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.
• 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.
• Persistent bone or back pain in someone aged 60 and over points to myeloma.
A small number of presentations are true emergencies 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 or 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 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, serum protein electrophoresis and serum free light chains • Suspected cancer pathway 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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