Haematology Oncology

At Max Hospitals, we understand that getting diagnosed with blood cancer can be overwhelming, bringing with it intense emotions, fear, and uncertainty. Aligned with this understanding, our team of haemato oncologists and support staff is deeply committed to supporting you through every step of this difficult journey, leveraging the latest technology and treatment approaches. We believe that compassionate care is just as crucial as precise treatment, and we strive to ease your burden with personalised attention, empathetic guidance, and a relentless focus on your well-being. With us, you are never alone; our team is by your side, offering hope, comfort, and expertise to help you fight and heal.

What is Haematology Oncology?

Haematology oncology is a specialised branch of medicine that focuses on the diagnosis, treatment, and management of blood cancers and blood-related disorders. This includes various types of cancer such as leukaemia, lymphoma, and myeloma, which affect the blood, bone marrow, lymph nodes, and other parts of the lymphatic system.

Haematology oncologists are medical professionals who are trained in both haematology (the study of blood and blood-forming tissues) and oncology (the study of cancer), allowing them to treat a wide range of complex conditions. Their work involves understanding the biology of these diseases, providing appropriate treatments such as chemotherapy, immunotherapy, and targeted therapies, and offering comprehensive care to patients throughout their cancer journey.

Types of Haematologic Cancers

Haematologic cancers, also known as blood cancers, affect the blood, bone marrow, and lymphatic system. Here’s a breakdown of the three main types:

Leukaemia

Leukaemia is a type of blood cancer that originates in the bone marrow, the soft tissue inside bones where blood cells are produced. It primarily affects white blood cells, which are crucial for the immune system. In leukaemia, abnormal white blood cells are produced uncontrollably and don't function properly. This overproduction crowds out healthy cells, impairing the body’s ability to fight infections, transport oxygen, and control bleeding. There are different types of leukaemia, including acute and chronic forms, which are classified based on the speed of progression and the specific type of white blood cell affected.

Lymphoma

Lymphoma is a type of cancer that begins in the lymphatic system, a network of tissues and organs that help rid the body of toxins and waste. Lymphomas affect lymphocytes, a type of white blood cell that plays a key role in the immune response. The two main types of lymphoma are Hodgkin lymphoma, which is characterised by the presence of Reed-Sternberg cells, and non-Hodgkin lymphoma, which includes a diverse group of cancers that can develop in different parts of the lymphatic system. Lymphomas can cause swollen lymph nodes, fever, weight loss, and fatigue, among other symptoms.

Myeloma

Myeloma, specifically multiple myeloma, is a cancer of the plasma cells, which are a type of white blood cell found in the bone marrow that produces antibodies to help fight infection. In myeloma, abnormal plasma cells multiply uncontrollably and produce large amounts of an abnormal protein that can cause kidney damage and other complications. The overgrowth of these cancerous plasma cells also leads to weakened bones, anaemia, and a compromised immune system. Myeloma is often diagnosed through blood tests, urine tests, and bone marrow examinations.

Note: Each of these cancers requires different approaches to diagnosis, treatment, and management, but all share the common feature of originating in the blood or lymphatic tissues.

Causes or Risk Factors for Haematologic Cancer

The causes of haematologic cancers, or blood cancers, are not always clear, but several risk factors can increase a person's likelihood of developing these diseases. Here are some common causes and risk factors associated with haematologic cancers:

