AI Summary Overview
What is Blood Cancer?
Blood cancer is defined as any type of cancer affecting the body tissues concerned with the production of blood cells. Some of the body tissues associated with the development of blood cells include bone marrow, the lymphatic system, and lymph nodes.
Body tissues involved in the development of blood consist of those responsible for the development of three major blood components, including:
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Red blood cells, which transport oxygen in the body
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White blood cells, which fight any infections within the body
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Platelets, which ensure the coagulation of blood cells.
Normally, the production of blood cells takes place primarily in the bone marrow, guided by regulatory signals from other organs. However, in a patient suffering from blood cancer, the uncontrolled growth of abnormal cells disrupts this entire process inside the bone marrow.
What are the Types of Blood Cancer?
Blood cancers are broadly categorised based on the specific blood cell lineage involved (myeloid or lymphoid) and the site of the abnormality.
The following are the types of blood cancer:
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Leukaemia
Leukaemia is a common form of cancer of the bloodstream. This cancer starts in the bone marrow and results in an uncontrolled growth of immature white blood cells. Leukaemia is classified based on how quickly or slowly the disease develops (acute or chronic) and depending on the cells affected by the disease.
Four types of leukaemias include:
- Acute Lymphoblastic Leukaemia (ALL)
- Acute Myeloid Leukaemia (AML)
- Chronic Lymphocytic Leukaemia (CLL)
- Chronic Myeloid Leukaemia (CML)
ALL is a prevalent form of leukaemia among Indian kids.
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Lymphoma
Lymphoma is a cancer that occurs due to problems arising within the lymphatic system, which is made up of the lymph node system. Lymphoma is classified into the following two categories based on the cell type causing the disease:
- Hodgkin Lymphoma (HL)
- Non-Hodgkin Lymphoma (NHL)
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Multiple Myeloma Multiple myeloma occurs due to the abnormal formation and overproduction of plasma cells, the bone marrow cells that make antibodies. It affects the bone marrow’s ability to produce healthy blood cells. It mostly affects people above the age of 50, and men are more prone to such disorders than women.
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Myelodysplastic Syndromes (MDS) and Myeloproliferative Neoplasms (MPN) Myelodysplastic syndromes refer to disorders of the bone marrow that are caused by abnormal production of blood cells, resulting in low production of blood. Myeloproliferative neoplasms are conditions relating to blood cells where there is an overproduction of cells, including polycythaemia vera, essential thrombocythemia, and myelofibrosis. Such disorders may finally lead to acute leukaemia.
How Common is Blood Cancer in India?
Blood cancer is common in India, with one person being diagnosed with blood cancer every five minutes. Leukaemia is considered the most common type of blood cancer in India, which constitutes more than 50% of the total number of cases.
The increasing prevalence of blood cancers in India is attributed to the increased elderly population, obesity, exposure to chemicals and pesticides in agricultural fields, and improved diagnostic modalities.
What are the Symptoms of Blood Cancer?
The blood cancer symptoms depend on the type and stage of the disease. Initially, some patients develop mild symptoms, while others present with more advanced signs.
Some of the commonly noticed early warning signs and advanced symptoms of blood cancer are listed below:
| Early Symptoms | Advanced Symptoms |
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What Causes Blood Cancer?
There are several causes of blood cancer, which include:
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Genetic Mutations: Blood cancers usually develop because of genetic mutations in blood-forming cells, with oncogenes (responsible for growth stimuli) or tumour suppressors (responsible for arresting proliferation) being affected.
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Ionising Radiations: High levels of ionising radiations, like those from occupational or medical exposure and even accidental exposures from nuclear disasters, are established risk factors for developing various forms of leukaemias.
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Chemical Exposure: Prolonged chemical exposure to certain harmful elements can increase the risk of AML and NHL. Excessive exposure to carcinogenic chemicals like benzene (solvents, petrol products, and pesticides) and formaldehyde poses a high risk of these cancers.
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Consequences of Cancer Treatment: Some treatment therapies in patients who suffer from other kinds of cancers might lead to therapy-related leukaemia (t-AML or t-MDS) after a period of 5-10 years from exposure to these drugs, specifically in relation to chemotherapy.
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Infectious Agents: Certain agents of viral infections are capable of causing blood cancers: the Epstein-Barr virus causes Burkitt Lymphoma and Hodgkin Lymphoma; the HTLV-1 virus causes adult T-cell leukaemia, while Helicobacter Pylori causes gastric MALT lymphoma.
