GPAtlas🧭 When to suspect
"Blood cancer" (haematological cancer) is an umbrella term for malignancies of the blood, bone marrow and lymphatic system. The three a GP must recognise are leukaemia (clonal proliferation of immature white cells crowding out the marrow), lymphoma (Hodgkin and non-Hodgkin, arising in lymphoid tissue), and multiple myeloma (a malignant plasma-cell disorder). Together they account for around 40,000 new UK diagnoses each year, yet the early symptoms are notoriously vague and easily attributed to something benign.
The value a GP adds is pattern recognition and acting on the correct timescale set out in NICE guideline NG12 (Suspected cancer: recognition and referral). Three patterns are worth committing to memory: marrow failure (anaemia + bleeding + infection) points to leukaemia; persistent lymphadenopathy with "B symptoms" (drenching night sweats, unexplained weight loss and persistent fever) points to lymphoma; and persistent bone or back pain in someone aged 60 and over points to myeloma. A small number of presentations are true emergencies (see Red Flags) and must never be missed.
| Blood cancer | Typical primary-care presentation | First primary-care action |
|---|---|---|
| Leukaemia | Pallor, persistent fatigue, unexplained fever or recurrent infection, unexplained bruising / bleeding / petechiae, hepatosplenomegaly | Very urgent full blood count (FBC) within 48 hours. A child with petechiae or hepatosplenomegaly needs immediate specialist assessment |
| Lymphoma (Hodgkin & non-Hodgkin) | Unexplained lymphadenopathy ± splenomegaly, B symptoms, pruritus; alcohol-induced lymph node pain (classic Hodgkin) | Suspected cancer pathway (2-week-wait, 2WW) referral in adults; children → very urgent (48-hour) specialist referral |
| Multiple myeloma | Age ≥ 60 with persistent bone pain (especially back) or unexplained fracture; features of CRAB (below) | Bloods: FBC, calcium, ESR or plasma viscosity, and serum free light chains; very urgent tests if hypercalcaemia / leukopenia; 2WW referral if results suggest myeloma |
Throughout, CRAB is the shorthand for the end-organ damage of myeloma: hyperCalcaemia, Renal impairment, Anaemia and Bone lesions.
Source: NICE NG12
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