Table of ContentsView AllTable of ContentsTypes of CancerCancer Treatment and AnemiaAnemia SymptomsDiagnosing AnemiaTreatmentCoping
Table of ContentsView All
View All
Table of Contents
Types of Cancer
Cancer Treatment and Anemia
Anemia Symptoms
Diagnosing Anemia
Treatment
Coping
Many types of cancer are associated with low hemoglobin (anemia). Hemoglobin is a protein found in red blood cells that contains iron and helps transport oxygen around the body. Types of cancer most often associated withlow hemoglobininclude blood, bone, colon, and cervical cancers.
Cancer-related factors linked to anemia include internal bleeding from tumors, altered production of hemoglobin, and side effects of treatments, such as chemotherapy. If you have anemia without an established cause, your healthcare provider may pursue further testing to rule out cancer-related causes.
Verywell / Brianna Gilmartin
Types of Cancer That Cause Anemia
Anemia is the medical term for having lower-than-normal levels ofhemoglobin. Hemoglobin plays an essential role in oxygen transport throughout your body.Anemia related to cancer can be due to blood loss from a tumor or a disruption in the development of healthy red blood cells.
The three main causes of low hemoglobin levels—blood loss, decreased red blood cell production, and high rates of red blood cell destruction—are also associated with certain cancers and cancer treatments.
Examples of types of cancers that cause anemia include:
Blood and Bone Marrow Cancers
Blood andbone marrow cancersalter the production and function of blood cells and can lead to anemia. This is because blood cancers cause uncontrolled growth of abnormal blood cells that interrupt the development of healthy blood cells. There are three main types of blood and bone marrow cancers:
Cancer in other parts of the body can also metastasize (spread) to bones and interfere with the production of red blood cells, leading to anemia.
Cervical Cancer
Research shows about half of all people with cervical cancer have anemia at the time of diagnosis. This is often due to bleeding tumors. It can also be due to cancer spreading to the bone marrow or malnutrition due to cancer diminishing your appetite.
Colon Cancer
Iron deficiency anemia can be one of the first symptoms of colon cancer. It is possible to have anemia at any stage of colon cancer.
Because the right side of the colon is distant from the rectum,blood in the stoolhas time to degrade and may not be recognizable when it passes through the bowels during a bowel movement. Large tumors in this portion of the colon can continue to bleed slowly, and over time, this will be reflected in a low blood count.
Kidney Cancer
Renal cell carcinoma and other types ofkidney cancercan cause anemia. The kidneys secrete a hormone callederythropoietin, which stimulates the production of red blood cells. Kidney cancer can hinder this process and cause anemia.
Metastatic Breast Cancer
Skeletal metastases are the most common location for breast cancer to spread. However, another common location for breast cancer to spread is the bone marrow.If breast cancer spreads to the bone marrow, it can affect red blood cell production.
Additionally, a rare form of breast cancer, called occult breast cancer, happens when there isno primary lesionin the breast and breast cancer is found elsewhere in the body. It occurs in less than one percent of breast cancer cases and is challenging to diagnose.
Prostate Cancer
One of the first symptoms of prostate cancer is sometimes anemia. Additionally, anemia occurs frequently with advanced prostate cancer. However, while prostate cancer can spread to the bone marrow like other cancers, one of the most common causes of anemia in advanced prostate cancer is due to androgen deprivation therapy (ADT).
Lung Cancer
Several different cytokines are involved in inflammatory processes in the body, and if there are too many of them, they can negatively affect red blood cell production. Additionally, cancer-related anemia can induce tumor hypoxia, which can make lung cancer more resistant to treatments such as chemotherapy and radiation.
Cancer’s Impact on Red Blood CellsCancer can impact the production and storage of red blood cells in several ways:Blood loss: Tumors can bleed, causing you to lose blood.Bone marrow replacement: Some cancers, such as lymphomas, invade the bone marrow and replace its cells.Cytokines: High levels of proteins known ascytokinescan cause inflammation and slow the production of red blood cells.Hemolytic anemia: Red blood cells may be broken down faster than the body can replace them.Nutritional deficiencies: Cancer and treatment can cause a poor appetite and other challenges that make eating difficult.
Cancer’s Impact on Red Blood Cells
Cancer can impact the production and storage of red blood cells in several ways:Blood loss: Tumors can bleed, causing you to lose blood.Bone marrow replacement: Some cancers, such as lymphomas, invade the bone marrow and replace its cells.Cytokines: High levels of proteins known ascytokinescan cause inflammation and slow the production of red blood cells.Hemolytic anemia: Red blood cells may be broken down faster than the body can replace them.Nutritional deficiencies: Cancer and treatment can cause a poor appetite and other challenges that make eating difficult.
Cancer can impact the production and storage of red blood cells in several ways:
Anemia can be a side effect of cancer treatments, including chemotherapy and radiation.
Chemotherapy attacks all rapidly growing cells, not just cancer cells, and the cells in the bone marrow that are used to replace white blood cells, red blood cells, and platelets are some of the most rapidly dividing cells in the body.
