Hematological
malignancy
Although
hematological
malignancies
are a form
of cancer,
they are
generally
treated by
specialists
in
hematology,
although in
many
hospitals
oncology
specialists
also manage
these
diseases.
("Hematology/Oncology"
is a single
subspecialty
of Internal
Medicine;
there are
also
surgical and
radiation
oncologists.)
Hematological
malignancies
are the
types of
cancer that
affect
blood, bone
marrow and
lymph nodes.
As the three
are
intimately
connected
through the
immune
system, a
disease
affecting
one of the
three will
often affect
the others
as well:
although
lymphoma is
technically
a disease of
the lymph
nodes, it
often
spreads to
the bone
marrow,
affecting
the blood
and
occasionally
producing a
paraprotein.
Chromosomal
translocations
are a common
cause of
these
diseases,
while this
is uncommon
in solid
tumors. This
leads to a
different
approach in
diagnosis
and
treatment of
hematological
malignancies.
Diagnosis
For the
analysis of
a suspected
hematological
malignancy,
a complete
blood count
and blood
film are
essential,
as malignant
cells can
show in
characteristic
ways on
light
microscopy.
When there
is
lymphadenopathy,
a biopsy
from a lymph
node is
generally
undertaken
surgically.
In general,
a bone
marrow
biopsy is
part of the
"work up"
for the
analysis of
these
diseases.
All
specimens
are examined
microscopically
to determine
the nature
of the
malignancy.
A number of
these
diseases can
now be
classified
by
cytogenetics
(AML, CML)
or
immunophenotyping
(lymphoma,
myeloma, CLL)
of the
malignant
cells.
Treatment
Treatment
can
occasionally
consist of
"watchful
waiting"
(e.g. in CLL)
or
symptomatic
treatment
(e.g. blood
transfusions
in MDS). The
more
aggressive
forms of
disease
require
treatment
with
chemotherapy,
radiotherapy,
immunotherapy
and - in
some cases -
a bone
marrow
transplant.
Follow-up
If
treatment
has been
successful
("complete"
or "partial
remission"),
a patient is
generally
followed up
at regular
intervals to
detect
recurrence
and monitor
for
"secondary
malignancy"
(an uncommon
side-effect
of some
chemotherapy
and
radiotherapy
regimens -
the
appearance
of another
form of
cancer). In
the
follow-up,
that should
be done with
pre-determined
regular
intervals,
general
anamnesis is
combined
with
complete
blood count
and
determination
of lactate
dehydrogenase
or thymidine
kinase in
serum. |
