What are blood cancers?
Blood cancers, also known as hematologic cancers, are a group of cancers that may affect the blood, bone marrow, or lymphatic system.1 The three main types of blood cancer are leukemia, multiple myeloma, and lymphoma. These cancers disrupt the normal production and functionality of blood cells, leading to uncontrolled growth of abnormal cells.1 In the United States, someone is diagnosed with leukemia, lymphoma, or myeloma approximately every three minutes. In 2024, an estimated 187,740 people were expected to receive a diagnosis of one of these blood cancers.2 Together, they accounted for about 9.4% of all cancer-related deaths that year (based on the estimated total of 611,720 cancer deaths).2 These statistics highlight the urgent need for continued research, early detection, and public awareness to improve patient outcomes.
Types of blood cancer
The three most common type of blood cancer are:
1. Multiple myeloma
Multiple myeloma is a cancer of plasma cells in bone marrow. These cancerous cells accumulate in the marrow, crowding out healthy blood cells and disrupting normal immune function.
Effects on immune function and bone health:
- The overgrowth of malignant plasma cells impairs the production of red cells, white cells, and platelets—leading to anemia, increased infection risk, and bleeding disorders3
- Myeloma cells produce dysfunctional monoclonal antibodies (M proteins), which can harm the kidneys3
- These cells stimulate bone-resorbing activity, causing lytic lesions, increased bone fragility, and result in elevated calcium levels in the blood (hypercalcemia)3
Common signs and symptoms1,3
Patients with multiple myeloma often experience:
- Bone pain
- Anemia
- Kidney dysfunction
- Hypercalcemia
- Increased susceptibility to infection
- Easy bruising or bleeding
Testing guidelines
National and international guidelines recommend the following tests for the initial diagnostic workup:
- Recommends serum protein electrophoresis (SPEP), immunofixation electrophoresis (IFE), and serum free light chains (sFLC) for the highest sensitivity to aid in the diagnosis of multiple myeloma
- 24-hour urine studies are not required, unless AL amyloidosis is suspected
- Recommends SPEP, IFE, sFLC and serum quantitative immunoglobulins
- Additionally recommend 24-hour urine for total protein, UPEP and UIFE
- Recommends ordering both SPEP and sFLC for initial detection with the option to reflex to IFE
2. Lymphoma
Lymphoma is a cancer of the lymphatic system, where lymphocytes (white blood cells) multiply uncontrollably and accumulate in lymph nodes and lymphatic tissues, compromising immune function.1 Two main types exist:
- Hodgkin lymphoma (HL): Characterized by Reed–Sternberg cells; more curable and often affects younger adults1,8
- Non-Hodgkin lymphoma (NHL): Far more common (about 10× HL),2 includes a diverse group of blood cancers that all arise from lymphocytes, ranging from slow-‑growing to aggressive forms1,8
How lymphoma affects the immune and lymphatic systems
Cancerous lymphocytes displace healthy immune cells, impairing pathogen defense. Tumor growth within lymph nodes can cause systemic symptoms and compress nearby structures.1
Common signs and symptoms8
- Painless swollen lymph nodes (neck, armpits, groin)
- Unexplained fever, night sweats, weight loss
- HL may cause cough or breathing difficulties due to enlarged lymph nodes in the chest
- NHL can involve fatigue, abdominal swelling, or gastrointestinal issues depending on subtype and spread
Testing guidelines
- NCCN guidelines cover specific subtypes such as diffuse large B-cell lymphoma (DLBCL), follicular lymphoma, mantle cell lymphoma, and primary cutaneous lymphomas, providing diagnostic and treatment frameworks9
- Diagnosis typically involves lymph node biopsy, imaging (CT/PET), and bone marrow biopsy when staging is needed1,8
3. Leukemia
Leukemia is a cancer of the blood-forming tissues, typically originating in the bone marrow. It leads to excessive production of abnormal white blood cells that crowd out normal blood cells, impairing immunity, hemostasis, and oxygen transport. Leukemia can be either acute or chronic, and occurs in both children and adults.1,10
Effects on the blood and immune system1,10
Leukemia disrupts normal blood cell production in the bone marrow, leading to anemia, increased risk of infection, and easy bleeding or bruising.
Common signs and symptoms1,10
- Persistent fatigue, fever, increased infections
- Easy bruising or bleeding, petechiae
- Bone pain or fullness in the spleen or liver (in some types)
Testing guidelines
- The American Society of Hematology (ASH), NCCN and CAP guidelines provide structured frameworks for the initial diagnostic workup of acute leukemias, including acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), mixed phenotype acute leukemia (MPAL), and others, as part of interdisciplinary evaluation.9,11-12
- This includes complete blood count (CBC) with differential, peripheral smear, bone marrow aspiration and biopsy, flow cytometry, cytogenetic and molecular testing.9-12
Primary care providers (PCPs): The frontline for early detection
PCPs play a pivotal role in the early detection of blood cancers, often serving as the first point of contact when patients present with vague or nonspecific symptoms. Timely diagnosis is critical. Delays allow disease progression, reduce treatment options, and negatively affect survival outcomes.3,13 When physicians are aware of early warning signs and maintain a high index of suspicion, particularly for persistent unexplained symptoms, they can expedite referrals and diagnostic testing. Coupled with patient self-advocacy, promptly reporting new or worsening symptoms, a collaborative approach can help lead to earlier intervention and improved prognoses for leukemia, lymphoma, and myeloma.
Patient support and additional resources
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References
1. Blood Cancers. Amercian Society of Hematology. Accessed 8/21/2025. Blood Cancers - Hematology.org
2. Facts and Statstics Overview. Leukemia & Lymphoma Society. Accessed 8/21/2025. https://www.lls.org/facts-and-statistics/facts-and-statistics-overview
3. Mikhael et al. Multiple Myeloma for the Primary Care Provider: A Practical Review to Promote Earlier Diagnosis Among Diverse Populations. Am J Med. 2023 Jan;136(1):33-41.
4. Dispenzieri et al. International Myeloma Working Group Guidelines for serum free light chains in multiple myeloma and other related disorders, Leukemia 2009;23:215-24
5. Rajkumar SV, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol 2014; 15:e538-e548
6. NCCN Clinical Practice Guidelines in Oncology® for Multiple Myeloma V.1.2025. National Comprehensive Cancer Network. Accessed 3/20/2025. https://www.nccn.org/professionals/physician_gls/pdf/myeloma.pdf.
7. Keren et al. Laboratory Detection and Initial Diagnosis of Monoclonal Gammopathies Arch Pathol Lab Med 2021;146:575-90
8. Lymphoma. Leukemia & Lymphoma Society. Accessed 8/21/25. https://www.lls.org/lymphoma
9. NCCN Clinical Practice Guidelines in Oncology® Accessed 8/21/2025. https://www.nccn.org/home
10. Leukemia. Leukemia & Lymphoma Society. Accessed 8/21/25. https://www.lls.org/leukemia
11. ASH Clinical Practice Guidelines. American Society of Hematology. Accessed 8/21/2025. https://www.hematology.org/education/clinicians/guidelines-and-quality-care/clinical-practice-guidelines
12. Arber, et al. Initial Diagnostic Work-up of Acute Leukemia. Guideline from the College of American Pathologists and the American Society of Hematology. Arch Pathol Lab Med. 2017 Oct;141(10):1342-1393.
13. Kariyawasan et al. Multiple myeloma: causes and consequences of delay in diagnosis. QJM. 2007 Oct;100(10):635-40