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Immunosuppressive Conditions: HIV/AIDS, autoimmune conditions, and prolonged use of immunosuppressant drugs following transplantations make patients prone to developing lymphomas.
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Age and Gender: Blood cancers are commonly diagnosed in older adults. Multiple myeloma and CLL (chronic lymphocytic leukaemia) are predominantly found among the elderly. Acute Lymphoblastic Leukaemia tends to occur in children aged between 2 and 5. Males are more prone to having blood cancer than females.
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Genetic Factors: While blood cancer is not directly hereditary, individuals with a family history of CLL or lymphoma face an elevated risk due to shared genetic predispositions that make them more vulnerable to the disease.
Stages of Blood Cancer
Blood cancers are staged differently depending on the specific type. The doctor determines the stage or disease status using blood counts, bone marrow findings, imaging, genetic tests and other disease-specific investigations. The stages are given in brief in the table below:
| Blood Cancer Type | Stage or Disease Status | Features |
| Acute Leukaemia | Newly Diagnosed | Abnormal blood and bone marrow findings before treatment begins |
| Acute Leukaemia | Remission | Marrow blasts <5%. Full blood count recovery (ANC >1,000/μ L, platelets >100,000/μ L). No disease outside the marrow. Verified at a molecular level via MRD testing. |
| Acute Leukaemia | Refractory | The disease does not respond adequately to treatment |
| Acute Leukaemia | Recurrent | The disease returns after a period of remission |
| Chronic Lymphocytic Leukaemia - Stage 0 | Early disease | Increased lymphocytes without enlarged lymph nodes, anaemia or low platelets |
| Chronic Lymphocytic Leukaemia - Stage I | Lymph-node involvement | Increased lymphocytes with enlarged lymph nodes |
| Chronic Lymphocytic Leukaemia - Stage II | Organ enlargement | Increased lymphocytes with an enlarged liver or spleen |
| Chronic Lymphocytic Leukaemia - Stage III | Anaemia develops | Increased lymphocytes with a reduced red blood cell count |
| Chronic Lymphocytic Leukaemia - Stage IV | Platelet count falls | Increased lymphocytes with a reduced platelet count |
| Lymphoma - Stage I | Localised disease | One lymph-node region or one nearby organ is affected |
| Lymphoma - Stage II | Limited spread | Two or more lymph-node regions on the same side of the diaphragm are affected |
| Lymphoma - Stage III | Wider lymphatic spread | Lymph nodes above and below the diaphragm are affected |
| Lymphoma - Stage IV | Extralymphatic spread | Disease has spread widely to organs such as the bone marrow, liver or lungs |
| Multiple Myeloma - Stage I | Lower-risk disease | Lower disease burden and no high-risk staging features |
| Multiple Myeloma - Stage II | Intermediate disease | Findings fall between Stage I and Stage III |
| Multiple Myeloma - Stage III | Higher-risk disease | Higher disease burden, raised LDH or high-risk genetic changes may be present |
Diseases Similar to Blood Cancer
Blood cancer, aplastic anaemia and immune thrombocytopenia may cause fatigue, bruising, bleeding or abnormal blood counts. However, they differ in their causes and the blood cells affected.
A brief comparative overview of two such conditions similar to blood cancer is given below:
Blood Cancer Vs. Aplastic Anaemia Vs. Immune Thrombocytopenia
| Feature | Blood Cancer | Aplastic Anaemia | Immune Thrombocytopenia |
| How It Happens | Abnormal blood cells multiply uncontrollably | The immune system attacks stem cells, causing bone marrow failure | The immune system destroys platelets |
| Location | Blood, bone marrow or lymphatic system | Red bone marrow | Bloodstream (circulating platelets) and the spleen |
| Associated Symptoms | Fatigue, infections, bruising, swollen lymph nodes | Fatigue, infections, easy bleeding | Bruising, petechiae, nosebleeds, heavy periods |
| Severity | Varies; may be life-threatening | Mild to life-threatening | Often mild; severe bleeding possible |
| Can It Be Reversed? | Sometimes, depending on the type | Sometimes, with appropriate treatment | Sometimes; remission may occur |
What are the Complications of Blood Cancer?
Complications associated with blood cancer include:
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Sepsis: Due to the low quantity of white blood cells, sepsis develops because the organs cannot cope with infections induced by bacteria and fungi. Sepsis is the major reason for fatalities while undergoing chemotherapy.
