Symptoms of Blood cancer are usually subtle and missed. Certain symptoms may point towards the disease and should not be taken lightly if present.

Blood cancer means leukemias. Leukemias are classified as acute or chronic leukemia.

Acute leukemia can be either myeloid leukemia or lymphoblastic leukemia. Chronic leukemia can be chronic myeloid leukemia or chronic lymphocytic leukemia.

What is a Blood Cancer:

Blood cancer or leukemia is a bone marrow disorder of the stem cells, primarily the WBCs (White Blood Cells).

WBCs are of different types that include neutrophils, lymphocytes, monocytes, eosinophils, and basophils.

Other cellular elements include the Red Blood Cells and Megakaryocytes that give rise to platelets.

Blood cancer is the abnormal cellular proliferation of the primitive cells that result from abnormal cellular signaling and mutations.

It is characterized by an excess of blast cells (more than 20%) in the bone marrow and can be either of the lymphoid or myeloid series.

Symptoms of blood cancer:

Patients with blood cancer may be asymptomatic and diagnosed on routine investigations. Most patients who are asymptomatic have the type of blood cancers called as chronic leukemias.

Patients who are symptomatic may have any one or more of the following symptoms:

  • Fatigue and Pallor:

    • Fatigue is a non-specific symptom that may be an indicator of anemia or an underlying subacute infection.
    • Patients might also notice progressive pallor and notice other symptoms of anemia such as shortness of breath, lethargy, headache, palpitations, and generalized weakness.
  • Bleeding:

    • Bleeding from orifices such as epistaxis, gum bleeding, bleeding from the genital, urinary, rectal, and into the skin may occur.
    • Gum bleeding and bleeding from the nose are common, however, females may present with heavy menstrual bleeds.
    • Deep bleeds such as intracranial, intraperitoneal, and bleeding into the joints may be the presenting complaints in a minority of patients.
  • Fever:

    • Since the bone marrow is not properly functioning, proper functional WBCs are absent in these patients.
    • Patients with blood cancer are prone to develop infections.
    • Even mild infections may result in complications and get prolonged in these cases.
    • However, serious infections caused by virulent bacteria and fungi are not uncommon.
    • A patient who has a history of a recurrent febrile state must be investigated for an underlying blood disorder especially leukemias (blood cancer).
    • Fever in patients with blood cancer usually requires broad-spectrum antibiotics and antifungal agents.
  • Body pain:

    • Body pains, and especially skeletal pain and tenderness, is a very prominent feature of blood cancer.
    • Body pain may occur as a result of the leukemic cells or as a result of the hyperuricemia associated with blood cancers.
    • Patients may develop joint pains and swellings because of the deposition of uric acid crystals in the joints. The uric acid formation is increased because the blood cancer cells replicated very rapidly.
  • Lymphadenopathy:

    • Patients with blood cancer, especially acute and chronic lymphoid leukemias, may notice swellings in their neck, armpits, or groin.
    • Lymph nodes may be present in other diseases as well such as viral infections caused by Epstein barre virus and cytomegalovirus infections, and bacterial infections such as mycobacterium tuberculosis.
    • Lymph nodes in patients with blood cancers are usually discrete and painless.
  • Visceral enlargement:

    • Patients with chronic leukemias especially may notice abdominal fullness and early satiety. They might also complain of dull aching pain and a dragging sensation in the left upper side of the abdomen.
    • These symptoms are due to enlarged liver and spleen.
  • Other symptoms of blood cancer:

    • Symptoms of leukostasis may be noted by the patient. These include dizziness, vertigo, blurred vision, tinnitus, altered mentation, inability to perform higher mental tasks, and loss of balance and co-ordination.
    • Gum hypertrophy is commonly seen in a variant of leukemia called as myelomonocytic leukemia.
    • Eye redness, blurring of vision, and rarely complete visual loss may occur as a result of retinal hemorrhage and leukemic deposits.

What are the predisposing factors of blood cancer?

In the majority of the patients with blood cancer, the cause is unknown. However, certain factors may predispose a patient to blood cancer. These include:

  • Radiation

    • Radiation damages the DNA resulting in uncontrolled cellular proliferation in the bone marrow.
    • Patients who are treated with ionizing radiation are at risk of developing acute leukemia.
    • The incidence of acute and chronic leukemias increased in survivors of Hiroshima and Nagasaki.
  • Chemical and drugs

    • Blood cancer may develop following treatment with alkylating agents like melphalan and topoisomerase 2 inhibitors e.g etoposide.
    • Benzene, a chemical used in the oil industry, can cause marrow toxicity and increase the incidence of blood cancer.
  • Genetic

    • Certain genetic disorders may increase the risks of developing blood cancer.
    • These include Fanconi anemia, ataxia-telangiectasia, and Li Fraumeni syndrome.
    • The risk is 30 times increased in patients with Down’s syndrome (trisomy 21).
    • Also, a high degree of concordance among monozygotic twins increases the risk of blood cancer.
  • Viruses

    • Blood cancer is also associated with human T cell lymphotropic retrovirus type 1 (HTLV-1) ]

Acute Myeloid leukemia Vs Acute Lymphoblastic leukemia:

AML

ALL

Age Common in adult Children
Lymphadenopathy Less common More common
Hepatosplenomegaly Less common More common
Bone and Joint Pains Less common More common
Gum hypertrophy More common Less common
Blast cells Myeloblast Lymphoblast
Auer rods Present Absent

 

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