What we do
We provide care for patients with blood disorders. We run outpatient clinics, a haematology ward and the haematology day unit.
We also process blood tests and blood transfusion requests.
We are involved in research at the haematology research laboratory at the University of Sussex and the Clinical Investigation and Research Unit at the Royal Sussex County Hospital.
Conditions treated
The conditions we treat include:
- Acute lymphoblastic leukaemia
- Acute myeloid leukaemia
- Chronic lymphocytic leukaemia
- Chronic myeloid leukaemia
- Essential thrombocythaemia
- Hodgkin lymphoma
- Myelofibrosis
- Multiple myeloma
- Non-Hodgkin lymphoma
- Polycythaemia rubra vera
Location
We provide outpatient services at the Royal Sussex County Hospital. Most patients are seen at the main outpatient building on Eastern Road but we also hold clinics at the Sussex Cancer Centre (for patients with lymphoma and myeloma) and on the haematology ward (for patients who have undergone bone marrow transplant). Your appointment letter will state the location of your appointment.
Our inpatient ward and day unit are on Level 9 of the Sussex Kidney Unit. They are located above the RSCH multi-storey car park which is accessed from North Road.
Contact
- Outpatients: contact the Booking Hub on 0300 303 8360
- Haematology ward: 01273 664771
- Haematology Day Unit: 01273 696955 extn 7413
Further information about tests and treatment
What is bone marrow?
Bone marrow is found in the middle of our bones. Its job is to make new blood cells which enter the blood, travelling around the body.
What is a biopsy?
A biopsy involves taking a very small sample of tissue. In the case of a bone marrow biopsy a very small piece of bone marrow is taken from the inside of bone, along with a small amount of liquid from inside the bone. The sample is then looked at under the microscope.
Why is it performed?
In many blood diseases the bone marrow is affected and does not work properly. Looking at bone marrow down the microscope provides lots of information which helps to make the diagnosis. It can also provide information about the type and activity of disease present. Bone marrow biopsies are sometimes repeated to help confirm that treatment is working.
Where is it performed?
The easiest site for this to be performed is from the back of the hip bone above the buttocks.
Who is it performed by?
Bone marrow biopsies are performed by an experienced doctor.
How is it performed?
Patients lie on their side or front. First of all the skin is cleaned thoroughly. Then a local anaesthetic is injected, this stings a little at first but then soon numbs the area. The biopsy is then taken, patients do feel pushing and pulling but with the anaesthetic it is not painful. The procedure lasts 10 minutes from start to finish. A small dressing is applied afterwards and the area may feel bruised for a few days.
When will I get the results?
As the samples are looked at under the microscope it takes a few days for the results to come back. Sometime part of the sample is sent to London for special testing and the results from this may take 1-2 weeks.
Further information
Bone marrow biopsy at PubMed Health (US National library of medicine)
What is it?
Velcade is a chemotherapy drug. Chemotherapy kills cancerous cells which divide and grow rapidly. However healthy cells which grow quickly are also affected by chemotherapy which is why patients can get side effects.
What is it used for?
It is used in myeloma which has not responded to the first treatment course. It can be used by itself, so no other chemotherapy drugs are used at the same time. However it is usually combined with steroids and other medications.
How does it work?
Velcade blocks messages inside cells which are important for cell growth.
How is it given?
Velcade needs to be injected into a vein. This is either by a small tube going into a vein called a cannula, which is removed after the injection is finished. The other option is to have the drug given by a long line, which is a longer tube inserted into a vein and is kept in place for a few weeks.
What are the most important side effects?
The most important side effect to be aware of is neutropenic sepsis. This will be explained to you before you start treatment. Chemotherapy affects the bone marrow so that blood cells are not produced in the normal way. This is only temporary, but leaves the body vulnerable to infection as the immune system will not be able to fight against infection in the normal way. Therefore please read the neutropenic sepsis box for full information about what to do if you feel unwell.
