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Bone Marrow Cancer

Bone marrow cancer does not refer to a single cancer. It can be classified under two main categories: acute leukemias and chronic leukemias. In addition to leukemias, Multiple Myeloma is also a type of bone marrow cancer. Bone marrow is a spongy tissue-like structure located primarily in the center of certain bones, especially the hip and thigh bones. One of the most important features of bone marrow is that it contains stem cells that can differentiate into various types of blood cells. Bone marrow cancers, or hematological cancers, require different treatments depending on the type and stage of the cancer.

What is bone marrow cancer?

The body contains different types of cells.

  • Leukocytes: Leukocytes, also known as white blood cells or warrior cells, are cells that fight against infections.

  • Erythrocytes: Erythrocytes, also known as red blood cells, are responsible for carrying oxygen to tissues.

  • Platelets: Platelets, also known as thrombocytes, assist in blood clotting and are also called clotting cells or blood platelets. The body generally produces these blood cells when needed.


Sometimes, these cells can proliferate uncontrollably, rapidly, and abnormally. These conditions are known as hematological cancers or bone marrow cancers.


What are bone marrow cancers types?


Bone marrow cancers, also known as hematological cancers or blood cancers, refer to a group of cancers that affect the cells in the bone marrow. There are several types of bone marrow cancers, including:

  1. Leukemia: Leukemia is a cancer of the blood and bone marrow, characterized by the overproduction of abnormal white blood cells.

  2. Multiple Myeloma: Multiple Myeloma is a cancer that affects plasma cells, a type of white blood cell that produces antibodies. It causes the excessive growth of abnormal plasma cells in the bone marrow.

  3. Lymphoma: Lymphoma is a cancer that begins in the lymphatic system, which includes the lymph nodes, spleen, and bone marrow. It can involve the bone marrow and affect its normal functioning.

These bone marrow cancers can have different subtypes and may require specific treatments depending on the type, stage, and individual factors of the disease.


What is Multiple Myeloma?

Multiple Myeloma is a type of cancer that occurs in the cells called plasma cells, which are found in the bone marrow. Plasma cells play an important role in the immune system and produce necessary antibodies to fight against foreign particles and microbes. When plasma cells become abnormal and cancerous, and they grow out of control, this condition is called multiple myeloma. A single plasma cell undergoes malignant transformation, multiplies, and forms myeloma cells. Myeloma cells produce abnormal proteins (antibodies) known by various names.

However, there are other plasma cell disorders that have abnormal plasma cells but do not meet the criteria to be classified as active multiple myeloma. These other plasma cell disorders include:

  • Monoclonal gammopathy of undetermined significance (MGUS) or monoclonal gammopathy of clinical significance (MGCS)

  • Smoldering multiple myeloma (SMM)

  • Solitary plasmacytoma

The diagnosis, monitoring, and treatment approaches for each of these conditions are different. Additionally, these conditions can progress to multiple myeloma after a certain period of time.


Leukemias


The bone marrow produces various types of blood cells in the body. Leukemias are cancers of the white blood cells. Sometimes, these types of cancers can also originate from other types of blood cells. Chronic leukemias are slow-progressing cancers, while acute leukemias are rapidly progressing cancers.


There are several different types of leukemia:


What are acute leukemia types?

  • Acute Lymphoblastic Leukemia (ALL): This type of leukemia is more common in children than in adults. It is a malignant disease of the bone marrow cells. In this disease, there is an excessive proliferation of immature lymphoid cells, replacing the normal cells in the marrow. As these cells occupy the entire marrow, normal blood production is disrupted, and the patient's blood counts decrease.

  • Acute Myeloid Leukemia (AML): AML is also referred to by various other names such as "acute myelocytic leukemia," "acute myelogenous leukemia," "acute granulocytic leukemia," and "acute non-lymphocytic leukemia." The term "acute" indicates that this leukemia can progress rapidly and can potentially be fatal within a few months if left untreated. "Myeloid" refers to the cell type from which this leukemia originates in the bone marrow. Most cases of AML arise from cells that would normally develop into white blood cells (excluding lymphocytes), but some AML cases can also arise from other blood-forming cells. AML originates in the bone marrow but rapidly enters the bloodstream in most cases.

  • Both acute leukemias can sometimes involve lymph nodes, liver, spleen, central nervous system (brain and spinal cord), and testes.


What are chronic leukemias?

