LeukemiaLeukemia is a type of blood cancer that begins in the bone marrow. Bone marrow is the soft tissue in the center of the bones, where blood cells grow. The term "leukemia" literally means "white blood." White blood cells (leukocytes) are used by the body to fight off infections and other foreign substances. They are made in the bone marrow.
Leukemia leads to an uncontrolled increase in the number of white blood cells.
The cancerous cells prevent healthy red cells, platelets, and mature white cells (leukocytes) from being made. Life-threatening symptoms may then develop.
The cancer cells spread to the bloodstream and lymph nodes. They can also travel to the brain and spinal cord (the central nervous system) and other parts of the body.
Leukemias are divided into two major types:
- Acute (which progresses quickly)
- Chronic (which progresses more slowly)
- Acute lymphocytic leukemia (ALL)
- Acute myelogenous leukemia (AML)
- Chronic lymphocytic leukemia (CLL)
- Chronic myelogenous leukemia (CML)
- Hairy cell leukemia
Multiple myelomaMultiple myeloma is cancer of the plasma cells in bone marrow.
Alternative NamesPlasma cell dyscrasia; Plasma cell myeloma; Malignant plasmacytoma; Plasmacytoma of bone; Myeloma - multiple
Causes, incidence, and risk factorsPlasma cells help your body fight infection by producing proteins called antibodies. In multiple myeloma, plasma cells grow out of control in the bone marrow and form tumors in the areas of solid bone.
The growth of these bone tumors makes it harder for the bone marrow to make healthy blood cells and platelets.
Multiple myeloma mainly affects older adults. Past treatment with radiation therapy raises your risk for this type of cancer.
SymptomsMultiple myeloma causes anemia, which makes a person more likely to get infections and have abnormal bleeding. As the cancer cells grow in the bone marrow, bone or back pain, most often in the ribs or back.
If the bones in the spine are affected, it can put pressure on the nerves, resulting in numbness or weakness of the arms or legs.
Other symptoms include:
- Bleeding problems
- Fatigue due to anemia
- Fevers without any other cause
- Shortness of breath due to anemia
- Unexplained broken bones
Non-Hodgkin’s lymphomaThe non-Hodgkin’s lymphomas (NHL) are a group of cancers that develop in the body’s lymphatic system. There are many different types of non-Hodgkin’s lymphoma. Most types of NHL involve B cells, while a small percentage involve T cells. Common types of B-cell non-Hodgkin’s lymphomas include diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma.
Risk FactorsThe risk of NHL increases with age, and most patients are diagnosed when they are in their 60s and 70s. NHL can develop, however, in people of any age, including children. People who have had immune system impairment through infections, disease, or exposure to certain types of chemicals appear to have increased risk. Still, people without any known risk factors can develop NHL.
SymptomsThe most common first sign of lymphomas is painless enlargement of one or more lymph node, usually in the neck, armpits, or groin.
More generalized symptoms can include:
- Drenching night sweats
- Unexplained weight loss
- Fever Severe itching Diagnosis
Hodgkin’s lymphomaHodgkin's lymphoma is a cancer of lymph tissue found in the lymph nodes, spleen, liver, bone marrow, and other sites.
Alternative NamesLymphoma - Hodgkin's; Hodgkin's disease; Cancer - Hodgkin's lymphoma
Causes, incidence, and risk factorsThe first sign of Hodgin's lymphoma is often a swollen lymph node, which appears without a known cause. The disease can spread to nearby lymph nodes. Later it may spread to the spleen, liver, bone marrow, or other organs.
The cause is not known. Hodgkin's lymphoma is most common among people ages 15 - 35 and 50 - 70. Past infection with the Epstein-Barr virus (EBV) is thought to contribute to some cases. Patients with HIV infection are more at risk than the general population.
- Fever and chills that come and go
- Itching all over the body that cannot be explained
- Loss of appetite
- Soaking night sweats
- Painless swelling of the lymph nodes in the neck, armpits, or groin (swollen glands)
- Weight loss that cannot be explained
Other symptoms that may occur with this disease:
- Coughing, chest pains, or breathing problems if there are swollen lymph nodes in the chest
- Excessive sweating
- Pain or feeling of fullness below the ribs due to swollen spleen or liver
- Pain in lymph nodes after drinking alcohol
- Skin blushing or flushing
Multiple myelomaBlood tests can help diagnose this disease. They may include:
- Blood tests to check calcium level, total protein level, and kidney function
- Complete blood count (CBC)
- Blood and urine tests to check to identify proteins, or antibodies (immunofixation)
- Blood tests to quickly and accurately measure the specific level of certain proteins called immunoglobulins (nephelometry)
Bone x-rays may show fractures or hollowed out areas of bone.
If your doctor suspects this type of cancer, a bone marrow biopsy will be performed. Bone density testing may show bone loss.
