Radiology in Blood Cancer: Imaging Techniques, Diagnosis, & Treatment Monitoring

Blood cancer is considered the fifth most death-causing cancer in the world. According to research in 2020, around 1.3 million people were diagnosed with blood cancer worldwide. Blood cancer accounts for 8.2% of all types of cancers. The average rate of people getting diagnosed with blood cancer is 5.5 cases per 1 lakh people in India. In 2023, an estimated 80,000 people were diagnosed with blood cancer. This statistical data raises concerns about better treatment as soon as possible. But for an effective treatment option, it is crucial to diagnose it at early stages. Radiology plays a key role in diagnosis and prognosis before, during, or after the treatment.

Why Radiology is Critical in Blood Cancer

Radiology plays a critical role in the diagnosis, staging, treatment planning, and follow-up of all types of blood cancers, which include Leukemia, Lymphoma, and Multiple myeloma. Although blood cancers primarily affect the bone marrow and lymphatic system, radiological imaging is essential in assessing the extent of the disease and detecting complications. Not only early and proper diagnosis, but it also helps in the visualization of internal structures of the body, including bone marrow and lymph nodes, to detect abnormalities related to blood cancer.
However, the question arises, what is the use of biopsies different from imaging diagnostic tests? Also, when imaging & biopsies must be used.

Imaging vs. Biopsy: When and Why

Both imaging and biopsy are essential diagnostic tools, but they serve different roles, especially when it comes to diagnosing and monitoring blood cancer. Understanding when and why each is used helps doctors to make decisions regarding treatment and tests.

Imaging Test: Imaging is diagnostic techniques that provide visual reports of the internal structure of the body. These include tools like X-ray, CT (computed tomography) scans, MRI (magnetic resonance imaging), PET (positron emission tomography) scans, and ultrasound.

They are used in primary screening and interpretation of cancer size and stage. Plus, they provide rapid results, lower risk, and an overview of body structure.

Biopsy: A biopsy includes the removal of a small sample of tissue from a suspected area. It is then further analyzed under a microscope. It is used when imaging tests don't provide the expected results. A biopsy is done to diagnose the exact cancer type. It also enables the doctor to decide on additional therapy methods.

Advantages of Radiological Approaches

Radiology has several advantages in the diagnosis and treatment of blood cancer. Certain of them are outlined below:

• Versatile process
  
• Painless procedure
  
• Non-invasive diagnosis
  
• Early detection of cancer
  
• Cost-effective and rapid results
  
• Monitoring Treatment Response
  
• Guidance for medical procedures
  
• Establishing Severity and Prognosis
• Treatment of blood vessel diseases and tumors

Imaging Techniques Used

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• X-ray: It is used in the Initial Assessment of cancer diagnosis like leukemia. X-ray is useful in detecting bone lesions and chest inflammation.
  
• CT Scans: A CT scan will employ an X-ray to give images of surrounding parts of the liver. It shows detailed cross-sectional images for evaluation of Lymph Node and organs where the chances of spreading cancer are high.
  
• MRI: An MRI scan helps to find out the presence and location of cancer cells in the spinal cord and brain. A dye is introduced into a vein to show the blood vessels in more depth. It shows duct blockage and the affected areas of cancer cells.
  
• PET-CT: It is frequently done together with a CT scan. It is done for staging and monitoring blood cancers, like leukemia and lymphoma. It helps visualize the spread of cancer and its extent on the body by combining it with details from a CT scan.
  
• ​Ultrasound: Ultrasound scans employ sound waves to determine the size and location of tumors. This scan shows how cancer cells proliferate. It is used to examine organs such as the spleen and liver.
• Nuclear Medicine scans: This scan includes gallium scans and PET scans. It uses radioactive tracers to visualize the body's tissues and organs, helping doctors identify areas of increased metabolic activity or abnormal cell growth, which can indicate cancer or infection.

