Throughout your treatment you will be cared for by a number of specialist health care providers including

• Consultant Haematologist – Specialist doctors who look after and investigate conditions that are associated with blood and bone marrow disorders. They will diagnose your condition and decide on the best treatment plan for you.
• Non Consultant Hospital Doctors (NCHD’s) – these are doctors undergoing higher training, including many training to be consultant haematologists who will help assess and treat you.
• Advanced Nurse Practitioner (ANP) – An ANP is a senior nurse who has specialised in one area through education and research. They can assess and prescribe treatments for you as needed.
• Clinical Nurse Specialist (CNS) – A CNS is a senior nurse who has specialised in one area. They can provide you with education and information about your condition and treatment.  They can provide a link for you between hospitals if needed as part of your treatment plan.  They can help to link you in with other services and provide emotional support for you and your family members.
• Acute Haematology Oncology Nurse (AHOS) – An AHOS is a senior nurse who has specialised in Haematology Oncology. They will help you if you are feeling unwell or experiencing side effects of your treatment at home.
• Research nurse – if you are participating in a clinical trial your research nurse will guide you through this process.
• Palliative care team – the palliative care team can help you throughout your cancer treatment as needed, not just at end of life. They are focused on the management of symptoms that are the result of your cancer or treatment.
• Psych-Oncology team – receiving a cancer diagnosis and undergoing treatment can be a difficult time not just physically but mentally. The psych oncology team can support you through this process.
• Medical Social Worker – the medical social worker can help you face the financial impact of your cancer diagnosis. They can also help with planning your discharge when it is time to go home from hospital and support you emotionally throughout your cancer treatment.
• Physiotherapist and Occupational Therapist – These team members often work together to help you go about your day to day activities to the best of your ability.
• Dietician – you may experience changes in your appetite and as a result need a dietician to give advice and information about your diet.
• Hospital Pharmacist – They help by ensuring your medications are right for you.

We use various techniques to determine your diagnosis; some of these techniques are discussed below. You may undergo one or all of these tests.  Also, some of these tests are carried out before you have any treatment to determine your level of fitness for different treatments.  Others may be carried out before, during and after your treatment to determine how effective treatment has been.

• Medical history and Physical examination – doctors can tell a lot by asking you about your general health and symptoms prior to your visit with them. They may also feel your lymph nodes in your neck, armpits and groin and palpate your abdomen to examine your liver and feel your spleen.
• Blood tests- as haematology is the study of blood, a haematologist can tell a lot from your blood results. Both by laboratory testing and examining it under a microscope.  We can also test for genetic changes or cancer markers in your blood depending on your condition.
• Ultrasound – a small probe is covered in gel and moved over the area of your body that needs to be examined. Using high frequency sound waves a picture of the inside of that part of the body can be created.
• Electrocardiograph or ECG – small sticky pads are placed on your body and then connected to a machine which measures your heart rate, rhythm and electrical activity. This can then be printed on graph paper for your doctor to read.
• Echocardiograph or Echo – this is an ultrasound of your heart and surrounding blood vessels. The muscle and valves of your heart can be seen and a doctor can determine how well this is working.
• Pulmonary Function Test or PFT – this is a breathing test that measures how well your lungs are working. It involves you inhaling and exhaling deeply as guided by the technician while holding a mouth piece in your mouth that is connected to a machine recording the results.
• X-Ray – is when an image is created of a part of body by passing electromagnetic radiation through it. By using X-ray doctors can examine many parts and bones in the body.
• Computed tomography scan or CT scan – in this type of scan you lie on a bed that passes through a ring type scanner. Several  x-rays can be taken at once giving a more detailed picture of inside your body
• Magnetic resonance imaging scan or MRI – this scan uses radio waves and strong magnetic fields to produce detailed images of your body. You will need to lie flat and pass through a long tube to get this scan.  Depending on the size of the area being scanned it can take up to one hour.  This scanner can also be quite noisy.  It is important that you tell your doctor if you have difficulty being in confined spaces or have any metals in the body before undergoing this scan.
• PET-CT or Positron Emission Tomography scan – you will be injected with a glucose solution that has a radioactive dye in it. Cancer cells are ‘greedy’ and will try to take in all of the sugar solution taking with it the radioactive dye.  This radioactive dye can then be seen on the images highlighting where in the body your cancer is on the scan images.  You will be given instructions on what you should and shouldn’t do on the day of your scan.
• Lymph node biopsy/excision – a piece or all of an affected lymph node can be taken by surgical procedure. This will then be tested in the laboratory to determine if cancer is present and also the type of cancer that you may have.
• Bone marrow biopsy – this procedure can be performed on the ward you are admitted on or in our day ward, CKB. During this procedure you will be asked to lie on your side and your hip bone exposed.  You will be given a local anaesthetic, after which a needle will be inserted into the spongy marrow inside your bone.  Some of this spongy tissue may be taken as well as some of the blood in the marrow.  These can then be sent to the laboratory for various different tests which can tell us what type of cancer you have and how best to treat it.  You can go home after this procedure but it is best to have someone else drive you.
• Lumbar puncture – this procedure can be carried out on the ward you are admitted on or in our day ward, CKB. During this procedure you will be asked to lie on your side with your knees high to your chest or to sit up and lean over a table.  The doctor will give you some local anaesthetic and then insert a very fine needle into the spinal canal below your spinal cord to remove some spinal fluid.  This fluid will be sent to the laboratory to determine if cancer has moved into this space.  Also frequently during this procedure chemotherapy is injected into this space as treatment/prevention.

