Chicago and its residents feel the impact of cancer every day. Everyone knows that cancer exacts an enormous toll on individuals and families battling and disease in Illinois and across the country. The National Institutes of Health (NIH) estimates that 66,090 people in Illinois will be diagnosed with cancer and 24,080 will die from cancer this year. Accordingly to NIH, 1,660,290 new cases of cancer will be diagnosed and more than 580,350 people will die from cancer in the United States in 2013. Though far less important than the humanomics, the overall cost of cancer in the United States in 2008 was $201.5 billion according to the NIH - $77.4 billion for direct medical costs and $124 billion for indirect costs (cost of lost productivity due to premature death).
Blood Cancers (lymphoma, leukemia, and myeloma) are one of the three leading causes of cancer deaths in our country, behind only respiratory cancer (mostly lung cancer) and digestive system cancer (including colorectal cancer). For example, there are expected to be 2,020 new cases and 1,010 deaths from leukemia this year and 2,840 new cases and 780 deaths in Illinois from non-Hodgkin lymphoma alone.
Further, blood cancer research has been responsible for developments and treatments for a wide range of cancers. Yet, it seems that the blood cancer community often is the forgotten step-child when it comes to publicity and fundraising. It is important that blood cancers receive considerably more publicity and research funding - not only for the people impacted by blood cancer and those who love them, but for all people impacted by cancer. Remarkable blood cancer research is being done right here at the great Chicago area medical institutions such as Rush University Medical Center, University of Chicago, and Northwestern University.
September is National Blood Cancer Awareness Month and September 15 is World Lymphoma Awareness Day. This is an appropriate time to promote awareness and provide some basic information about blood cancer, which are the most the common cancers in children. Last year, we examined why blood cancer gets the short end of the awareness and fundraising stick. This year, we decided to provide some general information about blood cancer because so few people really understand blood cancer.
What Is Blood Cancer: There are three general categories of cancer: skin cancer (such as basal cell and melanoma), solid tumors (such as breast, colon, and lung cancer), and blood cancer. Blood cancers are cancers of the blood and lymph systems. There are three major types of blood cancers: lymphoma, leukemia, and myeloma.
Lymphoma: Lymphoma is the most common blood cancer. It is cancer of the lymph system and white blood cells known as lymphocytes, which fight infection and disease. There are two major types: Hodgkin’s disease and non-Hodgkin’s lymphoma (NHL) and dozens of sub-types that range from indolent or slow growing to aggressive sub-types. By some counts, there are 70 sub-types of lymphoma. The treatments, prognoses, and survival rates can vary significantly depending upon the type and stage. Accordingly, it is not enough to know someone has lymphoma or non-Hodgkin lymphoma – you need to know the sub-type. Some of the sub-types are: Anaplastic Large-Cell Lymphoma; Angioimmunoblastic Lymphoma; Blastic NK-Cell Lymphoma; Burkitt’s Lymphoma; Small Lymphocytic Lymphoma (SLL); Cutaneous T-Cell Lymphoma; Diffuse Large B-Cell Lymphoma; Follicular Lymphoma; Hepatosplenic Gamma-Delta T-Cell Lymphoma; Mantle Cell Lymphoma; Marginal Zone Lymphoma; Pediatric Lymphoma; Peripheral T-Cell Lymphomas; Transformed Lymphomas; various T-Cell Lymphomas; and Waldenstrom's Macroglobulinemia.
Leukemia: The next most common category of blood cancer is leukemia. Leukemia is cancer of the blood and bone marrow, the spongy center of bones where our blood cells are formed. The disease develops when blood cells produced in the bone marrow grow out of control. The most common types are acute myeloid leukemia (AML), chronic myeloid leukemia (CLL), acute lymphocytic leukemia (ALL), and chronic lymphocytic leukemia (CLL). One man’s CLL may be another’s SLL – leukemia and lymphoma are sister diseases. There also is hairy cell leukemia, chronic myelomonocytic leukemia, and juvenile myelomonocytic leukemia. Once again, the stage and type are important determinants of treatment and prognosis.
Myeloma: Myeloma is the final major category of blood cancer. Myeloma begins in the bone marrow and impacts the plasma cells. There are several forms identified by the areas of the body impacted and the rate of progression. Most patients (about nine in ten) have multiple myeloma, meaning the disease is in multiple areas of the body by the time of diagnosis. The disease is most common in older individuals – the medium age at diagnosis is 70 years. Many times, it is a broken bone that leads a patient to seek treatment and that results in the diagnosis.
The Impact Of Blood Cancer: Every four minutes someone is America is diagnosed with blood cancer and someone dies from the disease every 10 minutes. Nearly 150,000 Americans are diagnosed annually with blood cancer, accounting for over 9 percent of new cancer cases diagnosed in the United States and over 9.4% of the cancer deaths. Blood cancer is the most common form of cancer in children, with leukemia causing more deaths in children and young adults under the age of twenty than any other cancer. Leukemia, lymphoma, and myeloma cause more than 54,600 deaths per year in the United States. Nearly 1,000,000 Americans are living with blood cancer. This is a lot of people impacted by cancers that few know very much about.
Lymphomas are responsible for more than 79,000 new cases and 20,200 deaths annually, leukemias account for 48,600 new cases diagnosed and 23,720 deaths a year, and myeloma new cases and deaths are 22,350 and 10,700 in the United States. While many forms of cancer have been declining, the rate of incidence of non-Hodgkin lymphoma has nearly doubled since the 1970s.
