Blood Cancer: Myths Vs Facts - Experts Bust 10 Common Misconceptions About Diagnosis, Risk & Treatment

  

Blood cancer, or hematologic malignancy, is often surrounded by misconceptions that delay diagnosis and treatment. From the belief that it’s always inherited or contagious, to myths around stem cell transplants and alternative cures, misinformation can cost precious time and hope. To bring clarity, Dr Chepsy C Philip, Clinical Hematology & Bone Marrow Transplant Physician at Believers Church Medical College Hospital, Thiruvalla, debunks the most common myths about blood cancer and shares the truth about how it can be detected, treated, and even cured with today’s advanced therapies. 

Myth 1: Blood cancer is always an inherited disease. 

Fact: While blood cancer results from acquired genetic changes, most cases are not inherited. Environmental exposures and random mutations are often the cause.  

Myth 2: Blood cancer affects older people 

Fact: Dr Philip says, "All age groups, including Children, young adults, and the elderly, are susceptible to blood cancer." 

Myth 3: Blood cancer spreads from person to person.
 
Fact: Blood cancer is not contagious, as it develops inside the body and poses no risk of being contagious.  

Myth 4: A Blood test is sufficient to detect blood cancer 

Fact: "Blood tests can show abnormalities, but a diagnosis often requires a bone marrow biopsy, imaging and gene testing," reveals Dr Philip.

Myth 5: You cannot have blood cancer if you look healthy. 

Fact: There are tendencies to overlook the common symptoms of blood cancers, such as persistent fatigue, unexplained weight loss, recurring fever, and night sweats. While such symptoms may not seem severe, preventive measures, such as routine blood tests, often help reveal the onset of the disease, allowing for early intervention in such cases. 

Myth 6: There is no hope once a patient is diagnosed with blood cancer. 

Fact: There are living examples worldwide where survivors have overcome or survived blood cancer. Advanced therapies, including immunotherapy, targeted therapy, CAR-T cells, and blood stem cell transplants, have improved survival rates and significantly enhanced the quality of life.  

Myth 7: Blood cancer can be cured with alternative medicine. 

Fact: Evidence-based therapies are beneficial in treating blood cancer. It is essential to note that alternative remedies may offer comfort but cannot replace medical treatments that are already proven to have better patient outcomes.  

Myth 8: Blood cancers spread quickly in all patients. 

Fact: Dr Philip says, "Not all types of blood cancer progress rapidly; for example, lymphoma may grow slowly and remain stable for years. Having said that, leukemia progresses rapidly. So it is not right to club all types of blood cancers to progress quickly in patients."

Myth 9: Blood cancer is just one disease. 

Fact: There are different types of blood cancer, including leukemia, lymphoma, and multiple myeloma. 

Myth 10: A blood stem cell transplant is risky and rarely successful. 

Fact: Blood stem cell transplants have enough evidence to potentially give someone with blood cancer and blood disorders a second chance at life. This treatment method has a proven track record, with success rates continually improving patient outcomes.  

 

 

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Blood test accurately detects over 50 types of cancer, often before symptoms show

Researchers have developed the first blood test that can accurately detect more than 50 types of cancer and identify in which tissue the cancer originated, often before there are any clinical signs or symptoms of the disease.

In a paper published in the leading cancer journal Annals of Oncology [1] today (Tuesday) the researchers show that the test, which could eventually be used in national cancer screening programmes, has a 0.7% false positive rate for cancer detection, meaning that less than 1% of people would be wrongly identified as having cancer. As a comparison, about 10% of women are wrongly identified as having cancer in national breast cancer screening programmes, although this rate can be higher or lower depending on the number and frequency of screenings and the type of mammogram performed.

The test was able to predict the tissue in which the cancer originated in 96% of samples, and it was accurate in 93%.

Tumours shed DNA into the blood, and this contributes to what is known as cell-free DNA (cfDNA). However, as the cfDNA can come from other types of cells as well, it can be difficult to pinpoint cfDNA that comes from tumours. The blood test reported in this study analyses chemical changes to the DNA called "methylation" that usually control gene expression. Abnormal methylation patterns and the resulting changes in gene expression can contribute to tumour growth, so these signals in cfDNA have the potential to detect and localise cancer.

The blood test targets approximately one million of the 30 million methylation sites in the human genome. A machine learning classifier (an algorithm) was used to predict the presence of cancer and the type of cancer based on the patterns of methylation in the cfDNA shed by tumours. The classifier was trained using a methylation database of cancer and non-cancer signals in cfDNA. The database is believed to be the largest in the world and is owned by the company involved in this research, GRAIL, Inc. (California, USA).

Senior author of the paper, Dr Michael Seiden (MD, PhD), President of US Oncology (Texas, USA), said: "Our earlier research showed that the methylation approach outperformed both whole genome and targeted sequencing in the detection of multiple deadly cancer types across all clinical stages, and in identifying the tissue of origin. It also allowed us to identify the most informative regions of the genome, which are now targeted by the refined methylation test that is reported in this paper."

