How cancers present

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There are basic operational differences between how different types of cancer present:

Solid Tumours consist of an abnormal mass of tissue in organs such as the breast, lung, bowel or prostate. These are often what people look for when checking for lumps.

Liquid or Blood Cancers such as leukaemia are cancers that circulate in the fluid of the body. Their symptoms are often more systemic, like extreme fatigue, unexplained bruising, or frequent infections, rather than a physical lump.

Now read this conversation between Sarah, who has been recently diagnosed with cancer, and her doctor:

Sarah: Thanks for taking the time to sit down with me today. Since my diagnosis, I’ve been reading a lot online. I keep seeing terms like “solid tumours” and “liquid cancers.” I know I have a solid tumour, but what exactly is the difference between the two?

Doctor: It’s a good question, Sarah, and honestly, it’s one of the most fundamental concepts in oncology. I’m glad you asked. The simplest way to think about it is where the cancer starts and how it travels through the body.

Sarah: Okay, so “solid” means it’s a physical lump, right?

Doctor: Exactly. A solid tumour is an abnormal mass of tissue that forms in a specific organ or tissue type, such as cancers of the breast, lungs, colon, or prostate. They start in one local spot, form a hard lump, and can eventually try to invade surrounding tissue or spread to other organs through a process called metastasis.

Sarah: And what about “liquid” cancers? That sounds strange because it’s liquid.

Doctor: It does sound a bit odd! Liquid cancers are what we formally call haematologic malignancies, which is just a big medical word for blood cancers. These don’t form solid lumps. Instead, they originate in the bone marrow or the lymphatic system, where your blood cells are made. Because they affect the blood, the cancer cells flow freely throughout your circulatory system.

Sarah: Ah, I see. So things like leukaemia?

Doctor: Example. Leukaemia is one of the more common examples. It starts in the bone marrow and causes an overproduction of abnormal white blood cells. There is also lymphoma, which affects the lymphatic system of your immune system, and myeloma, which targets the plasma cells that normally make your antibodies.

Sarah: Wow, okay. So if solid tumours stay in one place initially, does that mean they are diagnosed and staged differently than blood cancers?

Doctor: Yes, completely differently. For solid tumours like yours, we use the TNM staging system, where we look at the size of the tumour, whether it has spread to local lymph nodes, and if it has reached more distant parts of the body. With liquid cancers, because the cancer cells are already circulating in the blood or lymph fluid from day one, they are technically everywhere right away. Therefore, we evaluate them instead based on specific blood counts, bone marrow involvement, or physical symptoms like an enlarged spleen.

Sarah: That makes sense. You can’t really say a blood cancer is “localised.” Looking at how they differ, it seems like surgery is a big deal for solid tumours, but wouldn’t make sense for a liquid cancer.

Doctor: Exactly, Sarah. For a solid tumour, if we catch it early enough, surgery to physically cut out the tumor is often the frontline defence, sometimes accompanied by radiation to target that exact spot. But you can’t surgically remove blood, so we have to treat liquid cancers differently.

Sarah: Right, you can’t operate on the whole bloodstream. So, how do you treat a liquid cancer?

Doctor: We rely almost entirely on systemic treatments, which are therapies that travel through the entire body. This includes chemotherapy, targeted therapies, and immunotherapies. In some cases, we use bone marrow or stem cell transplants to completely wipe out the diseased marrow and replace it with healthy, blood-producing cells.

Sarah: This makes a lot of sense. Even though they are both called “cancer,” they act like entirely different diseases.

Doctor They really do. The word “cancer” just means cells are growing out of control. But the biology, the progression, and our playbook for beating them depend entirely on whether they are solid or liquid. For your specific solid tumour, our plan is tailored to its exact location and characteristics.

Sarah: Thank you, Doctor. I feel a lot better knowing the logic behind our treatment plan.