Overview of Blood Cancer Types (Leukemia, Lymphoma, Myeloma)

Blood cancer is divided into different categories. The type of blood cell impacted determines the outcome. Blood and bone marrow cancer is classified into three types:

1. Leukemia: It can be caused by genetic alterations in bone marrow cells. People over the age of 60 are at an increased risk of developing this condition. The various kinds of leukemia are listed below:

• Acute Lymphocytic Leukemia: It is the most common type of blood cancer that mostly affects children. Some incidences of this condition can affect adults. This condition is caused by an abnormal synthesis of white blood cells, or leukocytes, by the bone marrow.
• Acute Myelogenous Leukemia: This cancer primarily affects adults aged 40 to 60. This condition affects men more than women. Acute myelogenous leukemia develops when the bone marrow produces immature white blood cells in an uncontrolled manner.
• Chronic Lymphocytic Leukemia: People over the age of 55 are more likely to get this disease. This disease is infrequently found in children and adolescents. Gender is considered a risk factor since males are more likely to develop this blood malignancy. This malignancy grows over time as aberrant WBCs are created.
• Chronic myelogenous leukemia: This form of cancer is diagnosed in its advanced stages. This condition develops gradually, thus there are no noticeable signs in the early stages. This condition predominantly affects the elderly.​

2. Lymphoma: It is characterized by uneven cell growth in the lymphatic system. This system is critical to the human body's ability to fight infections and illnesses. This system involves several organs, including bone marrow, lymph nodes, the thymus gland, and the spleen. There are two types:

• Non-Hodgkin Lymphoma: This disease targets a type of white blood cell present in the lymphatic system. The primary function of white blood cells is to fight infections within the body.
  
• Hodgkin Lymphoma: This disease targets a type of white blood cell present in the lymphatic system. White blood cells' major role is to combat infections in the body.
  
  

3. Myeloma: Also known as multiple myeloma and plasma cell myeloma. Myeloma occurs when plasma cells continue to grow uncontrollably. This disorder interferes with the normal creation of antibodies, weakening the immune system. It prevents red and white blood cells from developing normally. These aberrant changes include kidney injury, fractures, and bone deterioration.

Radiological Findings in Different Blood Cancers

Radiological findings vary in different blood cancers, like leukemia and lymphoma. It varies according to the type and stage of cancer. Imaging studies like CT scans, MRI, and PET scans are used to detect and monitor these cancers. A few specific details are discussed below:

Leukemia Imaging Features: Leukemia is characterized by abnormal growth of WBCs from bone marrow in blood. Some essential radiological imaging modalities help detect issues during treatment operations. They include X-ray, CT scan, Magnetic Resonance Imaging (MRI), Ultrasound, and Positron Emission Tomography (PET).

Some imaging features are discussed below:

• Leukemia affects bone marrow which leads to skeletal abnormalities and loss of bone density.
  
• Chest inflammation and body fluid infection, enlarged lymph nodes are the chest imaging findings.
  
• MRI scan for brain and spinal cord lesions growth or meningeal infection.
• Ultrasound and CT scans detect lymph nodes and soft tumor formation in other body parts.

Myeloma Radiographic Signs: Multiple myeloma is a cancer in plasma cells that affects bone marrow. Skeletal abnormalities and bone lesions are common findings in multiple myeloma. Some Radiographic Signs in Multiple Myeloma are:

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• Bone loss is visualized in the skull, spine, ribs, pelvis, and long bones.
  
• Osteoporosis (loss of bone density) is seen in the spine and pelvis.
  
• Weak bones and fractures are visualized.
  
• MRI and CT scan helps to distinguish between benign and malignant fractures.
  
• Inflammation of Ribs, femur, and vertebrae is monitored via CT scan and X-ray.
• X-ray detects for "raindrop" appearance on the skull X-ray.

Lymphoma Imaging Patterns: Lymphoma is a kind of blood cancer affecting the lymphatic system. It is classified into two types: Hodgkin's lymphoma (HL) and non-Hodgkin lymphoma. Radiological imaging in lymphoma is listed below.

• The CT scan is utilized to confirm the stage and for post-treatment follow-up.
  
• PET-CT scan detects stage and treatment response.
  
• MRI is used to assess the extent of malignancy in the CNS and brain.
• Ultrasound detects evaluation of superficial nodes and abdominal.

Radiology in Staging and Prognosis

Radiology plays a crucial role in the staging and prognosis of blood cancers such as leukemia, lymphoma, and multiple myeloma. It allows physicians to evaluate the extent of disease, affected organ, monitor treatment response, stage determination and patients outcome. It also helps to monitor insights of treatment response in patients body. Tools like CT, MRI, and especially PET-CT not only help to decide further treatment but also help to evaluate risk therapies and treatment outcomes.

