Hematology Cancer

We provide care for various forms of blood cancer. Bone marrow, lymphoma, leukemia and Hodgkin lymphoma are all treated in our Hematology Cancer Center.


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Hodgkin Desease

What is Hodgkin disease?

Hodgkin disease, or Hodgkin lymphoma, is a cancer established in white blood cells called lymphocytes, which are a part of the immune system.

There are two types; Hodgkin disease and non-Hodgkin lymphoma. They both differ in how they spread, behave, and respond to treatment.

This disease can spread throughout the body via lymphoid tissues. However, it is most commonly diagnosed in the upper body, such as in the chest, neck, or under the arms.

It spreads from lymph node to lymph node and can extent into the bloodstream, liver, lungs, and bone marrow in its late stages.

In classic Hodgkin disease, the cancer cells are called Reed-Stemberg cells, which are an abnormal B lymphocyte. These cells are larger and look different than normal lymphocytes or non-Hodgkin lymphoma. Enlarged lymph nodes with this disease will have a high count of Reed-Stemberg cells.

There are 4 types of classic Hodgkin disease:

Nodular sclerosis Hodgkin disease - The most common and comprises of about 60% to 80% of all cases. It is the most common for young adults and typically starts in the neck or chest.

Mixed cellularity Hodgkin disease - The second most common type and comprises of about 15% to 30% of cases and is mostly common in older adults. It typically occurs in the upper half of the body.

Lymphocyte-rich Hodgkin disease - Only accounts for about 5% of all cases. It typically occurs in the upper half of the body and is found in few lymph nodes.

Lymphocyte-depleted Hodgkin disease - The least common form and only comprises of about 1% of all cases. It is mainly seen in seniors and is usually advanced when first found in the abdomen, spleen, liver, and bone marrow.

Signs and Symptoms

The first sign of early Hodgkin disease is the painless swelling of a lymph node usually in the neck. Swelling of the lymph node may also be caused by an infection. If so, the swelling should return to its normal size once the infection is gone.

As it progresses, symptoms may include:

  • Continuation of swollen lymph nodes
  • Vacillating fevers
  • Decrease in appetite
  • Itching sensations
  • Night sweats
  • General exhaustion
  • Sudden weight loss
  • Pain or swelling of the abdomen
  • Coughing
  • Shortness of breath
  • Chest discomfort
  • General symptoms of Hodgkin disease can be related to a cold or the flu

How is it Diagnosed?

There are different tests and procedures to determine if you have this disease.

  • A physical exam - A doctor will look for swelling in your lymph nodes and other main areas affected by this disease, including the spleen and liver. Your doctor may also recommend a blood test.
  • Biopsies - Your doctor will perform a biopsy to ensure that your symptoms are not being caused by something else. A lymph node will be removed to be examined under a microscope and used in other lab tests.
    • Different Types of Biopsies:
    • Excisional or incisional biopsy- This is the most common biopsy for an enlarged lymph node. The doctor will cut through the skin to remove the target lymph node. If the entire lymph node is removed, it is an excisional biopsy. If only a part of the lymph node is removed, it is an incisional biopsy. The severity of the procedure is dependent on where the node is located.
    • Fine needle aspiration or core needle biopsy- Instead of an incision being made, this biopsy involves a hollow needle attached to a syringe being inserted into the lymph node and withdrawing a small amount of fluid or bits of tissue. A larger needle withdraws more matter in a core needle biopsy. This biopsy is not used as often, however, due to the needle not retrieving a necessary amount of matter.
  • Immunochemistry - Part of the biopsy sample is given special antibodies that attach only to certain molecules on the surface of cells and cause a color change. This can diagnose Hodgkin’s disease, non-Hodgkin lymphoma, or another disease entirely.

Prevention

There is no way to absolutely prevent this disease. However, to prevent cancer in general, it is important to keep healthy habits.

  • Don’t smoke
  • Eat a balanced diet
  • Maintain a healthy weight
  • Exercise regularly

Risk Factors

  • Although it is unclear why, people who have had mononucleosis, commonly known as mono, have a higher risk of developing Hodgkin disease.
  • It is most common between ages 15-40, and in late adulthood after age 50.
  • It is slightly more occurring with males.
  • Siblings of a person with this disease are at a higher risk (however, a family link is uncommon).