Leukaemia is cancer of the white blood cells.  The cells do not develop correctly, instead they take up space in your bone marrow reducing the development of healthy cells.  You begin to feel unwell as you do not have enough healthy cells to give you energy or protect you from bleeding and infection.

There are four main types of leukaemia.  They are named after the cell affected and the speed of their development.  Acute leukaemia develops very quickly over a period of days or weeks whereas chronic leukaemia develops very slowly over many months or years.  You can find out more about your type of leukaemia following the links below to the Irish Cancer Society website.

Acute Myeloid Leukaemia AML   https://www.cancer.ie/cancer-information-and-support/cancer-types/acute-myeloid-leukaemia-aml

Acute Lymphoblastic leukaemia ALL  https://www.cancer.ie/cancer-information-and-support/cancer-types/acute-lymphoblastic-leukaemia-all

Chronic Myeloid Leukaemia CML  https://www.cancer.ie/cancer-information-and-support/cancer-types/chronic-myeloid-leukaemia-cml

Chronic Lymphoblastic Leukaemia CLL  https://www.cancer.ie/cancer-information-and-support/cancer-types/chronic-lymphocytic-leukaemia-cll

Lymphoma is cancer of the lymphatic system which is a very important part of your immune system.  Your body makes B lymphocytes and T lymphocytes. These lymphocytes are types of white blood cells that travel around your body through your lymphatic system.  Your lymphatic system runs all over your body like a series of train lines with ‘train stations’ called lymph nodes along the way. In lymphoma you produce far too many of one type of these lymphocyte and they take up lots of space in your lymphatic system.  They can become lodged in your lymph nodes causing noticeable swelling in your neck, armpits or groin, or move into your other organs and tissues.

There are approximately 100 different types of lymphoma, but they can be divided into major groups, Hodgkin lymphoma (HL) and non Hodgkin lymphoma (NHL).  The only way to tell the difference between them is by examining the cells under a microscope.   NHL can be high-grade, i.e. fast-growing, or low-grade i.e. slow-growing. You will find more information on these conditions and subtypes by following the links to the Irish Cancer Society webpage below.

• Hodgkin Lymphoma https://www.cancer.ie/cancer-information-and-support/cancer-types/hodgkin-lymphoma
• Non Hodgkin lymphoma https://www.cancer.ie/cancer-information-and-support/cancer-types/non-hodgkin-lymphoma

Myeloma or sometimes referred to as multiple myeloma is a cancer of your plasma cells.  It is the job of your plasma calls to make antibodies to help fight infections.  However, in Multiple Myeloma your plasma cells over produce poorly developed antibodies called paraproteins.  These paraproteins do not die off naturally and the body can become overwhelmed with them and begins to look for places within the body to store it.  It can take over your bone marrow, reducing your ability to make healthy cells.  These abnormal plasma cells can replace pockets of your healthy bone resulting in weakened bones.  They can also cause damage to the tiny blood vessels in your kidneys causing kidney damage.  Myeloma is not regarded as curable but in most cases is very treatable and there are lots of treatments available.  You will find more information about multiple myeloma at by following the below link to the Irish Cancer Society webpage.