Velcade can also affect the nerves in your hands and feet. If you develop tingling, pain or numbness in your hands inform you doctor.
Like most chemotherapy drugs Velcade can cause nausea, vomiting, constipation or diarrhoea. Other medications are often used when chemotherapy is given to minimise these side effects. Let your doctor know if you are troubled by these side effects.Other possible side effects are tiredness and loss of appetite, dizziness, cramps and mood changes.
These may sound like a lot of side effects but please speak to the nursing staff or doctors if you are worried or concerned at any point.
Further information
Bortezomib at Macmillian cancer support
What is it?
There are many different types of chemotherapy and often several different ones are used at the same time. Chemotherapy targets rapidly growing cells which is the key features of cancer cells. However the chemotherapy can affect other cells of the body which grow fast such as hair- that why it can fall out with some of the chemotherapy treatments, and the lining of the gut- which is why patients often feel sick and can develop diarrhoea on chemotherapy treatment.
What drugs are used?
This depends on the condition they are being used to treat. Often a combination of drugs is used as this has been shown to improve outcomes. For further information on individual drugs please see the boxes on this page for:
- Bortezomib (Velcade)
- Chlorambucil
- Cyclophosphamide
- Cytarabine
- Danuorubicin
- Glivec
- Hydroxycarbamide
- Hydroxyurea
- Imatinib
- Lenalidomide
- Melphalan
- Rituximab
- Steroids
- Velcade (bortezomib)
What is it?
Chlorambucil is a chemotherapy drug, see chemotherapy sheet for background information. Chemotherapy kills cancerous cells which divide and grow rapidly. However healthy cells which grow quickly are also affected by the chemotherapy which is why patients can get side effects.
What is it used for?
It is mainly used to treat chronic lymphocytic leukaemia. Chlorambucil is also used to treat some forms of non-Hodgkins lymphoma and Hodgkins lymphoma.
How does it work?
Chlorambucil interferes with DNA replication. This is essential for a cell to divide and replicated which is how Chlorambucil kills cancer cells.
How is it given?
Chlorambucil is given by mouth in a tablet.
What are the most important side effects?
The most important side effect to be aware of is neutropenic sepsis. This will be explained to you before you start treatment. Chemotherapy affects the bone marrow so that blood cells are not produced in the normal way. This is only temporary, but leaves the body vulnerable to infection as the immune system will not be able to fight against infection in the normal way. Therefore please read the neutropenic sepsis box for full information about what to do if you feel unwell.
Chlorambucil can also cause a rash. See a doctor straight away if this occurs. Otherwise, patients tend not to suffer with many other side effects if taking Chlorambucil by itself.
Further information
What is it?
Cyclophosphamide is a chemotherapy drug. Chemotherapy kills cancerous cells which divide and grow rapidly. However healthy cells which grow quickly are also affected by the chemotherapy which is why patients can get side effects.
What is it used for?
Cyclophosphamide is used in many different conditions. It is used mainly to treat non-Hodgkin lymphoma, Hodgkin lymphoma, and myeloma
How does it work?
Cyclophosphamide works by disrupting DNA within cancerous cells which leads to cell death.
How is it given?
When treating Haematological disease it is mainly given by mouth as a tablet. However, occasionally it is given by an injection into a vein. It is mainly used in combination with other chemotherapy drugs.
What are the most important side effects?
The most important side effect to be aware of is neutropenic sepsis. This will be explained to you before you start treatment. Chemotherapy affects the bone marrow so that blood cells are not produced in the normal way. This is only temporary, but leaves the body vulnerable to infection as the immune system will not be able to fight against infection in the normal way. Therefore please read the neutropenic sepsis box for full information about what to do if you feel unwell.
Like most chemotherapy drugs Cyclophosphamide can cause nausea, vomiting, constipation or diarrhoea. Other medications are often used when chemotherapy is given to minimise these side effects. Let your Doctor know if you are troubled by these side effects.