Non-Hodgkin’s lymphomaThe doctor will first ask questions about the patient's medical history and perform a physical examination to detect any node enlargements. If these steps point to lymphoma, additional tests will be done to rule out other diseases or to confirm the diagnosis and extent of the lymphoma.
Physical ExaminationThe doctor will examine not only the affected lymph nodes but also the surrounding tissues and other lymph node areas for signs of infection, skin injuries, or tumors. The consistency of the node sometimes indicates certain conditions. For example, a stony, hard node is often a sign of cancer, usually one that has metastasized (spread to another part of the body). A firm, rubbery node may indicate lymphoma. Soft tender nodes suggest infection or inflammatory conditions.
BiopsyA biopsy is the most important test for diagnosing non-Hodgkin’s lymphoma and determining the subtype. Tissue samples retrieved from biopsy are examined under a microscope to find out if the cell type involved is indicative of Hodgkin’s disease or non-Hodgkin’s. (Hodgkin’s disease is marked by the presence of Reed-Sternberg cells, which are not found in non-Hodgkin’s lymphomas.) Sometimes a doctor may choose to wait and observe the involved lymph nodes, which will usually go away on their own if a temporary infection is causing the swelling. (However, some lymphomas may go away and appear to be benign, only to reappear at a later time.)
The Procedure. The type of biopsy performed depends in part on the location and accessibility of the lymph node. The doctor may surgically remove the entire lymph node (excisional biopsy) or a small part of it (incisional biopsy). In some cases, the doctor may use fine needle aspiration to withdraw a small amount of tissue from the lymph node.
The Results. Even if biopsies do not show any problems, disease may still be present in some patients. The doctor should continue to observe the patient until swelling or other signs of disease are gone. Biopsied tissue samples should be frozen in case special tests are later required. Such tests may include detection of particular antibodies, genetic and immune factors, and certain markers (substances that may indicate disease) located on the surface of the cells. If lymphoma has been diagnosed, the tissue will be examined for its histology, the cellular structures that will determine the lymphoma type.
Bone Marrow Aspirate and BiopsyBone marrow aspirate and biopsy are routinely performed to determine whether the disease has spread. With bone marrow aspirate, bone marrow cells are sucked out through a special needle. A biopsy may be performed before or after the aspiration. In this procedure, a special needle removes a core of the marrow that is structurally intact.
Imaging TechniquesChest X-Ray. A chest x-ray may show lymph nodes in the chest and neck area. It is particularly useful in detecting Hodgkin's disease and enlarged lymph nodes.
Computed Tomography. Computed tomography (CT) scans are much more accurate than x-rays. They can detect abnormalities in the chest and neck area, as well as revealing the extent of the cancer and whether it has spread. CT scans are used to evaluate symptoms and help diagnose lymphomas, help with staging of the disease, monitor response to treatment, and evaluate symptoms. A CT scan is also often used to detect lymphomas in the abdominal and pelvic areas, the brain, and the chest.
Magnetic Resonance Imaging (MRI). MRIs may be used to detect the spread of the disease to the brain, spine, chest, pelvis, and abdomen. Click the icon to see an image of a MRI machine.
Positron Emission Tomography (PET). PET scans can help predict whether an enlarged lymph node is benign or cancerous. PET scans are more accurate than CT scans or other imaging tests for staging lymphomas. PET scans may also help doctors determine how well a patient has responded to treatment, if any residual cancer exists, and if a patient has achieved remission.
Blood TestsBlood tests help rule out infection and other diseases. Such tests include a complete blood count to measure the number of white blood cells. In a patient already diagnosed with lymphoma, blood tests that measure the enzyme lactate dehydrogenase are important in determining the prognosis of patients with fast-growing lymphomas. High levels indicate bulkier tumors.
Molecular Diagnostic TestsTests of lymphoma's DNA are in use or are being developed to detect particular gene defects that help determine prognosis and response to treatment. Examples of such abnormal genetic arrangements are those that affect normal cell death, resist chemotherapy, or trigger aggressive cancer growth.
Hodgkin’s lymphomaThe disease may be diagnosed after:
- Biopsy of suspected tissue, usually a lymph node biopsy
- Bone marrow biopsy
The following procedures will usually be done:
- Blood chemistry tests including protein levels, liver function tests, kidney function tests, and uric acid level
- CT scans of the chest, abdomen, and pelvis
- Complete blood count (CBC) to check for anemia and white blood count
- PET scan
What now? It’s the most natural question to ask when you receive a cancer diagnosis. And it’s a question that’s hard to answer when dealing with the emotions and thoughts that inevitably overwhelm you after you’re given your test results. We understand this is a difficult time for you and your family. That’s why we offer the following treatment programs to all of our oncology patients in the Alegent Health system.
