Haematological Oncology

Haematology
Haematology is concerned with all aspects of blood formation and the diseases which occur when the process breaks down.
Blood is composed of cells, proteins, and fluids that are made in the lymphatic organs and bone marrow. With a range of leading-edge haematology services, including bone marrow and stem cell transplantation the hospital is well-equipped to deal with any blood related problems.
Haematological Malignancies
The haematological malignancies are a complex group of cancers derived from bone marrow cells arising as a result of disruption of the normal cellular processes in the bone marrow and immune system that are distinctive and show many differences from solid tumours.
Haematological malignancies include myeloma, lymphoma and leukaemia and account for over 10% of cancers. Their accurate diagnosis and management is central to the major improvements in survival and quality of life that has occurred over the last 10-15 years.
The diagnosis and management of patients has been transformed as new technologies replace traditional approaches to diagnosis and accelerate the introduction of novel treatments that increasingly define not just the diseases themselves, but how an individual patient should best be treated based on sound and comprehensive diagnostic information.
Patients often present with non-specific symptoms of tiredness and lethargy, recurrent infections and bleeding due to anaemia, low white blood cell count and low platelets.
A detailed clinical examination, pathological investigations and where appropriate, radiological imaging allows an accurate diagnosis to be made and a targeted, individualised approach to patient treatment that maximises the effect on the disease whilst minimising the risk of side-effects to the patient
Diagnosis:
It is extremely important to accurately establish early on the exact diagnosis and to attempt to identify factors that might predict how well or otherwise patients may respond to treatment. Increasingly, the appropriate investigation of patients at the time of diagnosis is allowing physicians to select treatments that are more or less likely to produce the best outcomes for patients.
In addition to blood tests and bone marrow tests, specialised radiological investigations are accurately identifying the extent of disease and are being used to identify minimal disease at follow-up that may predict for outcomes.
The main types of specialised investigation are:
Cytogenetics: Recent advances in cytogenetic technology has dramatically improved the value of these investigations that now play a major role in diagnosis and management of haematological malignancies. The tests are normally performed on bone marrow however, blood may sometimes be used.
Gene expression profile: Gene expression profiling is a laboratory technique that allows you to measure the activity of thousands of genes at the same time and build up a picture of the genetic activity of a cell. The pattern of activity provides a genetic signature that is unique to that patient and their disease and helps the clinician to select the best treatment.
Immunophenotyping: These tests are used to identify molecules expressed on the cell surface or internally in the cytoplasm to define specific sub-types of cells that occur in different types of malignancies. They are used to aid accurate diagnosis and assit with predicting the most effective treatment and likely outcome for patients. It is performed on both blood and bone marrow cells.
The main types of radiological investigation are:
Computerised tomography (CT) scan: a technique that uses X-rays to identify internal organs and tumours. It is a painless procedure that using our state of the art equipment can normally be completed within 10-20 minutes.
Magnetic resonance imaging (MRI):This is a radiological technique that does not use ionising radiation to image the contents of the body. It is particularly good at assessing the brain, heart,muscles and spinal cord.
Positive emission tomography (PET) scanning: a functional radiological technique used to scan the whole body and define the extent of disease that identifies areas of activity in bones and soft tissues both at diagnosis and follow-up after treatment.
Treatment:
New treatments are continually being developed in this rapidly evolving field and the introduction of novel agents has dramatically improved the outcomes for haematological malignancies by both improving survival and reducing toxicity.
Our Specialists are active clinical researchers, both devising and participating in local, national and international patient orientated clinical trials allowing patients the opportunity to access state of the art treatments at the earliest stage of their development.
The main types of treatment are:
Drugs (that directly kill cancer cells) or Chemotherapy. This may be given as a single agent but more commonly they are used as combinations of different chemotherapies to avoid the development of drug resistance. Steroids are frequently used as part of treatment, to help destroy cancer cells and make chemotherapy more effective.
Bone marrow or stem cell transplantation.The aim of these types of treatment is to allow you to have much higher doses of chemotherapy than usual to eradicate disease and to subsequently replace your own blood forming cells from a source of healthy blood cells.
Radiotherapy uses high energy x-rays and similar beams to treat and eradicate disease and is extremely effective in a wide variety of haematological malignancies.
Biological therapy works by helping your immune system to recognize and attack tumour cells by either stimulating the patient’s own immune system or administering antibodies or immune cells collected and processed from an external source.
