Stage 4 is the last stage of blood cancer. Each cancer type will have different occurrences according to various individuals. The extent of the spread of cancer and the organs affected will vary in each case. So, it is essential to understand the basics of blood cancer and the various types and stages to understand what happens in the last stage of it.

Primary types of Blood Cancers

Blood cancers develop when abnormal blood cells multiply uncontrollably, interfering with the regular blood cells ability to combat infection and generate new blood cells. One of the most common cancers, blood cancer, is classified into three main subtypes. They all fall under the same group of blood cancers. However, they differ in their area of origin and the areas they impact. Cancer can be acute, which is rapidly proliferating or chronic, which is slowly spreading cancer.

Also Read: Blood Cancer And Its Complications And Ways To Manage It

Leukemia, lymphoma, and myeloma are the three primary cancers that affect the blood and bone marrow:

Leukaemia

Blood cancer and leukaemia develop in the bone marrow and blood. It occurs when the body produces excessive malformed white blood cells, interfering with the production of red blood cells and platelets by the bone marrow.

Non-Hodgkin lymphoma

It is a blood cancer that arises from lymphocytes, a type of white blood cell that aids in the body's ability to fight infections.

Hodgkin lymphoma

It is a blood cancer that arises from lymphocytes, which are lymphatic system cells. The Reed-Sternberg cell, an abnormal lymphocyte, is a defining feature of Hodgkin lymphoma.

Myeloma

Plasma cell cancer, or myeloma, affects lymphocytes that produce antibodies to ward off infections. The immune system becomes weak due to myeloma, making the body more prone to infection.

Symptoms of Blood Cancer

The symptoms of blood cancer may vary according to each body, stage and type of cancer. However, there are some symptoms common to all types of cancer.

• Chills
• Fatigue
• Fever
• Weakness
• Joint pain
• Unexplained weight loss
• The swelling of lymph nodes or liver

Diagnosing Blood Cancers

Since there are so many distinct types of blood cancer. There are three primary categories. Each distinct type of cancer affects a certain kind of blood cell. Early identification of certain malignancies may be possible by a regular blood test.

Leukemia

A complete blood count (CBC) test checks for abnormally high or low levels of white blood cells about red blood cells and platelets.

Lymphoma

A biopsy, which involves removing a small amount of tissue to be studied under a microscope, will be necessary. To look for swollen lymph nodes, occasionally additionally, an X-ray, CT, or PET scan might be necessary.

Myeloma

Your doctor may request a CBC or other blood or urine tests to identify chemicals or proteins from myeloma development. Bone marrow biopsy, X-rays, MRIs, PET scans, and CT scans can occasionally be used to determine the incidence and extent of myeloma spread.

The stages mentioned above do not apply to all types of blood cancer. Different types of blood cancer, and each has stages.

Acute Lymphocytic Leukaemia (ALL)and its stages of blood cancer This is caused due to the excess lymphocytes (white blood cells) in the bone marrow (so it doesnt form tumours), which crowd the healthy white blood cells. If not treated soon, ALL can spread far too quickly. ALL is generally seen in kids aged three to five and adults over seventy-five. As ALL doesnt form tumours, the staging is done based on the spread of the disease ?1?.

B cell staging these B cells or lymphocytes are produced in the bone marrow and grow there. These cells are responsible for hormonal and immune responses and provide antibodies to fight diseases. The growth of the B cell is taken into consideration for staging.

1. Just about 10 per cent of ALL cases have: Early pre-B ALL
2. Almost 50 per cent of the patients have: Common ALL
3. Approximately 10 per cent of the cases: Pre-B ALL
4. Just about 4 per cent of the cases have: Mature B-cell ALL

T cell staging:T cells or lymphocytes are produced in the bone marrow and left in the thymus, where they grow. There are different subtypes of T cells: Helper, Cytotoxic, memory, regulatory, natural killer, and gamma delta T cells.