  • Chronic Lymphocytic Leukemia (CLL): Similar to acute leukemias, CLL is a cancer of the bone marrow, which is the spongy tissue inside bones where blood cells are made. The term "chronic" is used to describe its typically slower progression compared to other types of leukemia. In this disease, the term "lymphocytic" indicates the affected cell type in the bone marrow. These cells belong to a group of white blood cells called lymphocytes, which play a role in the body's immune response. CLL most commonly affects older adults.

  • Chronic Myeloid Leukemia (CML): CML, also known as chronic myelogenous leukemia, is a type of cancer that starts in specific blood-forming cells in the bone marrow. In CML, there is a genetic change in an early (immature) version of myeloid cells, which are the cells that give rise to red blood cells, platelets, and most types of white blood cells (except lymphocytes). This change creates an abnormal gene called BCR-ABL, which transforms the cell into a CML cell. The leukemia cells grow and divide, accumulating in the bone marrow and entering the bloodstream. Over time, the cells can also settle in other parts of the body, including the spleen. CML is a relatively slow-progressing leukemia but can also transform into rapidly growing acute leukemia, which is difficult to treat. Most cases of CML occur in adults but can rarely occur in children as well.

  • Chronic Myelomonocytic Leukemia (CMML): CMML is a type of blood cancer characterized by the proliferation of cells outside the leukemia and an inclination to transform into leukemia, known as myeloproliferative disorders and myelodysplastic syndrome, respectively. Therefore, the World Health Organization (WHO) classifies CMML as a mixed myelodysplastic/myeloproliferative neoplasm. It is seen in approximately three out of every 100,000 individuals annually. It typically affects older adults and is diagnosed twice as often in males as in females. It has been reported in only a small number of older children and young adults. In this disease, a change occurs in the stem cell, disrupting the normal development of a type of white blood cell called monocytes. Along with monocytes, immature bone marrow cells that make up monocytes (myeloblasts and myelocytes) accumulate in the bone marrow and other organs. As a result of this accumulation, other normal blood cells cannot be produced.


What are the symptoms of bone marrow cancer?

The symptoms of bone marrow cancer can vary depending on where it originates in the body, the type of cancer, the subtype, and the aggressiveness of the disease.

For multiple myeloma, a type of bone marrow cancer, the symptoms can include:

  • Bone pain or fractures

  • Fatigue

  • Frequent infections

  • Changes in urination frequency

  • Altered mental state

  • Increased thirst

  • Nausea or vomiting

  • Weight loss

For leukemias, the symptoms can include:

  • Weakness

  • Fatigue

  • Shortness of breath

  • Fever

  • Bone pain

  • Weight loss

  • Night sweats

  • Enlarged lymph nodes and spleen

  • Frequent infections

  • Pallor of the skin

  • Easy bruising

  • Prolonged bleeding from small cuts

  • Body aches, especially in the bones

It's important to note that these symptoms can also be associated with other medical conditions, and a proper medical evaluation is necessary for an accurate diagnosis.


How is the diagnosis of bone marrow cancer made?

Your doctor can make a diagnosis of hematological cancer based on physical examination, medical history, and tests that examine the blood and bone marrow cells.

Medical history: Your doctor will inquire about your medical history, including your health habits, past illnesses, and treatments. Physical examination: Your doctor will conduct a general physical examination of your body to check for any unusual findings or symptoms. During the physical examination, your lymph nodes, spleen, and liver will be examined for enlargement. Complete Blood Count (CBC): A blood sample is taken and examined to measure various parameters. The quantity of red blood cells (erythrocytes), white blood cells (leukocytes), and platelets (thrombocytes), as well as the hemoglobin level associated with the red blood cells and the ratio of the sample composed of red blood cells, known as hematocrit, are determined by this test. Blood and urine biochemistry tests: These involve analyzing a blood sample to measure the levels of specific substances released by organs and tissues into the bloodstream. Unusually high or low levels of these substances can help in the diagnosis of the disease. Peripheral blood smear: Your doctor examines your blood sample under a microscope to observe any changes in the shape of blood cells. This is especially important for the diagnosis of acute and chronic leukemias. Your doctor also checks the quantity and type of white blood cells and the platelet count through this examination. Bone marrow aspiration and biopsy: This procedure involves collecting and examining the bone marrow, which is a spongy tissue present in certain large bones. It is used to diagnose and monitor various blood and marrow diseases, including blood and bone marrow cancers. Bone marrow biopsy and aspiration are usually performed together. Cytogenetic analysis: After obtaining your bone marrow sample, an analysis of the tissue cells is conducted under a microscope to search for genetic abnormalities. Immunohistochemistry: This is the analysis of markers on the surface of bone marrow cells. Doctors compare them with healthy cells of the immune system to determine the type of cancer cells. Flow cytometry: Flow cytometry test reveals various characteristics of cells, such as the size, shape, and presence of tumor markers on the cell surface. For this test, cells are labeled with a fluorescent dye and placed in a fluid. By passing a beam of light through the cells, the properties of the cells can be determined by examining the scattering pattern of the light. It is a helpful analysis in the diagnosis of all hematological cancers. Computed Tomography (CT) Scan: This is a test that involves creating several X-ray images of specific body areas from different angles. Sometimes, a contrast material can be ingested or administered intravenously to provide a clearer view of organs and tissues. A computed tomography scan of the chest, abdomen, and/or pelvis may be performed to determine if lymph nodes or the spleen have enlarged. Genetic mutation testing: It is a laboratory test that examines a blood or bone marrow sample to search for abnormalities in the genes of cancer cells. It can be helpful in determining the diagnosis, understanding the course of the disease, and guiding treatment adjustments in various hematological cancers.


