{"id":27127,"date":"2026-03-03T13:29:53","date_gmt":"2026-03-03T13:29:53","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=27127"},"modified":"2026-04-02T15:27:37","modified_gmt":"2026-04-02T14:27:37","slug":"haematological-cancers","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/haematological-cancers\/","title":{"rendered":"Haematological Cancers"},"content":{"rendered":"\n<p>Please see the <a href=\"https:\/\/www.rightdecisions.scot.nhs.uk\/scottish-referral-guidelines-for-suspected-cancer\/haematological-cancers\/\" target=\"_blank\" rel=\"noreferrer noopener\">haematology section<\/a> of the <a href=\"https:\/\/www.gov.scot\/binaries\/content\/documents\/govscot\/publications\/advice-and-guidance\/2025\/08\/scottish-referral-guidelines-suspected-cancer-2025\/documents\/scottish-referral-guidelines-suspected-cancer-2025\/scottish-referral-guidelines-suspected-cancer-2025\/govscot%3Adocument\/scottish-referral-guidelines-suspected-cancer-2025.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Scottish Referral Guidelines for Suspected Cancer<\/a> for more detail.<\/p>\n\n\n\n<p>There are 3 main groups of haematological cancers, with many subtypes. They are generally commoner in older people, but can occur any age, with some, such as Hodgkin\u2019s Lymphoma, being commoner in young adults:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Leukaemias (acute and chronic) &#8211; 70% are usually diagnosed in people aged \u2265 60, though any age can be affected<\/li>\n\n\n\n<li>Lymphoma:<ul><li>Non-Hodgkin\u2019s \u2013 75% aged \u2265 60<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>Hodgkin\u2019s \u2013 almost half diagnosed aged &lt;40<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Multiple myeloma \u2013 most in those aged \u2265 60.<\/li>\n<\/ul>\n\n\n\n<p><strong><u>Please note in terms of presentation and diagnosis<\/u><\/strong>:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Chronic Lymphocytic Leukaemia (CLL) is the commonest leukaemia in adults &#8211; often an indolent disease with the incidental finding of asymptomatic lymphocytosis.&nbsp; Please see advice on assessing <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/lymphocytosis\/\" target=\"_blank\" rel=\"noreferrer noopener\">lymphocytosis<\/a>.<\/li>\n\n\n\n<li>Myeloma is a difficult cancer to identify, especially in its early stages, often presenting with vague symptoms which could also have many other alternative causes. For key symptoms and assessment advice, see the <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/myeloma-and-mgus\/\" data-type=\"page\" data-id=\"27481\" target=\"_blank\" rel=\"noreferrer noopener\">myeloma <\/a>page.\u00a0 <span style=\"text-decoration: underline\">If blood tests are normal, myeloma is unlikely and other causes of the symptoms should be considered, including HIV<\/span>.\u00a0 There is a higher incidence of myeloma in people of black ethnicity.\u00a0<\/li>\n\n\n\n<li>MGUS (monoclonal gammopathy of undetermined significance) &#8211; Isolated paraproteins are a common incidental finding in the elderly and are not a blood cancer.\u00a0\u00a0 See the <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/myeloma-and-mgus\/\" data-type=\"page\" data-id=\"27481\" target=\"_blank\" rel=\"noreferrer noopener\">myeloma <\/a>and <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/paraprotein\/\" target=\"_blank\" rel=\"noreferrer noopener\">paraprotein<\/a> pages for further advice.<\/li>\n\n\n\n<li>Baseline tests and investigations should be repeated if a person\u2019s condition remains concerning and unexplained following investigation for other causes \u2013 combined with safety netting advice for the patient<\/li>\n\n\n\n<li>Splenomegaly can be identified on imaging (e.g. USS or CT abdomen).<\/li>\n<\/ul>\n\n\n\n<p><strong>Other blood cancers<\/strong><\/p>\n\n\n\n<p>Further information on less common cancers such as myeloproliferative neoplasms and myelodysplastic syndromes can be found via <a href=\"https:\/\/bloodcancer.org.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">Blood Cancer UK<\/a> or <a href=\"https:\/\/www.cancerresearchuk.org\/about-cancer\/blood-cancers\" target=\"_blank\" rel=\"noreferrer noopener\">Cancer Research UK<\/a> resources, and via the Ref Help guidelines for <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/thrombocytosis\/\" target=\"_blank\" rel=\"noreferrer noopener\">thrombocytosis<\/a> and <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/polycythemia\/\" target=\"_blank\" rel=\"noreferrer noopener\">polycythaemia<\/a>.<\/p>\n\n\n\n<p><strong>NS &amp; CM 6\/3\/26<\/strong><\/p>\n\n\n\n<p><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidance<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><strong><em>Please also see the guidance about the individual haematological cancers for more detail. Patients can be referred to the Western General Hospital or St John\u2019s.