• Multiple Myeloma in Ireland – a patient partnered education resource.
•  More information on Multiple Myeloma https://www.cancer.ie/cancer-information-and-support/cancer-types/multiple-myeloma

AL Amyloidosis is a very rare blood cancer. It is related to myeloma in that it is a plasma cell disease. In amyloidosis, a part of the antibody called light chain becomes misshapen preventing the body from getting rid of it in the normal way. This light chain is then deposited in organs like the kidney and heart. AL Amyloidosis is treated in a similar way to myeloma but specialist involvement is very important as many organs can be affected. if you would like to know more about AL Amyloidosis please see the link below

• AL Amyloidosis https://www.myeloma.org.uk/understanding-myeloma/related-conditions/al-amyloidosis/

Myleoproliferative neoplasms are group blood cancers that can range from being mild, majority of cases, requiring monitoring only to being aggressive and requiring urgent treatment, very rare.  There are three main types of MPN, Polycythaemia Vera (PV), Essential thrombocythaemia (ET), and Myelofibrosis (MF).  Below is a brief explanation of what each of these conditions are however for more detail please visit UK based webpage dedicated to them at https://www.mpnvoice.org.uk/about-mpns

• Polycythaemia Vera is a condition that causes your bone marrow to make far too many red blood cells. This can cause headaches, blurred vision, itching and excessive bleeding or clotting.  If your over production of red blood cells is not corrected it can have devastating effects.  Sometimes PV is used by a change in how your blood cells are being produced, this is a genetic mutation which we can test for in a blood test.  However sometimes PV is secondary and is caused by something reversible, like smoking.
• Essential thrombocythaemia is a condition what causes your bone marrow to produce far too many platelets. Platelets help to form blood clots if you are bleeding.  However too many platelets may mean you developing blood clots that may be harmful.  This can result in you suffering life threatening illnesses such as a stroke or a blood clot in your lung or other large blood vessel.
• Myelofibrosis is a condition where you have too many scar tissue making cells, fibroblasts. They replace your healthy cell making marrow with scar tissue.  As a result you may have lower red blood cells, causing anaemia, white blood cell, increasing your risk of infection or platelet count, increasing your risk of bleeding or bruising.  You can have problems with one or more of these cell types.  

In order to receive your anti cancer therapy you may require a central line.  In haematology we use a variety of types of central lines mainly peripherally inserted central catheter PICC, Hickman lines and Portacaths.  You will find more information on these devices here.

• PICC line https://www.macmillan.org.uk/cancer-information-and-support/treatment/types-of-treatment/chemotherapy/picc-lines
• Hickman line https://www.macmillan.org.uk/cancer-information-and-support/treatment/types-of-treatment/chemotherapy/central-lines
• Portacath https://www.macmillan.org.uk/cancer-information-and-support/treatment/types-of-treatment/chemotherapy/implantable-ports

Some haematological cancers require a stem cell or bone marrow transplant as treatment.  If this is the case your haematology consultant and clinical nurse specialist will discuss this with you when it is appropriate.  Depending on your condition your transplant may be facilitated in Beaumont or you may be transferred to St James Hospital for this portion of your treatment.  The types of transplant you may receive are

• Autologous transplant – in this process you receive your own stem cells. When your cancer has been controlled your stem cells will be harvested from you, stored and then returned to you after you have received more intense treatment.  This whole process takes place over several weeks and stages and you will be given lots of information at all stages.  If you like to know more about this please see the link attached.   https://www.cancer.ie/cancer-information-and-support/cancer-information/cancer-treatments-and-side-effects/stem-cell-transplants/stem-cell-transplants-using-your-own-stem-cells-autologous-transplants
• Allogeneic transplant – in this process you will receive cells that have been donated by a matched sibling or a matched unrelated donor. Your clinical nurse specialist will discuss with you how we determine if your siblings are a suitable match for you.  To receive this treatment your cancer needs to be under control, you will then receive intensive chemotherapy and or radiotherapy followed by the donated stem cells/marrow after a period of time.  This treatment has many stages which takes place over several weeks to months.  You will receive lots of information at each stage from your clinical nurse specialist.   If you like to know more information about allogeneic stem cell transplant please see the link below.  https://www.cancer.ie/cancer-information-and-support/cancer-information/cancer-treatments-and-side-effects/stem-cell-transplants/stem-cell-transplants-using-another-persons-stem-cells-allogeneic-transplants
• CAR-T cell therapy – this treatment is not currently available in Ireland although it may be available in the very near future. This treatment is available to a very small number of lymphoma patients where standard treatments have not been effective.  If you require this treatment you can be referred to London to be assessed for suitability and potentially treatment.  In this treatment your T cells, cells that help fight infection, are harvested. These cells are modified in a laboratory so that they can identify and attack the cancer cells in your body.  You will be given more chemotherapy and then these modified T cells returned to you in order to treat your cancer.  Again this is a lengthy and detailed procedure and you will be given lots of information at every stage however if you would like to know more please follow the link below.  https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/immunotherapy/types/CAR-T-cell-therapy