Cancer is an important public health problem as it is the second cause of death after cardiovascular diseases, both in the world and in our country. In this article, we will try to briefly review the types of blood, lymph node and bone marrow cancers known as "hematological cancers", the signs and symptoms they may cause in patients, how they are diagnosed and their treatments.
Bone marrow includes hip and femur. It is a spongy tissue found in the center of some bones, including Bone marrow contains stem cells that develop into many types of blood cells found in the body. These include:
• Red blood cells (erythrocytes = red blood cells) that carry oxygen and carbon dioxide throughout the body
• White blood cells (white blood cells = leukocytes) that fight infection
• Contains platelets (clotting cells = blood platelets) that help blood clotting. The normal appearance of the bone marrow is given in Figure 1.
Picture 1: View of the biopsy taken from the bone marrow tissue under the microscope
Body It usually produces these blood cells when needed. Sometimes, these cells can proliferate uncontrollably, too quickly and abnormally. These diseases are known as hematological cancers (blood, bone marrow and lymph node cancers).
In this article, we will briefly review the types of these diseases, known as hematological cancers, the signs and symptoms they will cause in patients, the tests used to diagnose them and their treatments. we will try.
WHICH ARE THE HEMATOLOGICAL CANCERS?
Hematological cancers are categorized according to the type of cells affected.
MULTIPLE MYELOM
strong>Multiple myeloma is a type of cancer that occurs in cells called plasma cells made in the bone marrow. Plasma cells play an important role in the immune system and produce the antibodies needed to fight foreign microbes. When plasma cells become abnormal and become cancer cells and grow out of control, this disease is called multiple myeloma (Picture 2). A single plasma cell becomes cancerous, multiplies and forms myeloma cells. Myeloma cells can grow in many different ways. It produces abnormal proteins (antibodies) known as.
Picture 2: View of the bone marrow of a Multiple Myeloma patient under the microscope
However, There are other plasma cell disorders that have abnormal plasma cells but do not meet the criteria to be called active multiple myeloma. These other plasma cell disorders include:
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Monoclonal gammopathy of undetermined significance (MGUS)
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Smoldering multiple myeloma (SMM)
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Solitary plasmacytoma
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Light chain amyloidosis
Each of these diseases Diagnosis, follow-up and treatments are different. They can also turn into myeloma disease after a certain period of time.
LEUKEMIA
Bone marrow produces various blood cells in the body. Leukemias are cancers of white blood cells. Sometimes this type of cancer can start from other types of blood cells. While chronic leukemias are slowly progressing cancers, acute leukemias are rapidly progressing cancers. There are several different types of leukemia:
ACUTE LEUKEMIA
• Acute lymphoblastic leukemia (ALL): This type of leukemia is more common in children than in adults. is more common. It is a malignant disease of bone marrow cells. In this disease, there is excessive proliferation of lymphoid cells that are not yet fully developed and replace the normal cells of the marrow. Since these cells invade the entire marrow, normal blood production is disrupted and the patient's blood values decrease.
• Acute myeloid leukemia (AML): “Acute myelocytic leukemia”, “acute myelogenous leukemia”. It is also referred to by many other names, such as “acute granulocytic leukemia” and “acute non-lymphocytic leukemia”. The word “acute” means that if left untreated, this leukemia can progress rapidly and possibly be fatal within a few months. “Myeloid” refers to the type of cells in which this leukemia begins in the bone marrow. Most cases of AML develop from cells that become white blood cells (other than lymphocytes), but some cases of AML can also develop from other blood-forming cells. AML begins in the bone marrow but in most cases quickly spreads to the blood. Sometimes lymph nodes, liver, spleen, central nervous system (brain and spinal cord) and testicles.
CHRONIC LEUKEMIA
• Chronic lymphocytic leukemia (CLL): Like acute leukemias, it is a cancer of the bone marrow, the spongy tissue within bones where blood cells are made. The term "chronic" in CLL is used to describe its typically slower progression than other types of leukemia. In this disease, the term "lymphocyte" refers to the type of cells in the bone marrow that are affected. These cells are a group of white blood cells called lymphocytes that help the body fight infection. CLL most commonly affects older adults.
