Hemato-Oncology: Understanding Blood Cancers & Bone Marrow Disorders

How blood diseases behave differently

What makes blood cancers unique?

Unlike solid tumors, blood cancers:

• Affect the bone marrow — where blood is made
• Circulate throughout the body
• Can change blood counts dramatically
• Often require close monitoring and repeated tests

Because the disease lives in the bloodstream and marrow, symptoms can appear in many different ways — fatigue, infections, bone pain, or falling counts.

Why counts keep dropping despite transfusions

Many patients expect blood transfusions to “fix the numbers.” But transfusions are temporary support — not a cure.

Think of your blood like a supermarket’s apple supply: fresh apples keep coming in, customers keep taking them away, and a transfusion is like restocking the shelf. But if the farm isn’t sending enough apples, or customers are taking them too fast, the shelf will empty again.

Unless we treat the underlying cause, transfusions will only give temporary improvement. This is why doctors focus on diagnosing the reason behind low counts — not just repeatedly correcting numbers.

When back pain is more than just aging

Persistent low back pain can sometimes be an early sign of multiple myeloma — a type of blood cancer that affects plasma cells in the bone marrow. Myeloma often goes undiagnosed for months because symptoms are mistaken for normal aging.

Red flags include: back pain that doesn’t improve with medication, pain that worsens at night, unexplained fatigue, and frequent infections.

In myeloma, the cancer weakens bones by creating “holes” called lytic lesions, making fractures more likely. It can also affect kidney function due to abnormal proteins and high calcium levels. Persistent pain plus fatigue should never be ignored. Early detection can prevent serious complications.

How blood cancers can hide (sanctuary sites)

Why some cancers return even after treatment. Some blood cancers can hide in areas where treatment drugs don’t easily reach — sometimes called “sanctuary sites,” such as: brain and spinal fluid (CNS), testes, and deep marrow spaces.

Even when blood reports look normal, tiny amounts of disease may remain hidden. This is one reason treatments are planned in phases and follow-up is essential.

Microscopic residual disease (MRD)

When tests look normal but disease may still exist. Modern tests can detect extremely small numbers of cancer cells that regular tests cannot see. This is called Minimal / Microscopic Residual Disease (MRD).

It explains why treatment continues even after remission, why doctors monitor patients closely for years, and why relapse can happen even after good responses. MRD is one of the most important concepts in blood cancer care today.

Common questions patients ask