UNDERSTANDING BLOOD CANCER

What is blood cancer?

Cancer is the uncontrolled growth of cells within the body. Usually, all of our cells have a specific lifespan of days to years that is genetically programmed in our DNA. When our DNA becomes damaged, either through the aging process, exposure to toxins such as radiation or chemicals or through inherited genes, some cells do not die a natural death but continue to grow or divide to produce more abnormal cells. As they do, they form new cells with the same genetic misinformation. These extra cells may form masses or tumours that can be either malignant or benign or affect the bone marrow, leading to changes in the quality of our blood cells.

Nearly 1 million people are diagnosed with blood cancer every year. While some types are associated with older individuals, others develop in the very young, making this one of the few paediatric cancer forms. Blood cancers are responsible for up to 7% of all cancers and are particularly difficult to detect in early stages as there are no visible signs. There are over a hundred different but very specific types of blood cancer, although the majority of these are found within the main categories of leukaemia, lymphoma and multiple myeloma.

The term blood cancer is a little too specific as it also includes cancer of the lymph system. This should not be confused with other cancers travelling via lymph nodes and blood to other parts of the body (metastasis) such as metastasized breast cancer or prostate cancer, for example. Blood cancer is also not a cancer of the vessels that carry blood and lymph. It is possible that the spleen and liver are affected; the spleen is a blood storage organ and the liver detoxifies, filtering more than a litre of blood every minute. In fact, at any one time, the liver contains 10% of your total blood volume. If you have read the term hepatosplenomegaly in your medical notes, these two organs may have become enlarged.

Blood cancer in its primary form begins in the cells of the blood, bone marrow and lymph nodes. Treatment involves the healing or replacement of the part of the body that produces new blood and lymph cells - the bone marrow. Bone marrow transplants must match the recipient’s cell type. Even so, only 30% of transplanted tissue is obtained from relatives. The other 70% is voluntarily donated by blood marrow donors.

Risk factors are multiple, ranging from pollution to family history. Screening for blood cancer in higher-risk groups are limited to blood tests that show the presence of low numbers or abnormal cells and confirmation of blood cancer requires a bone marrow biopsy.

Understanding blood cancers means being aware of the role of the bone marrow. This is a sponge-like tissue found in the centre of some bones. Bone marrow comes in two types, red and yellow. While yellow bone marrow stores fat, red bone marrow produces the early forms of all blood cells. Red bone marrow is primarily found in the bones of the pelvis, sternum and femur (thigh bone). These small areas can produce approximately 500 billion cells every day in a manufacturing process known as haematopoiesis. As we grow older, the percentage of red bone marrow decreases.

Understanding blood cancer

Different types of blood cells – in fact, different types of all cells - are not immediately produced in their functional form but begin from a single, same cell. You may have heard about stem cells, and this is where they fit in. Stem cells can be found all over the body and are currently a topic of much discussion. If we can ensure this original cell type is not abnormal, perhaps all of the cells that follow can be normal, too. This could be the therapy that, in the future, contributes to the end of all cancer; however, research is still very much in its infancy. Even so, stem cell therapy is an available treatment but should only ever be prescribed and carried out in an approved clinic. Currently, diseases and disorders such as cancer, multiple sclerosis, type I diabetes and even damaged knee cartilage are being successfully treated by way of stem cell transplants.

Furthermore, while we used to believe stem cells of the bone marrow only produced blood cells, we are now beginning to discover that these cells can change (differentiate) into different cell types. A stem cell of the blood can be engineered to produce heart muscle, for example. Even better than this, scientists can now turn mature (differentiated) cells back into stem cells by reprogramming their DNA. You may have heard of CRISPR. This is a particular method of cutting away tiny areas of DNA that control a particular cell function and introducing a different piece that can change the cell type. This also means that all that cell’s descendants will continue in this changed form. This field of research is called genome editing. 

Stem cell therapy or regenerative medicine may have a long way to go for some diseases but it has been the basis of blood cell cancer treatment for many years. All blood cell types – red blood cells, white blood cells and blood platelets – originate from a single pluripotential stem cell that can be found in embryos, amniotic fluid or bone marrow. As scientific research using human embryos is neither ethically acceptable nor legal in most countries, new research paths such as converting adult cells into stem cells are becoming more advanced. 

In the human body, a pluripotential stem cell of the bone marrow, also known as the haematopoietic stem cell (HSC), changes into one of two slightly more developed forms: a myeloid stem cell or a lymphoid stem cell.

The following phase (the progenitor phase) describes the next group of changes that turn myeloid and lymphoid stem cells into a number of letter-coded cells. These intermediate cells have no function as blood cells and must go through further changes.

These further changes form the precursor phase. Precursor cells are not functional and may be referred to as blasts. For example, a lymphoid stem cell will progressively become either a B lymphoblast or a T lymphoblast in the precursor phase.

Precursor blood cells then leave the bone marrow and become functional blood cells in the blood or lymph. Myeloid stem cells, through all the preceding stages, eventually become red blood cells (erythrocytes), blood platelets (to help the blood to clot) and white blood cells in the form of neutrophils, monocytes, eosinophils and basophils. Understanding what these cell types do helps us to understand the symptoms of blood cancer. Lymphoid stem cells become B and T lymphocytes (lymph cells).

Two myeloid cell types then differentiate further when they leave the blood or lymph to enter tissues. These are monocytes that become bacteria-digesting cells called macrophages, and B lymphocytes that become plasma cells.

The four types of white blood cells have specific functions that explain the symptoms of leukaemia. Neutrophils are the first cells to reach the scene when the body senses infection or toxins and when healthy, these cells can stop you from becoming ill. The monocytes that turn into macrophages travel into the tissues to destroy dead cells, toxins and even cancer cells. Eosinophils help us to fight viruses and parasites but also release chemicals that contribute to inflammation and allergic reactions. Finally, basophils contribute to inflammation and allergic reactions and help to stop the blood from clotting.

The two types of lymphocyte cells (a little confusingly, these are also white blood cells but originate from a different stem cell) are essential for our immunity and explain the symptoms of lymphoma. B-lymphocytes connect to previously-produced antibodies. Antibodies are substances manufactured in the body that can recognise harmful substances. When a B-lymphocyte connects with an antibody, it becomes a plasma cell. Plasma cells produce and release thousands of antibodies.

T-lymphocytes (the second type of lymphocyte) cause inflammation, help B-lymphocytes turn into plasma cells and assist with the design and manufacture of antibodies. This is why lymphoma leads to an inability to fight certain infections and why you may have to be isolated from other people. 

Blood platelets are more like shards of cells rather than cells themselves. They do not contain DNA so you cannot have direct cancer of the platelets. However, if your bone marrow is not functioning as it should, less platelets may be produced and it will be difficult for your blood to clot naturally. If too many platelets are present through badly-functioning bone marrow, you may need to take blood-thinning medication to prevent blood clots.

Finally, red blood cells are responsible for carrying oxygen throughout the body and also remove poisonous carbon dioxide gas. These cells do not contain DNA so you cannot have cancer of the red blood cells. However, if the bone marrow is not functioning as it should you may experience anaemia; some parts of your body may not receive enough oxygen and you will feel extremely tired and short of breath.

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