Cyclophosphamide can cause irritation to the bladder so it is important to drink plenty of water when receiving this drug and inform your Doctor or Nurse if it is painful when you pass water.
Further information
Cyclophosphamide at Macmillian cancer support
What is it?
Cytarabine is a chemotherapy drug. Chemotherapy kills cancerous cells which divide and grow rapidly. However healthy cells which grow quickly are also affected by the chemotherapy which is why patients can get side effects.
What is it used for?
Cytarabine is used to treat acute myeloid leukaemia and some myelodysplastic syndromes.
How does it work?
Cytarabine prevents new DNA from being made within cancer cells. Making new DNA is the first stage a cell undergoes when it is replicating and growing. Cytarabine therefore blocks cancer cells from dividing which leads to cancer cell death.
How is it given?
Cytarabine is not available in tablet form, it has to be injected into a vein. This is either by a small tube going into a vein called a cannula, which is removed after the injection is finished. The other option is to have the drug given by a long line, which is a longer tube inserted into a vein and is kept in place for a few weeks. The drug is given on the Haematology Day Unit or occasionally as an in-patient on the ward.
What are the most important side effects?
The most important side effect to be aware of is neutropenic sepsis. This will be explained to you before you start treatment. Chemotherapy affects the bone marrow so that blood cells are not produced in the normal way. This is only temporary, but leaves the body vulnerable to infection as the immune system will not be able to fight against infection in the normal way. Therefore please read the neutropenic sepsis box for full information about what to do if you feel unwell.
Like most chemotherapy drugs cytarabine can cause loss of appetite, mouth ulcers, nausea, vomiting, constipation or diarrhoea. Other medications are often used when chemotherapy is given to minimise these side effects.
Further information
What is a CT scan?
A CT scan provides detailed information about the insides of our bodies. It uses X-ray beams which are used when taking a standard chest X-ray. However a CT scan takes many different pictures using many X-ray beams so the detail of information is better. In particular CT scans are good at looking at bones, the lungs, lymph nodes and the bowel. CT scans provide different information to MRI scans, with some parts of the body best looked at with an MRI, and some with a CT scan.
What does the machine look like?
The machine looks like a big white doughnut or polo mint. Patients lie still and the machine moves over them. The machine is ring like in structure and there is no tunnel. Sometimes contrast is needed to highlight certain parts of the body. This is injected into a vein just before images are taken.
How long does it take?
Patients are required to lie flat on their backs for 15-30 minutes and keep still when the images are taken. There are plenty of breaks in between images being taken. There is a radiographer present who controls the machine, they give instructions as the scan is taken.
When will I get the results?
Once the scan is finished it is then looked at by an X-ray doctor called a radiologist. These doctors specialise at looking at scans. They look at the pictures and write a report. This process takes a few days to complete.
Further information
What is it?
Danuorubicin is a chemotherapy drug. Chemotherapy kills cancerous cells which divide and grow rapidly. However healthy cells which grow quickly are also affected by the chemotherapy which is why patients can get side effects.
What is it used for?
Danuorubicin is used to treat acute lymphoblastic leukaemia and acute myeloid leukaemia.
How does it work?
Danuorubicin binds to DNA within cancerous cells, this stops the cell from dividing and kills the cancerous cells.
How is it given?
Danuorubicin is not available in tablet form, it has to be injected into a vein. This is either by a small tube going into a vein called a cannula, which is removed after the injection is finished. The other option is to have the drug given by a long line, which is a longer tube inserted into a vein and is kept in place for a few weeks. The drug is given on the Haematology Day Unit, or occasionally on the ward as an in-patient.
What are the most important side effects?
The most important side effect to be aware of is neutropenic sepsis. This will be explained to you before you start treatment. Chemotherapy affects the bone marrow so that blood cells are not produced in the normal way. This is only temporary, but leaves the body vulnerable to infection as the immune system will not be able to fight against infection in the normal way. Therefore please read the neutropenic sepsis box for full information about what to do if you feel unwell.