• Chronic myeloid leukemia (CML): Chronic myeloid leukemia (CML), also known as “chronic myelogenous leukemia,” is a disease of the bone marrow that forms certain blood cells. It is a type of cancer that starts in cells. In CML, there is a genetic change in an early (immature) version of myeloid cells (the cells that make red blood cells, platelets, and most types of white blood cells (except lymphocytes). This change creates an abnormal gene called BCR-ABL, which turns the cell into a CML cell. Leukemia cells grow and divide, accumulate in the bone marrow and pass into the blood. Over time, cells can settle in other parts of the body, including the spleen. CML is a fairly slowly progressing leukemia, but it can also develop into a fast-growing acute leukemia that is difficult to treat. Most cases of CML are seen in adults, but very rarely in children.
• Chronic myelomonocytic leukemia (CMML): Bone marrow inactivity and "myeloproliferative diseases" characterized by proliferation of the bone marrow other than leukemia. It is a type of blood cancer known as the intermediate form of "myelodysplastic syndrome", which has the ability to turn into leukemia. Therefore, the World Health Organization (WHO) classifies CMML as a mixed myelodysplastic/myeloproliferative disease. It occurs in approximately three in 100,000 people each year. It usually affects older adults. It is diagnosed twice as often in men as in women. Only a small number have been reported in older children and young adults.
In this disease; As a result of a change in the stem cell, monos The normal development of a type of white blood cell called it is disrupted. Monocytes, along with other immature bone marrow cells (myeloblasts and myelocytes) that form monocytes, accumulate in the marrow and other organs. As a result of this accumulation, other normal blood cells cannot be made.
LYMPHOMAS
Lymphoma is cancer that starts in the cells of the lymph system. The lymphatic system is part of the immune system that helps the body fight infection and disease. Since lymph tissue is found throughout the body, lymphoma can start almost anywhere.
Image 3: Image of an enlarged lymph node on the neck of a lymphoma patient
There are two main types of lymphoma:
1. Hodgkin lymphoma (HL)
2. Non-Hodgkin lymphoma (NHL).
Both types of lymphoma can occur in both children and adults.
To understand what lymphoma is, learn about the body's lymphatic system (also known as the lymphatic system) and what it does. need to know. As we said above, the lymphatic system is part of the immune system that helps fight infections and some other diseases. The lymph system also helps move fluids through the body. Lymphatic system cells are lymphocytes.
Lymphocytes
These cells are white blood cells. There are 2 main types of lymphocytes:
B lymphocytes (B cells): B cells normally help protect the body against germs (bacteria or viruses) by making proteins called antibodies. Antibodies bind to microbes and are destroyed by other parts of the immune system.
T lymphocytes (T cells): There are various types of T cells. Some T cells destroy germs or abnormal cells in the body. Other T cells help increase or slow the activity of other immune system cells.
Different types of lymphoma can develop from each type of lymphocyte, mature or immature.
• Non-Hodgkin's. lymphoma (Non-Hodgkin Lymphoma, NHL): It is a type of lymphoma that affects lymphocytes. NHL from any lymphocyte type may develop, but B-cell lymphomas are much more common than T-cell lymphomas. These cancers can develop anywhere in the body and affect many different types of lymphocytes.
How does NHL start and spread?
Lymph tissue is found in many parts of the body, so This type of lymphoma can start almost anywhere.
Picture 4: Lymphatic system in the body
The main places where lymph tissue is found are:
Lymph nodes: Lymph nodes are the system where lymphocytes and other immune system cells are carried throughout the body. Lymph nodes are connected to each other by the lymphatic vascular system.
Spleen: The spleen is an organ located under the lower ribs on the left side of the body. The spleen makes lymphocytes and other immune system cells. It also stores healthy blood cells and filters out damaged blood cells, bacteria, and cell waste.
Bone marrow: Bone marrow is the spongy tissue inside certain bones. This is where new blood cells (including some lymphocytes) are made.
Thymus: The thymus is a small organ behind the top of the breastbone and in front of the heart. It is important in the development of T lymphocytes.
Adenoids and tonsils: These are collections of lymph tissue in the back of the throat. They help produce antibodies against inhaled or swallowed microbes.
Digestive system: The stomach, intestines and many other organs also have lymph tissue.
It can start in different parts of the body. There are many different non-Hodgkin lymphomas. This can affect the symptoms a person has.
Non-Hodgkin lymphoma can grow and spread at different rates depending on the subtype of the disease:
Some types of lymphoma tend to grow and spread slowly. These are known as “indolent lymphomas.” This type of lymphoma may not need to be treated right away, but instead may be monitored closely. The most common type of indolent lymphoma is follicular lymphoma.
Some types of lymphoma grow and spread rapidly. These are known as “aggressive lymphomas” and usually need to be treated right away. The most common a
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