Blood cancers, a diverse group of diseases affecting the blood, bone marrow and lymphatic system, carry a significant burden in India. The latest estimates from the Global Cancer Observatory put the number of new cases at around 1.19 lakh in 2024 across three major categories of blood cancer: leukaemia, lymphoma and multiple myeloma. Though often grouped under one term, these diseases are not the same: they arise from different cells, behave differently and require different approaches to diagnosis and treatment. Recognising the warning signs early can be an important step towards timely diagnosis and treatment.

Why Are These Cancers Different

Although leukaemia, lymphoma and multiple myeloma all involve cells of the blood or immune system, they do not begin in the same place or behave in the same way. Leukaemia affects blood-forming tissue and disrupts normal blood cell production. Lymphoma develops in lymphocytes, a type of white blood cell, usually involving the lymph nodes and lymphatic system. Multiple myeloma begins in plasma cells, the antibody-producing immune cells, typically in the bone marrow, where it can affect blood production and damage bones.

This matters because the same symptom can have very different causes, and treatment depends heavily on the precise diagnosis and subtype. The pace of progression also varies widely: some forms need treatment soon after diagnosis, while slow-growing ones can be safely monitored for a time.

Leukaemia: A Cancer Of Blood-Forming Cells

Leukaemia begins in the bone marrow, where blood cells are produced. Abnormal cells multiply and crowd out healthy red cells, white cells and platelets. Depending on the type, the disease may develop rapidly, as acute leukaemia, or more gradually, as chronic leukaemia.

Resulting symptoms can include persistent fatigue or breathlessness from anaemia, frequent infections, fever, easy bruising or bleeding, and sometimes bone or joint pain. None of these are specific to leukaemia, which is why the disease is often initially mistaken for a common infection or a general health problem.

Age can also influence which forms are encountered. Leukaemia is the most common cancer in children younger than 15. Acute Lymphoblastic Leukaemia, or ALL, is especially important in paediatric oncology. In adults, incidence rises sharply after 55, peaking in those 65 and older.

Lymphoma: When Abnormal Lymphocytes Multiply

Lymphoma develops from lymphocytes, immune cells that form part of the body's defences, and is broadly divided into Hodgkin lymphoma and non-Hodgkin lymphoma.

Hodgkin lymphoma is marked by abnormal cells called Reed-Sternberg cells, identified when affected tissue is examined under a microscope. Non-Hodgkin lymphoma is not one disease but a large group of cancers involving lymphocytes, and the distinction matters because these subtypes behave very differently and need different treatment approaches.

A painless swelling in the neck, armpit or groin is a common presentation. Patients may also have prolonged fever, drenching night sweats, unexplained weight loss, itching or fatigue, though symptoms vary considerably depending on where the lymphoma develops.

Multiple Myeloma: Cancer Of Plasma Cells

Multiple myeloma arises from plasma cells, which normally produce antibodies. The abnormal cells accumulate in the bone marrow, interfere with normal blood cell production, and weaken bone, making bone pain and fractures common manifestations.

Patients may develop persistent pain, particularly in the back or ribs, unusual fractures, fatigue from anaemia, recurrent infections or kidney problems. Increased calcium levels caused by bone damage can lead to excessive thirst, frequent urination, constipation, nausea, weakness or confusion. Not everyone has symptoms at diagnosis; some have an early, precursor condition called smouldering multiple myeloma, which may be monitored rather than treated right away.

Multiple myeloma is predominantly a disease of older adults, unlike some forms of leukaemia and lymphoma, which are more common in younger age groups.

Why Symptoms Can Be Confusing

One of the reasons blood cancers can be difficult to recognise early is that some of their symptoms overlap. Fatigue and weakness can occur with all three, while fever and recurrent infections are particularly associated with leukaemia and can also occur in lymphoma and multiple myeloma. Swollen lymph nodes may point towards lymphoma, but lymph-node enlargement can also occur with infections. Similarly, bone pain is particularly associated with multiple myeloma, although it is not exclusive to the disease. This overlap means symptoms alone cannot confirm a diagnosis. A doctor may need a complete blood count and blood smear, imaging, a lymph-node biopsy, bone marrow examination and, in suspected multiple myeloma, specialised blood and urine tests for abnormal proteins, with the exact combination depending on the suspected disease.

Treatment Is Usually Systemic, Not Surgical

Unlike many solid tumours, these cancers are not generally treated by removing a mass with surgery. Because malignant cells can be present throughout the blood, bone marrow or lymphatic system, treatment relies mainly on therapies that act throughout the body: chemotherapy, targeted medicines, immunotherapy, radiation therapy and stem-cell transplantation. Surgery's role is usually limited to obtaining a lymph-node biopsy for diagnosis or managing complications.

Sometimes, The Best First Step Is Observation

A cancer diagnosis does not always mean immediate treatment. Some blood cancers grow so slowly that starting therapy before it is necessary can expose a patient to side effects without real benefit, which is why doctors often recommend watchful waiting for selected patients, such as those with asymptomatic chronic lymphocytic leukaemia or certain indolent non-Hodgkin lymphomas.

Leukaemia, lymphoma and multiple myeloma are all called blood cancers, but they are not interchangeable diagnoses. Knowing where each begins, recognising the symptoms they share and understanding treatment options can make the journey from suspicion to diagnosis more informed, and timelier.

(By Dr Davinder Paul, Additional Director Medical Oncology, Fortis Hospital Ludhiana)

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