Danuorubicin is red coloured and may cause your urine to turn to an orange colour. This does not cause any harm to your body.
Danuorubicin can cause hair loss which will be discussed with you before you start treatment, hair loss is temporary.
Like most chemotherapy drugs danuorubicin can cause nausea, vomiting, constipation or diarrhoea. Other medications are often used when chemotherapy is given to minimise these side effects.
Further information
What is it?
Hydroxycarbamide is a chemotherapy drug. Chemotherapy kills cancerous cells which divide and grow rapidly. However healthy cells which grow quickly are also affected by the chemotherapy which is why patients can get side effects.
What is it used for?
Hydroxycarbamide is mainly used to treat polycythaemia rubra vera and essential thrombocythaemia when treatment is required for these conditions. Hydroxycarbamide can also be used in sickle cell disease, chronic myeloid leukaemia, acute myeloid leukaemia and other conditions.
How does it work?
Hydroxycarbamide blocks new DNA from being made which is essential for a cell to grow and divide, therefore hydroxycarbamide stops new cell formation.
How is it given?
Hydroxycarbamide is given in the form of a tablet and is never given as an injection.
What are the most important side effects?
The most important side effect to be aware of is neutropenic sepsis. This will be explained to you before you start treatment. Chemotherapy affects the bone marrow so that blood cells are not produced in the normal way. This is only temporary, but leaves the body vulnerable to infection as the immune system will not be able to fight against infection in the normal way. Therefore please read the neutropenic sepsis box for full information about what to do if you feel unwell.
Common side effects include nausea, vomiting, constipation or diarrhoea. This is because the lining of the gut grows relatively quickly and therefore is affected by the chemotherapy. Other medications are often used when chemotherapy is given to minimise these side effects.These may sound like a lot of side effects but please speak to the Nursing staff or Doctors if you are worried or concerned at any point.
Further information
Hydroxycarbamide at Macmillian cancer support
What is it?
Imatinib, also called Glivec, is a new type of drug. It is more of a targeted anti-cancer treatment then older chemotherapy drugs.
What is it used for?
The main use of Imatinib is to treat chronic myeloid leukaemia, but it is also used to treat some types of acute lymphoblastic leukaemia.
How does it work?
Imatinib targets an enzyme within cells called tyrosine kinase. This enzyme is over active in chronic myeloid leukaemia and results in increased cell division and growth. By blocking this enzyme Imatinib therefore stops cancer cell growth and kills cancerous cells.
How is it given?
Imatinib is taken by mouth as a tablet, it is not given alongside other chemotherapy medications.
What are the most important side effects?
As Imatinib is a targeted treatment so patients tend to suffer with fewer side effects when compared to those taking other chemotherapy medications.
It is possible for Imatinib to affect bone marrow like other chemotherapy agents so there is a risk of developing neutropenic sepsis. This will be explained to you before you start treatment. If bone marrow is affected blood cells are not produced in the normal way. This temporarily leaves the body vulnerable to infection as the immune system will not be able to fight against infection in the normal way. Therefore please read the neutropenic sepsis box for full information about what to do if you feel unwell.
Other side effects patients notice are fluid retention so ankles may become swollen, this is easily treatable. Nausea and diarrhoea are other possible side effects which can also be easily managed.
Further information
What is it?
Lenalidomide strictly speaking is not a chemotherapy drug and is call an immunomodulator drug. Chemotherapy drugs are directly toxic and kill cancer cells directly, whereas Lenalidomide works against cancer in a different way.
What is it used for?
It is used to treat myeloma and occasionally used to treat chronic lymphocytic leukaemia.
How does it work?
Lenalidomide works in a similar way to thalidomide, both drugs are called angiogenesis inhibitors. This means Lenalidomide stops new blood vessels from forming. Cancerous cells like normal cells need a good blood supply to survive. So when a cancer is growing it needs to form new blood vessels in order to grow. Lenalidomide blocks this and therefore helps to shrink the cancer.