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Anaemia:Due to a lack of red blood cells, several issues arise, including difficulty breathing, weakness, and heart disorders, which may necessitate a blood transfusion.
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Bleeding Disorders: Thrombocytopenia, or a low platelet count, can increase the risk of excessive or internal bleeding. In severe cases, it may lead to life-threatening bleeding, including brain haemorrhage.
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Tumour Lysis Syndrome: Associated with the rapid, chemotherapy-induced destruction of cancer cells, this condition results in profound electrolyte imbalances and hyperuricaemia.
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Bone Marrow Failure (Multiple Myeloma): There is an increase in a particular substance produced by myeloma cells, stimulating osteoclasts' activity, which induces bone damage.
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Cancer Metastasis in Other Organs: Blood cancers are capable of penetrating other organs such as the brain, spinal cord, kidneys, liver, and lungs.
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Graft-versus-Host Disease (GvHD): Allogeneic bone marrow transplantation could cause GvHD due to the aggressive action of T-cells donated by another person.
When Should I See My Healthcare Provider?
Consult with a physician immediately, preferably a haematologist, if you experience any of the following blood cancer symptoms:
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Persistent fatigue that lasts for more than 2-3 weeks without a known cause
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Enlargement of lymph nodes found on the neck, armpits, and groin areas that feel painless, solid, and firm that persist for more than 2 weeks
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Easy bruising, uncontrollable bleeding, especially when wounded, and constant nosebleeds
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Persistent fever higher than 38 degrees Celsius without a known infectious cause
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Awakening from sleep, sweaty (menopausal sweating not included), and no infections found
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Weight loss of at least 10 percent for no known reason
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Dull or severe bone pain in the spine, rib cage, and hips without prior injury
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Very low red blood cells, white blood cells, and platelet levels in the blood test
How is Blood Cancer Diagnosed?
The medical tests that can help diagnose blood cancer are given below:
| Test Name | Relevance of Test | Confirmed Diagnosis |
| Complete Blood Count (CBC) | Blood has abnormal levels of blood cells: excess white blood cells, a lack of red blood cells, and platelets | The test is used initially and may require further tests |
| Peripheral Blood Smear | Microscopic identification of leukaemic blasts in the patient's blood cells | The test proves the presence of abnormalities in cells and requires a bone marrow biopsy |
| Bone Marrow Biopsy | Suspicion of acute leukaemia when blast > 20%, suspicion of myeloma because of plasma cell infiltration | The most useful test in the diagnosis, staging, and classification of blood cancers |
| Flow Cytometry | Detection of markers on the surface of blood cells | The test helps classify the type of blood cancer for future treatment |
| BCR-ABL Molecular Testing | Existence of the Philadelphia chromosome | The test confirms the existence of the blood cancer and the possibility of targeted therapy |
| PET-CT Scan | Metabolically active lymph nodes/organ identified | Used in staging lymphoma and assessment of treatment response |
Note: The correct diagnosis of blood cancer always involves consulting an expert in haematology. The results of any routine test reveal abnormalities, but a positive diagnosis is made via bone marrow biopsy and molecular testing.
How is Blood Cancer Treated?
Blood cancer treatment options vary widely depending on the kind of disease, its stage, age, and other factors. Haematologists administer blood cancer treatment in a multidisciplinary approach.
Blood cancer treatment methods include:
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Chemotherapy: This is the main treatment option used for treating blood cancer, using drugs that kill cancer cells or stop their multiplication.
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Targeted Therapy: They are therapies that target the specific molecular process of cancer formation and have fewer side effects than chemotherapy.
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Immunotherapy: Immunotherapy uses the body’s immune system to locate and kill cancer cells circulating within the bloodstream.
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Radiation Therapy: Radiation therapy involves focusing high-energy rays on a selected lymph node or tumour mass. This procedure can also be done before a bone marrow transplant.
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Bone Marrow (Stem Cell) Transplantation (BMT): For those eligible for BMT treatment, specifically, those with high-risk acute leukaemias, lymphomas, or multiple myelomas, BMT offers the prospect of full remission or even curing the disease.
Common Medicines Used to Treat Blood Cancer
The medicines used depend on the specific type of blood cancer, its stage, genetic characteristics and the patient's overall health. Common medicines used for blood cancer treatment are listed below:
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Cytarabine with Daunorubicin: This combination is commonly used as initial chemotherapy for eligible patients with acute myeloid leukaemia.