In the part of the Circulating Cell-free Genome Atlas (CCGA) study reported today, blood samples from 6,689 participants with previously untreated cancer (2482 patients) and without cancer (4207 patients) from North America were divided into a training set and a validation set. Of these, results from 4316 participants were available for analysis: 3052 in the training set (1531 with cancer, 1521 without cancer) and 1264 in the validation set (654 with cancer and 610 without cancer). Over 50 types of cancer were included.

The machine learning classifier analysed blood samples from the participants to identify methylation changes and to classify the samples as cancer or non-cancer, and to identify the tissue of origin.

The researchers found that the classifier's performance was consistent in both the training and validation sets, with a false positive rate of 0.7% in the validation set.

The classifier's ability to correctly identify when cancer was present (the true positive rate) was also consistent between the two sets. In 12 types of cancer that are often the most deadly (anal, bladder, bowel, esophageal, stomach, head and neck, liver and bile duct, lung, ovarian and pancreatic cancers, lymphoma, and cancers of white blood cells such as multiple myeloma), the true positive rate was 67.3% across clinical stages I, II and III. These 12 cancers account for about 63% of cancer deaths each year in the USA and, at present, there is no way of screening for the majority of them before symptoms show. The true positive rate was 43.9% for all cancer types in the study across the three clinical stages.

Detection improved with each cancer stage. In the 12 pre-specified cancers, the true positive rate was 39% in stage I, 69% in stage II, 83% in stage III and 92% in stage IV. In all of more than 50 cancer types, the corresponding rates were 18%, 43%, 81% and 93%, respectively.

The test was also consistent between the training and validation sets in its ability to identify the tissue where cancer had originated, with an accuracy of 93% in the validation set.

Dr Seiden said: "These data support the ability of this targeted methylation test to meet what we believe are the fundamental requirements for a multi-cancer early detection blood test that could be used for population-level screening: the ability to detect multiple deadly cancer types with a single test that has a very low false positive rate, and the ability to identify where in the body the cancer is located with high accuracy to help healthcare providers to direct next steps for diagnosis and care.

"Considering the burden of cancer in our society, it is important that we continue to explore the possibility that this test might intercept cancers at an earlier stage and, by extension, potentially reduce deaths from cancers for which screening is either not available or has poor adherence. To our knowledge, this is the largest clinical genomics study, in participants with and without cancer, to develop and validate a blood test for early detection of multiple cancers."

The study is funded by GRAIL, the maker of the blood test. Researchers are continuing to validate the test in large, prospective studies in the USA (STRIVE and PATHFINDER studies) and the UK (SUMMIT study), and to examine its feasibility for screening populations [2].

A strength of the CCGA study is that it includes more than 15,000 participants from 142 clinics in North America, ensuring results are generalisable to a diverse population. The ongoing studies are assessing the test's performance in even broader populations. Limitations include: all the participants with cancer had already been diagnosed with cancer (e.g. via screening or patients presenting with symptoms); the study was not designed to establish the test's impact on death from cancer or other causes; at the time of this analysis, not all patients had been followed for a year, which is needed to ensure their non-cancer status was accurate; and some inaccuracy occurred in the detection of the tissue of origin for cancers that are driven by the human papilloma virus (HPV), such as cancers of the cervix, anus, and head and neck - this information is being used to improve the test's performance.

Editor-in-chief of Annals of Oncology, Professor Fabrice André, Director of Research at the Institute Gustave Roussy, Villejuif, France, said: "This is a landmark study and a first step toward the development of easy-to-perform screening tools. Earlier detection of more than 50% of cancers could save millions of lives every year worldwide and could dramatically reduce morbidity induced by aggressive treatments.

"While numbers are still small, the performance of this new technology is particularly intriguing in pancreatic cancer, for which mortality rates are very high because it is usually diagnosed when it's at an advanced stage."

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Good vitamin D status can prevent cancer, improve prognosis of several cancers

A good vitamin D status is beneficial both in cancer prevention and in the prognosis of several cancers, according to a new research review.

The anti-cancer effects of vitamin D are especially pronounced in the prevention and treatment of colon cancer and blood cancers. In addition, high vitamin D responsiveness can be linked to a smaller cancer risk. Vitamin D responsiveness varies between individuals, affecting their need for vitamin D supplementation.

The review article, published in Seminars in Cancer Biology and written by Professor Carsten Carlberg from the University of Eastern Finland and Professor Alberto Muñoz from the Autonomous University of Madrid, provides an update on the molecular basis of vitamin D signaling and its role in cancer prevention and therapy.

Vitamin D is commonly known for its crucial role in bone health, but the authors point out it also regulates the immune system, and its anti-cancer effects are mediated mainly by immune cells, such as monocytes and T cells. Vitamin D exerts its effects via the vitamin D receptor (VDR), which is a transcription factor involved in the expression and epigenetic regulation of numerous genes.
According to the review, studies focusing on the effect of vitamin D on different types of cancers provide the strongest evidence of its benefits in colorectal cancer and in blood cancers, such as leukemias and lymphomas.