How is it given?
Lenalidomide is given by mouth as a tablet. It is given alongside other anti-cancer or chemotherapy drugs.
What are the most important side effects?
The most important side effect to be aware of is neutropenic sepsis. This will be explained to you before you start treatment. Chemotherapy affects the bone marrow so that blood cells are not produced in the normal way. This is only temporary, but leaves the body vulnerable to infection as the immune system will not be able to fight against infection in the normal way. Therefore please read the neutropenic sepsis box for full information about what to do if you feel unwell.
There is also an increased risk of developing a blood clot whilst taking Lenalidomide, therefore if you notice calf pain and swelling or become short of breath then contact us.
Patients can also become nauseated, have constipation and notice rashes. These can all be easily managed with additional medications.
Further information
Lenalidomide at Macmillian cancer support
What is it?
The brain and the spine are bathed in a layer of fluid. A lumbar puncture involves taking a sample of this fluid from the lower back. This is then analysed in the laboratory.
Why is it performed?
There are a number of reasons that a Lumbar Puncture is performed. Most commonly it is performed if there is a suspicion of an infection of the brain or spine. A lumbar puncture is sometime required is some forms of leukaemia or lymphoma. This is to assess whether the brain or spine are affected by the disease and to determine if they need treating.
How is it performed?
A lumbar puncture is performed by a Doctor who will talk you through the procedure before it is performed. The skin is cleaned and then a local anaesthetic is applied to the lower back. The anaesthetic does sting a little before the area goes numb. A sample of fluid surrounding the lower spine is then removed using a fine needle. The whole process is very similar to an epidural which women sometimes have during pregnancy. The only difference is that with epidurals drugs are injected into the fluid around the spine rather then removing some of the fluid.
What do I need to know about it?
The whole process takes around 15 minutes. You will be required to lie on your side in a curled up position whilst the fluid is being removed. The main side effect from the procedure is a headache. To minimise this happening you will be asked to lie down for an hour after the procedure is finished. The site where the fluid is taken from may feel bruised afterwards for a few days but this should not prevent you from doing anything.
When will I get the results?
The results are obtained quickly when looking for infections. Other tests can take longer to process, this will be completed after around a week.
Further information
What is a lymph node?
Lymph nodes are an important part of the immune system which helps the body to fight infections. Usually it is not possible to feel lymph nodes but they can become enlarged in several diseases. When they are enlarged they can be felt in the neck, groin or armpit areas.
What is a biopsy?
A biopsy involves taking a small piece of tissue from the body and looking at it down the microscope. In the case of a lymph node biopsy usually the whole node is removed. Most commonly this is done from the neck, however it can be done from other areas of the body if required. Sometimes small thin cores are taken instead of the whole lymph node, this can usually help determine the cause of the swelling.
Why is it being performed?
Looking at tissue under the microscope gives a great detail of information which cannot be obtained from scans alone. The individual cells can be seen, this helps to determine which disease is present and the activity of disease. This information is essential in planning the best course of treatment.
How is it performed?
The procedure is performed by a surgeon and not your haematology doctor. The area is numbed with local anaesthetic before the short procedure is performed. In most cases patients are not put to sleep and patients are not kept in hospital after the procedure.
When will I get the results?
After the sample is removed it is looked at by a pathologist, these doctors specialise in looking at tissue down the microscope. After they have analysed the sample they write a report which is then given to your doctor. This takes about a week in total to happen.
What is it?
Melphalan is a chemotherapy drug. Chemotherapy kills cancerous cells which divide and grow rapidly. However healthy cells which grow quickly are also affected by the chemotherapy which is why patients can get side effects.
What is it used for?
Melphalan is used to treat myeloma in addition to several other forms of cancer. It is also used occasionally to treat polycythaemia rubra vera.
How does it work?
Melphalan acts by binding to DNA within cancerous cells. It disrupts the DNA and stops the cancerous cell from replicating and growing.