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All-Trans Retinoic Acid with Arsenic Trioxide: These medicines are used specifically for acute promyelocytic leukaemia and are not routine treatments for other forms of leukaemia.
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Vincristine, Daunorubicin, Prednisolone and Asparaginase: These medicines may be used together in treatment regimens for acute lymphoblastic leukaemia. Dexamethasone may sometimes be used instead of prednisolone.
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Imatinib, Dasatinib or Nilotinib: One of these medicines may be prescribed for chronic myeloid leukaemia. The choice depends on the disease phase, genetic test results, treatment response and side effects.
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Rituximab with Cyclophosphamide, Doxorubicin, Vincristine and Prednisolone: This combination, commonly called R-CHOP, is frequently used for selected B-cell non-Hodgkin lymphomas.
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Doxorubicin, Bleomycin, Vinblastine and Dacarbazine: This combination, called ABVD, may be used to treat Hodgkin lymphoma.
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Bortezomib, Lenalidomide and Dexamethasone: This combination is commonly used for multiple myeloma. The regimen may be modified according to age, kidney function and transplant eligibility.
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Thalidomide: Thalidomide may be used with bortezomib and dexamethasone or with other medicines for selected patients with multiple myeloma.
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Daratumumab: Daratumumab may be combined with other medicines for newly diagnosed or relapsed multiple myeloma in selected patients.
Note: Medicines for blood cancer should only be prescribed and monitored by a qualified haematologist or oncologist. Treatment plans vary significantly between individuals.
Living with Blood Cancer in India: Daily Challenges and Caregiving
Living with blood cancer can affect energy levels, immunity, daily routines and emotional well-being. The impact varies according to whether the person has leukaemia, lymphoma or multiple myeloma and the treatment required.
The following are some challenges and caregiving tips for patients living with blood cancer in India:
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Challenges
- Tiredness and Weakness: Anaemia, blood cancer and its treatment may reduce energy and make everyday activities difficult.
- Risk of Infections and Bleeding: Low white blood cell or platelet counts may require additional precautions and urgent medical attention when symptoms occur.
- Work and Education Disruption: Hospital admissions, chemotherapy sessions and follow-up tests may cause repeated absence from work, school or college.
- Emotional Stress: Uncertainty, changes in appearance and fear of treatment outcomes may cause anxiety, sadness or social withdrawal.
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Caregiving and Patient Well-Being
- Treatment and Appointment Support: Caregivers can help organise medicines, chemotherapy visits, blood tests and follow-up appointments.
- Infection and Bleeding Precautions: Patients should follow hygiene guidance and promptly report fever, unusual bruising, bleeding or worsening weakness.
- Nutrition and Daily Care: Balanced meals, adequate fluids, rest and light activity as advised may support recovery and general well-being.
- Emotional and Practical Support: Family reassurance, counselling and assistance with daily activities may help patients cope with prolonged treatment.
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Expenses
- Consultation and Test Costs: Expenses may include haematologist visits, blood tests, bone marrow examinations, imaging and genetic or molecular tests.
- Medicine and Treatment Costs: Chemotherapy, targeted therapy, immunotherapy, blood transfusions and supportive medicines may create substantial expenses.
- Travel and Accommodation Costs: Patients may need repeated travel or temporary accommodation near specialised cancer centres, particularly outside major cities.
- Income and Caregiving Costs: Treatment schedules may result in wage loss for patients and family caregivers, even when medical care is subsidised.
What is the Prognosis for Blood Cancer?
The prognosis for blood cancer varies depending on the type and subtype of cancer, age, overall health, and response to treatment. Some blood cancers, such as acute lymphoblastic leukaemia in children, Hodgkin lymphoma, and chronic lymphocytic leukaemia, can often be successfully managed. Others, such as acute myeloid leukaemia and multiple myeloma, may be more difficult to treat and have lower survival rates.
There has been an increase in the survival rates of patients in India owing to the accessibility of bone marrow transplantation centres. Early detection significantly increases the survival rate of blood cancer patients.
Can Blood Cancer Be Prevented?
There is no medically proven way to prevent blood cancer, as random genetic mutations cause it. However, the following measures can help avoid or diagnose blood cancer early:
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Avoid Exposure to Harmful Chemicals: Avoid contact with carcinogens such as benzene, formaldehyde, and pesticides from farms.
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Avoid Radiation Treatments: Discuss any procedure you may require involving radiation therapy with the doctor before proceeding.
