Blood cancers pose challenges in detection, but treatments have greatly improved

The specialist: Dr. Steven Gruenstein on hematologic malignancies.

An associate clinical professor at Mount Sinai Hospital, Dr. Steven Gruenstein splits his practice treating hematology and oncology problems. Over the past 20 years, Gruenstein has seen thousands of patients with hematologic malignancies like myeloma, chronic myeloid leukemias and lymphomas.

Who’s at risk

Hematology is the field of medicine that studies blood and blood diseases. Hematologic malignancies are cancers of the blood, bone marrow and lymph nodes. "Normally all our blood is produced in a broadly similar way, in which progenitor cells produce many types of cells," says Gruenstein. "A malignancy, or cancer, is when a cell mutates and develops clones that are not under normal controls."

A common result of hematologic malignancies is too much or too little blood. Individual hematologic malignancies are not very common in the general population, though some disorders appear more frequently than others. "For instance, non-Hodgkin’s lymphoma is fairly common, but Hodgkin’s disease is not," says Gruenstein. "As yet, we’re not sure if some groups are more at risk than others." The Leukemia and Lymphoma Society reports that hematologic malignancies account for 9% of all newly diagnosed cancers in the country.

Doctors consider hematologic malignancies to be idiopathic, which means they arise spontaneously or from an unknown cause." There aren’t really risk factors," says Gruenstein. "Some patients have it in the family, but that’s only a small fraction."

Environmental exposure to toxins like benzene also can cause hematologic malignancies.

"There are different pathways — a lot of times a genetic mechanism leads to a change in an enzyme or protein that forms a malignant population of cells," says Gruenstein.

Signs and symptoms

Patients often go undiagnosed for years because hematologic malignancies can be chronic diseases that progress slowly. "Usually, the symptoms are noticed by the internist at the annual physical," says Gruenstein. "After speaking to the patient and performing a physical exam, the doctor makes the diagnosis with a blood test, which is sometimes followed by a radiographic exam or a biopsy of the bone marrow or lymph node."

When bone marrow cells are the ones altered, the symptoms are usually related to too much or too little of certain cells like platelets or hemoglobin or white blood cells. Common red flags are anemia, high hemoglobin or thrombosis accompanied by fatigue, bleeding, night sweats, abdominal pain or pain in general.

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