Scottish Referral Guidelines for Suspected Cancer
7 HAEMATOLOGICAL MALIGNANCIES
7.1 Key Points
Leukaemias : Acute and Chronic
Approximately 560 adult cases p.a. (all types) in Scotland.
75% occur in patients aged over 60 years, but all ages can be affected.
Risk factors include previous chemotherapy/radiotherapy and exposure to radiation.
Most cases are diagnosed following a blood count undertaken because of symptoms and/or signs of bone marrow failure (fatigue, pallor, bruising, bleeding, infections, etc).
Some leukaemias may present with lymphadenopathy and/or hepatosplenomegaly.
Chronic lymphocytic leukaemia (CLL) is an indolent disease normally diagnosed on blood film. Cases should be discussed on an individual basis with the local haematologist to decide degree of urgency of referral.
Non Hodgkin's Lymphoma
Approximately 850 adult cases p.a. in Scotland.
65% of cases occur in patients aged over 60 years, but all ages can be affected.
Presenting features include:
Lymphadenopathy
Hepatosplenomegaly
Fatigue
Weight loss
Night sweats
40% present with tumour outside lymph glands.
Hodgkin's Disease
Approximately 130 new cases p.a. in Scotland.
Almost 40% of cases occur below the age of 40 years.
Clinical features similar to those for Non-Hodgkin's lymphomas (but 95% present with lymph gland involvement).
Myeloma
Approximately 310 new cases p.a. in Scotland.
98% of cases are aged over 40 years and 94% are aged over 50 years.
Clinical features include:
Bone pain +/- bone fractures
Symptoms of anaemia
Renal impairment
Symptoms of hypercalcaemia (eg polyuria, polydipsia)
Erythrocyte sedimentation rate (ESR) may be grossly elevated.
7.2 Haematological Malignancies : Guidelines for Urgent Referral
Blood count/film reported as suggestive of acute leukaemia or chronic myeloid leukaemia*.
Lymphadenopathy (> 1 cm) persisting for 6 weeks.
Hepatosplenomegaly in the absence of known liver disease
Bone pain associated with anaemia and a raised ESR.
Bone x-rays reported as being suggestive of myeloma.
Constellation of 3 or more of the following symptoms:
Fatigue,
night sweats
weight loss
itching
breathlessness
bruising
recurrent infections
bone pain
polyuria and polydipsia
* will normally be picked up in the laboratory and communicated immediately to GP for management to be agreed