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Getting referred to a medical specialist may make individuals feel nervous, but people should remember that it doesn’t always mean they have cancer. Specialists such as hematologists apply their education to test and treat a wide variety of conditions or rule them out as a possibility.
Hematologists and hematologist-oncologists at Regional Cancer Care Associates (RCCA) have extensive expertise in diagnosing, treating, and managing all types of blood disorders, both malignant and benign. RCCA is a group of more than 90 medical oncologists and hematologists who treat patients who have solid tumors, blood-based cancers and benign blood disorders at more than 20 locations throughout New Jersey, Connecticut, Massachusetts, and the Washington, DC area. They strive to educate patients while providing innovative care.
Here, we discuss what hematologists are, what they do, and what to expect when you meet with one.
A hematologist is a medical specialist who focuses on blood. The name comes from the Greek word heme, which means blood. The specialty looks closely at blood cells and components, blood-forming organs such as bone marrow, and the lymphatic system. It also studies conditions that affect them, including cancers and non-malignant disorders.
All hematologists have completed at least nine years of training, including a three-year residency and a four-year fellowship or subspecialty training. This education gives them an in-depth understanding of blood and blood disorders. They apply this knowledge to provide diagnoses and cutting-edge treatments for a wide range of conditions, helping people understand their needs and get the medical tools they need to feel better.
Hematologists are not the same as oncologists, or cancer doctors. However, many cancer types start in the blood or lymph systems, so there is a natural overlap between the fields. For this reason, some hematologists complete additional training in oncology. These doctors are known as hematologist-oncologists. They are experts in cancers of the blood.
People are referred to a hematologist or oncologist when their primary care physician wants the opinion of a specialist. Which type of doctor is referred to depends on what concerns the primary care physician has:
Seeing a specialist does not mean that the person has cancer. In most cases, the appointment is just for additional testing to clarify an abnormal result or find out the cause of new symptoms. The appointment is more likely to rule out cancer as a possibility. If the patient does have cancer or another serious disorder, then seeing a hematologist or oncologist is the first step toward receiving the treatment they need to get a good outcome.
Hematologists treat blood disorders. This is a broad category that includes a wide range of conditions, not all of which are cancerous. Many blood disorders can be treated with good results. Others are managed long term to allow patients a high quality of life.
Blood cancers are cancers that start in the blood or lymph system. They occur when a single cell develops a DNA mutation that causes it to multiply rapidly. Over time, the mutated cells crowd out healthy ones. The blood loses its ability to perform roles such as fighting infection and transporting nutrients, which are required for full-body function.
Leukemia is a blood cancer that begins in the bone marrow, or the soft tissue inside bones where most blood cells are produced. It causes the marrow to produce abnormal white blood cells (lymphocytes) or red blood cells (myeloid cells). Leukemias can be fast-growing or slow-growing, depending on the type:
Acute leukemias are the most aggressive, but also the easiest to detect. Early identification gives patients an advantage when it comes to treatment. Chronic leukemias, on the other hand, can go for years without causing symptoms. They are harder to detect and diagnose, which can make them harder to treat before they reach advanced stages.
Lymphoma is a blood cancer that begins in the lymph nodes, which are tiny organs that trap and destroy harmful substances such as bacteria and viruses. This condition produces abnormal white blood cells (lymphocytes) that accumulate in the lymph nodes, forming solid growths under the skin. There are two broad categories of lymphomas:
Lymphoma is the most common type of blood cancer overall, although leukemia is more common in children. It also generally has the best survival rates, although the specific prognosis varies depending on the type of lymphoma and the patient’s unique case.
Multiple myeloma is a blood cancer that begins in the bone marrow and affects plasma cells. Plasma cells produce antibodies, which are Y-shaped proteins that attach themselves to foreign invaders. They tell white blood cells which objects are safe and which should be destroyed. When plasma cells become cancerous, they cannot produce antibodies correctly. The body loses its ability to identify and fight disease. Meanwhile, the faulty antibodies build up in the organs, damaging them.
Blood cancers also include a few less common conditions. Myelodysplastic syndrome (MDS) prevents blood cells from fully maturing. This leads to low blood counts (cytopenia), fatigue, and infections. Myeloproliferative neoplasms (MPNs), on the other hand, cause blood cells to overproduce. This leads to thick blood that increases the risk of clots. Both conditions can progress to leukemia.
Not all conditions treated by hematologists are cancerous. Many blood disorders are benign, meaning they do not involve cancer cells and do not spread. While benign disorders can still be serious, long-term outcomes are generally good when patients receive the correct medical care.
Anemia occurs when the body cannot produce enough red blood cells to transport oxygen and nutrients. Over time, the organs are deprived of the materials they need to function, causing symptoms such as fatigue, weakness, and shortness of breath, and in severe cases, there could be eventual organ failure. There are several types of anemia, classified by their cause:
All types of anemia can be managed to reduce their symptoms and improve the patient’s overall function. Depending on the type of anemia, patients may have good results from dietary adjustments, medications, or blood and bone marrow transplants.
Bleeding disorders occur when the patient lacks enough blood factors, which are proteins that react to cuts to form a clot that stops the bleeding. Without enough blood factors, the blood cannot clot effectively. Even minor cuts lead to excessive blood loss. Blood-clotting disorders, on the other hand, occur when the patient has too many blood factors, potentially leading to blockages. Common types of bleeding and clotting disorders include:
Bleeding and blood-clotting disorders can both be managed with medications or infusion therapy, which give the body what it needs to form clots correctly.