Myeloma
Myeloma is a disease of blood cells called plasma cells that are an important component of the immune system found in the bone marrow. Their job normally is to produce a type of protein, or antibody that acts as on line of defence against infection, but in myeloma, malignant plasma cells in the bone marrow produce large amounts of an abnormal antibody known as paraprotein.
Unlike normal antibodies, paraproteins are not directed against infections and serve no useful function. The excess protein can, however, damage the kidneys leading to kidney failure and slow down the circulation causing confusion and heart failure.
On the other hand, expansion of the plasma cells in the bone marrow causes damage and weakening of the bone with bone pain, abdominal pain and constipation, fractures, tiredness, lethargy, weakness, recurrent infections and bleeding.
Diagnosis requires specialised pathological investigation of the blood and a bone marrow biopsy and imaging of the bones and organs using computerised tomography (CT), magnetic resonance imaging (MRI) or positive emission tomography (PET) scans.
Treatment is not required immediately for all patients but if there is evidence of organ damage or disease progression caused by the plasma cells or paraprotein, treatment should be initiated, This is given to the majority of patients as an outpatient in the newly commissioned Treatment Suite.
For some patients a haemopoeitic stem cell transplant is needed to consolidate the gains of initial treatment. This would be discussed at the time of your consultation and is delivered as an inpatient in specially designed, individual, en-suite treatment rooms.
Lymphoma
Lymphoma refers to a cancer of the lymphatic system which is a specialised network of nodes (knots of tissue) connected by vessels that forms a part of the circulatory system. The lymphatic system’s largest organ is the spleen and together, they drain fluid, the lymph, from all the organs and structures of your body back to the heart.
The lymph nodes act as filters, straining out invading organisms and cancerous cells. Lymphocytes are a type of white blood cell that attacks infectious invaders, such as bacteria, viruses and fungi, to destroy infections before they can enter the bloodstream.
Lymphoma occurs when specialised cells in the lymph-node or the lymphocytes begin to multiply in an uncontrollable manner, producing cancerous cells that expand and invade other tissues throughout your body.
The two main types of lymphoma are Hodgkin’s lymphoma and Non-Hodgkin’s lymphoma (NHL), which are classified using a specialised laboratory technique known as immunophenotyping, to characterise unique features of the cancer cells. This is important because it allows the clinician to select the treatment that is likely to induce the best response for that specific type of NHL.
Patients commonly present with a swelling in the neck, under the arm or in the groin. Lymphoma is normally a painless condition and early in the course of the disease patients may have no symptoms. However, as the disease progresses non-specific symptoms such as unintended weight loss, fever, night sweats and itching may develop.
Treatment requires biopsy of one of the enlarged lymph nodes and a bone marrow biopsy to confirm the type and extent of lymphoma. Specialised radiology imaging is used to evaluate the extent of spread or stage of the disease. The treatment and outcomes of lymphoma have been transformed in recent years by the introduction of novel agents and antibody therapy.
The treatment of lymphoma is usually very successful and many people are cured of their disease.
Leukaemia
Leukaemia is a complex disease with many diverse types and subtypes requiring expert diagnostic tests and management if there is to be a chance of cure. It arises in the bone marrow where the different types of blood cells are made and rapidly travels into the blood. From here it can travel to other parts of the body, such as the lymph nodes, liver, central nervous system, spleen and other organs.
The bone marrow is composed of blood-forming cells but also a microenvironment consisting of fat cells and cells that aid the development of blood forming cells. Early blood cells are called stem cells which grow in an orderly process to produce all types of blood cells including red and white blood cells and platelets.
Any of the blood-forming or lymphoid cells can turn into a leukemic cell. Once that happens, the cell reproduces to form several new cancer cells. In time, these cells can overwhelm the bone marrow, spilling out into the bloodstream and spread to other organs.
Leukaemia can present with a short period of illness (acute leukaemia) or with a prolonged period of deteriorating ill health (chronic leukaemia). Patients present with symptoms as a result of reduction in normal blood cells; bleeding (heavy periods in women or gum bleeding) or extensive easy bruising because of low platelets, recurrent chest infections and ulcers in the mouth because of impaired white cell numbers or function whilst anaemia can cause or intensify tiredness fatigue or shortness of breath.
It is extremely important to identify which sub-type of leukaemia patients are suffering from because this will dictate what treatment should be given. This requires a bone marrow and blood samples to be taken for specialised genetic and molecular studies.
Acute leukaemia requires a prolonged period of in-patient care with long term follow-up whilst chronic leukaemias can usually be managed and treated as an out-patient.