• Genetic Factors: Some blood cancers have genetic components, meaning they can run in families. Certain genetic mutations or inherited conditions can increase the risk of developing blood cancers. For example, people with Down syndrome or Fanconi anaemia have a higher risk of leukaemia. Additionally, specific gene mutations, such as those involving the JAK2 gene, can predispose individuals to certain blood cancers.
• Age: The risk of developing blood cancers increases with age. Most cases of blood cancers, such as non-Hodgkin lymphoma and chronic leukaemias, are diagnosed in people over the age of 60. However, some types of blood cancers, like acute lymphoblastic leukaemia (ALL), are more common in children.
• Radiation Exposure: Exposure to high levels of radiation, such as that from radiation therapy for other cancers or from nuclear accidents, can increase the risk of developing blood cancers. People who have been exposed to ionising radiation have a higher chance of developing leukaemia and other types of blood cancers.
• Chemical Exposure: Certain chemicals, such as benzene (commonly found in industrial settings, cigarette smoke, and some plastics), are known carcinogens that can increase the risk of developing blood cancers, particularly leukaemia. Long-term exposure to agricultural chemicals like pesticides and herbicides has also been linked to a higher risk of developing lymphomas.
• Previous Cancer Treatment: People who have undergone chemotherapy or radiation therapy for other cancers may have an increased risk of developing secondary blood cancers. Some chemotherapy drugs, particularly alkylating agents and topoisomerase II inhibitors, are associated with a higher risk of developing leukaemia later in life.
• Infections: Certain viral infections are linked to an increased risk of developing blood cancers. For example, the Epstein-Barr virus (EBV) is associated with an increased risk of certain types of lymphoma, such as Burkitt lymphoma and Hodgkin lymphoma. Similarly, human T-cell leukaemia virus type 1 (HTLV-1) is linked to adult T-cell leukaemia/lymphoma (ATL).
• Weakened Immune System: A weakened immune system, whether due to a medical condition like HIV/AIDS, organ transplantation (requiring immunosuppressive drugs), or inherited immune deficiencies, can increase the risk of developing blood cancers, particularly lymphomas.
• Lifestyle Factors: Although lifestyle factors like smoking, excessive alcohol consumption, and obesity are not as strongly linked to blood cancers as they are to some other types of cancer, they may still contribute to an increased risk. Smoking, for instance, is a known risk factor for certain types of leukaemia.
• Chronic Inflammatory Conditions: Certain chronic inflammatory conditions, such as rheumatoid arthritis or inflammatory bowel disease, can increase the risk of developing blood cancers, particularly lymphoma. The chronic inflammation associated with these conditions may lead to changes in the lymphatic tissue that increase cancer risk.

Note: While understanding these risk factors can help in the early detection and prevention of haematologic cancers, it is important to note that having one or more of these risk factors does not mean a person will develop blood cancer. Moreover, some individuals without any known risk factors may still develop the disease.

How are Haematologic Cancers Diagnosed?

Diagnosing haematologic cancers may involve a series of tests and evaluations to detect abnormal cells in the blood, bone marrow, or lymphatic system. Here are the main steps and methods used to diagnose haematologic cancers:

Medical History and Physical Examination

The diagnostic process typically starts with a thorough medical history and physical examination. Doctors will ask about symptoms such as fatigue, unexplained weight loss, frequent infections, bruising, or swelling of lymph nodes. A physical exam may include checking for enlarged lymph nodes, spleen, or liver.

Blood Tests

Blood tests are crucial for diagnosing haematologic cancers. Common blood tests include:

• Complete Blood Count (CBC): A CBC measures the levels of different types of cells in the blood, including white blood cells, red blood cells, and platelets. Abnormal levels of these cells can indicate the presence of blood cancer.
• Blood Smear: A blood smear involves examining a drop of blood under a microscope to identify abnormal shapes or sizes of blood cells and the presence of immature or abnormal cells.
• Blood Chemistry Tests: These tests measure certain chemicals in the blood, such as calcium, uric acid, and enzymes, which may be elevated in people with blood cancers.

Bone Marrow Aspiration and Biopsy

If blood tests suggest a haematologic cancer, a bone marrow aspiration and biopsy may be performed. This involves extracting a small sample of bone marrow, usually from the hip bone, using a needle. The sample is then examined under a microscope to check for abnormal cells and to assess the proportion and types of cells present. This procedure helps determine the type and severity of blood cancer.

Lymph Node Biopsy

For suspected lymphomas, a lymph node biopsy may be necessary. This involves removing a small sample of a lymph node or an entire lymph node and examining it under a microscope to look for cancerous cells. There are different types of lymph node biopsies, including fine needle aspiration, core needle biopsy, and excisional biopsy.

Imaging Tests

 Imaging tests help determine the extent and spread of the cancer. Common imaging tests include:

• X-rays: To detect bone damage or enlarged lymph nodes.
• CT Scans (Computed Tomography): Provide detailed cross-sectional images of the body to identify enlarged lymph nodes, organs, or other masses.
• MRI (Magnetic Resonance Imaging): Offers detailed images of soft tissues and helps detect cancer spread.
• PET Scans (Positron Emission Tomography): Used to detect areas of high metabolic activity that could indicate cancer cells.

Flow Cytometry and Immunophenotyping

These tests are used to analyse the characteristics of blood or bone marrow cells. Flow cytometry measures the size, shape, and presence of specific markers on cell surfaces, which helps differentiate between types of blood cancers. Immunophenotyping identifies proteins on the surface of cells, providing information about the specific type of cancer and its characteristics.

