Haemato Oncology

The blood consists of four components- white blood cells, red blood cells, platelets, and plasma. They together help to transfer oxygen to the organs and tissues, help to protect the body against infections, and form clots to stop bleeding. But they also have abnormal invaders that act as cancer-causing agents. At this point hematology-oncology comes into action.

Hematology, is the branch of medicine that deals with blood related diseases. The cause of such diseases are studied, it is then followed by prognosis, treatment and prevention. of such diseases. Oncology is the branch of medicine which deals with the diagnosis, treatment and prevention of various forms of cancer. The person who deals with it is an Oncologist. Hemato- oncology is the study of all kinds of blood cancers that account up to one tenth of global cancers. The specialist who deals with such cases is known as a Hemato- oncologist. Diseases like leukemia, hemophilia, anemia, lymphomas, thalassemias and cancer of other organs come under Hemato- oncology. The abbreviated term for it is hem-onc.

Lymphoma (Hodgkin and non-Hodgkin)
Chronic lymphocytic leukaemia and related disorders
Chronic myeloid leukaemia and related disorders
Acute lymphoblastic leukaemia
Acute myeloid leukaemia and myelodysplastic syndrome
Multiple myeloma

Symptoms of blood cancer can include:

Fever and chills
Persistent coughing
Pain in the chest
High frequency of infectious illnesses
Constant weakness, fatigue, or night sweats
Shortness of breath
Itchy skin or a rash
Swollen yet painless lymph nodes in the groin, armpits, or neck
Changes in appetite
Nausea

If you are experiencing any of these symptoms, you should get yourself examined by a hemato-oncologist. Diagnostic management includes undergoing blood screens, bone marrow examination, imaging tests to know if they are related to blood cancer.

Diagnosis & Treatment

These tests can include:

PET and MRI scans to stage many lymphomas and myelomas
Immunophenotyping
Molecular tests to look for mutations
Cytogenetics to look for chromosomal changes in cancer cells
Histopathology to look at tissue biopsies at the microscopic level

Treatments

The treatment will depend on the type of blood cancer, health condition of the patient at the time of treatment, and how the patient wishes to receive the treatment. Some patients need a single treatment and some may need more. . Intensive treatments are not for everyone, these tend to be taxing on the body and are not recommended, unless absolutely necessary. Gentler treatment options appeal to many as it improves the quality of life, even if it fails to cure blood cancer.

Everyone is different, so the treatment regimen may be classified into several categories that suits individual needs.

Intensive treatment: Intensive treatments are strong treatments and require the use of strong drugs to stop the spread of cancer cells. Primary examples of intensive treatment are:

Heavy dose chemotherapy: In this procedure, heavy dose of drugs are used to kill the cancer cells.
Standard chemotherapy dose: The use of cancer cell-killing drugs that stop the infected cells from multiplying.
Stem cell transplantation: High doses of cancer killing drug are used to kill the cancer cells present in the the bone marrow or lymph nodes. Then new stem cells from a donor or from the patient are introduced into the body through a drip. The new stem cells start producing fresh blood cells.
Radiotherapy: Radioactive rays are used to kill cancer cells present in a specified region of the body . (Primary treatment for lymphoma).
Surgery: Surgery is a rare occurrence. Splenectomy, the removal of spleen is performed, if required.

All these treatments, whether in short term or long term have been found to cause a number of side effects.

Non- intensive treatment: Low dose chemotherapy is an example of non- intensive treatment. Such treatments have mild effects on the body and have fewer side effects. In such treatments, the cancer cells are not killed, r but may help in keeping the cells in remission and in maintaining physical stability for a certain length of time. Some examples of non- intensive treatments are as follows:

