in exploring you clinical trial options, ask your consultant. Questions you may want to ask your consultant: What are clinical trials and why they are important? How is your safety protected? Who pays for clinical trials? Watchful Waiting Your doctor may suggest watchful waiting if you’re diagnosed with chronic lymphocytic leukaemia (CLL) ? sometimes MDS?? but you don’t have symptoms. Watchful waiting means delaying treatment until you have symptoms. By opting for watchful waiting you will avoid unnecessary side effects of treatment until it is needed. If you and your doctor agree that watchful waiting is a good idea, you’ll get exams and blood tests every three to six months. Your doctor may suggest starting treatment if you develop symptoms. Some people worry that waiting to start treatment may reduce the chance to control leukaemia before it gets worse. Having regular checkups reduces this risk. If you choose watchful waiting but later become concerned about delaying treatment, you should talk with your doctor. Questions you may want to ask your doctor about watchful waiting Is it safe for me to delay treatment? How often will I have checkups? How will we know if my blood cancer is getting worse? Chemotherapy Chemotherapy is one of the most common types of cancer treatment, and uses drugs to kill off the cells that cause cancer. Chemotherapy involves drug treatment for a set period, followed by a break for a set period and this process may be repeated. The time in between drug treatments helps your body to recover from the effects of the chemotherapy. You may receive chemotherapy in a clinic, in hospital, or at home. Chemotherapy works by attacking and destroying fast-dividing cancer cells. However chemotherapy also attacks other healthy, fast-dividing cells, such as hair cells. Chemotherapy can cause unpleasant side effect that may include: Infections, fatigue and bruising: When drugs lower the levels of healthy blood cells, you’re more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. If your levels are low, your health care team may stop the chemotherapy for a while, reduce the dose of the drug, or give you a blood transfusion. They may also give you medicines that help your body to make new blood cells. Hair loss: Some chemotherapy drugs may cause hair loss. If you lose your hair, it will grow back after treatment, but the colour and texture may be changed. Sickness, nausea and loss of appetite: Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhoea, or mouth blisters. Your healthcare team can give you medicines and suggest other ways to help with these problems. Infertility: In order to have a child after treatment, you may choose to store sperm or eggs before treatment starts although this is not always possible. These options will be discussed by your healthcare team. Targeted Therapy Targeted therapies are drugs that can help stop the growth and spread of cancer cells. Several targeted therapies are used for some cancers. The type of targeted therapy depends on the type of blood cancer. Targeted therapies work by directing at specific genes or proteins that are found in cancer cells or in cells related to cancer growth, like blood vessel cells. Targeted therapies are often used with chemotherapy and other treatments. Questions you may want to ask your doctor about chemotherapy or targeted therapy Which drug or drugs do you suggest for me? What will they do? What are the possible side effects? What can we do about them? When will treatment start? When will it end? How often will I have treatments? How will I know the treatment is working? Will there be lasting side effects? Why do I need this treatment? Will I have to stay in the hospital? Will I experience side effects during treatment? How long will they last? What can I do about side effects? Can these drugs cause side effects later on? How often will I need check-ups? Radiation Therapy Some people with blood cancer receive radiation therapy along with chemotherapy. Treatment involves lying down on a treatment table, and a large machine will aim high-energy rays at your body to kill cancer cells. The machine may be aimed at the brain or other parts of the body where blood cancer cells have been found, or the machine may be aimed at the whole body. Side effects depend mainly on how much radiation is given and the part of your body that is treated. Ask your health care team what to expect. Side effects may develop during radiation therapy or months or years later. Radiation therapy aimed at the brain may cause you to feel tired or to lose hair from your head. Your health care team can suggest ways to manage these problems, which usually go away when treatment ends. However, some side effects, such as memory loss or other problems, may be permanent. It’s common for skin in the treated area to become red, dry, and itchy. Check with your doctor before using lotion or cream on that area. The skin will slowly recover and get back to normal. You’re likely to become tired during radiation therapy, especially in the later weeks of treatment. Although getting enough rest is important, most people say they feel better when they exercise every day. Try to go for a short walk, do gentle stretches, or try yoga practice. Questions you may want to ask your doctor about radiation therapy Why do I need this treatment? When will treatment start? When will it end? How often will I have treatments? How will we know the treatment is working? What side effects should I expect? What should I tell you about? Are there any lasting effects? Stem Cell Transplant Some people with cancer receive a stem cell transplant. Some people will receive radiation therapy and chemotherapy as part of the Stem Cell Transplant treatment but most will receive chemotherapy alone. This is known as conditioning therapy. Stem cell transplants can either take place in the hospital or increasingly common nowadays in the Ambulatory setting. People who are treated in the Ambulatory setting may stay in their own homes if they live near enough to the hospital or in a ‘patient’ hotel and visit the ambulatory unit each day for treatment or blood checks. Ambulatory patients often tolerate treatment well and are able to eat away from the hospital, tend to sleep better and are more active. They are admitted to the hospital if they become unwell and then may stay in hospital for the rest of the transplant or be discharged back into Ambulatory care for a few days. Ambulatory care isn’t for everyone and if your team suggest that you have all your transplant care in the hospital, then you will likely stay in the hospital for several weeks. To replace the blood stem cells that are destroyed by the conditioning therapy you’ll receive blood or marrow stem cells through a vein. It’s like getting a blood transfusion. The transplanted stem cells will move to the bone marrow and make new blood cells. People who receive stem cells from a donor, such as a sister or brother, may develop graft-versus-host disease. You might also have your own stem cells collected and then given back to you after high dose treatment. Questions you may want to ask your doctor before a stem cell transplant Why do I need radio therapy? When will the treatment begin? How often will it be given? When will it end? How will I feel during therapy? Will there be side effects? How long will they last? What can I do about side effects? Can radio therapy cause side effects later on? What can I do to take care of myself during therapy? How will we know if the radio therapy is working? Will I be able to continue my normal activities during treatment? How often will I need check-ups? Questions you may want to ask your doctor about stem cell transplants What kind of stem cell transplant do you recommend? Where will the stem cells come from? How long will I be in the hospital? Will I need special care? How will I be protected from infection? What care will I need when I leave the hospital? What are the risks and side effects of this treatment? What can we do about them? How will we know if the treatment is working? What is my chance of a full recovery? How long will that take? Nutrition Eating well is important before, during, and after treatment for blood cancer. Your consultant may refer you to a dietician, or another health care professional to suggest ways to help you meet your nutrition needs during treatment. Remission In many cases, the aim of blood cancer treatment is to achieve remission. When someone is in remission it means that the cancer cells in their body cannot be detected. Following blood cancer treatment, tests are carried out to find out whether the cancer cells have gone completely or partially. There are different types of remission, and these depend on how well their body has responded to treatment and how many cancer cells are still there. Further contacts Below are links to a number of other organisations and charities which offer useful help and advice to patients with blood cancer. The Anthony Nolan charity produces a number of downloadable guides, including Seven Steps, a guide to long term recovery after a stem cell transplant. Cancer Research UK has statistics and information on many blood cancers as well as information on bone marrow and stem cell transplants. Macmillan Cancer Support offers a range of useful information, including a guide to cancer treatment. The charity Bloodwise provides information on the latest blood cancer research. NHS Choices has information on acute lymphoblastic leukaemia, chronic lymphocytic leukaemia, non Hodgkin lymphoma, Hodgkin lymphoma, myeloma.