Vitamin D is important both for the differentiation of blood cells during hematopoiesis as well as adult stem cells in rapidly regenerating tissues, such as colon or skin. A too low vitamin D status leads to a suboptimal function of the VDR and in an increased risk that these cells are not fully differentiating and start to turn into uncontrolled growing cancer cells.

Even in other types of cancer, such as breast and prostate cancer, a low vitamin D status, measured as the level of 25-hydroxyvitamin D in the blood, has been associated with a higher cancer incidence and a poorer prognosis. However, vitamin D supplementation has not been consistently shown to reduce cancer mortality in randomized controlled trials.

According to the authors of the review, the impact of vitamin D could be shown more clearly if the participants were stratified according to their individual vitamin D responsiveness and the health outcomes analyzed in relation to changes in individual vitamin D status.

Professor Carlberg's research group has earlier shown that individuals differ in their molecular response or sensitivity to vitamin D supplementation. For example, 25% of the Finnish population seem to be low responders, needing a higher dose of vitamin D supplementation to reach the full clinical benefit. In terms of cancer risk, being a high responder can be expected to have a protective effect.

According to the review, a good vitamin D status is beneficial in general cancer prevention. There is less evidence of its usefulness in the treatment of cancer.

Human body resists antibiotics that treat harmful bacteria for stomach condition

Antibiotic resistance occurs when bacteria develop the ability to survive exposure to medications designed to kill or halt their growth. It is one of the greatest threats to global health today, causing more than 750,000 deaths every year and, without urgent action, this number is expected to rise dramatically in the future.

The research was presented today at UEG Week Barcelona 2019.

The study analysed 1,232 patients from 18 countries across Europe, investigated resistance to antibiotics regularly taken for ‘helicobacter pylori’ (H. pylori) infection, a harmful bacterium associated with gastric ulcer, lymphoma, and gastric cancer.

Presenting the study, lead researcher Prof Francis Megraud explained: ” ‘H pylori infection is already a complex condition to treat, requiring a combination of medications. With resistance rates to commonly used antibiotics such as clarithromycin increasing at an alarming rate of nearly one per cent per year, treatment options for ‘H pylori’ will become progressively limited and ineffective if novel treatment strategies remain undeveloped.”

‘H pylori’ is one of the most common bacterial infections in humans and is estimated to be present in one-half of the world’s population. ‘H pylori’ leads to inflammation of the stomach lining, namely gastritis, which can result in peptic ulcers.

Underlining the severity of the situation, in 2017, the World Health Organisation (WHO) identified clarithromycin-resistant ‘H pylori’ as a high priority bacterium for antibiotic research and development.

The survey also found that the rates of primary clarithromycin resistance in ‘H pylori’ were highest in southern Italy (39.9 per cent), Croatia (34.6 per cent) and Greece (30 per cent), aligning with previous reports that predict that both Italy and Greece will have the highest number of deaths due to antimicrobial resistance amongst EU members by 20507.

The high levels of resistance exhibited in these countries have been attributed to the overconsumption of antibiotics for conditions including cold and flu, and a lack of institutional support for antibiotic resistance containment strategies.

“The findings of this study are certainly concerning, as ‘H pylori’ is the main cause of peptic disease and gastric cancer,” commented Mario Dinis-Ribeiro, president of the European Society of Gastrointestinal Endoscopy. “The increasing resistance of ‘H pylori’ to a number of commonly-used antibiotics may jeopardise prevention strategies.

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Study discovers targeted therapy to help adolescents with deadly nerve cancer

A targeted therapy has been discovered to treat adolescent patients who suffer from a deadly paediatric nerve cancer called neuroblastoma, a recent study has stated.


Neuroblastoma is one of the most common and aggressive paediatric nervous system tumours and generally has a poor prognosis, particularly when it advances in older children.

Treatment success for the disease varies, but is exponentially less in adolescent patients, particularly because the disease lacks effective targeted therapies.

The Mount Sinai researchers found that neuroblastoma in older children and adolescents harbouring deletions within a gene called ATRX may be responsive to a targeted therapy called tazemetostat.

Tazemetostat disables an enzyme called EZH2 that inhibits genes that promote normal neuron development, in turn killing neuroblastoma cells. Neuroblastoma arises in immature nerve cells of the adrenal glands and portions of the spine during the development of the sympathetic nervous system, which controls the body's "flight or fight" response to stress.

EZH2 inhibitors are already being tested in phase I and phase II clinical trials for other cancers, including lymphomas, sarcomas, and other solid tumours, with some favourable results.

"We hypothesised that mutant ATRX proteins contribute to aggressive neuroblastoma," said a Professor of Oncological Sciences and senior corresponding author.

"In this study, we aimed to decipher the underlying biology of these altered proteins in neuroblastoma, a tumor for which effective therapeutic strategies remain obscure, and to exploit identified dependencies," added the Prof.

Mount Sinai scientists continue to expand this research into the role of the mutant ATRX protein in the laboratory and hope to eventually open a clinical trial with collaborating institutions.

Based on this research, they believe that EZH2 inhibitors could also be effective in other ATRX mutant cancers, such as pediatric glioblastoma, multiforme and osteosarcoma.

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