Low dose chemotherapy: Low dose of chemotherapy drugs are used to kill cancerous cells and to prevent them from multiplying.
Immunotherapy or bio therapy: Drugs that boost your immune system so that your body fights against the cancerous cells and keeps them in check.
Curative treatment: If the doctor feels that a patient may not be able to withstand strong treatments due to certain compatibility issues, then he/she is given some low risk treatments that may not essentially kill all cancer cells, but can keep them in check for extended periods of time. Less number of side effects and low risk are the benefits of such a treatment.
Non curative treatments: Such treatments can be either very strong or mild. They can maintain remission and manage a patient’s symptoms, but they do not cure cancer. They are known as maintenance treatment regimen.
Wait and watch: Is a type of treatment for people whose cancer development and is called 'wait and watch' or 'active surveillance'. Here, the patient has to undertake a number of tests from time to time to observe the symptoms of the slowly spreading cancer. Even when the treatment starts, it will start with a very low dose of the drug.
Supportive care: Supportive care along with non- intensive or/and intensive care is a necessity. Such treatments don't directly fight the cancer cells, but helps in better management of symptoms.
Palliative care: Such care can help you cope with symptoms. It helps you in maintaining a quality through all the adversities.
Follow up care: Here, signs of complications and relapse are observed. To make sure you have received the right treatment.
Palliative care: Such a care can help a patient to get relief from his/her symptoms and that wiil improve the quality of life
Follow- up care: To see for complications and relapse of disease
A wider range of treatments are required for patients with lymphomas or myeloma, which include the following:

Bone marrow transplantation

Patients with certain forms of cancer like leukaemia and lymphoma can be benefitted from bone marrow transplantation. Stem cells transplants from the bone marrow or other sources are widely used for cancer treatment, as they can help in replenishing the healthy cells and bone marrow, destroyed by chemotherapy and radiation.

Following a successful transplant, the bone marrow will begin producing oxygen-carrying red blood cells, infection-fighting white blood cells and clot-forming platelets.

Enzyme inhibiting drugs

In cancer treatment, enzyme inhibiting drugs are used to block specific enzymes that cancer cells depend on for their growth. Some of the drugs include:

- Histone Deacetylase Inhibitors – They target the proteins that support the DNA in the cell nucleus.

- Hormones (Corticosteroids) – Corticosteroids are hormones that can kill malignant lymphocytes by blocking cell metabolism.

- JAK or Janus-Associated Kinase Inhibitors – They block JAK1, JAK2, JAK3 and tyrosine kinase 2 enzymes, which are responsible for inflammatory and immune responses in certain diseases.

- Proteasome inhibitors – Proteasome are cell structures that need to function properly to keep a cell alive. Proteasome inhibitors can be used to block the functions of proteasome in cancer cells.

- Tyrosine Kinase Inhibitors – A tyrosine kinase inhibitor blocks the action of a certain abnormal protein that signals the cancer cells to grow.

Immunotherapy

Immunotherapy uses the patient’s own immune system to attack and fight cancer. Also known as biological therapy, it has fewer short-term side effects than chemotherapy. Few immunotherapies used to treat blood cancer include chimeric antigen receptor T-cell therapy, cytokine treatment, donor lymphocyte infusion, monoclonal antibody therapy, radioimmunotherapy, etc.

Cytotoxic chemotherapy

In cytotoxic chemotherapy, cytotoxic drugs are used to inhibit cell division, and thereby destroy cancer cells. They are also capable of killing small tumours that pathological tests are not able to detect. Cytotoxic drugs affect healthy tissues as well, but cancer cells are sensitive to these drugs as they divide faster than normal cells.

Potential Side effects:

Responses and side effects vary from individual to individual. There are some short term side effects that one gets during the blood cancer treatment or immediately after treatment. Then there are the long term side effects, which may last for months, years or even a lifetime.

There are cases where people have shown little to no side effects during and after treatment.

Remission

This is common in India among patients being treated for blood cancer., Remission occurs when cancer cells cease to multiply and have been completely replaced by normal cells.

A number of tests are performed after treatment to determine if remission has been achieved. The tests that are done show the amount of remaining cancer cells, if any, and whether the cancer cells have completely or partially left the body. It all depends on how well the body of the patient has responded to treatment. Once remission is achieved, the doctor may describe you as 'cured'.

Relapse

Relapses occur due to several factors. One major factor is patient’s health condition, age, and the stage at which cancer was diagnosed. There are options available for further treatment to restore remission. The longer you stay in remission, the better is the overall outlook.

Complementary therapies

Along with cancer treatment, massage, acupuncture, and meditation help in relieving from all the stress and tension, and ensures that the patient has a clear mind and feels good during treatment. There is no medical evidence that such therapies directly help in fighting blood cancer.. With complementary therapies, a patient will be more relaxed, calm, and receptive during treatment, and this helps in maintaining his/her overall well- being.