I was recently watching Good Morning America regarding Robin Robert?s fight against Myelodysplastic Syndrome and was inspired to write a post on blood cancer. Her resilience is infectious and I encourage everyone to support her fight. Team Robin!!!!!
Despite advances in technology, radiation and chemotherapeutic agents; the incidence of cancer steadily increases which theoretically may be a reflection of better detection. Never the less, many people still wonder when the road to a cure will be discovered. ?Cancer awareness is a public health initiative to provide information on cancer related facts in an effort to educate the public, support ongoing research and empower current cancer survivors and caretakers. With September being Blood Cancer Awareness Month, this article strives to answer the following questions:
- What is blood cancer?
- What is the epidemiology of blood cancer?
- What are the risk factors and clinical signs and symptoms?
- What is the role of radiation, chemotherapeutic agents and stem cell transplantation?
- How can we make a difference?
What is blood cancer?
Blood cancer is a form of cancer that attacks the production and function of your blood cells, bone marrow and lymphatic system; a system that aids the immune system in eradicating waste products, bacteria, toxins and cancer cells. Blood cancers are comprised of the following: leukemia, lymphoma (Hodgkin or non-Hodgkin), myeloma and myelodysplastic syndromes. These diseases typically arise from acquisition of a single abnormal cell that multiplies and interferes with the production of functional blood and immune cells.
What is the epidemiology of blood cancer?
In the United States, one person is diagnosed with blood cancer approximately every 4 minutes. If you extrapolate that data out for a total of 7 days, that is approximately 2,520 people; the equivalent to the entire undergraduate population of Smith College having this diagnosis. The incidence rate is lower than that of diabetes (one person every 30 seconds), but higher than HIV (one person every 9.5 minutes). According to the American Cancer Society, an estimated combined total of 1,638,910 people in the US are expected to be diagnosed with leukemia (47,150), lymphoma (79,190) or myeloma (21,700) in 2012. Based on these statistics, my guess is that everyone might agree that this is quite alarming.
Blood cancers represent the most common types of cancer in children and adolescents. Leukemia represents the highest incidence at 27.5%, followed by Hodgkin lymphoma and non-Hodgkin?s lymphoma at 7.1% and 6.5% respectively. Males seem to be disproportionately more at risk of developing and dying from leukemia than females. Although blood cancers are relatively rare in comparison to other forms of cancer, African Americans are disproportionately at higher risk for more aggressive forms of blood cancers (i.e. multiple myeloma) and typically have poorer survival rates when compared to other racial and ethnic groups.? However, clinical outcomes relative to survival rates have improved over the years and can be best illustrated in figure below.
What are the risk factors and clinical signs and symptoms?
The truth is nobody knows exactly what causes the development of blood cancers, but there are certain risk factors that place you at a higher likelihood of developing them. Blood cancer risk factors include the following: increased age, exposure to chemotherapy and ionizing radiation, smoking and tobacco use, obesity and exposure to chemicals (i.e. benzene).? ?Chemotherapy and ionizing radiation not only destroy abnormal cells but can actually also injure normal host cells. As a result, these nonfunctional injured cells proliferate and become the primary cells in your bone marrow; thus causing blood cancers. Early detection of blood cancers is extremely difficult as the symptoms can mimic less severe conditions like common cold. The clinical signs and symptoms are malaise, swollen lymph nodes, itching, night sweats, unexplained weight loss, fever, bruising easily, fatigue, headaches, frequent infections and generalized weakness. Patients are diagnosed through a series of blood tests and a bone marrow biopsy.
What is the role of radiation, chemotherapeutic agents and hematopoietic stem cell transplantation (HSCT)?
The goals of treatment are to relieve symptoms, minimize the risk of serious toxicities and ultimately eradicate the abnormal cells and produce new functional cells. Treatment decisions are based on the type of blood cancer, the age of the patient and their general overall well-being. Undergoing chemotherapy and radiation causes a lot of stress on the human body, therefore patients should be in good health otherwise to successful complete it. Chemotherapeutic agents are utilized in order to destroy the abnormal cells; patients typically receive them in different stages (i.e. induction, consolidation and maintenance stages).
Under appropriate conditions, stem cell transplantation may also be useful in treating certain types of blood cancers. Stem cell transplantation is the process of transplanting stem cells derived from bone marrow, peripheral blood or an umbilical cord. An autologous HSCT is when cells are taken out of the patient, harvested and then returned to their body. Allogeneic HSCT is when cells are taken out of a donor (i.e. a relative or non-relative), harvested and then inserted into the patient. The patient must undergo high doses of chemotherapy (with or without radiation) to eradicate the malignant cells from the body prior to HSCT. Patients are at risk of developing a syndrome called graft versus host disease, if the patient?s residual cells attack the new cells.
How can we make a difference?
Many of us may feel that we lack the capacity to make a difference in the fight against cancer. But, I am here to tell you that ?you can? and here?s how:
1. Be a resource of information for your friends and family. ?There are many misconceptions about medical conditions that exist in today?s society leading to the spread of inaccurate information. Knowing the facts are key. For example, some people believe all cancers form tumors. This is false. Leukemia as we read above does not form tumors but arises from abnormal blood cells that affect the functionality of the immune system. A second misconception is ?people should not bank stem cells from placenta or cord blood if blood cancers don?t exist in their family?. ?This is also false. People chose to bank their child(ren)?s stem cells as a safeguard for the future. There is not always a genetic link for the development of cancer. Additionally, stem cells may have a role in other conditions such as Alzheimer?s, diabetes and heart disease. I encourage everyone to visit the following website for more information and to spread the WORD about blood cancers.
2. Seek medical attention and trust your body. For many cancers, there are warning signs that individuals tend to ignore. If something is abnormal for 2 weeks or longer, please seek assistance.
3. Stop smoking. Smoking is a risk factor for nearly all cancers and other medical conditions (i.e. heart disease, diabetes?..shall I continue).
4. Become a bone marrow donor. Due to lack of donors in ethnic communities, treatment modalities are limited; thus making the disease harder to eradicate in our communities. Consider donating today.
5. Donate your time and money to the cause if you can. In these hard economic times, I know everyone is holding on to every piece of pocket change. But if you can donate, please do. There are other ways to contribute monetarily including hosting bake sales, skipping those mid-afternoon coffee breaks. Every cent counts on the road to a cure. It is important to donate to charities recognized by the IRS, if not the money you contribute may go to marketing as opposed to research.? Lastly, participate in blood cancer awareness events in your city.
Lastly, I encourage everyone to get out there and SPREAD AWARENESS!!!! Just like Lottery, you never know!!
Dr. Bias
References:
- Cancer Facts & Figures 2011. Atlanta, GA: American Cancer Society; 2011.
- Cancer Facts & Figures for African Americans 2011-2012. Atlanta, GA: American Cancer Society; 2011.
- Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, Waldron W, Altekruse SF, Kosary CL, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Chen HS, Feuer EJ, Cronin KA, Edwards BK (eds). SEER Cancer Statistics Review, 1975-2008, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2008/, based on November 2010 SEER data submission, posted to the SEER web site, 2011.
- Porter DL, Levine BL, Kalos M, Bagg A, June CH. Chimeric antigen receptor?modified T cells in chronic lymphoid leukemia. New England Journal of Medicine.2011;365:725-733.
- Toxicological profile for benzene. www.atsdr.cdc.gov/toxprofiles/tp3.pdf. Accessed September 21, 2011.
- Zuelzer WW. Implications of long-term survivals in acute stem cell leukemia of childhood treated with composite cyclic therapy. Blood. 1964;24:477-494.
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