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DEAR MAYO CLINIC: My spouse was recently diagnosed with a blood cancer, and we're overwhelmed by everything we're being told. What should patients and families expect after a diagnosis, and how do doctors determine the right treatment?
ANSWER: A blood cancer diagnosis can bring a lot of information and uncertainty all at once. In the first days and weeks, you may meet with specialists and undergo several tests as your healthcare team learns more about your cancer and plans your care.
It can feel like treatment should begin immediately, but one of the most important first steps is getting the diagnosis right. Blood cancers such as leukemia, lymphoma and multiple myeloma have different types and subtypes that can behave and respond to treatment differently.
A pathology review is a key part of this process. A pathologist examines blood, bone marrow or tissue samples to look for features that help identify the cancer. For complex or uncommon cases, having someone with extensive experience diagnosing blood cancers review the samples can provide valuable insight.
Additional testing may look more closely at the cancer's characteristics, including changes in its chromosomes or DNA. These changes are found in the cancer itself and are not necessarily inherited. They can help your healthcare team understand how the cancer may behave and guide decisions about your care.
How are blood cancers treated?
Not every blood cancer needs to be treated immediately. An acute leukemia, for example, generally requires urgent care, while some chronic leukemias or slow-growing lymphomas may be monitored until treatment is needed.
Treatment options for blood cancers may include:
- Chemotherapy.
- Immunotherapy.
- Targeted therapy.
- Radiation therapy.
- Stem cell transplant.
Which treatment is recommended depends on the type and behavior of the cancer. Your healthcare team also considers your age, overall health, other medical conditions, possible side effects and practical considerations, such as how often you'll need to travel for treatment.
Clinical trials are research studies that help researchers learn more about new or existing approaches to care. They can be considered at different points in the care process. A common misconception is that clinical trials are only an option when standard therapies have stopped working. Some trials are available at the time of diagnosis, and they may study new approaches or ways to reduce the intensity or side effects of existing therapies.
If you're considering a clinical trial, ask what is already known about its safety, how often you'll need appointments, how long participation lasts and whether assistance is available for expenses such as travel or lodging.
Blood cancer care often takes a multidisciplinary team. Specialists in areas such as hematology, pathology, radiology and radiation oncology may work together when making treatment decisions. This collaboration helps them consider your cancer, other health conditions and potential complications.
During and after treatment, you may hear several terms used to describe the status of your cancer:
- Response: Testing shows the cancer is decreasing in some way.
- Remission: There is no evidence of cancer based on the tests used to detect it, but this does not necessarily mean the cancer is cured.
- Disease control: The cancer isn't growing, even if it hasn't disappeared.
- Recurrence: The cancer has returned after a period of remission.
Follow-up depends on the type of blood cancer and care you've received. It may include physical exams, blood tests, imaging or bone marrow biopsies. Your healthcare team also will monitor for potential long-term effects related to your cancer and its treatment, including cardiovascular problems and the risk of developing other cancers.
After a blood cancer diagnosis, you don't have to understand everything at once. Ask questions, bring a family member or friend to appointments if it helps, and take time to learn about your diagnosis and options. Having the right information can help you feel more prepared for the decisions ahead.
Urshila Durani, M.D., Hematology, Mayo Clinic, Rochester, Minnesota.
Join the conversation on Mayo Clinic Connect Blood Cancers & Disorders Support Group.
