About blood cancers About leukaemia and blood cancers About blood cancer About Blood Cancer There are over 130 different types of blood cancer and anyone can be affected regardless of age, gender and ethnicity. In the UK alone, someone is diagnosed every 14 minutes with a potentially life threatening blood cancer. Leukaemia is the most common form of cancer in children, although 94% of people diagnosed with leukaemia are adults. Survival rates vary widely across the different forms of blood cancer but thanks to improvements in research today over 90% of children with leukaemia are cured . What are the symptoms of blood cancer? Symptoms of the most common forms of blood cancer may include the following: Leukaemia (cancer of the white blood cells. It is named according to the type of white blood cell which is affected and whether it is acute (faster growing) or chronic (slower growing). Unexplained weight loss Feeling tired or weak Easily bruise or bleed Swollen lymph nodes Swollen stomach Infections Fever/night sweats Pain in bones/joints Lymphoma (cancer of the lymphatic system. There are two main types – Hodgkin lymphoma and non-Hodgkin lymphoma) Swollen lymph nodes Fever/night sweats Feeling tired/weak Itchy skin Unexplained weight loss Coughing/breathing difficulty/chest pain Increased alcohol sensitivity or feeling pain in the lymph nodes after drinking (Hodgkin lymphoma) Swelling or feeling pain or fullness in the stomach (non-Hodgkin lymphoma) Myeloma (cancer of plasma cells in the bone marrow. Plasma cells are a type of white blood cell) Weight loss Fevers and infections Frequent broken bones, often in the back Bone pain (ribs/back) Thirst Frequent urination Nausea/constipation Acute and chronic blood cancers Blood cancers may be described as either: Acute: this is an aggressive or fast-growing cancer that spreads quickly, or Chronic: this is a slower-growing cancer that takes longer to spread About Leukaemia Leukaemia is cancer of the blood and bone marrow. Unlike other cancers, leukaemia does not typically produce lump-like tumours but results in overproduction of cancerous white blood cells. The blood contains three main types of cells: white cells fight infection red cells carry oxygen platelets help with clot formation All these cells are suspended in liquid plasma. Every day, hundreds of billions of new blood cells are produced in the bone marrow – most of them red cells. When people develop leukaemia, the body starts producing more white cells than it needs. Many of the extra white cells do not mature normally, but they tend to live much longer than their normal life span. Despite their vast numbers, the leukemic cells are unable to help fight infection the way normal white blood cells do. As they increase, they interfere with vital organ functions, and get in the way of the production of healthy blood cells. Eventually the body cannot produce enough red cells to supply oxygen, enough platelets to ensure proper clotting, or enough normal white cells to fight infection. This means that people with leukaemia often become anaemic and susceptible to bruising, bleeding and infection. Leukaemias are classified as acute or chronic. Cancer cells in acute leukaemia start multiplying before they develop beyond their immature stage. Chronic Leukaemia progresses more slowly, with cancer cells often developing to full maturity. Leukaemia is further categorised according to the type of white blood cell involved. There are two broad categories: Myeloid leukaemia Lymphoid leukaemia For each type of leukaemia, the treatment plan may be different. About Lymphoma Lymphoma is a blood cancer which appears as a solid tumour most commonly in the lymph nodes of the neck, chest, armpit or groin but can be detected elsewhere in the body too. There are two main types of lymphoma. The most common being non-Hodgkin Lymphoma and the less common Hodgkin Lymphoma. (NEED FIGURES and references) About Myeloma Myeloma is a kind of plasma cell disorder with a ‘relapsing remitting’ behaviour that requires treatment intermittently. Myeloma, also known as multiple myeloma is a cancer arising from plasma cells, a type of white blood cell which is made in the bone marrow. Myeloproliferative neoplasms and Myelodysplastic syndromes Some other conditions are closely related to blood cancers. They are similar because the cells grow in an uncontrolled way. They tend to develop more slowly than blood cancers. There may be too many or too few of certain types of blood cells. The cells may be made too quickly and don’t mature properly. These cells come from myeloid stem cells, which are made in the bone marrow. (Myelodysplastic syndrome? this is just MPN)The main conditions are: essential thrombocythaemia (ET) polycythaemia vera (PV) myelofibrosis (MF ) ET, PV and MF belong to a group of conditions called myeloproliferative neoplasms (MPNs). This is when the bone marrow makes too many of one or more types of blood cell. Myelodysplastic syndrome (MDS) is a blood disorder where some of the blood cells made in the bone marrow are damaged. This means that not enough healthy blood cells make it into the bloodstream. Some people with MPNs and MDS can develop leukaemia. 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. Possible questions to ask your consultant: What are clinical trials and why they are important? How is your safety protected Who pays for clinical trials What to think about if you’re deciding whether to take part in a clinical trial 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 3 to 6 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 by 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: Blood cells: 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. Cells in hair follicles: 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. Cells that line the digestive tract: 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. Chemotherapy can also cause 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 at 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 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? 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? 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 Note: Plus will add links to further recourses, info and support i.e. NHS direct and other charities [mk1]It would be good to provide references for this data [mk2]Reference needed [mk3]Not sure this means anything to a patient – suggest delete [mk4]Would be good to support with figures for adult and children and references [mk5]These are MPNs what about MDS?? [mk6]What about types of MDS – RA, RARS, RAEB etc….. [mk7]What does this mean? Is it a sub header? [mk8]Suggest delete as treatment wont be delivered based only on growing concern [mk9]This also needs to be mentioned for other therapies too… [mk10]What about rehab and exercise Smoking, alcohol?? [mk11]Please include links for the seven steps books (Blood wise and Anthony Nolan) – these are the standard texts for transplantation. What about sections on emotional support and carers - especially given the M&B focus…..