How is it given?
Melphalan can be given by mouth as a tablet or can be injected into a vein. If melphalan is given by injection then it is given on the Haematology Day Unit.
What are the most important side effects?
The most important side effect to be aware of is neutropenic sepsis. This will be explained to you before you start treatment. Chemotherapy affects the bone marrow so that blood cells are not produced in the normal way. This is only temporary, but leaves the body vulnerable to infection as the immune system will not be able to fight against infection in the normal way. Therefore please read the neutropenic sepsis box for full information about what to do if you feel unwell.
Melphalan can also cause nausea and tiredness.
Further information
What is a MRI scan?
An MRI scan provides detailed information about the insides of our bodies. Unlike CT scans it does not use X-ray beams. Images are produced by comparing how much water is in different internal structures. The machine contains a large magnet which helps to produce the images. The staff on the day go through a checklist with patients so that all jewellery is removed and any metal work inside the body is known about e.g pacemaker, surgical clips or hip replacements. MRI scans are very useful at looking at the brain, muscles and bones. They provide different pictures to a CT scan, with some parts of the body best looked at with an MRI, and some with a CT scan.
What does the machine look like?
The machine has a tunnel, at no point does the machine come into contact with the patient. It is necessary for the part of the body being looked at to enter the tunnel. The machine can be a little noisy so headphones are provided to block this out. The headphones also enable the staff to talk to you throughout the scan.
How long does it take?
The scan takes between 15-45 minutes depending on how much of the body is being scanned. When the images are being taken patients are required to lie still, there are plenty of breaks in between images being take.
Sometimes contrast is used to highlight certain parts of the body. This is injected into a vein just before the images are taken.
When will I get the results?
Once the scan is finished it is then looked at by an X-ray doctor called a radiologist. These doctors specialise at looking at scans. They look at the pictures and write a report. This process takes a few days to complete.
Further information
What is a PET scan?
A PET scan is a new type of scan which can provide very useful information. PET is short for Positron Emission Tomography. It is different from CT and MRI scans as it can provide information about function i.e how well parts of the body are working.
Why is it used?
The information provided by a PET scan can then be looked along side other scans and can provide a more complete picture as to what is happening inside a patients body.
How is it performed?
A small volume of radioactive tracer is injected into a vein. It is very similar in structure to sugar and is taken up by tissues inside the body. There are no long lasting effects of using the radioactice tracer and it does not make patients feel ill. Patients are instructed not to eat anything for 6 hours before the scan, this is very important. The scan will give false results if these instructions are not followed. You will be provided with full instructions when given your appointment.
The time taken to perform the scan is around 2-3 hours. It takes this long as the tracer needs to be taken up into the bodies tissues perform the images can be taken. Not all this time will be spent inside the scanner.
Where is it performed?
The PET scan machine is located at the University of Brighton campus at Falmer.
When will I get the results?
After the scan is performed it takes a few days to analyse the results. A report is produced and sent to your doctor. This takes about a week in total.
Further information
What is radiotherapy?
Radiotherapy is the use of X-ray beams to treat cancer. X-ray beams are also used to take X-ray images. In radiotherapy a similar beam is used but it is focused on a very small area of the body.
What is it used for?
Radiotherapy is used to treat cancer. Depending on the type of cancer it is used by itself or in combination with chemotherapy or surgery.
Radiotherapy can also be used to treat pain coming from bone if this is affected by cancer.
How does it work?
The X-ray beams are narrow beams of high energy which destroys cancer cells which they are focused on.
How is it delivered?
Radiotherapy is given at the Sussex Cancer Centre which is also located at the Royal Sussex County Hospital. Usually several doses are required. Before the first dose is given you will have a planning session. Sometimes a mark with a pen or small tattoo is required to mark the areas where the X-ray beams will be focused. This will be explained to you by the staff. When the radiotherapy is given you will have to lie still whilst the beams are given. Nothing comes into contact with your body and it does not take a large amount of time. But often several doses are needed.
