Haemato-oncology: blood cancers, tests, treatment and what to expect

Haemato-oncology brings together cancer care and blood science. Its specialists are haematologists with additional training in blood cancers, working in multidisciplinary teams with clinical nurse specialists, pathologists, radiologists, transplant physicians, pharmacists and palliative care colleagues. Because these cancers circulate in blood or marrow, they are usually treated with drugs rather than surgery, and diagnosis depends heavily on laboratory tests of blood, marrow and lymph node tissue.

The NHS describes acute myeloid leukaemia as a rare cancer of the blood and bone marrow, myeloma as a cancer that affects the bones and other parts of the body, and non-Hodgkin lymphoma as a cancer of the glands. Hodgkin lymphoma is a separate lymphoma type with its own pathway, and chronic leukaemias progress more slowly than acute ones.

The NHS says symptoms of acute myeloid leukaemia usually appear quite quickly over a few weeks: tiredness, paleness, breathlessness, easy bleeding or bruising, repeated infections, fever, bone or joint pain, a swollen tummy and swollen glands. It advises an urgent GP appointment or NHS 111, and says a GP will usually arrange an urgent blood test.

Treatment is often started quickly. The NHS divides it into intensive treatment, which aims to cure and is usually given in hospital, and non-intensive treatment, which aims to control the disease with fewer side effects and is usually at home. Chemotherapy is the main treatment, sometimes with targeted medicines, radiotherapy or a stem cell or bone marrow transplant. Chronic lymphocytic leukaemia is different: the NHS says it cannot be cured but can be controlled, treatment may not be needed straight away, targeted medicines are the main treatment, and people can live with it for years.

The NHS lists a painless lump in the neck, armpit or groin as the most common symptom of non-Hodgkin lymphoma, with fever, night sweats, breathlessness, itchy skin and unexplained weight loss. The main test is a biopsy of an affected lymph node, with results usually within 2 weeks, followed by blood tests, scans such as PET, CT or MRI, and sometimes a bone marrow biopsy to stage the disease.

Treatment depends on whether the lymphoma is fast or slow growing, where it is, the exact type, spread and general health. It can include chemotherapy, targeted medicines, immunotherapy, radiotherapy, stem cell transplant and, for slow-growing disease, watch and wait with regular monitoring. The NHS notes fast-growing lymphoma can often be cleared completely, while treatment for slow-growing lymphoma controls it for many years.

Myeloma can cause bone pain, unexplained tiredness, breathlessness, muscle weakness, headaches, thirst, needing to pee more and weight loss, and sometimes none at first. The NHS says some people find out after a blood test for another reason. Sudden loss of feeling in the arms or legs, trouble walking or standing, confusion or loss of bladder or bowel control may signal spinal cord compression and needs a 999 call.

The NHS lists chemotherapy, steroids, radiotherapy, stem cell transplant, targeted medicines and bisphosphonates for bone protection, and says sometimes no treatment is needed straight away. It says myeloma cannot usually be cured, so treatment aims to limit the cancer and its symptoms and help people live longer, supported by a palliative or symptom control team. Precursor conditions such as MGUS and smouldering myeloma are usually monitored.

Cancer Research UK describes CAR T-cell therapy as immunotherapy in which a person T cells are collected, modified in a laboratory and returned by drip to find and attack cancer cells. It is a possible treatment for some children and adults with relapsed or refractory B-cell acute lymphoblastic leukaemia and for some adults with relapsed or refractory diffuse large B-cell, primary mediastinal large B-cell and mantle cell lymphoma, and a national panel decides who can have it. T-cell collection can take 4 to 6 hours, the cells take several weeks to make, and people are monitored closely in hospital for at least the first 2 weeks, with side effects including cytokine release syndrome and neurological changes.

Bispecific antibodies and antibody-drug conjugates are other targeted approaches used in some relapsed or hard-to-treat blood cancers. Eligibility, access and funding differ between the NHS and private providers and change as new evidence emerges, so ask your haematologist what is approved for your type and stage.

On the NHS, a GP who suspects a blood cancer makes an urgent referral. The NHS says the specialist appointment or tests are often within 2 weeks, cancer should be confirmed or ruled out within 28 days, and you will be assigned a clinical nurse specialist as main contact. Treatment decisions are made by a multidisciplinary team, and some treatments such as stem cell transplant and CAR T-cell therapy are only available at designated centres.

Privately, you can see a haematologist directly, though insurers normally require a referral and pre-authorise treatment. Costs of blood cancer care can be substantial and depend on the drugs, number of cycles, day-case or inpatient admissions, scans and monitoring. Ask for a written treatment and cost plan, which treatments are covered by insurance, and what happens if care needs to move to the NHS.

Useful questions include the exact subtype and stage, the aim of treatment (cure or control), side effects, fertility preservation before treatment, vaccination and infection precautions, and who to call out of hours. Ask a friend or family member to come with you and take notes.

During or after treatment, a high temperature, shivering, new bleeding or bruising, breathlessness or severe pain needs urgent contact with your treating team or NHS 111, and sometimes 999. Follow your hospital emergency advice card, since treatment can lower your resistance to infection.