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The two major classes of this cancer are Hodgkin lymphoma and non-Hodgkin lymphoma. Hodgkin lymphoma has several subtypes, but they all involve B cells. Overall, this is a predictable and highly treatable form of cancer. Non-Hodgkin lymphoma is much more common, has many subtypes, and is notorious for being unpredictable and resistant to treatment. It can affect any type of lymphocyte, including B cells, T cells, or natural killer cells. In addition to being identified as Hodgkin or non-Hodgkin lymphoma, this disease is sometimes described by its behavior: • Low-grade, or indolent, lymphoma grows slowly. It is often nonresponsive to treatment and may change to a more aggressive form later. • Intermediate-grade lymphoma is aggressive, but responsive to treatment. • High-grade lymphoma is aggressive and grows rapidly, but it may be resistant to treatment. MYELOMA Myeloma (literally, "marrow tumor") is a blood cancer involving maturing B cells that are found in bone marrow. HOW COMMON IS IT? Myeloma is almost exclusive to people over 50 years old. It is twice as common among African-Americans as it is among the general population, and Asian Americans have the lowest rate of myeloma in the United States. Myeloma is diagnosed about 177,000 times each year, and it causes about 11,000 deaths. HOW DOES MYELOMA AFFECT THE BODY? Most B cells are produced in bone marrow. Sometimes as they mature, they begin to differentiate into nonfunctional cells. This condition is called monoclonal gammopathy of undetermined significance (MGUS): it points to the presence of some dysfunctional B cells and the production of abnormal antibodies, but it does not always develop into myeloma. If myeloma does develop, it means cells have undergone a mutation that causes them to do three bad things: they proliferate into tumors; they secrete cytokines that dissolve bone (usually in the spine, pelvis, or skull); and they produce faulty antibodies, called monoclonal immunoglobulins, or M-proteins. Fragments of M-proteins can pass through the kidneys into the urine. This is good news because myeloma can be detected and, to a certain extent, tracked through urinalysis. It is also bad news, because if the disease is rapidly progressive, the kidneys can sustain extensive damage and even fail altogether. Tumors inside bone marrow can interfere with normal blood cell production, leading to the signs and symptoms of other blood cancers: anemia, poor clotting, and reduced resistance to infection. But because myeloma cells also secrete cytokines that signal osteoclasts to dismantle bone tissue, this disease leads to pathologic thinning or spontaneous fractures in bone tissue. When this occurs at the spine or pelvis, the result can be devastating. A single tumor is called solitary myeloma; more than one tumor is called multiple myeloma. Occasionally tumors form outside the bones: these are called extramedullary plastocytomas. TREATMENT OPTIONS FOR HEMATOLOGIC CANCERS CHEMOTHERAPY Chemotherapy is the use of medications that kill any fast-growing cells. The idea is that this suppresses the growth of new tumors, but the side effects of chemotherapy involve other fast- growing cells as well. In the case of hematologic cancers, the side effects of chemotherapy essentially exacerbate the symptoms of the cancer: bone marrow function is suppressed, with the result that the patient experiences anemia (shortage of red blood cells), neutropenia (shortage of the most common and fastest-moving white blood cells), and thrombocytopenia (shortage of platelets). The net results: poor stamina, poor resistance to infection, and poor blood clotting. In addition to limiting bone marrow function, chemotherapy affects other cells, notably the follicle cells of the skin (leading to hair loss), and the epithelial lining of the GI tract, leading to painful ulcers, nausea, and vomiting. Boost your practice with ABMP's Website Builder—free for members on ABMP.com 103