1. Just about 5 to 10 per cent of cases have: Pre T ALL
2. Almost 15 to 20 per cent of cases have Mature T cell ALL.

Acute Myeloid Leukemia(AML) The myeloid cells form white blood cells, Red blood cells and Platelets. People with this condition include far fewer healthy blood cells of all three types. If not treated, AML can spread quickly. AML is a condition primarily seen in men above the age of 65. Since this condition starts in the bone marrow, instead of the traditional TNM method, the subtypes of AML are used to stage through a cellular system.Acute myeloid leukaemia is classified into eight subtypes based on the size, number of healthy cells, number of leukaemia cells, changes in chromosomes and genetic abnormalities^?1?. AML is divided into eight subtypes:

1. Undifferentiated AML M0: In this stage of Acute myeloid leukaemia, the cells do not mutate.
2. Myeloblastic leukaemia M1: In this stage, the bone marrow blood cells indicate granulocytic differentiation with or without minimal cell maturation.
3. Myeloblastic AML M2: The granulocytic differentiation and maturation are observed in this stage.
4. Promyelocytic leukaemia M3: In this stage, most of the bone marrow cells are myelocytes or early stages of granulocytes. These cells contain nucleases with abnormal sizes and shapes.
5. Myelomonocytic leukaemia -M4: In this stage, more than 20 per cent of monocytes and promonocytes are found in the bone marrowboth the bone marrow and circulating abnormal blood amounts of monocytes and differentiated granulocytes in them. There is also a chance of increasing the number of granular leukocytes, which frequently have a two-lobed nucleus.
6. Monocytic leukaemia -M5: This subset is further divided into two. The first category has low monoblasts with frilly-appearing genetic material. The second category has vast quantities of monoblasts, promonocytes and monocytes. The monocytes in the bloodstream are higher than those in the bone marrow in this stage.
7. Erothroleukemia -M6: This stage of Acute myeloid leukaemia has abnormal red blood cells, which comprise half the blood cells in the bone marrow.
8. Megakaryoblastic leukaemia- M7: The cells at this stage of Acute myeloid leukaemia either become megakaryocytes(giant cells of the bone marrow) or lymphoblasts(lymphocyte-forming cells). The megakaryoblastic stage has extensive furious tissue deposits.

Chronic lymphocytic leukaemia (CLL) Like ALL, this condition starts with the Lymphocytes in the bone marrow. The only difference is that this condition takes time to spread. People suffering from this condition, mostly aged 70 or older, dont show symptoms for years. This cancer uses the Rai system and the Binet system (used mainly in the United States of America) to do the staging based on the blood cell count and spreading of cancer through lymph nodes^?2?.

The Rai system of staging for Chronic lymphocytic leukaemia considers three factors: if the lymph nodes are enlarged, the number of lymphocytes in the blood, and if blood disorders like thrombocytopenia or anaemia have developed. A sample of 10,000 lymphocytes is considered too high, and the first stage is called 0. The rail system has five stages

• Stage Rai 0: This has a high level of lymphocytes. Usually, 10,000 per sample and no other symptoms are shown. The cell count of the other blood cells is average. It is a low-risk stage.
• Stage Rai 1: This also has a high level of lymphocytes, and the lymph nodes are enlarged. The cell count of the other blood cells is still average. It is a medium-risk stage.
• Stage Rai 2:This stage has a high level of lymphocytes, and the liver and spleen may have swollen. It is a medium-risk stage.
• Stage Rai 3: This stage has a high level of lymphocytes higher than the red blood cells causing anaemia. The lymph nodes, spleen and liver are still swollen. It is a high-risk stage.
• Stage Rai 4: This stage has lower red blood cells and platelets, causing anaemia. The lymph nodes, spleen and liver are still swollen. It is a high-risk stage.
• Binet staging system:This system provides information about the areas where the lymphoid tissues are in contact with cancer.

1. Clinical stage A In this stage, the lymph nodes are swollen, and the cancer has spread to less than three areas.
2. Clinical stage B More than three areas are affected by cancer, and lymphoid tissues are swollen.
3. Clinical stage C Blood disorders like anaemia and thrombocytopenia are developed.

Chronic Myeloid Leukaemia (CML)- Like AML, this condition starts with Myeloid cells with a slower difference in the spread of the disease. CML is mainly seen in adult men, but children can get it in rare cases. Chronic myeloid leukaemia has three stages:

1. Chronic phase CML This is the first stage of the disease, and most patients get diagnosed during this stage. Patients at this stage show symptoms such as fatigue.
2. Accelerated phase CML If the treatment given in the chronic stage does not work and the cancer becomes aggressive, this provides us with the accelerated phase. In this stage, the symptoms can be observed.
3. Blastic phase CML This is the riskiest stage, with 20 per cent lymphoblasts in the body. The symptoms in this stage are the same as Acute myeloid leukaemia.

