Dr. David Hill (Host): This is Expert Insights with the Carle Foundation Hospital. I'm Dr. David Hill. Today, we're going to be hearing from Dr. Priyank Patel, a Medical Hematologist and Oncologist and Clinical Assistant Professor of Hematology and Oncology at the Carle Illinois College of Medicine. Dr. Patel, welcome.

Priyank Patel, MD: Thank you so much, Dr. Hill.

Host: And today I was curious to learn a little bit more about blood cancers. That's quite a few different things we're thinking about, and they sound similar, and sometimes they have similar symptoms, but telling them apart is probably kind of an important thing, would you say?

Priyank Patel, MD: Absolutely.

Host: Great. So, do you mind giving us an overview of what the different blood cancers are, and what we call them?

Priyank Patel, MD: So, blood cancers are, actually, a bunch of cancers, actually, I would say a few hundred of them, that are combined under a single umbrella called blood cancers. I'd like to take a step back and say blood is a fascinating organ. It's a highway that connects our whole body. It transports oxygen, it transports immune system cells all throughout the body from the topmost part of the body to the tip of the toe is where the blood is involving every single place.

Now, interestingly enough, blood is an extremely complex organ and henceforth, the cancers of the blood are also very, very complicated. Depending on the type of the cell that is involved, there are many different types of cells in our blood. There are red blood cells, white blood cells, platelets. White blood cells, there are many, many subtypes of them.

Some of those white blood cells can be immature, some of them are mature. So we're talking about hundreds of different cancers. Some of them are chronic. They are slow growing. Some of them are acute. That means they are fast growing.

Host: Can we categorize these cancers in any sort of larger way to help us understand them?

Priyank Patel, MD: Absolutely. Generally speaking, blood cancers can be divided into leukemias and lymphomas. Leukemias are cancers that usually arise from the white blood cells that cause increased white blood cell counts in the body. Most of the leukemias are acute leukemias, but there are chronic leukemias which people may have them and they may not have any symptoms.

Lymphomas on the other hand are blood cancers technically, but they are cancers more of the immune side of the blood cells, so more of lymphocytes. And lymphocytes have different stages of maturation and depending on which stage gets messed up genetically, that's the type of cancer we have and there are more than 100 kinds of lymphomas as well.

Lymphomas typically manifest as more like tumors that grow in our lymph nodes, so they may present as a lump rather than increased white blood cell counts, but certainly both of them can also happen at the same time.

Host: Now I've heard of yet another kind of blood cancer called myeloma. Do we consider that the same category as these others?

Priyank Patel, MD: Correct. So myeloma is kind of a subcategory for lymphoma or we can also call it its own third category. Myeloma technically is a cancer of plasma cells and interestingly enough plasma cells are more mature lymphocytes. So it's a very big hodgepodge of all these complicated confusing things. But as it is, blood is a very complicated organ.

Host: So what sorts of symptoms might somebody notice that makes them want to go to the doctor and ask about blood cancers?

Priyank Patel, MD: That's a very good question, and the presentation is very heterogeneous. Many people may not have symptoms forever. Some people actually die with chronic leukemias rather than of chronic leukemias, and they may never know that they had CLL, which is chronic lymphocytic leukemia.

And in those cases, people may not feel bad at all, or they may have slight lump somewhere in their neck or their armpit, or their groin or somewhere else. In contrast, if we talk about acute leukemias; acute leukemias are very fast growing cancers, typically over days to weeks, in which case what happens, the cancerous cells take over our bone marrow.

And because of that, the normal red blood cells and platelets, they go down. So people can have signs and symptoms of more severe fatigue, which can develop very, very rapidly over the course of days or weeks, nosebleeds, gumbleeds, bruising, tiny dots called patechiae on their shins or their forearms.

Those are kind of the symptoms of low blood counts. Usually, in acute leukemias, things change very acutely, very, very fast. So those are the signs for acute leukemias. Now, if we talk about myeloma, again, myeloma may not appear for a long period of time until and unless it starts causing problems. More commonly, we can sometimes see people have sudden onset back pain.

Let's say they have a compression fracture and they were feeling completely fine. And they may have a prolapsed disc, which is causing severe pain, and then eventually we find out that that can be involved by myeloma.

Host: So I think a lot of people find discussion of cancer or thinking they might have it to be incredibly frightening. But over the last many years, we have seen progressive advances in our abilities to treat these cancers. Can you talk a little bit about what you as an oncologist and hematologist can do for people now that you didn't used to be able to do?

Priyank Patel, MD: Absolutely. One of the reasons why I am in this field is because this field is advancing so rapidly, that it is fascinating. Many of these cancers have become so curable at this time that when somebody is very sick in our clinic or in the hospital with a very, very large lymphoma, let's say a large grape ball sized ulcerating mass growing in their neck, we can look at them, we do a biopsy, we come to a diagnosis, and we can confidently say that yes, there is more than 60, 70, 80 percent chance that we can cure this cancer.

Now, for example, in myelomas or other life threatening cancers, yeah, we still don't have complete cure, but compared to where the survival was, about 15-20 years ago where average patient with myeloma used to survive about two and a half, three years, maybe four years if they were very young and fit. Now we can easily say that is easily seven to ten plus years and even longer for younger people and new and new treatments are coming up.

Not only do we have chemotherapy, but we also have immunotherapy. We use combination of chemotherapy and immunotherapy. And within the last 10 years, there is a very significant advancement in the field of bioengineering where we have CAR T cells, we have bispecific antibodies which kind of marry the cancer cells and the immune system cells together, which have affinity towards both the cells and they bring them together so the immune system cells can destroy the cancer cells. And we also have significant advances in stem cell transplant, which is blood stem cell transplant, both autologous, that means our own stem cells are given back to us, or allogeneic, in which we basically get stem cells, blood stem from an alternative donor in a donor pool.

Host: That is so impressive and really gives me a tremendous amount of hope that these diagnoses that honestly when I was in medical school and training were quite frightening, should be a lot less frightening for a lot of people. So thank you so much for your work in advancing that sort of therapy.

Priyank Patel, MD: Thank you so much.

Host: So this has been a tremendous amount of information. Before you leave us today, Dr. Patel, do you have anything you want to make sure everybody knows and remembers?

Priyank Patel, MD: One thing is always make sure that you do the right things. There is no single risk factor for cancer. I always try to educate my patients and medical students and residents working with me. It's always a combination of different risk factors, family history, what we are exposed to in the environment, what we eat, what we live our life, and how long do we live.

So all of those things combined together creates a risk factor profile for cancers. Most of the times, common things are common. So these cancers are not that common, but it is always important for you to make sure that you have regular follow up with your regular doctors, do the right things to live a proper life and not worry about things and leave it to the professionals and find out if there is any other concern.

Host: That is great advice. Dr. Priyanka Patel, thank you so much for talking with us today.

Priyank Patel, MD: Thank you for having me.

Host: For more information and to get connected with one of our providers, please visit carle. org. For a listing of Carle providers and a few Carle sponsored educational activities, head on over to our website at carleconnect.com.