HEMATO-ONCOLOGY

Hemato-Oncology is the field that takes care of Blood Cancers. It is a part of Hematology. Hematologists are experts in this field. Common blood cancers are AML – Acute Myeloid Leukemia, ALL – Acute Lymphoid Leukemia, CML – Chronic Myeloid Leukemia, CLL – Chronic Lymphocytic Leukemia, Multiple Myeloma, Hodgkin’s Disease, Non Hodgkin’s Lymphoma and others.

Blood cancers are considered separate from other cancers, due to following reasons:

• Their diagnosis and treatment is very different from other common cancers, such as breast, lung etc. Diagnosis requires very high expertise, experience, and special tests like flow cytometry, cytogenetics, FISH, PCR and other molecular tests. There are very few pathologists who focus in this field.
• They are treated using various medicines. Surgery, and radiotherapy are rarely needed unlike other cancers.
• Treatment in most cases, has to be started fast. Delay can result in death, or some major disability. Frequently, patients are admitted on the day of diagnosis and treatment is started. In other cancers, this can commonly wait for 1-3 weeks for various planning purposes, such as good surgery or radiotherapy etc.
• Cure rates are very high in many cases, up to 80% or more.
• Blood cancers which have spread to many parts of body can also be frequently cured, such as lymphoma or leukemia. Most other cancers cannot be cured once spread to other parts of body.
• Treatment is frequently aggressive, with risk of unique complications. These can be prevented or handled only by properly trained experts.
• Treatment requires special ward and facilities, as these patients frequently have low immunity and other special needs during and after treatment. Such as need for isolation ward, staff sensitive to infection prevention, blood bank equipped to provide specialized blood products, laboratory (hematology, microbiology…), and more. Also, multispecialty support is important such as infectious disease specialists, hospitalists, nephrologists and others.
  There are very few dedicated hemato-oncology units all over India.
• Post treatment care is also different for these patients. Many of these patients can be cured by Bone Marrow Transplant / Stem Cell Transplant, if disease comes back. Hence, early diagnosis of recurrence is important.
• Children with blood cancers have especially high cure rates. However, their needs are very different from adults, and require understanding of these issues and a different approach.
• Finally, some blood cancers are very slow growing, and need no or minimal treatment only. This requires understanding to ensure excessive treatment is not done, and patients are reassured properly. Such as CLL – chronic lymphocytic leukemia or Follicular lymphoma, in many cases is observed without any treatment for a long time, OR CML – chronic myeloid leukemia, which can be treated with just one tablet without any hospitalization in many cases.

Physicians who specialize in hematology are known as Hematologists. Their routine work mainly includes the care and treatment of patients with hematological diseases, although some may also work at the hematology laboratory viewing blood films and bone marrow slides under the microscope, interpreting various hematological test results and blood clotting test results. In some institutions, hematologists also manage the hematology laboratory. Physicians who work in hematology laboratories, and most commonly manage them, are pathologists specialized in the diagnosis of hematological diseases, referred to as hematopathologists. Hematologists and hematopathologists generally work in conjunction to formulate a diagnosis and deliver the most appropriate therapy if needed. Hematology is a distinct subspecialty of internal medicine, separate from but overlapping with the subspecialty of medical oncology. Hematologists may specialize further or have special interests, such as few choose to work in field of Bone Marrow Transplant or Stem Cell Transplant.