Lymphoma:This cancer starts in the lymph system network, including lymph nodes, spleen, and thymus gland. This network of vessels carries white blood cells throughout the system to fight diseases. There are two types of Lymphoma.

Hodgkins Lymphoma:B lymphocytes or B cells are the immune cells that make antibodies to fight off hostile bodies. People with this condition have large lymphocytes called Reed Sternberg cells in their lymph nodes. People suffering from this condition are primarily between 15 to 35 or over 50.

Non- Hodgkins lymphoma-B cells and T cells are the immune cells in this condition. People are more likely to contract Non-Hodgkins Lymphoma than Hodgkins Lymphoma. People suffering from this condition are primarily between 15 to 35 or over 50.

Staging of Lymphoma:

The exact staging method is used for Hodgkins and non-Hodgkins Lymphoma in adults. There are four stages of blood cancer. Stages one and two are considered early, and stages three and four are considered advanced^?3?.

• Stage 1 This stage tells us about Lymphoma in the lymph nodes. But only in one place, either above or below the diaphragm.
• Stage 1E This means that the Lymphoma spreads to one organ outside the lymphatic system, called extranodal Lymphoma.
• Stage 2 This means the Lymphoma is in more than two groups in the lymph nodes. But these should be on the same side, either above the diaphragm or below, to be diagnosed as stage 2.
• Stage 2E means that the Lymphoma spreads to an organ outside the lymphatic system and more than two lymphoma groups. All these should be on the same side of the diaphragm.
• Stage 3- The patient has Lymphoma in the lymph nodes on both sides of the diaphragm.
• Stage 4-This is the last stage and the advanced stage. Lymphoma is spread throughout the lymph nodes and organs outside the lymphatic system.

Also Read:What Is the Reason for Blood Cancer?

Staging of Lymphoma in Children:

Hodgkins Lymphoma is staged the same in adults, but non-Hodgkin lymphoma is staged differently in children and adolescents^?4?.

• Stage 1 In this stage, one of the following things happens Lymphoma is seen as a group at one part of lymph nodes, with the chest and abdomen as an exception.

Lymphoma is seen in one organ outside the lymphatic system, with the chest and abdomen as an exception.

Lymphoma is seen in the spleen or one bone. It is an early stage of Lymphoma.

• Stage 2 In this stage, one of the following things can happen

Lymphoma is seen as a group at more than two lymph nodes on the same side of the diaphragm.

Lymphoma can be present in one extranodal organ or the gut. This

It is an early stage of Lymphoma.

• Stage 3 In this stage, one of the following things can happen

Lymphoma is found above and below the diaphragm or the gut

Lymphoma can be present in two or more extranodal organs

It is found around the spinal cord or in one bone. It is

An advanced stage of Lymphoma.

• Stage 4 In this stage, the advanced stage, Lymphoma, can be found in the central nervous system or the bone marrow.

Also Read:Blood Cancer And Its Complications And Ways To Manage It

Myeloma:

The bone marrow consists of Plasma cells, a type of blood cell that produces antibodies. Myeloma affects the plasma cells, thus producing antibodies that cant fight infection and crowd the healthy blood cells. It can damage the bones, and hence its also called Multiple Myeloma. People suffering from this condition are mostly men over the age of 50. There are two systems for staging multiple myeloma: The Durie-salmon staging system and the Revised International Staging System (RISS) ^?5?. RISS is the system that is more recent, advanced and frequently used. This system measures Albumin levels, genetic changes, lactate dehydrogenase(LBH) and Beta-2 microglobulin (B2M) to know cancer and predicts how well the body responds to the treatment.

• Stage 1 Albumin, LBH and B2M measure is somewhat expected. If diagnosed, myeloma is treatable at this stage, but the symptoms dont mainly show due to the nature of the disease.
• Stage 2- The albumin level is low, and the LBH and B2M are normal or high.
• Stage 3-The B2M and LDH levels are high, and the DNA of the cells starts to change. Patients who are diagnosed at this stage live for about three years.

These are some of the stages of blood cancer.

References