What causes bone marrow cancer?


The body contains different types of blood cells, and it produces these cells as needed. However, in some cases, certain acquired genetic abnormalities can lead to the uncontrolled, rapid, and abnormal proliferation of these cells. These conditions are known as hematological cancers or bone marrow cancers. The exact causes of cells multiplying faster and abnormally are not fully understood.


What are the risk factors for bone marrow cancer?


In chronic myeloid leukemia, radiation is particularly implicated as a risk factor.

For multiple myeloma, agricultural pesticides and insecticides are among the recognized risk factors.

In addition to radiation and agricultural pesticides, advanced age is a significant risk factor, particularly for multiple myeloma and acute and chronic leukemias. However, it is important to note that acute leukemias and, rarely, other hematological cancers can also occur in young and middle-aged individuals.

Bone marrow cancers are slightly more common in men compared to women.

While there may not be a genetic predisposition for bone marrow cancers, a family history of bone marrow cancer can increase the risk. Specifically, individuals with a family history of chronic lymphocytic leukemia may consider undergoing an annual blood count check-up.

Please note that these risk factors are associated with an increased likelihood of developing bone marrow cancers but do not guarantee the development of the disease. Regular medical check-ups and consultations with healthcare professionals are essential for early detection and appropriate management.


What are the stages of bone marrow cancer?


Acute leukemias do not have stages of cancer.

For multiple myeloma, staging is based on laboratory values. Chronic myeloid leukemia has three stages. The stages of chronic myeloid leukemia are determined based on factors such as spleen size, age of the patient, the proportion of leukemia cells, and certain blood tests. The first stage is called the chronic stable phase. The second stage, called the accelerated phase or accelerated blast phase, represents a faster progression of the disease. The third stage, known as the blast phase, indicates the transformation of the disease into acute leukemia.

Chronic lymphocytic leukemia has five stages:

  • Stage 0: Only lymphocytosis and elevated white blood cell count.

  • Stage 1: In addition to the elevated counts, there are pathologic lymph nodes.

  • Stage 2: In addition to the previous findings, an enlarged spleen is detected.

  • Stage 3: Evidence of anemia related to the disease.

  • Stage 4: Platelet count below 100,000 due to the disease.

It's important to note that the staging systems can vary depending on the specific type of bone marrow cancer, and the staging process may involve additional factors and tests. The staging helps in determining the extent of the disease and guiding the appropriate treatment approach.


How is bone marrow cancer treated?

The treatment of bone marrow cancer is highly individualized and depends on various factors, including the extent of the cancer and the overall health of the individual.

The goals of treatment may include curing the cancer, preventing its spread, or sometimes providing symptom relief and improving the person's quality of life.

Remission is achieved when there are no longer any abnormal cells in the blood or bone marrow.

The treatment options for bone marrow cancer can include:

  1. Chemotherapy: Chemotherapy involves the use of drugs to kill cancer cells or prevent their growth. There are many different chemotherapy regimens available, which can be administered intravenously through a drip or taken orally as pills.

  2. Targeted therapy (Smart drugs): These are treatments developed to target the genetic and molecular mechanisms responsible for the formation of cancer cells or the specific markers that identify the cancer cell. Depending on the type of drug, they can be given as oral medications or intravenous infusions. Each drug has its own specific effects and side effects.