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Blood Cancers |
Benign Blood Disorders |
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Leukemia – ALL – CLL – AML – CML Lymphoma – Hodgkin lymphoma – Non-Hodgkin lymphoma Multiple Myeloma Myelodysplastic syndrome (MDS) Myeloproliferative neoplasms (MPNs) |
Anemia – Iron-deficient anemia – Aplastic anemia – Sickle cell disease Bleeding disorders – Hemophilia – Thrombocytopenia Clotting disorders Deep vein thrombosis |
Doctors refer people to hematologists for a variety of reasons. In most cases, the first hematologist visit is only an evaluation to confirm test results, find out the cause of new symptoms, or check for inherited issues before they become a problem.
An abnormal blood test result is the most common reason to see a hematologist. A complete blood count (CBC) is a standard part of most routine physicals. It measures how many of each cell type are present in the patient’s blood. The results can detect issues such as:
If a routine CBC test returns unusual results, then the individual may be referred to a hematologist to learn more. The hematologist will request additional testing to confirm the CBC results and find out what is causing the abnormality.
Individuals may also see a hematologist if they develop new symptoms without a clear cause. Symptoms that may be caused by blood disorders include:
Primary care physicians do not have the tools or training to diagnose blood disorders. Instead, they refer the patient to a hematologist. The hematologist will talk with the person about their symptoms before performing diagnostic tests to find out the cause.
If a individual has a strong family history of blood disorders, then they may get a hematologist referral without having abnormal test results or symptoms. This is a preemptive visit to find out whether the person is at risk of a blood disorder. The hematologist may perform a CBC or genetic testing. If anything abnormal is found, then the patient gets a head start on treatment, potentially stopping symptoms and complications before they occur.
Your first hematology appointment is focused on evaluation. You will get to know the hematologist, learn more about the reason for your visit, and get diagnostic tests done. It is also an opportunity to ask some initial questions and learn more about your options.
Before a hematology appointment, make sure you understand why the referral was made. Your primary care provider will tell you if you ask. You should also collect materials to bring to your appointment. Some useful items include:
These items provide valuable information that the hematologist can use to narrow down possibilities and arrive at a diagnosis faster.
While providing information for your hematologist, don’t hesitate to ask for information in return. Understanding your options can provide peace of mind and help you get engaged with your care. Questions to ask include:
If the answers sound overwhelming, then do not hesitate to ask for clarification. You are also welcome to bring a friend or family member for additional support.
The hematology appointment usually begins with a physical examination. The hematologist checks your blood pressure and pulse, examines your body for bruising, and asks questions about your symptoms. The exam is followed by a set of initial tests, which may include:
The results of these tests will inform the hematologist’s next steps. If a diagnosis is found, then treatment can begin. Otherwise, further testing may be necessary to identify or rule out a possible disorder.
If certain conditions are suspected, the hematologist may request a bone marrow biopsy. This procedure uses a specialized needle to remove a small sample of bone marrow from the inside of the bone. It takes 20 to 30 minutes and usually isn’t painful, though you may feel some soreness afterward. The results are used to diagnose leukemia, multiple myeloma, and certain types of anemia.
Afterward, the hematologist will schedule a follow-up appointment in a few days or weeks. The follow-up is an opportunity to discuss test results, talk about your diagnosis, and learn more about treatment options.
Seeing a hematologist does not always mean you have cancer, as the specialists at Regional Cancer Care Associates (RCCA) treat a wide variety of benign blood disorders as well. RCCA physicians offer patients innovative therapies, including immunotherapies and targeted therapy, cutting-edge diagnostics as well as access to approximately 300 clinical trials in community-based centers close to home.
Does being referred to a hematologist mean I have cancer?
Being referred to a hematologist does not always mean you have cancer. While hematologists do treat cancer, they also work with a wide range of benign blood disorders.
What is the difference between a hematologist and an oncologist?
Hematologists test for and treat conditions that affect the blood, including blood cancers and benign conditions. Oncologists, on the other hand, test for and treat cancer.
What blood tests does a hematologist order at a first visit?
Blood tests to expect at the first visit include a complete blood count (CBC), peripheral blood smear, and coagulation panel. These tests provide more information about the patient’s blood, including its clotting behavior and blood cell shortages.
How long does it take to get results from a hematologist?
Blood test results can take a few days or weeks to come back from the laboratory. While it is normal to feel anxious about waiting, this delay is normal and does not indicate that anything is wrong.
Can a hematologist treat anemia?
Yes, a hematologist can treat anemia. Treatment options for anemia include dietary changes, medications, infusion therapy, and bone marrow transplants, depending on what causes the anemia.
What are the most common reasons for a hematology referral?
The most common reasons for a hematology referral are abnormal blood test results, new symptoms that indicate a blood disorder, or a strong family history of blood disorders.
Is a bone marrow biopsy painful?
Hematologists numb the testing area before taking a bone marrow biopsy. The procedure is usually painless, though you may still feel a slight pressure. You may also experience some soreness afterward.
What is the difference between a benign blood disorder and a blood cancer?
Benign blood disorders do not involve mutated or cancerous cells. They cannot spread, and they usually do not get worse over time. Blood cancers involve mutated cells that reproduce quickly and spread through the body to other organs.
How do I know if my hematologist is board-certified?
You can usually check a physician’s qualifications online to confirm that they have the correct certifications to provide hematology care.
Can a hematologist also treat cancer?
Yes, a hematologist can also treat cancer. Many hematologists complete additional training in oncology to get better at treating blood cancers. These specialists are called hematologist-oncologists.
For more information or to schedule an appointment,
call 844-346-7222. You can also schedule an appointment by calling the RCCA location nearest you.
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