Should I be concerned about blood cancer?

[Keebee88]

I'm 65 yr old female with osteopenia for 10+years.
  
Have extensive family history of cancer. Mother died of lung/ breast cancer, mother's sister died lung/ breast cancer, mother's brother died throat cancer, one of my brothers has lung cancer x 3 yrs, another brother recently diagnosed with colon cancer, youngest brother has had precancerous polyps but cancer free as far as we know at this time.

I have had basal cell carcinoma surgically removed twice in last 5 years and believe I have another. Appointment with dermatologist in a couple weeks.

In September 2020 I suddenly developed muscle pain, spasms and stiffness in neck, shoulder hips and thigh. By Thanksgiving I could barely walk, rise or sit, I literally had to use my hands to lift my right leg.

In November labs indicated negative for Rheumatoid arthritis but positive for systemic inflammation.

In December 2020 Rheumatologist diagnosed me with Polymyalgia Rheumatica and placed me on 10 mg prednisone daily.

January 2021 labs indicated no inflammation, but high absolute lymphocytes and low VitD.

I created a spreadsheet of all labs since 2017 and a concerning pattern emerged.

Labs that steadily increased:
Absolute lymphocytes - 1752-4099 (high normal=3900)
Carbon dioxide - 28-32 (high normal = 32)
MCHC - 33.0-36. (high normal = 36)
WBC - 4.8-9.6 (high normal = 10.8)

Labs steadily decreased:
Hematocrit - 42.8-36.7. (low normal = 35.0)
RBC - (in 2019) 4.60-4.18 (low normal = 3.80)
VitD - currently 24 (even though I take 1000 i.u. vitD3 daily)

Although my muscle pain and stiffness has resolved, my fatigue, bruising, aching under left ribs, aching in right pelvic, has not resolved.  Also experiencing bouts of shivering lasting 5-10 mins then I'm fine. During all of this -- no fevers.

The labs that are out of range can be caused by inflammation; however, if my latest ESR was 32 in November and now is 9 - indicating no systemic inflammation then why did my labs still go up or down more. Also the aching was said to be part of the muscle inflammation -- that I no longer have!

My fear is not having cancer. My fear is having cancer and not knowing it until it's too late,,, like so many of my family!

I don't want to overreact but I don't want to downplay the possibility of something more serious than PMR or that maybe there is more than one thing going on.

I thinking about asking for a bone marrow biopsy. The worse that can happen is cancer is ruled out. The best that could happen is cancer is confirmed and treatment can begin.

I averaged the changes over the last 8 months and if the pattern continues my RBC, WBC, hematocrit levels will all be out of range within 4-10 mos.

Early detection is key they say but they don't look deeper until a bunch of levels are off at the same time.

My body has been trying to fight something for the past 4 years and I started feeling fatigued and experiencing issues for the past 3 years of which no one could give answers.

Am I crazy or should I push to have them dig deeper for answers?

[Ken_PA]

If you are talking about water weight gain? Then you can call the doc and ask for a diuretic prescription.

Better yet, also go on low salt/sodium. The reason pred makes a person gain water weight is because it causes retention of sodium.

The pred also causes some fat gain.

[Ken_PA]

Hi, first off it doesn't appear that you have a blood cancer. On the slim chance that you do, the likeliest candidate would be CLL. So call your doc today and insist that they order for you the test called a blood smear. (The lab tech looks with a microscope. CLL cells tend to be fragile, so some get damaged when preparing the slide. Those are called smudge cells. The microscope can also see if any red blood cells are misshapen.) Tell the doc that you are extra worried because of your personal and family history and you WANT some peace of mind.

Next, revisit pages on Polymyalgia Rheumatica, and notice they all state that, "we don't know what causes it". That means they don't truly know what it is. It's a mystery condition, which means there is likely something mysterious going on with your immune system. We can discuss that more if you have the motivation.  

I'll suggest to you that there is no such *single* entity as inflammation. It's a heterogeneous thing with lots of possible immune cells and biochemicals involved, in different branches/pathways that are often intertwined. So if ESR is normal, that does not necessarily mean "no systemic inflammation".

Related to the above: you had probably found that NSAIDs didn't help. Different mechanism.

There is no single test for inflammation. Btw, what was your CRP test result? Rheumys always do CRP.


Bruising from blood cancers results from low platelets, which you don't have.


I'm glad that the pred is working for you, but I hope you are very aware of the many side effects. Some strategies exist to counter the sides, and most docs don't know or won't discuss them.


"I thinking about asking for a bone marrow biopsy."
I doubt any doc would order that at this point, but you never know.


Yes, I'd think you should be concerned and not complacent. Not about cancer, but about whether your inflammatory condition is truly progressing and why.

[Keebee88]

Thank you for your response.
I will ask about a blood smear test.

I will try to get off prednisone as I have gotten quite puffy in just 30 days.

Thanks again.