  3. Stem cell transplantation: Stem cell transplantation may be an option in certain cases, but not everyone is a candidate for this treatment. In acute leukemias, stem cell transplantation is recommended after chemotherapy when the bone marrow has returned to normal if the disease carries poor-risk features. In chronic leukemias, transplantation is not the first-line treatment and is decided based on the course of the disease. Prior to the infusion of the transplanted stem cells, high-dose chemotherapy is given to eliminate the patient's existing bone marrow.

It is important to note that the treatment approach may vary for different types and stages of bone marrow cancer. The treatment plan is determined by a team of healthcare professionals and is tailored to the individual needs and circumstances of each patient.


FREQUENTLY ASKED QUESTIONS ABOUT BONE MARROW CANCER

What are the clinical outcomes after treatment for bone marrow cancer?

The post-treatment outcome of bone marrow cancer can vary significantly from patient to patient. Many patients diagnosed with bone marrow cancer at an early stage respond well to treatment and achieve remission, remaining cancer-free for years.

In some cases, the cancer can be aggressive and may not respond to treatment. Additionally, both the cancer itself and the cancer treatments can lead to life-threatening complications such as severe infections or kidney failure.

Cancer research is continuously developing new treatments and promising drugs. Individuals diagnosed with these diseases should discuss the available treatment options with their doctor or specialist.

How long do people with bone marrow cancer live?

In bone marrow cancers, the life expectancy can vary based on criteria such as the type, extent, and stage of the disease. It should also be noted that each patient's response to treatment can be different.

In general:

Bone marrow cancers can be categorized into two main groups: acute leukemias and chronic leukemias, and separately, multiple myeloma, which is a type of bone marrow cancer.

  • Acute leukemias can be completely curable diseases. Both acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) have a high chance of complete cure for the majority of patients.

  • In chronic leukemias, such as chronic myeloid leukemia (CML), if treatment is initiated early, the overall survival rate of patients is equivalent to that of the general population.

  • Chronic lymphocytic leukemia (CLL) is not a disease that can be completely cured. However, the term "remission" can be used when the disease is controlled and brought back to normal. The use of targeted therapies has significantly extended the duration of remission. It is a slow-progressing disease.

  • Complete cure is not achievable for multiple myeloma. New treatment approaches aim to transition the disease into a chronic state.


How should bone marrow cancer be managed nutritionally?


The nutrition of bone marrow cancer patients can vary depending on specific circumstances. The most common condition encountered during chemotherapy treatment for bone marrow cancer is neutropenia. Neutropenia is a decrease in the number of neutrophils, a subtype of white blood cells known as WBCs. This condition increases the risk of infection, so patients need to pay close attention to hygiene in their diet. Therefore, it is recommended to consume hygienic and well-cooked food as much as possible. Raw fruit and vegetable consumption is generally not recommended, but if consumed, it is important to ensure their hygiene.

In non-chemotherapy situations, attention should be paid to daily consumption of fresh fruits, vegetables, and an adequate amount of water.

During chemotherapy, changes in blood values and discomforts such as diarrhea may occur. In such cases, it is important to increase water intake, consume fiber-rich foods, and prefer cooked foods such as boiled potatoes.

Similarly, during chemotherapy, a metallic taste sensation may develop in the mouth. In moderation, consuming mildly spicy foods can be advised.

If appetite loss occurs in patients, it is recommended to eat frequent small meals throughout the day.


How is Bone Marrow Cancer Detected?


Which test is used to detect bone marrow cancer? This question is one of the concerns for patients. The question of how bone marrow cancers are determined can be generally answered as follows:

  • Acute leukemias can be identified through a test called peripheral blood smear, which involves microscopic examination of the blood. However, to determine whether it is Acute Myeloid Leukemia (AML) or Acute Lymphoblastic Leukemia (ALL), a special test called flow cytometry is performed to show the surface markers of the cells invading the bone marrow.

  • For Chronic Myeloid Leukemia (CML), it is necessary to demonstrate a specific chromosomal abnormality and the presence of a pathological gene (BCR-ABL) resulting from the translocation of chromosomes 9 and 22. Bone marrow biopsy is not required for the diagnosis of chronic myeloid leukemia, but it can be performed to determine the risk group, staging, and clinical course of the disease.

  • For Chronic Lymphocytic Leukemia (CLL), a test called peripheral blood smear is performed. The test involves an increase in mature lymphocytes and the appearance of "basket cells" when these lymphocytes are crushed during peripheral smear preparation. Definitive diagnosis is made by a test called flow cytometry, which shows the surface antigens, or identity markers, of these cells. Bone marrow biopsy is not necessary for diagnosis.