Cytogenetic and Molecular Tests

These tests analyse the chromosomes and genes within the cancer cells to identify specific genetic abnormalities or mutations that may be driving the cancer.

• Cytogenetic Analysis: Looks at the chromosomes in cells to detect any changes, such as translocations, deletions, or duplications.
• FISH (Fluorescence In Situ Hybridization): A molecular test that uses fluorescent probes to detect specific genetic abnormalities in cells.
• PCR (Polymerase Chain Reaction): Detects specific genetic mutations or translocations in cancer cells that may not be visible under a microscope.

Lumbar Puncture (Spinal Tap)

In cases where blood cancer may have spread to the central nervous system, a lumbar puncture may be performed to collect cerebrospinal fluid (CSF) for analysis. This test helps determine whether cancer cells are present in the spinal fluid.

Biomarker Testing

Biomarker testing involves identifying specific proteins, genes, or other molecules in the blood or tissue that can help diagnose a specific type of cancer and guide treatment decisions.

Note: Each of these diagnostic methods provides crucial information to confirm the presence of haematologic cancer, identify its type, and determine the best treatment options.

Haemato-Oncology Treatment Approaches

Haematologic cancers are treated using a variety of approaches, often tailored to the specific type and stage of the disease, as well as the patient's overall health. Here are the main treatment approaches used in haematology oncology:

Chemotherapy

Chemotherapy uses drugs to kill cancer cells or stop them from growing. These drugs can be administered orally or intravenously and work by targeting rapidly dividing cells, which includes cancer cells. Chemotherapy is commonly used for leukaemias, lymphomas, and myelomas. The treatment is typically given in cycles, with periods of treatment followed by rest to allow the body to recover.

Radiation Therapy

Radiation therapy uses high-energy radiation to target and destroy cancer cells. It is often used for lymphomas, particularly if the cancer is localised to a specific area. Radiation can be delivered externally, using a machine that directs the radiation at the cancer, or internally, through radioactive substances placed near the cancer site.

Targeted Therapy

Targeted therapies are designed to specifically target cancer cells without affecting normal cells. These treatments work by interfering with specific molecules involved in cancer cell growth and survival. For example, tyrosine kinase inhibitors are used for chronic myeloid leukaemia (CML) to block the activity of the BCR-ABL protein that drives the cancer. Targeted therapies can be used alone or in combination with other treatments.

Immunotherapy

Immunotherapy harnesses the body's immune system to fight cancer. It includes various approaches, such as:

• Monoclonal Antibodies: These are lab-made antibodies that specifically target cancer cells. For example, Rituximab is used to target CD20-positive B-cell lymphomas.
• Checkpoint Inhibitors: These drugs help the immune system recognize and attack cancer cells by blocking proteins that prevent immune cells from attacking the cancer.
• CAR-T Cell Therapy: This innovative treatment involves modifying a patient’s own T cells to recognize and attack cancer cells. It is particularly effective for certain types of leukaemias and lymphomas.

Stem Cell Transplantation

Stem cell transplants, also known as bone marrow transplants, replace damaged or destroyed bone marrow with healthy stem cells. There are two main types:

• Autologous Transplant: The patient's stem cells are collected before treatment, treated, and then returned to the patient after chemotherapy or radiation.
• Allogeneic Transplant: Stem cells are obtained from a matched donor. This approach can be more challenging due to the need for a suitable donor and potential complications such as graft-versus-host disease (GVHD).

Hormone Therapy

Some blood cancers, like certain types of lymphomas and myelomas, may be influenced by hormones. Hormone therapy works by blocking or altering the effects of hormones that promote cancer growth.

Supportive Care

Supportive care focuses on relieving symptoms and improving the quality of life for patients undergoing treatment. This includes managing pain, preventing and treating infections, addressing nutritional needs, and providing psychological support. Medications to boost blood cell counts, manage side effects, and alleviate symptoms are an integral part of supportive care.

Clinical Trials

Clinical trials are research studies that test new treatments or combinations of treatments. Participating in a clinical trial can provide access to cutting-edge therapies and contribute to advancing medical knowledge. Trials often offer promising new options for patients who may not have responded to standard treatments.