Treatment

  • Chemotherapy followed by radiation is the most common course of treatment. The length of each treatment is dependent upon many factors including the stage and type of the disease.
  • Frequently, oncologists order a PET/CT scan after a few chemotherapy treatments to assess how the disease is responding and if further treatment is necessary.
  • When the disease responds poorly to treatment, different or higher doses of chemotherapy or radiation therapy may be recommended followed by a stem cell transplant.

Non-Hodgkin Lymphoma

What is non-Hodgkin lymphoma?

Non-Hodgkin lymphoma, or just lymphoma, is a cancer that occurs when too many abnormal white blood cells called lymphocytes are produced, which are a part of the immune system.

There are two types of lymphomas

  • Hodgkin disease
  • Non-Hodgkin lymphoma

Non-Hodgkin lymphoma differentiates from Hodgkin disease with its unique characteristics of the different lymphoma cells. Each type of lymphoma behaves, spreads, and responds to treatment differently.

How is it diagnosed?

Clinical symptoms play an important role in diagnosing lymphomas. Most common symptoms are:

  • Tiredness
  • Unintentional weight loss
  • Night sweats
  • Lumps in neck, armpits and groin etc.

There are different tests and procedures to determine if you have this disease. They are:

Symptoms vary depending on where in the body the disease is. The most common side effects are:

  • A physical exam A doctor will look for swelling in your lymph nodes and other main areas affected by this disease, including the spleen and liver. Your doctor may also recommend a blood test.
  • Biopsies Your doctor will perform a biopsy to ensure that your symptoms are not being caused by something else. A lymph node will be removed to be examined under a microscope and used in other lab tests.
    • Different Types of Biopsies:
    • Excisional or incisional biopsy - This is the most common biopsy for en enlarged lymph node. The doctor will cut through the skin to remove the target lymph node. If the entire lymph node is removed, it is an excisional biopsy, if a part of the lymph node is removed, it is an incisional biopsy. The severity of the procedure is dependent on where the node is located.
    • Fine needle aspiration or core needle biopsy - Instead of an incision being made, this biopsy involves a hollow needle attached to a syringe being inserted into the lymph node and withdrawing a small amount of fluid or bits of tissue. A larger needle withdraws more matter in a core needle biopsy. This biopsy is not used as often, however, due to the needle not retrieving a necessary amount of matter.
    • Bone marrow aspiration and biopsy - Samples are taken from either the back of the pelvic bone or the sternum. This is performed after lymphoma diagnosis to determine if it has reached the bone marrow.
    • Lumbar puncture (spinal tap) -A hollow needle is placed between spinal vertebrae and withdraws fluid to see if there are lymphoma cells in the cerebral spinal fluid.
    • Pleural of peritoneal fluid sampling - A hollow needle is placed in the chest or abdomen to withdraw fluid that has accumulated to check for lymphoma cells.
  • Immunochemistry Part of the biopsy sample is given special antibodies that attach only to certain molecules on the surface of cells and cause a color change. This can diagnose Hodgkin’s disease, non-Hodgkin lymphoma, or another disease entirely.
  • Computed tomography (CT) scan An x-ray that provides a more detailed cross-section image of your body. It is capable of taking pictured of soft tissue, allowing doctors to see if a lymph node or organ is enlarged.

Signs and Symptoms

  • Enlarged lymph nodes
  • Unexpected weight loss
  • Night sweats
  • Extreme tiredness
  • Fevers
  • Anemia
  • Swollen abdomen
  • Feeling extremely full
  • Chest pain/pressure
  • Shortness of breath
  • Cough
  • Lymphoma in the abdomen can cause the belly to become very swollen. It also causes swelling of the spleen and intestines, which can lead to abdominal pain, nausea, and vomiting.
  • Lymphoma in the chest can cause the lymph nodes to press on the trachea, resulting in trouble breathing.
  • Lymphoma in the brain causes headaches, difficulty thinking, overall weakness, personality change, or seizures. It can also result in double vision, numbness in the face, and difficulty speaking.
  • Lymphoma in the skin can cause itchiness with red or purple lumps under the skin’s surface.

Prevention

There is no way to absolutely prevent this disease. -However, to prevent cancer in general, it is important to keep healthy habits.