Haematology

Haematology is concerned with all aspects of blood formation and the diseases which occur when the process breaks down.haematology_oncology

Blood is composed of cells, proteins, and fluids that are made in the lymphatic organs and bone marrow. With a range of leading-edge haematology services, including bone marrow and stem cell transplantation the hospital is well-equipped to deal with any blood related problems.

Haematological Malignancies

The haematological malignancies are a complex group of cancers derived from bone marrow cells arising as a result of disruption of the normal cellular processes in the bone marrow and immune system that are distinctive and show many differences from solid tumours.

Haematological malignancies include myeloma, lymphoma and leukaemia and account for over 10% of cancers. Their accurate diagnosis and management is central to the major improvements in survival and quality of life that has occurred over the last 10-15 years.

The diagnosis and management of patients has been transformed as new technologies replace traditional approaches to diagnosis and accelerate the introduction of novel treatments that increasingly define not just the diseases themselves, but how an individual patient should best be treated based on sound and comprehensive diagnostic information.

Patients often present with non-specific symptoms of tiredness and lethargy, recurrent infections and bleeding due to anaemia, low white blood cell count and low platelets.

A detailed clinical examination, pathological investigations and where appropriate, radiological imaging allows an accurate diagnosis to be made and a targeted, individualised approach to patient treatment that maximises the effect on the disease whilst minimising the risk of side-effects to the patient

Diagnosis

It is extremely important to accurately establish early on the exact diagnosis and to attempt to identify factors that might predict how well or otherwise patients may respond to treatment. Increasingly, the appropriate investigation of patients at the time of diagnosis is allowing physicians to select treatments that are more or less likely to produce the best outcomes for patients.

In addition to blood tests and bone marrow tests, specialised radiological investigations are accurately identifying the extent of disease and are being used to identify minimal disease at follow-up that may predict for outcomes.

The main types of specialised investigation are:

Cytogenetics: Recent advances in cytogenetic technology has dramatically improved the value of these investigations that now play a major role in diagnosis and management of haematological malignancies. The tests are normally performed on bone marrow however, blood may sometimes be used.

Gene expression profile: Gene expression profiling is a laboratory technique that allows you to measure the activity of thousands of genes at the same time and build up a picture of the genetic activity of a cell. The pattern of activity provides a genetic signature that is unique to that patient and their disease and helps the clinician to select the best treatment.

Immunophenotyping: These tests are used to identify molecules expressed on the cell surface or internally in the cytoplasm to define specific sub-types of cells that occur in different types of malignancies. They are used to aid accurate diagnosis and assit with predicting the most effective treatment and likely outcome for patients. It is performed on both blood and bone marrow cells.

The main types of radiological investigation are:

Computerised tomography (CT) scan: a technique that uses X-rays to identify internal organs and tumours. It is a painless procedure that using our state of the art equipment can normally be completed within 10-20 minutes.

Magnetic resonance imaging (MRI): This is a radiological technique that does not use ionising radiation to image the contents of the body. It is particularly good at assessing the brain, heart,muscles and spinal cord.

Positive emission tomography (PET) scanning: a functional radiological technique used to scan the whole body and define the extent of disease that identifies areas of activity in bones and soft tissues both at diagnosis and follow-up after treatment.

Treatment

New treatments are continually being developed in this rapidly evolving field and the introduction of novel agents has dramatically improved the outcomes for haematological malignancies by both improving survival and reducing toxicity.

Our Specialists are active clinical researchers, both devising and participating in local, national and international patient orientated clinical trials allowing patients the opportunity to access state of the art treatments at the earliest stage of their development.

The main types of treatment are:

Drugs (that directly kill cancer cells) or Chemotherapy. This may be given as a single agent but more commonly they are used as combinations of different chemotherapies to avoid the development of drug resistance. Steroids are frequently used as part of treatment, to help destroy cancer cells and make chemotherapy more effective.

Bone marrow or stem cell transplantation.The aim of these types of treatment is to allow you to have much higher doses of chemotherapy than usual to eradicate disease and to subsequently replace your own blood forming cells from a source of healthy blood cells.

Radiotherapy uses high energy x-rays and similar beams to treat and eradicate disease and is extremely effective in a wide variety of haematological malignancies.

Biological therapy works by helping your immune system to recognize and attack tumour cells by either stimulating the patient’s own immune system or administering antibodies or immune cells collected and processed from an external source.