Note: Treatment plans for haematologic cancers are often multimodal, meaning they combine several of these approaches to maximise effectiveness and address the cancer from multiple angles. The choice of treatment depends on factors such as the type of cancer, its stage, genetic and molecular characteristics, and the patient’s overall health and preferences.

When to see a haematology oncologist?

Seeing a haematology oncologist is important when you or someone you know is experiencing symptoms or has been diagnosed with a condition that involves blood or lymphatic cancers. Here are key situations when it is advisable to consult a haematology oncologist:

• Unexplained Symptoms: If you experience persistent or unexplained symptoms such as unusual fatigue, frequent infections, unexplained bruising or bleeding, persistent swollen lymph nodes, or weight loss, it’s important to seek a haematology oncologist. These symptoms could be indicative of a blood-related issue that requires specialised evaluation.
• Abnormal Blood Test Results: If routine blood tests reveal abnormal results, such as high or low levels of red blood cells, white blood cells, or platelets, or if there are abnormal cell shapes or counts, a haematology oncologist can provide further investigation and diagnosis.
• Diagnosis of a Blood Disorder: If you have been diagnosed with a blood disorder such as anaemia, thrombocytopenia, or a coagulation disorder, a haematology oncologist can offer specialised management and treatment options.
• Blood Cancer Diagnosis: If you have been diagnosed with a blood cancer, such as leukaemia, lymphoma, or myeloma, a haematology oncologist is essential for developing and managing a treatment plan. They specialise in the complex and specific treatments required for these cancers.
• Recurrent or Persistent Symptoms: If you have a history of blood cancer and experience a return of symptoms or new symptoms, a haematology oncologist can assess for possible relapse or complications and recommend appropriate management.
• Need for Advanced Treatment Options: If your condition requires specialised treatments such as chemotherapy, targeted therapy, immunotherapy, or stem cell transplantation, a haematology oncologist has the expertise to administer and manage these advanced therapies.
• Complex Cases or Uncertainty: When there is uncertainty about a diagnosis or if the condition is particularly complex, consulting a haematology oncologist provides access to their specialised knowledge and advanced diagnostic tools to clarify the diagnosis and develop a comprehensive treatment plan.
• Second Opinions: If you have been diagnosed with a blood cancer or a related condition and want to seek a second opinion on your diagnosis or treatment plan, a haematology oncologist can provide an expert review and alternative recommendations if needed.
• Monitoring and Follow-Up: If you are undergoing treatment for a blood disorder or cancer, regular follow-up with a haematology oncologist is important to monitor your progress, manage side effects, and adjust treatment as necessary.
• Genetic or Family History: If you have a family history of blood cancers or genetic conditions that predispose you to blood disorders, consulting a haematology oncologist for genetic counselling and early evaluation may be beneficial.

Risk Assessment in Haematology Oncology

The risk assessment in haematology oncology involves evaluating various factors that can influence the likelihood of developing blood cancers and understanding the potential severity and progression of the disease. This assessment helps in early detection, prevention, and personalised treatment planning. Here’s a breakdown of the key components involved in a comprehensive risk assessment:

Medical History

• Personal Health History: Review of any past or current medical conditions, especially those related to blood or immune system disorders.
• Family History: Analysis of any family history of haematologic cancers or genetic disorders, as some blood cancers have hereditary components.

Genetic Factors

• Genetic Testing: Identification of specific genetic mutations or chromosomal abnormalities associated with blood cancers, such as the BCR-ABL gene in chronic myeloid leukaemia (CML) or mutations in the TP53 gene.
• Family Genetic Testing: For individuals with a family history of blood cancers, genetic counselling and testing can identify inherited risks and guide early surveillance and preventive strategies.

Environmental and Lifestyle Factors

• Exposure to Radiation: Evaluation of past exposure to high levels of radiation, such as from previous cancer treatments or environmental sources.
• Chemical Exposure: Assessment of exposure to known carcinogens like benzene, pesticides, or other industrial chemicals.
• Lifestyle Factors: Consideration of lifestyle choices such as smoking, excessive alcohol consumption, and obesity, which may contribute to cancer risk.

Infection History

• Viral Infections: Assessment of past infections with viruses linked to blood cancers, such as Epstein-Barr virus (EBV) and human T-cell leukaemia virus type 1 (HTLV-1). These infections can influence the risk of developing certain types of lymphomas and leukaemias.

Previous Cancer Treatments

• Assessment of Past Treatments: Review of any prior cancer treatments, including chemotherapy and radiation therapy, which can increase the risk of secondary blood cancers.