How Imaging Helps Determine Disease Extent: Radiology imaging allows physicians to detect cancer extent size and specific affected organs. It helps answer critical questions: How far have the cancer cells spread? Is the body responding to treatment? What is the patient’s condition? A CT scan helps to detect enlarged lymph nodes and MRI provides a high-resolution image of bone marrow, spinal cord, and part of the CNS. It also detects the affected number of lymph nodes and cancer cell distribution.

Advanced stages include inflammation in the Liver, spleen, lungs, GI tract, kidneys, brain, and bone marrow, which is detected via CT scan and ultrasound. Imaging findings are further associated with a correlation between response to treatment and risk during prognosis.

Role in Treatment Planning: Radiology not only helps in detecting the stage of cancer but also helps to plan treatment. By providing detailed information about disease extent, location, and response to therapy, imaging test helps clinicians to make important decisions on what type of treatment should be given.

For instance, early-stage cancer needs more localized treatment (radiotherapy or short-course chemotherapy), whereas Advanced-stage needs systemic therapy (multi-agent chemotherapy, immunotherapy, or stem cell transplant).

• Monitoring Response to Therapy: Radiological imaging serves as essential to evaluating patients' response to treatment. It helps in the evaluation of how well the disease is responding to treatment. It provides insights into how cancer cells are damaged by treatment and how the body responds to treatment. PET-CT and MRI help to detect treatment effectiveness. Now the question is Why Monitor Response with Imaging? So, the answer is:

1. Assess treatment effectiveness
   
2. Predict prognosis and survival
   
3. Detect incomplete response or progression
4. Guide modifications or any adjustment in therapy
5. Detect early regeneration if any

Risks and Safety in Repeated Imaging

Repeated radiological imaging carries potential risks from radiation exposure. It is quite common among patients who undergo frequent scans over a prolonged period. Repeated exposure to high levels of radiation may increase the risk of acquiring for a long time cancer.

• It may also result in severe reactions and neural disorders.
  
• Children are more vulnerable to radiation, which may lead to cancer recurrence.
• Radiation in pregnant women may affect fetal development.

Safety Measures and Risk Reduction Strategies

• Use of minimum radiation
  
• Less use of MRI and ultrasound
  
• Low-dose CT use
  
• Protection to organs
• Avoid unnecessary repetition

Frequently Asked Questions

Q. What is Blood Cancer?
A. Blood cancer is identified by the fast and abnormal growth of blood cells from the bone marrow.

Q. What is the role of Radiology in Blood cancer?
A. Radiology in blood cancer helps to diagnose, visualize, monitor, interpret, and helps to decide the treatment.

Q. What is Radiology?
A. It is a branch of medicine that includes imaging techniques to visualize and monitor throughout the process from diagnosis to treatment of cancer-like diseases.

Q. What is the difference between Radiology and Diagnosis?
A. They are both relatively similar but distinct. Radiology includes imaging techniques (like X-rays, MRI, and CT scans) to create images of the body and monitor the disease whereas the diagnosis is the detection process of disease by considering signs and symptoms.

Conclusion

From diagnosing cancer to treating it, visualization and detection is crucial. It helps physicians detect cancer stages, plan treatment, body response to treatment, modification in therapy, and follow-up care. Through advanced imaging technologies, radiology supports more personalized and effective treatment planning. By identifying disease location, stage, burden, and treatment response, radiology ensures that therapies are tailored to individual patient needs. It also further helps in deciding cancer treatment, which is available on Magicine Pharma. We are an online pharmacy known for supplying cancer medicine worldwide. Just visit the website and talk to our experts about all your concerns.

Reference

https://www.worldwidecancerresearch.org/information-and-impact/cancer-myths-and-questions/what-isbloodcancerandwhydoweneedmoreresearch/#:~:text=Blood%20cancers%20are%20the%20fifth,But%20what%20are%20blood%20cancers?
https://www.thehindu.com/news/national/andhra-pradesh/majority-of-blood-cancers-are-curable-with-advanced-technology-says-expert/article66900614.ece
https://www.nfcr.org/cancer-types/cancer-types-blood-cancer/
https://www.cancer.gov/types/lymphoma#:~:text=Lymphoma%20is%20a%20broad%20term,depends%20on%20the%20specific%20type
https://pmc.ncbi.nlm.nih.gov/articles/PMC7217155/