Blood cancer

Leukaemia is cancer that develops in the bone marrow, which is where white blood cells are made.

Most commonly, leukaemia occurs when white blood cells develop abnormalities and multiply in an uncontrolled way. These abnormal white blood cells are called leukaemia cells, and they behave differently to normal blood cells.

Leukaemia is named after the type of white blood cell affected, and whether it grows quickly (acute) or slowly (chronic). It can affect both adults and children. There are four main types of leukaemia:

• acute myeloid leukaemia (AML)
• acute lymphoblastic leukaemia (ALL)
• chronic myeloid leukaemia (CML)
• chronic lymphocytic leukaemia (CLL).
  
  

The lymphatic system is part of the immune system, which defends the body against disease and infection. It is a network of vessels throughout the body, which carry a clear fluid called lymph. Organs including the spleen, thymus and bone marrow are also part of the lymphatic system.

Lymph is made of white blood cells called lymphocytes. These cells carry antibodies that destroy bacteria and viruses that make people sick. There are two types of lymphocytes, B-lymphocytes and T-lymphocytes. These cells protect the body from infections by producing antibodies and attacking organisms such as bacteria and viruses.

Lymphoma occurs when lymphocytes change and grow in an uncontrollable way and join to form a lump or tumour. The most common place for this to happen is in the lymph nodes, but it can also happen in other parts of the body.

There are more than 80 different sub-types of lymphoma, which are commonly grouped as either:

• Hodgkin lymphoma, or
• Non-Hodgkin lymphoma.

Myeloma is cancer that develops in plasma cells – a type of white blood cell. Plasma cells produce proteins called antibodies that help repair damaged cells and defend the body against disease.

Plasma cells can change and become cancerous. When this happens, these cells become known as myeloma cells, and they can multiply and join to form a lump or tumour. This often happens in the bone marrow and on the surfaces of different bones in the body.

Myeloma can cause the bones to become brittle and break more easily. It can also affect how your kidneys work and weaken the body’s immune system, which can make it easier for the body to bruise, bleed and get sick.

When your doctor first says you have cancer, you may not remember everything you are told. Taking notes can help, or you might like to ask if you can record the discussion. It is a good idea to have a family member or friend go with you to appointments to join in the discussion, write notes or simply listen.

If you are confused or want to check anything, it is important to ask questions. This will help you make an informed choice about your treatment and care. You may want to ask some of the questions below when meeting with your specialist:

• What are my treatment options?
• How long will the treatment take? When will treatment start?
• What is the aim of the treatment?
• How will I know if the treatment is working?
• Are there any out-of-pocket expenses not covered by Medicare or my private health cover? Can the cost be reduced if I can’t afford it?
• Are there any clinical trials being done for this cancer that I could join?

Side effects

• What are the risks and possible side effects of each treatment?
• How will these be managed?
• Will I have a lot of pain? If so, what will be done about this?
• Will treatment impact my ability to have children?
• Are there any complementary therapies that might help me?

After treatment

• How often will I need check-ups after treatment?
• If the cancer returns, how will I know? What further treatment could I have?
• After treatment, how do I manage fear of the cancer coming back?
• Who can I talk to if I feel worried or depressed after treatment?

Support

• Where can I get help for how I am feeling? How do I know if what I am feeling is a typical reaction? When should I think about getting some professional support?
• What are common emotional challenges with blood cancer?
• Will a multidisciplinary team (MDT) be involved in my care? Does the MDT include a psychologist and/or social worker?
• How can I see a social worker at my treatment hospital?
• How can I find a professional counsellor or psychologist? Should I see a psychiatrist?
• How can I connect with other people affected by cancer?
• Who can I talk to about my finances, legal matters and other practical concerns?
• Who can support my family or carers?
• Who can I call after hours if I need immediate emotional support?
• Should I consider medicines to support my emotional health?
• Are there any apps, podcasts or online programs that might be helpful?

You may want to get a second opinion from another specialist to confirm or clarify your specialist’s recommendations or reassure you that you have explored all your options. Specialists are used to people doing this.

Your GP or specialist can refer you to another specialist and send your initial results to that person. You can get a second opinion even if you have started treatment or still want to be treated by your first doctor. You might decide you would prefer to be treated by the second specialist.

It’s your decision – you have the right to accept or refuse any treatment you are offered. You may also want to discuss your decision with your treatment team, GP, family, and friends.

Your specialist may suggest you take part in a clinical trial. Clinical trials are conducted to test new or modified treatments and ways of diagnosing disease to see if they are better than current methods.

Over the years, trials have improved treatments and led to better outcomes for people diagnosed with cancer. You may find it helpful to talk to your specialist or GP, or to get a second opinion. If you decide to take part in a clinical trial, you can withdraw at any time.