Chronic Conditions

• Inflammatory or Autoimmune Diseases: Evaluation of chronic inflammatory conditions, such as rheumatoid arthritis or inflammatory bowel disease, which can increase the risk of developing lymphomas.

Symptoms and Clinical Signs

• Symptom Evaluation: Detailed assessment of symptoms such as unexplained fatigue, recurrent infections, bleeding or bruising, swollen lymph nodes, or bone pain. These symptoms can indicate underlying haematologic issues.

Diagnostic Testing

Blood Tests: Comprehensive blood tests, including complete blood count (CBC), blood smear, and specific biomarkers, to identify any abnormal findings indicative of blood cancer.

• Bone Marrow Analysis: Bone marrow aspiration and biopsy to examine the presence of abnormal cells or other abnormalities.
• Imaging Studies: Utilisation of imaging techniques like CT scans, MRI, and PET scans to detect any physical changes or spread of disease.

Assessment of Overall Health

• General Health Evaluation: Consideration of the patient’s overall health status, including comorbid conditions, which can affect treatment options and outcomes.

Consultation with Specialists

• Multidisciplinary Review: Collaboration with a team of specialists, including haematologists, oncologists, and genetic counsellors, to provide a comprehensive risk assessment and personalised management plan.

By integrating these components into a risk assessment, healthcare providers are able to garner a thorough understanding of an individual’s risk factors for haematologic cancers, and accordingly tailor surveillance, preventive measures, and treatment strategies, improving outcomes and quality of life for patients.

Why Choose Max Hospitals for Haematology Oncology Care?

Choosing Max Hospitals for haematology oncology care offers several advantages that can make a significant difference in the quality and outcomes of treatment. Here’s why Max Hospitals stands out:

Expertise and Specialisation

Max Hospitals boasts a team of highly skilled haematologists and oncologists who specialise in the diagnosis and treatment of blood cancers. Our expertise spans a wide range of haematological malignancies, including leukaemias, lymphomas, and myelomas. The specialised knowledge and experience of our medical professionals ensure that patients receive the most accurate diagnosis and effective treatment plans.

State-of-the-Art Facilities

Max Hospitals is equipped with advanced technology and cutting-edge medical equipment. This includes the latest diagnostic tools, imaging systems, and treatment technologies, which enable precise diagnosis and effective treatment. In addition, our facilities support a range of treatments from chemotherapy and radiation therapy to advanced immunotherapy and stem cell transplants.

Comprehensive Care

The approach at Max Hospitals is holistic, focusing not only on treating the cancer but also on the overall well-being of the patient. Our comprehensive care includes supportive services such as pain management, nutritional support, psychological counselling, and palliative care. This multidisciplinary approach helps address the physical, emotional, and psychological needs of patients.

Personalised Treatment Plans

At Max Hospitals, treatment plans are tailored to each patient’s unique needs. The medical team works closely with patients to develop personalised treatment strategies based on the type and stage of the cancer, as well as individual health factors. This personalised approach ensures that treatments are optimised for the best possible outcomes.

Multidisciplinary Team Approach

Treatment at Max Hospitals involves a collaborative team of specialists, including haematologists, oncologists, radiologists, pathologists, and nurses. This team works together to ensure a coordinated and integrated approach to patient care, ensuring all aspects of treatment and recovery are covered.

Patient-Centric Care

At Max Hospitals, we prioritise patient comfort and satisfaction. Our facilities are designed to create a supportive and caring environment, with attention to patient privacy and comfort. The staff is dedicated to providing compassionate care and support throughout the treatment journey.

Advanced Supportive Care

The hospital offers advanced supportive care services, including access to advanced pain management techniques, psychological support, and rehabilitation services. These services are crucial in managing side effects and improving the quality of life for patients undergoing treatment.

Accreditations and Recognition

Max Hospitals is recognised for its high standards of care and adherence to international healthcare quality standards. The hospital’s accreditations reflect its commitment to providing top-notch medical care and maintaining excellent patient safety practices.

By choosing Max Hospitals for haematology oncology care, patients benefit from a combination of expert medical care, advanced technology, and a supportive environment, all aimed at achieving the best possible outcomes and enhancing the overall patient experience.

Review 

Reviewed By Dr. Rayaz Ahmed, Senior Director - Cancer Care / Oncology, Bone Marrow Transplant, Hematology Oncology, Haematology on 11 Dec 2024.