What are the most important side effects?
There are side effects from radiotherapy as with any treatment, but on the whole patients suffer fewer side effects when compared to chemotherapy.
There are some general side effects that patients may notice such as feeling tired and skin irritation. Skin can become red and sore after radiotherapy this can be managed by using moisturiser and other methods which the staff will discuss with you. It is advised to avoid sunlight exposure to areas that have undergone radiotherapy as the skin will remain sensitive to sunlight.
Other side effects depend on which part of the body the X-ray beams are focused on. For example if they are focused near the stomach or bowel then patients may feel nauseated and may suffer with diarrhoea.
The main long term effect of radiotherapy is due to scarring from healthy cells which are affected by the X-ray beams. It is impossible to only focus the X-ray beams on cancerous cells and some normal cells are damaged. The bowel and bladder can be affected by this process, It is important to mention to doctors if you have had radiotherapy in the past.
Further information
Radiotherapy at Macmillian cancer support
What is it?
Rituximab is a new successful drug which works in a more targeted way then the traditional chemotherapy drugs.
What is it used for?
Rituximab is used to treat several diseases. It is used to treat non-Hodgkin lymphoma and chronic lymphoid leukaemia when treating haematological diseases.
How does it work?
Rituximab selectively recognises B-cells within the body. B-cells produce cells which normally help the body to fight infection. In non-Hodgkin lymphoma and chronic lymphoid leukaemia, B-cells are the cells that have turned cancerous. Rituximab therefore targets these cancerous B-cells and destroys them. However it also destroys some healthy B-cells which the body replaces after treatment.
How is it given?
Rituximab is not available in tablet form, it has to be injected into a vein. This is either by a small tube going into a vein called a cannulae, which is removed after the injection is finished. The other option is to have the drug given by a long line, which is a longer tube inserted into a vein and is kept in place for a few weeks. The drug is given on the Haematology Day Unit and is often given in combination with chemotherapy drugs.
What are the most important side effects?
Some patients react to Rituximab when it is first injected, if this occurs it does so during the first infusion. The first infusion is therefore given slowly, which takes up most of the day. The nurses on the Haematology Day Unit will talk you through this. After the first dose infusions can be given quicker.
Rituximab can also lower the number of white cells in the body. These cells help fight infection so the body may be left vulnerable to infection as the immune system will not be able to fight against infection in the normal way. This may result in neutropenic sepsis, this will be explained to you before you start treatment. Please read the neutropenic sepsis box for full information about what to do if you feel unwell.
Further information
What is it?
A skeletal survey is a series of X-rays which image the whole of the skeleton. This includes images of the spine, skull, ribs, pelvis in addition to arms and legs. The X-rays are taken in the standard way, the only difference with a skeletal survey is that several X-rays are taken and they cover the whole of the skeleton when put together.
Why is it performed?
It is most commonly performed in myeloma to look at the bones of the body and determine if the bones are affected by myeloma or not.
How is it performed?
It involves a series of X-rays being taken separately rather then scanning the whole body.
When will I get the results?
The X-rays are looked at by a specialist X-ray doctor who writes a report, the report is then sent to your doctor. In total this takes a week.
What is it?
There are a number of different types of steroids used in treating haematological diseases. Dexamethasone, prednisolone and hydrocortisone are the most commonly used ones. Steroids are naturally produced by the body and taking them as a form of medication can have several beneficial effects.
What is it used for?
Steroids have useful anti-inflammatory effects and are used alongside other chemotherapy drugs to treat myeloma and non-Hodgkin lymphoma. At a low dose dexamethasone is a good anti-sickness medication and can boost appetite.
How do steroids work?
In addition to having an anti-inflammatory effect steroids can affect which new proteins a cell makes. This has a wide ranging effect and can help slow cell growth.
How are they given?