Stem Cell Transplant ProgramThe Alegent Health Peripheral Stem Cell Transplant Program, accredited by Foundation for the Accreditation of Cellular Therapies (FACT), provides a treatment option for patients with leukemia, multiple myeloma and some lymphomas.
Peripheral stem cell transplant is a procedure where diseased bone marrow is destroyed and healthy new stem cells are re-infused back into the body through a vein. The healthy stem cells find their way to the destroyed bone marrow, engraft, and begin producing normal blood cells. Stem cells are found in bone marrow and peripheral blood.
Diseases Treated by Autologous Stem Cell Transplant
- Multiple Myeloma
- Lymphoma, Hodgkin Lymphoma, Diffuse Large B-Cell Lymphoma
- Allogeneic – Removal, storage and re-infusion of donor stem cells based on tissue typing, may not be a relative
- Syngeneic – Removal, storage, and re-infusion of stem cells from an identical twin
- Autologous – Removal, storage, and re-infusion of one’s own healthy stem cells
Cancer Medical TeamYour medical team consists of a multi-disciplinary team of highly skilled professionals who care for every patient of the Alegent Health Cancer Center. Using state-of-the-art technology and treatment regimens, our doctors, nurses and other healthcare professionals treat more cancer patients than any other health care provider in the Nebraska.
Nurse Navigator ProgramA Nurse Navigator is an oncology-certified nurse who is available to guide you and your family through the entire process of diagnosis and treatment at Alegent Health. The Nurse Navigator is a single point of contact who will be there with you every step of the way.
Support StaffThe Alegent Health Cancer Support Team is comprised of a group of healthcare professionals who work together in a variety of ways to help the patient and family cope with cancer. Individual team members include Cancer Support Services Specialists, Medical Social Workers, Cancer Rehabilitation Specialist, Pastoral Services, Dietitians, Oncology Nurse Navigators, Hospice & Home Care Services, Inpatient Nursing Services, Radiation Oncology, and Volunteer Services.
Technologies & Therapies
Alegent Health is the first in the Omaha area to offer the TomoTherapy® Hi·Art® (Highly Integrated Adaptive Radiotherapy) System. This all-in-one solution allows doctors to check the location of tumors before each treatment, then deliver painless, precise radiation therapy resulting in unmatched accuracy for cancer patients, especially those with breast, lung and prostate tumors.
- Varian Trilogy
The Varian Trilogy with RapidArc® radiotherapy technology is a revolutionary breakthrough in cancer treatment that delivers powerful tumor-destroying radiation with remarkable precision.
Although brachytherapy is a very popular and proven treatment for cancer, using brachytherapy instead of external beam radiation for breast cancer is a recent idea. Brachytherapy has the advantages of being a shorter treatment, and irradiating less of the body. Alegent Health has strict eligibility guidelines for patients who are candidates for partial breast irradiation.
Clinical TrialsWe believe our patients should have access to the most advanced medicines or treatments available. Studies are available for cancer control, cancer prevention and cancer treatment. No patient is obligated to participate in clinical trials and may withdraw at any time. However, those who do participate gain access to new medicines and other benefits, such as low or no-cost drugs and treatments.
Image Recovery CenterWhile cancer treatment outcomes are improving, hair loss, weight changes and skin changes leave you feeling like a shadow of your former self. At Alegent Health, we won’t let you face those challenges alone. The Image Recovery Center is an appearance-enhancement program designed to help you copy with some of the physical side effects of cancer treatment.
Complementary TherapyThe purpose of integrative movement therapy is to "complement" conventional medicine by stimulating the body’s natural healing power. Healing the body, mind and spirit, Alegent Health offers massage therapy, Yoga, T’ai Chi meditation and other therapeutic exercises during cancer treatment.
Second Opinion ProgramAfter you receive a cancer diagnosis, you will likely have many questions. It’s helpful to obtain as much information as possible to make informed decisions about your cancer management and treatment in order to feel confident about your care. Getting a second opinion from the Alegent Health Cancer Center can help with these concerns.
Cancer Inpatient ServicesFor more acute, palliative or end of life phases of cancer care, Alegent Health offers five locations throughout Omaha for inpatient cancer care services.
The OasisFor patients who need a different type of care, the Alegent Health Cancer Center has opened an oncology unit with 20 dedicated beds at Lakeside Hospital. The private patient rooms form the perimeter of an unexpected retreat for patients and families.
- Physical Therapy
- Occupational Therapy
- Speech Therapy
- Aquatic Therapy
- Stress Management
- Lymphedeman Prevention and Treatment
- Leukemia and Lymphoma Society
- Cancer Related Fatigue Support Group
- Cancer Survivorship Program
- Just for Kids - Cancer Support Group
- Look Good, Feel Better
- Lunch & Learn Cancer Support Group
- Surviving Bereavement
- Conversations for the Cure