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Take Antiretroviral Treatment if Infected with HIV: HIV has been identified as a trigger for lymphoma.
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Maintain a Healthy Body Weight: Being overweight is often associated with the development of various forms of blood cancer, such as myeloma and CLL.
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Undertake Regular Health Check-Ups: Regularly monitor, particularly if there is a family history of blood cancer.
In the event that you have been undergoing radiotherapy or chemotherapy previously, let your haematologist know, as this can result in the development of secondary blood cancer.
Blood Cancer Treatment Cost in India
Blood Cancer treatment cost in India varies significantly based on the type of cancer, stage, treatment protocol, hospital and city. Treatment costs can be expensive, especially with advanced therapy and stem cell transplantation.
An overview of the blood cancer treatment cost approximation is shared in the table below:
| Treatment | Approximate Cost Range |
| Haematologist Consultation | ₹800 - ₹2,500 |
| Complete Blood Count (CBC) | ₹300 - ₹1,000 |
| Peripheral Blood Smear | ₹150 - ₹600 |
| Bone Marrow Biopsy | ₹15,000 - ₹30,000 |
| Flow Cytometry | ₹5,000 - ₹20,000 |
| PET-CT Scan | ₹18,000 - ₹35,000 |
| Chemotherapy (Per Cycle) | ₹12,000 - ₹3 lakh |
| Targeted Therapy (Monthly) | ₹50,000 - ₹2.5 lakh |
| Immunotherapy (Per Cycle) | ₹1.5 lakh - ₹4 lakh |
| Radiation Therapy | ₹50,000 - ₹2.5 lakh |
| Stem Cell Transplant | ₹15 Lakh - ₹25 Lakh+ |
Note: Treatment costs vary across hospitals and may change over time. Actual expenses depend on the treatment plan recommended by the treating haematologist.
Does Health Insurance Cover Blood Cancer?
Yes. Health insurance plans cover blood cancer treatment in India. The coverage includes hospitalisation costs such as room rent, ICU charges, and nursing fees, along with the cost of medical procedures including chemotherapy, radiation therapy, immunotherapy, and targeted therapies, depending on the policy’s terms.
You can also get cancer insurance to get the cost of blood cancer treatment covered. Also, critical illness insurance plans provide a lump-sum payout after completing a waiting period of up to 90 days and a survival period of up to 30 days.
How Much Health Insurance Coverage is Needed for Blood Cancer Treatment?
The coverage of blood cancer insurance depends on various factors like the type of blood cancer, its stage, mode of treatment, and hospitalisation costs. In the case of conventional chemotherapy treatments for blood cancer, a sum insured ranging from ₹5 lakh to ₹10 lakh could suffice to cover the cost of hospital stay, tests, and chemotherapy.
In the case of a bone marrow or stem-cell transplantation procedure, which tends to be one of the costliest ways to treat blood cancer, more money would be spent. For coverage of aggressive forms of blood cancer as well as bone marrow transplants, an individual would need to have a sum insured of ₹40 to ₹50 lakh or more.
Frequently Asked Questions (FAQs)
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Q1. What is the difference between leukaemia, lymphoma, and myeloma?
Ans: Leukaemia originates in bone marrow, and its symptoms occur due to the growth of abnormal white blood cells. Lymphoma occurs in the lymph nodes or lymphatic tissues and results in enlarged lymph nodes. Lastly, multiple myeloma originates from plasma cells in the bone marrow and causes bone pain as well as hinders the formation of blood cells. -
Q2. Can blood cancer be cured?
Ans: Yes, many forms of blood cancer are highly treatable and potentially curable, especially when diagnosed early. Cure rates depend heavily on the specific subtype, age, and genetic markers. Even for types that are difficult to fully cure, such as multiple myeloma, modern targeted therapies allow the disease to be managed successfully for many years as a chronic condition. -
Q3. Is blood cancer hereditary?
Ans: No, not in most instances. Blood cancer results from mutations in genes that one gets rather than inherits. But family members of patients with CLL or lymphomas have an increased risk. Some inherited disorders like Li-Fraumeni syndrome, Fanconi anaemia, and Down's Syndrome put individuals at an increased risk for leukaemias.
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References
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https://www.cancer.gov/about-cancer/treatment/drugs/leukemia
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https://medlineplus.gov/lab-tests/bcr-abl1-genetic-test/
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https://www.apollohospitals.com/procedures/bone-marrow-biopsy
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https://my.clevelandclinic.org/health/diseases/22883-blood-cancer
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