Dexamethasone is most commonly given by mouth as a tablet. However it can also be injected into muscle or injected into a vein. Dexamethasone is usually given alongside other medication. Prednisolone is given as a tablet, and hydrocortisone is usually given as an injection into a vein.
What are the most important side effects?
Steroids can irritate the lining of the stomach so if you are suffering with acid reflux or stomach pains let your doctor know. It is also important to let your doctor know if you are diabetic as steroids can raise your sugar levels, your diabetic medication therefore may need altering.
Steroids at a higher dose can dampen down the immune system making the body more vulnerable to infections. This is particularly important to be aware of if taking steroids alongside chemotherapy. Please read the neutropenic sepsis box for further information.
There are other side effects which become more of an issue if steroids are taken for a prolonged period of time. Usually in treating haematology conditions this is not a significant issue as steroids are not given over a prolonged time course.
Further information
Steroids at Macmillian cancer support
What is an ultrasound scan?
Ultrasound scans are most commonly known for their use on pregnant women. However they are also used in a wide range of different settings.
How is it useful?
Ultrasound scans are very useful at looking at the different tissues below the skin. The probe shines a beam which is reflected back to it by the different layers of tissue under the skin. The beams used cause no harm to the body. Ultrasound is commonly used to look at the liver and spleen, but it also has a wide range of other uses.
How is it performed?
Some jelly is applied to the area being looked at and then a probe is placed onto the skin. Apart from slight pressure from the probe, patients do not feel anything. The scans are quite quick, lasting 5-10minutes. Patients are required to follow instructions from the Nurse or Doctor performing the scan.
When will I get the results?
The health professional performing the scan writes a report which is then sent to your Doctor. This process takes a few days.
Why are they different?
Haematological cancers can be different in nature to other cancers and sometimes difficult to understand.
Breast cancer is an example of a non-Haematological cancer which is easier to understand. Breast cancer forms in breast tissue. It is usually picked up as a lump in the breast and often treatment involves removing the lump of cancerous cells from the breast with an operation. Breast cancer if not caught early can spread from the breast to surrounding lymph nodes under the armpit and then to further away to places like the liver and bone.
Haematological cancers are often different in nature. With some leukaemias the problem arises in the bone marrow. The bone marrow is the spongy material that is found inside bone and makes new blood cells. Therefore a patient would never feel a lump in the same way as in breast cancer described above. A patient may notice symptoms which are a result of the bone marrow not working in the normal way. For example they way feel tired, short of breath, bruise easily and have infections. These are all general symptoms which affect the whole body. Treatment is also different in leukaemias as it would be impossible to perform an operation to remove the cancerous cells from inside several different bones. Therefore chemotherapy is the key to treatment as it can work on several different places as once.
Why can they affect several parts of the body?
Some Haematological cancers such as myeloma and non-Hodgkin’s lymphoma can affect many different parts of the body. With lymphoma the cancer affects the lymphoid system. So unlike breast cancer which initially only affects one organ- the breast, lymphomas can affect several different parts of the lymphoid system. So patients may notice lumps in the neck due to swollen lymph nodes. They may notice lumps in the abdomen due to their liver and spleen becoming enlarged- all manifestations of the same original problem.
Again this affects treatment as it would be impossible to surgically remove all these areas of abnormal cells. However surgery is sometimes performed, for example if there is a large group of cancerous cells located around the bowel. But again chemotherapy is the key treatment as it is good at targeting several different parts of the body at the same time.
In myeloma plasma cells become cancerous. Normally plasma cells produce cells which help fight infection. In myeloma when plasma cells become cancerous they produce too many cells in an unorganised manner, this process occurs all around the body. The cancerous cells can fill up the bone marrow stopping it from working, they can also thin bone and affect the kidneys.
So unlike breast cancer there is no one place where the cancer cells start and progress to form a lump. In myeloma there are typically several different parts of the body affected from the same original problem. Again this is why with myeloma operations are less commonly used to remove cancerous cells as there is not one original lump to remove.
