Blood cancer affects the blood, bone marrow and lymphatic system. Within these main groups, there are many different types of conditions - this is particularly the case for leukaemia and lymphoma. Most blood cancers start in the bone marrow, where blood is made. Many different types of blood cells are made in the bone marrow: broadly speaking, the type of blood cancer you have depends on the type of blood cell that's affected. In most blood cancers, the affected blood cells stop developing in the normal way and become cancerous. This leads to you having either too many or not enough of the affected type of blood cell. These abnormal blood cells, or cancerous cells, stop your blood doing what it normally does, such as fighting off infections. It's this that makes you feel unwell.
Being told you have “leukaemia” is a terrifying experience. A stream of horrible thoughts – chemotherapy, hair loss, isolation, the sinking feeling that everything you’ve taken for granted up to then, even whether you’ll be alive next weekend – takes over. It’s the often last word you hear the doctor say in your first consultation. Thankfully, for many, the event is very different from the initial expectation.

In fact there are many kinds of leukaemia. The “acute” leukaemias move quickly. They need intensive chemotherapy and often several months in hospital with only very occasional breaks of a few days between treatment courses. The chemotherapy isn’t as bad as many people imagine but it’s a tough time physically and emotionally and you’ll never be more grateful for the positive support of your family and close friends. “Chronic” leukaemias are completely different. Many people with these don’t feel at all unwell. You may be diagnosed incidentally through a routine blood count, having been walking around with it for years. These leukaemias usually change slowly.

Chronic lymphocytic leukaemia (CLL)

Some with this will remain well for decades, never requiring treatment. In others it will grow in the bone marrow, slowly or more quickly, crowding it out and preventing it from making healthy blood. This leads to anaemia, infections and bleeding. Treatment for CLL can be tablets or injections, but most people are treated as daycases or in clinic rather than in a hospital bed. This won’t cure the disease but can be very effective at returning the bone marrow to normal activity, remissions often lasting years before more treatment needs to be considered.
Chronic myeloid leukaemia (“CML”)

CML is a good example of how modern treatments are revolutionising cancer care in general. This leukaemia is caused by a specific genetic accident, effectively jamming a growth signal on. A new class of designer drugs fits like a key into the faulty signal molecule, turning it off. Formerly CML was an invariably fatal disease with an outlook of around 5 years. Nearly everyone now, taking the new tablets, has almost undetectable levels of CML 10 years after diagnosis and still counting!

Myeloma is a form of blood cancer which can cause bone pain, fractures and kidney damage if uncontrolled. For the most part it is incurable as yet but treatment has greatly improved over the past decade thanks to new classes of drugs such as Velcade, and the rediscovery of some surprising older ones such as thalidomide. The outlook for patients with myeloma is much better today than it was a few years ago.
Not all blood cancers are “liquid”. The lymphomas are a group of cancers of white blood cells occurring as solid lumps. This usually means enlarged lymph glands but they can occur in just about any organ. Again there are many types which behave very differently. Some grow even faster than the acute leukaemias and need intensive chemotherapy. Some need gentle treatment with surprisingly innocuous tablets. Some need radiotherapy. Many, as with CLL, just need to be watched over the years. Lymphoma treatment has been significantly improved using immunotherapy – antibodies designed to attack the cancer, given alone or in combination with chemotherapy or radiotherapy. The treatment of blood cancers in general has been a rapidly evolving field, particularly in the last few years. Blood is an easy tissue to obtain for research and historically research into blood cancers has spearheaded new advances in cancer treatment in general.

If you are confused already, there are many more kinds of blood cancer, over 100 in total. Although individually some are very rare, when one adds them up they account for around 10% of all malignancies. Further, they are some of the commonest cancers in young people – at school maybe, or supporting young families. It is almost certain several people you know have had or are currently living with some form of blood cancer. Today about two thirds of blood cancer patients can expect to be cured or at least to have the disease controlled so that it is not fatal. Thanks to generous contributions via charities such as LEAF, we can look forward to better prospects for the unfortunate few diagnosed over the next 10 years – offering vital emotional and financial support in the darkest hours, and a better chance that they and not their cancers will be the eventual winners.