The Good News – Blood Cancer Research Is The Super Highway To Curing Cancer: Although blood cancer garners too little publicity and far too little is spent on blood cancer research, blood cancer research has provided the biggest bang for our research dollar. Historical evidence establishes that blood cancer research has produced tremendous results that extend well beyond blood cancer. Many cancer treatments have been developed through lymphoma and leukemia research. Chemotherapy, radiation treatment, stem cell transplantation, combination chemotherapy, monoclonal antibodies (the smart drugs that target cancer cells and leave healthy cells alone), and other therapies used on blood cancers have proven to be successful with other forms of cancer. For example, during clinical trials of Rituxin (a monoclonal therapy now used for most forms of non-Hodgkin lymphoma) on blood cancer patients, it was discovered that it was efficacious in treating rheumatoid arthritis. The FDA has since approved it for use in rheumatoid arthritis patients.
The blood and lymph systems play a central role in cancer development and eradication. Solid tumors – such as prostrate cancer, colon cancer, and breast cancer often are readily treatable when localized. But these tumors can spread or metastasize. Through what mechanism does cancer spread to other parts of the body? The answer, of course, is through the blood and lymph systems. The immune system plays a major role in understanding cancer, preventing cancer, treating cancer, and curing cancer. Lymphomas and many leukemias actually are cancers of the immune system. There are many important reasons to invest in cogent blood cancer research projects.
Research And Awareness Make A Huge Difference: The 5-year survival rate for all cancers diagnosed between 2002 and 2008 is 68%, up from 49% in 1975-1977. The 5-year survival rate for blood cancer has increased across the board as well from 49% in 1975-77, to 56% 1987-89, to 68% in 2002-08. From 1975-77 to 2002-08 the 5-year survival rates have increased from 34% to 58% in leukemia, from 25% to 48% in myeloma, from 47% to 71 % in non-Hodgkin lymphoma, and from 72% to 87 in Hodgkin lymphoma. The improvement in survival reflects both progress in diagnosing certain cancers at an earlier stage and improvements in treatment.
Warning Signs And Symptoms: There are many signs and symptoms potentially suggestive of blood cancer. It is important to note, however, that many of these symptoms are general and do not necessarily mean the individual has blood cancer or any serious illness for that matter. Also, many people with blood cancer do not have any of these symptoms. Accordingly, it is important to seek medical attention when you are not feeling well, to avoid self-diagnosis or jumping to conclusions, to get regular physical examinations and routine blood work (many cancers are diagnosed this way), and to be on the lookout for symptoms that persist.
Common Lymphoma Symptoms: The classic sign of lymphoma is enlarged lymph nodes. Lymph nodes are located throughout the body, but generally the ones patients can identify are located in the head, neck, under the arms, or in the groin area. The swollen lymph nodes are usually painless. Keep in mind that it is common for lymph nodes to be enlarged while fighting a cold or infection. But if the lymph node persists or remains enlarged, seek medical attention. Other lymphoma symptoms include: fever; night sweets; unexplained itching; unexplained weight loss; weakness; fatigue; and chronic infections or infections that do not seem to resolve.
Potential Signs Of Leukemia: There is a wide range of potential symptoms of leukemia, including: easy bruising or blood (due to low platelet count) with no clear cause; pinhead size red spots under the skin; cuts that take a long time to heal; fatigue or chronic lack of energy and paleness (due to enema); shortness of breath during normal physical activity; mild fever; night sweats; swollen gums; frequent minor infections (due to low white blood cell count); unexplained weight loss; chronic aches or discomfort in bones or joints; and pain or discomfort in the upper left part of the stomach (caused by an enlarged spleen).
Signs Of Myeloma Symptoms: The most common sign of myeloma is bone fractures and bone pain without an apparent reason. Pain is most common in the back or ribs, but it can occur in any bone. The pain is usually made worse by movement. Other symptoms may include: weakness; fatigue; pale skin; recurring infections; neuropathy (numbness, tingling, burning or pain) in the hands or feet; increased thirst or urination; constipation; and kidney failure. Hyperviscosity syndrome is associated with myeloma. This may cause blurry vision, headaches, chest pain, abnormal bleeding, or shortness of breath.
Treatments: Through the investment in research, the armamentarium of treatments for blood cancers has grown, with more effective and less toxic treatments available for many sub-types. Some forms of blood cancer may not require active treatment for a long time and some patients may never require treatment. Surveillance or “watch and wait” (considered by some patients to be “watch and worry”) many times is an appropriate strategy in such cases. Various chemotherapies, biological therapies, monoclonal antibodies, radiation, combination chemotherapy and radiation, radioimmunotherapy, and stem cell transplantation are among the potential treatments. There are many promising drugs and therapies in clinical trial.
It Starts With Awareness: Almost everyone knows someone impacted by blood cancer, but many people do not know what lymphoma, leukemia, and myeloma are or even that these are cancers. They are hard to spell, sound strange, often involve generalized symptoms, and do not get nearly enough press or attention. Now you know the blood cancer basics. For more information about blood cancer, visit www.chicagobloodcancer.org.
Chicago has taken a leading role in blood cancer research and patient advocacy. Now is the time for all Chicagoans to be aware of blood cancer basics and for each of us to do something to promote blood cancer awareness and help eradicate lymphoma, leukemia, and myeloma in all of its forms.