Leukaemia, lymphoma and myeloma are the three main groups of blood cancer. Here you can read what each means, how they are diagnosed and what treatments are in general. The type and stage of the disease affect everything.

What does blood cancer mean?

Blood cancers affect the making and working of blood cells. Most begin in the bone marrow, the spongy tissue inside bones where stem cells turn into red cells, white cells and platelets. In blood cancer, abnormal cells multiply without control and disturb the work of healthy cells.

Unlike cancers that form a lump or a clear tumour (solid cancers), leukaemia usually has no mass, and the abnormal cells collect in the blood and bone marrow.

The three main groups:

Leukaemia. Cancer of the blood and bone marrow. Abnormal white cells are made that cannot protect against infection well and that stop the making of red cells and platelets. Acute leukaemia progresses fast and needs urgent treatment. Chronic leukaemia is slower. The most common in adults are acute myeloid leukaemia (AML) and chronic lymphocytic leukaemia (CLL).
Lymphoma. A cancer that starts from lymphocytes and collects in the lymph nodes and other tissues. It has two main groups: Hodgkin lymphoma and non-Hodgkin lymphoma. Each has many subgroups and their treatment differs.
Myeloma (multiple myeloma). Cancer of the plasma cells, which normally make antibodies. These cells collect in the bone marrow and can damage the bones and kidneys.

Who should be seen?

The symptoms of these diseases are non-specific and are seen in many simple illnesses too. So a symptom alone does not mean cancer. Reasons worth a visit:

Long-lasting tiredness and weakness with no explanation
Fever or night sweats that do not settle
Weight loss for no reason
Repeated infections
Easy bruising or bleeding, tiny red spots on the skin, gums that bleed
An enlarged lymph node in the neck, armpit or groin that gradually gets bigger or does not settle
Bone pain or a fracture for no reason (in myeloma)
An abnormal blood test that worries the family doctor

In myeloma, there may be no symptoms in the early stages, and the disease is found from a blood or urine test.

How is it investigated?

Complete blood count (CBC). The first step. An abnormal white cell level, or low red cells and platelets, may raise suspicion.
Bone marrow biopsy. To determine the exact type of leukaemia and of many blood diseases. It is done under local anaesthetic in the hip bone. It is usually an outpatient procedure and takes ten to thirty minutes. Pain varies from person to person; some people have little and some have more, but the moment the sample is taken is brief. The biopsy site may stay bruised and sore for about a week.
Lymph node biopsy. To diagnose lymphoma.
Blood and urine tests for myeloma. The presence of an abnormal protein (M protein) in the blood or urine.
Scans. Such as CT, PET or MRI to see how far the disease has spread.
Special tests on the sample. To determine the subgroup, which helps in choosing treatment.

After diagnosis, the stage is determined. Stage means how far the disease has gone. Blood cancers have their own staging systems, which differ from those of solid cancers.

How is it treated?

Treatment depends on the type of disease, the subgroup, age, general health and stage. The general methods named in sources:

Chemotherapy. For many diseases, especially acute leukaemia and lymphoma.
Targeted therapy. Medicines that target specific proteins in the cancer cell. Widely used in chronic leukaemias.
Immunotherapy. Treatments that help the immune system against the disease, including therapeutic antibodies and, in some diseases, CAR T cell therapy.
Radiotherapy. In some lymphomas and in myeloma.
Stem cell transplant. For some patients and some stages. Details are on the transplant page.
Supportive treatments. Such as medicine for the bones, blood transfusion and prevention of infection.
Clinical trial. Sometimes an option for access to new treatments.

Often several methods are used together or one after another. In some types, such as chronic lymphocytic leukaemia without symptoms, urgent treatment is not needed and the patient is followed with regular tests and examination. This is called “watchful waiting”, and sources say it is the standard approach for many patients.

On this site we do not give figures for chance of recovery or survival rates for the different types, because these figures mean something different for each patient. Your prognosis is explained by your treating doctor on the basis of the type and stage of the disease and your own situation.

What can you do yourself?

Gather your papers: tests, pathology report, scans
Write down your questions and come to the visit with a companion
If chemotherapy or another treatment is planned for you, ask the team for the around-the-clock contact number and the fever temperature
Tell your doctor about any supplement or herb before taking it
If you are not sure, get a second opinion. This is your right
Look after yourself and your family. See the page “For people supporting a patient”.

When should you get urgent help?

A fever of 38 degrees or higher during treatment, or whenever the doctor has said so: this is an emergency. Tell the treatment team at once.
Bleeding that does not stop with pressure, sudden shortness of breath, chest pain, confusion: call 115 (the emergency number inside Iran).
Signs of infection (shivering, cough, pain when passing urine, redness around a catheter): call the treatment team right now.
Back or spine pain with weakness, heaviness or numbness in the legs, being unable to pass urine, or losing control of your bladder or bowels: this may be pressure on the spinal cord. Call 115 or go to the emergency department, and do not wait to reach your treatment team.
New tiny red or purple spots on the skin, a lot of bruising for no reason or bleeding gums, especially with fever or weakness: go to a doctor or the emergency department right now to have a blood test.
Sudden, severe bone pain or a fracture: in myeloma the bone may have weakened. See a doctor or go to the emergency department the same day.

Details are on the page “When should I call for urgent help?” Your diagnosis and treatment plan are decided by your treating doctor.

Blood cancers