  • In the case of Multiple Myeloma, a bone marrow biopsy is required for diagnosis. A certain amount of abnormal plasma cells should be observed in the bone marrow. Additionally, the demonstration of abnormal proteins produced by these abnormal plasma cells in the blood and urine is important for both diagnosis and monitoring treatment response.


Does bone marrow cancer show up in the blood?


In acute leukemias, an accompanying high or low white blood cell count, along with anemia and low platelet count, can increase suspicion of the disease.

In Chronic Lymphocytic Leukemia (CLL), an increase in white blood cells, specifically lymphocytes, along with a significant increase in the subtype of white blood cells called lymphocytes, can raise suspicion.

In Chronic Myeloid Leukemia (CML), excessive increase in white blood cells, known as leukocytosis, can raise suspicion in diagnosis.

However, elevated or decreased levels of certain blood parameters do not necessarily indicate bone marrow cancer. While certain blood values going up or down can raise suspicion, these changes can also be caused by different conditions.


Is bone marrow cancer a type of leukemia?


Bone marrow cancer is a general term that includes both acute and chronic leukemias. In addition to these, multiple myeloma, which is the cancerous growth of plasma cells in the bone marrow, can also be included in this definition.


What are the initial symptoms of bone marrow cancer?


The initial symptoms of bone marrow cancer can occur as a result of cancerous cells invading the bone marrow and disrupting blood production, leading to anemia and its associated symptoms.

  • Fatigue

  • Weakness

  • Paleness

  • Sleepiness

  • Shortness of breath with exertion

  • Rapid heartbeat

  • Body aches

  • Muscle and bone pain

  • Frequent infections due to low white blood cell count

  • Fever

  • Various types of bleeding and bruising due to low platelet count, including skin discoloration

The initial sign of bone marrow cancer is usually related to changes in blood values.


Is bone marrow cancer curable?

  • Especially in acute leukemias, complete recovery can be achieved.

  • Chronic Myeloid Leukemia (CML) is a disease that can be controlled with medication, and when caught early, the overall survival rate is equivalent to the average population.

  • Chronic Lymphocytic Leukemia (CLL) and Multiple Myeloma do not have a complete chance of cure. The disease is managed with medications.


At what age does bone marrow cancer occur?


Multiple Myeloma, Chronic Lymphocytic Leukemia (CLL), and Chronic Myeloid Leukemia (CML) are known as diseases of advanced age. They are generally seen around the age of 60. Acute Myeloid Leukemia (AML) and Acute Lymphoblastic Leukemia (ALL) are types of bone marrow cancer that can occur in childhood, adolescence, and advanced age.


What happens in the final stage of bone marrow cancer?


Acute leukemias do not have stages. These are cancers with a sudden onset. The term "acute" is used to indicate this abrupt onset and rapid progression. Acute leukemia is an urgent condition that requires immediate treatment because the average survival time is short if treatment is not initiated promptly.

The final stage of Chronic Myeloid Leukemia (CML) is referred to as the blast phase. The blast phase of CML indicates the transformation of the disease into acute leukemia.

Chronic Lymphocytic Leukemia (CLL) is a disease that employs a "watch and wait" strategy in the early stages, where treatment is not immediately required. The final stage, or advanced stage, refers to the stage that requires treatment. In the advanced stage of CLL, symptoms such as enlarged spleen, bone pain, decreased blood counts, and bleeding due to low platelet count may occur.

In the final stage of Multiple Myeloma, symptoms related to anemia due to bone marrow infiltration may be experienced. Frequent infections due to low white blood cell count and bleeding due to low platelet count may also be observed.


Is bone marrow cancer dangerous?


Bone marrow cancer is dangerous. If left untreated, it can be a life-threatening disease.


Is bone marrow failure a type of cancer?


Bone marrow failure has two types known as "Aplastic Anemia" and "Myelodysplastic Syndromes."

Myelodysplastic syndromes are considered a pre-leukemic condition, indicating a state before acute leukemia. Therefore, it is classified as a form of cancer.

Aplastic anemia, a type of bone marrow failure, can transform into acute leukemia in the advanced stages due to abnormalities in stem cells.


Are Blood Cancer and Bone Marrow Cancer the same thing?


Blood cancer and bone marrow cancer are terms used to describe hematological cancers. The term blood cancer is more commonly used for acute leukemia. However, Chronic Lymphocytic Leukemia (CLL) and Chronic Myeloid Leukemia (CML) can be referred to as both blood cancer and bone marrow cancer. Multiple Myeloma is specifically mentioned as bone marrow cancer due to the involvement of plasma cells in the bone marrow.

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