Myeloma

Myeloma is a disease of blood cells called plasma cells that are an important component of the immune system found in the bone marrow. Their job normally is to produce a type of protein, or antibody that acts as on line of defence against infection, but in myeloma, malignant plasma cells in the bone marrow produce large amounts of an abnormal antibody known as paraprotein.

Unlike normal antibodies, paraproteins are not directed against infections and serve no useful function. The excess protein can, however, damage the kidneys leading to kidney failure and slow down the circulation causing confusion and heart failure.

On the other hand, expansion of the plasma cells in the bone marrow causes damage and weakening of the bone with bone pain, abdominal pain and constipation, fractures, tiredness, lethargy, weakness, recurrent infections and bleeding.

Diagnosis requires specialised pathological investigation of the blood and a bone marrow biopsy and imaging of the bones and organs using computerised tomography (CT), magnetic resonance imaging (MRI) or positive emission tomography (PET) scans.

Treatment is not required immediately for all patients but if there is evidence of organ damage or disease progression caused by the plasma cells or paraprotein, treatment should be initiated, This is given to the majority of patients as an outpatient in the newly commissioned Treatment Suite.

For some patients a haemopoeitic stem cell transplant is needed to consolidate the gains of initial treatment. This would be discussed at the time of your consultation and is delivered as an inpatient in specially designed, individual, en-suite treatment rooms.

Lymphoma

Lymphoma refers to a cancer of the lymphatic system which is a specialised network of nodes (knots of tissue) connected by vessels that forms a part of the circulatory system. The lymphatic system’s largest organ is the spleen and together, they drain fluid, the lymph, from all the organs and structures of your body back to the heart.

The lymph nodes act as filters, straining out invading organisms and cancerous cells. Lymphocytes are a type of white blood cell that attacks infectious invaders, such as bacteria, viruses and fungi, to destroy infections before they can enter the bloodstream.

Lymphoma occurs when specialised cells in the lymph-node or the lymphocytes begin to multiply in an uncontrollable manner, producing cancerous cells that expand and invade other tissues throughout your body.

The two main types of lymphoma are Hodgkin’s lymphoma and Non-Hodgkin’s lymphoma (NHL), which are classified using a specialised laboratory technique known as immunophenotyping, to characterise unique features of the cancer cells. This is important because it allows the clinician to select the treatment that is likely to induce the best response for that specific type of NHL.

Patients commonly present with a swelling in the neck, under the arm or in the groin. Lymphoma is normally a painless condition and early in the course of the disease patients may have no symptoms. However, as the disease progresses non-specific symptoms such as unintended weight loss, fever, night sweats and itching may develop.

Treatment requires biopsy of one of the enlarged lymph nodes and a bone marrow biopsy to confirm the type and extent of lymphoma. Specialised radiology imaging is used to evaluate the extent of spread or stage of the disease. The treatment and outcomes of lymphoma have been transformed in recent years by the introduction of novel agents and antibody therapy.

The treatment of lymphoma is usually very successful and many people are cured of their disease.

Leukaemia

Leukaemia is a complex disease with many diverse types and subtypes requiring expert diagnostic tests and management if there is to be a chance of cure. It arises in the bone marrow where the different types of blood cells are made and rapidly travels into the blood. From here it can travel to other parts of the body, such as the lymph nodes, liver, central nervous system, spleen and other organs.

The bone marrow is composed of blood-forming cells but also a microenvironment consisting of fat cells and cells that aid the development of blood forming cells. Early blood cells are called stem cells which grow in an orderly process to produce all types of blood cells including red and white blood cells and platelets.

Any of the blood-forming or lymphoid cells can turn into a leukemic cell. Once that happens, the cell reproduces to form several new cancer cells. In time, these cells can overwhelm the bone marrow, spilling out into the bloodstream and spread to other organs.

Leukaemia can present with a short period of illness (acute leukaemia) or with a prolonged period of deteriorating ill health (chronic leukaemia). Patients present with symptoms as a result of reduction in normal blood cells; bleeding (heavy periods in women or gum bleeding) or extensive easy bruising because of low platelets, recurrent chest infections and ulcers in the mouth because of impaired white cell numbers or function whilst anaemia can cause or intensify tiredness fatigue or shortness of breath.

It is extremely important to identify which sub-type of leukaemia patients are suffering from because this will dictate what treatment should be given. This requires a bone marrow and blood samples to be taken for specialised genetic and molecular studies.

Acute leukaemia requires a prolonged period of in-patient care with long term follow-up whilst chronic leukaemias can usually be managed and treated as an out-patient.