<\/em><\/strong><\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Who to refer<\/strong><\/h4>\n\n\n\n<p><strong><span style=\"text-decoration: underline\"><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">EMERGENCY SAME DAY REFERRAL \u2013 please phone haematology on call:<\/mark><\/span><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Blood count\/film reported as suggestive of Acute Leukaemia or Chronic Myeloid Leukaemia (CML)<\/mark><\/li>\n\n\n\n<li><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Blood tests or imaging suggestive of myeloma with significant acute kidney injury<\/mark><\/li>\n<\/ul>\n\n\n\n<p><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">If malignant spinal cord compression is suspected please refer via the<\/mark> <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/oncology\/malignantspinalcordcompression\/\" target=\"_blank\" rel=\"noreferrer noopener\">Malignant Spinal Cord Compression pathway<\/a>.<\/p>\n\n\n\n<p><span style=\"text-decoration: underline\"><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\"><strong>Refer to haematology as Urgent Suspicious of Cancer<\/strong>:<\/mark><\/span><\/p>\n\n\n\n<p><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\"><span style=\"text-decoration: underline\">A Lymphocyte count &gt;5 x 109 \/l and any of the following features:<\/span><\/mark><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">weight loss, fever, or drenching night sweats<\/mark><ul><li><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">lymphadenopathy and\/or splenomegaly<\/mark><\/li><\/ul><\/li>\n\n\n\n<li><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">cytopenia (haemoglobin less than 100 g\/l, neutrophils less than 1.0 x 109 \/l, platelets less than 100 x 109 \/l).<\/mark><\/li>\n<\/ul>\n\n\n\n<p><span style=\"text-decoration: underline\"><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Multiple myeloma<\/mark><\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">The patient has one or more CRAB criteria (raised corrected calcium, unexplained renal impairment, unexplained anaemia, or bone pain)<\/mark><\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">AND test results suggest that suggest the diagnosis: raised paraprotein bands, or abnormal serum Free Light Chain ratio, or urinary Bence Jones proteins.<\/mark><\/li>\n<\/ul>\n\n\n\n<p><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Generalised lymphadenopathy particularly with systemic upset (e.g. drenching night sweats or unintentional weight loss) and\/or hepatomegaly and\/or splenomegaly \u2013 please also see the<\/mark> <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/lymphadenopathy\/\" target=\"_blank\" rel=\"noreferrer noopener\">lymphadenopathy<\/a> <mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">page.<\/mark><\/p>\n\n\n\n<p><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Unexplained isolated lymphadenopathy (2 cm or more in size, persisting for six weeks or more, or increasing in size, or with size-significant lymphadenopathy&nbsp;AND drenching night sweats, weight loss, fever, alcohol-induced pain) as a USC. See<\/mark><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/lymphadenopathy\/\" data-type=\"page\" data-id=\"4102\"> <\/a><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/lymphadenopathy\/\" data-type=\"page\" data-id=\"4102\" target=\"_blank\" rel=\"noreferrer noopener\">lymphadenopathy<\/a> <mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">guidance for more advice about who to refer.<\/mark><\/p>\n\n\n\n<p><strong><u>For patients not meeting USC pathway criteria<\/u><\/strong><\/p>\n\n\n\n<p>Patients with <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/lymphadenopathy\/\" target=\"_blank\" rel=\"noreferrer noopener\">lymphadenopathy<\/a>, <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/lymphocytosis\/\" target=\"_blank\" rel=\"noreferrer noopener\">lymphocytosis<\/a>, &nbsp;or <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/paraprotein\/\" target=\"_blank\" rel=\"noreferrer noopener\">paraproteins<\/a>&nbsp;without the additional features for USC referral can be managed as per RefHelp guidelines.<\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Please see the haematology section of the Scottish Referral Guidelines for Suspected Cancer for more detail. There are 3 main groups of haematological cancers, with many subtypes. They are generally commoner in older people, but can occur any age, with some, such as Hodgkin&rsquo;s Lymphoma, being commoner in young adults: Please note in terms of<\/p>\n","protected":false},"author":7,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[],"class_list":["post-27127","page","type-page","status-publish","hentry"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"aparnaamanna","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/aparnaamanna\/"},"rttpg_comment":0,"rttpg_category":false,"rttpg_excerpt":"Please see the haematology section of the Scottish Referral Guidelines for Suspected Cancer for more detail. There are 3 main groups of haematological cancers, with many subtypes. They are generally commoner in older people, but can occur any age, with some, such as Hodgkin&rsquo;s Lymphoma, being commoner in young adults: Please note in terms of","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/27127","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=27127"}],"version-history":[{"count":5,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/27127\/revisions"}],"predecessor-version":[{"id":27499,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/27127\/revisions\/27499"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=27127"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=27127"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}