The diagnosis of blood cancers, such as leukemia, lymphoma or myeloma, can be challenging. A wide variety of types, a high variance in symptoms, a lack of specific screening standards and a low prevalence of family history are some of the factors that can make hematologic malignancies (blood cancers) difficult to detect.
For this reason, one of the most crucial factors in the early diagnosis and successful treatment of blood cancers is a patient’s relationship with his or her primary care provider (PCP).
Risk Factors for Blood Cancers
The majority of hematologic diseases are not hereditary, but there are some hereditary syndromes that are associated with an increased risk for bone marrow failure or pre-leukemia conditions. In some situations, if your family history is prominent, your doctor may recommend genetic testing.
Other factors associated with an increased risk of blood cancers include exposure to certain agricultural products (herbicides, fertilizers, insecticides or fungicides), biologic medications that cause immunosuppression, along with radiation and chemotherapy treatments for other types of cancer.
Symptoms Can Be Varied and Vague
The diverse spectrum of blood cancers means that some patients are minimally affected by a chronic condition for a long period of time, while others experience trouble immediately. Across these multiple disease types, and even within one kind of disease, symptoms and indicators are quite different in different people.
To add to the challenge, many people with a cancerous or pre-cancerous blood condition experience non-specific symptoms that can be caused by any number of things. If you notice any changes in your health, don’t ignore them. It’s always a good idea to talk with your primary care provider for peace of mind.
Is There a Screening for Blood Cancer?
Unfortunately, there is no such thing as an “early detection” screening for blood cancer. Instead, a close relationship with your primary care provider — including annual physical exams and recommended lab work — is the primary way to catch it early.
Ko Ko Maung, M.D., a hematologist and medical oncologist within the Riverside Cancer Care Network, explains that bone marrow, where most of your body’s blood is made, has a good quality control system, and it is not going to let highly abnormal cells, such as leukemia cells, out until it cannot control it anymore. “Once we see abnormal cells in the peripheral blood, it’s a little bit late and a diagnosis could have been made sooner,” he says. “That's why primary care is very important. When patients don't have anybody to talk to or seek help from, this can lead to late presentations in the emergency room, which usually means poor outcomes.”
Simply put, routine check-ups lead to earlier diagnosis, which provides more treatment options that aren’t always feasible for older or lower-functioning patients.
The Importance of Annual Physicals and Routine Bloodwork
Because many blood cancers are only obvious when the condition has progressed significantly, and because there is no particular set of symptoms to look out for, regular monitoring by your primary care provider can truly be the only way to notice subtle changes in your health that could indicate a hematologic malignancy.
In addition to physical exams, the routine bloodwork that your doctor typically orders at the time of your annual check-up is especially important. Typically, this regular testing will include a complete blood count (CBC) and comprehensive metabolic panel (CMP), as well as other tests to monitor things like how much iron and glucose are in your blood. These tests can pick up things like anemia, a condition in which the body doesn’t have enough red blood cells, or a slightly abnormal blood count, which can both indicate that something more serious is going on.
An abnormal result on these regular tests doesn’t mean someone has blood cancer. It may simply indicate the need for a diet change to get more iron. But that early flag can help a primary care provider take a deeper look to figure out the problem. Sometimes, especially in asymptomatic patients, blood counts that are a little low or high are the only thing that alerts your doctor to consider the possibility of a blood cancer. “Basic labs such as blood counts, liver enzymes and kidney function are a good catch-all, due to the variety of ways malignancies can show up,” Dr. Maung says.
Consistency is also key. Having a baseline with which doctors can compare your current and future labs is critical — without it, diagnosis and treatment decisions can be more challenging. This is yet another reason that routine tests and exams at primary care visits are incredibly worthwhile and possibly even lifesaving when it comes to hematologic cancer.
When Might You Be Evaluated by a Hematologist?
“In my experience, if the primary care provider feels like something is not right, such as when a patient develops concerning symptoms or blood abnormalities, the best way to go is to reach out to a local hematologist,” Dr. Maung says. “It’s our job to try to figure it out. We work together on these kinds of things because everybody presents differently.”
Even if blood cancer or a benign blood disorder is unlikely, your primary care provider may consult with a hematologist and/or advise you to be seen by one, just to be on the safe side.
What’s the Difference Between Hematologists and Oncologists?
Hematology, the study of blood and blood disorders, and oncology, the study of cancer, are closely related and often overlap. This is because some blood conditions are completely benign, some are malignant, and other times benign conditions can point to a cancerous or a pre-cancerous disease. “Sometimes the borders are not that clear,” Dr. Maung explains.
Doctors are often trained in both specialties, but just because you are referred to see a hematologist does not mean you have cancer. Many hematology disorders, such as bleeding and blood clotting disorders as well as some autoimmune conditions, are not cancerous. Sometimes hematology patients are unnecessarily alarmed when they arrive at a Riverside Cancer Care location for a visit, but you can rest assured that all kinds of non-cancerous blood issues fall under the care of your hematologist/oncologist.
How is Blood Cancer Detected?
Blood cancers are detected in a number of ways by hematologists/oncologists, hematopathologists (physicians specially trained to diagnose diseases of blood cells) and radiologists. There are several hematologic malignancies in which the cells have an abnormal appearance, which can be detected by testing a sample of blood, bone marrow or tissue. With other blood cancers, the appearance of the cells may be normal, but there are just too many of them. In this case, health care providers look for mutations (any change in the DNA sequence of a cell) and may do a bone marrow biopsy.
How is Blood Cancer Treated?
If you are diagnosed with a blood cancer, your care may be managed by a medical oncologist — a doctor who treats cancer using medication including chemotherapy, immunotherapy and targeted therapy to inhibit the growth or promote the death of cancer cells. This doctor is often also your hematologist.
Frequently, a radiation oncologist will also participate in blood cancer care with the use of radiation therapy to destroy cancer cells. Surgical oncology is less common in the care of blood cancers, though sometimes appropriate. In some complex cases, multidisciplinary tumor boards (regular meetings of various cancer specialists) will collaborate for care management. To determine the most appropriate therapies for you, personalized medicine may be also used to evaluate your unique genetic profile.
Before, during and after any treatment, it’s important to keep up with good nutrition, hydration and regular exercise to keep your body as strong as it can be and improve your chance for a successful outcome.
Regular Check-Ups are the Best Defense
Since there isn’t an easy way to screen for blood cancers, the best thing to do is to see your primary care provider regularly for annual checks-ups and lab work. And, if something feels off or you are experiencing symptoms, call your primary care provider. They can help diagnose the problem and, if needed, get you to the right specialists for additional care.
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