  • Don’t smoke
  • Eat a balanced diet
  • Exercise regularly

Risk Factor

  • Although it is unclear why, people who have had mononucleosis, commonly known as mono have a higher risk of developing non-Hodgkin disease.
  • It is most common between ages 15-40, and in late adulthood after age 50.
  • It is slightly more occurring with males.
  • Siblings of a person with this disease have a higher risk (however, a family link is uncommon).
  • The use of immunosuppressant drugs increases the risk.
  • Other infections such as HIV, Epstein virus, and Helicobacter pylori also increase the risk.

Treatment

  • The type of treatment you receive will depend on the type and stage of lymphoma and your age and other co-morbidities.
  • Chemotherapy in combination with monoclonal antibodies to target cancer cells may be used to treat lymphomas.
  • Radiation used high-powered beams of energy to kill cancer cells and reduce the size of tumors.
  • Stem cell transplant may be performed to treat lymphomas, mostly in relapse setting.

Leukemia

What is Leukemia?

  • A cancer that results in high numbers of mutated/abnormal white blood cells (white blood cells are a part of your immune system and help fight off dangerous pathogens).
  • Usually originates in bone marrow.
  • There is no positive knowledge on what causes it, but it is a combination of genetic and environmental factors.

Types of Leukemia

  • Acute lymphocytic Leukemia (ALL) - Occurs primarily in children
  • Acute myelogenous leukemia (AML) - common form of leukemia in adults
  • Chronic lymphocytic leukemia (CLL) - Primarily affects people over the age of 55
  • Chronic myelogenous leukemia (CML) - Primarily affects adults

How is it diagnosed?

A doctor may perform a physical exam and pay special attention to your mouth, skin, eyes, lymph nodes, liver, spleen, and nervous system, looking for bleeding, bruising, or any sign of infection.

A doctor may take samples; such as:

  • Blood samples – taken from a vein in the arm
  • Bone marrow samples (bone marrow aspiration or bone marrow biopsy)- usually taken from the back of the pelvic bone, but other bones may be used.
  • Spinal fluid sample- A hollow needle will be inserted between the bones of the spine to withdraw fluid. This is performed after the area is numbed with local anesthetic.
  • Cytometry- Is used to determine what type of leukemia is present
  • Cytogenetics- Uses microscopes to examine a cell’s chromosomes.
  • Imaging tests such as:
    • X-rays
    • Computed Tomography (CT) scans
    • Magnetic Resonance Imaging (MRI) scans
    • Ultrasounds.
  • There are other methods of diagnosis, but these are the methods that are typically used.

Signs and Symptoms

The most common symptoms include:

  • Vacillating fevers
  • Vacillating chills
  • Fatigue/Weakness
  • Loss of appetite/Unexpected weight loss
  • Easy bruising/Bleeding
  • Headaches/Migraines
  • Night sweats
  • Abdominal pain
  • Bone/joint pain
  • Shortness of breath
  • Reoccurring infections/Small red spots appearing under the skin
  • Anemia – low red blood cell count
  • Leukopenia – low white blood cell count
  • Thrombocytopenia – low blood platelet count, resulting in easy bruising or bleeding
  • Swollen lymph nodes
  • Enlarged liver or spleen

Risk Factors

People who have been treated for other cancers with chemotherapy and radiation have a higher risk of developing leukemia at some point in their life time.

  • Certain genetic disorders, such as Downs Syndrome, seem to increase the risk.
  • Smoking has been proven to also increase chances, along with other environmental factors.
  • If someone in your family has had or has it, there is a chance that it may be passed down.

Although the above factors increase the risk, they do not guarantee that you will get leukemia.

Treatment

With treatment for leukemia, the goal is to kill the abnormal white blood cells, allowing normal cells to regrow.

Most treatment plans involve three steps especially in acute leukemia:

  • Induction therapy - Kills the leukemia cells through chemotherapy and corticosteroids. This process usually lasts for 4 weeks.
  • Consolidation therapy - Kills any leukemia cells that may be remaining, even if they don’t show up in tests through chemotherapy and sometimes stem cell transplant or radiation. This process may take several months.
  • Maintenance therapy - Also prevents the growth of any remaining cancerous cells through a lower dosage of chemotherapy. This is often continued for up to 3 years.

There are also other means of treatment such as:

  • Biological therapy – helps your immune system attack cancerous cells.
  • Targeted therapy – Attacks specific characteristics of cancer cells.