Chemotherapyis a common cause of anemia in people with cancer, and this occurs with many of the drugs commonly used.
Blood counts are usually done before each chemotherapy infusion, and if the red blood cell count is too low, chemotherapy may need to be delayed. Some people with cancer are treated with medications that stimulate the production of red blood cells so that chemotherapy can continue to be given.
In a 2016 study, 90% of people receiving chemotherapy for solid tumors were noted to have anemia.
When you don’t have enough hemoglobin, you have a reduced capacity for delivering oxygen to the tissues in your body. This can lead to symptoms such as fatigue, shortness of breath, and lightheadedness.
Untreated and severe anemia can lead to complications, including depression, heart problems such asarrhythmiaand enlarged heart, and increased risk of infection.
However, it’s important to note that not everyone with anemia notices symptoms.
If you have one or more symptoms of anemia, especially if you have cancer or a family history of colon cancer, contact your healthcare provider right away.
Anemia is diagnosed on a complete blood count in which a low red blood cell count or low hemoglobin levels are noted:
In addition to the levels, healthcare providers look at other lab tests to learn more about the potential causes of anemia. Some of these include:
Your oncologist will check your iron levels periodically throughout your cancer treatment. Tell your healthcare provider if you experience signs of anemia, including fatigue, shortness of breath, dizziness, headache, a rapid heartbeat, and pale skin.
Diagnosing Cancer
When the cause of anemia is not known in someone without cancer, tests to rule out cancer may be considered.
Types of tests used todiagnose cancerinclude:
However, keep in mind that anemia may have several causes besides cancer and is a fairly common condition. It is estimated that approximately 5.6% of the population in the United States has anemia.
Treating Anemia
The treatment of anemia in people with cancer includes two primary steps. The first is treating the underlying cause of the anemia, which can sometimes eliminate the anemia. Treatment is also aimed at treating the anemia itself, especially if it is causing symptoms or has developed rapidly.
Treatment of the Underlying Cause
The treatment of anemia will depend on the underlying cause, which, as noted, can be attributed to many different things. For chemotherapy-induced anemia, your next infusion may need to be canceled or delayed until your counts have increased.
If your cancer has invaded your bone marrow, treatment addressing cancer in your bone marrow may be the first step.
Treatments for Anemia
Specific treatments for anemia may include:
Anemia can be difficult to cope with, especially the resultant fatigue. While fatigue is not dangerous on its own, many people findcancer fatigueto be one of the most debilitating symptoms of cancer and cancer treatments.
Some simple measures can help as your anemia is being evaluated and treated. Standing up or sitting up slowly can help to avoidorthostatic hypotension, the decrease in blood pressure that can lead to lightheadedness or “blacking out” when going from lying down to a standing position too rapidly.
Pacing yourself throughout the day and prioritizing activities is also helpful, as is learning to ask for help. Eating well and making sure you are hydrated is important both for anemia as well as coping with cancer itself.
Summary
Many types of cancer cause low hemoglobin (anemia) either directly or as a consequence of treatment. Internal bleeding from tumors, altered hemoglobin production, and chemotherapy, can each contribute to anemia’s development. If anemia has no established cause, further testing is often indicated.
Several cancers, including blood, bone, colon, cervical, breast, prostate, and lung cancers, are associated with low hemoglobin. Cancer is diagnosed using multiple means, including imaging, endoscopic testing, and biopsies. Treatment of both cancer and anemia is dependent on the condition diagnosed.
22 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.MedlinePlus.Anemia.American Society of Hematology.Blood cancers.Wassie M, Aemro A, Fentie B.Prevalence and associated factors of baseline anemia among cervical cancer patients in Tikur Anbesa Specialized Hospital, Ethiopia.BMC Womens Health. 2021;21(1):36. doi:10.1186/s12905-021-01185-9American Cancer Society.Colorectal cancer signs and symptoms.Väyrynen JP, Tuomisto A, Väyrynen SA, et al.Preoperative anemia in colorectal cancer: relationships with tumor characteristics, systemic inflammation, and survival.Sci Rep. 2018;8(1):1126. doi:10.1038/s41598-018-19572-yAmerican Cancer Society.Kidney cancer.Otsubo R, Yano H, Itonaga H, Iwasaki K, Segawa K, Nagayasu T.Severe thrombocytopenia and anemia as an initial presentation of breast cancer: a case report.Clinical Case Reports. 2022;10(12):e6762.Liu L, Zhang J, Chen M, Ren S, Liu H, Zhang H.Anemia and thrombocytopenia as initial symptoms of occult breast cancer with bone marrow metastasis: a case report.Medicine (Baltimore). 2017;96(45):e8529.Dai D, Han S, Li L, et al.Anemia is associated with poor outcomes of metastatic castration-resistant prostate cancer, a systematic review and meta-analysis.American Journal of Translational Research. 2018;10(12):3877.Wei J, Xiang J, Hao Y, et al.Baseline anemia predicts a poor prognosis in patients with non-small cell lung cancer with epidermal growth factor receptor mutations: a retrospective study.BMC Pulmonary Medicine. 2022;22(1):381.Gaspar BL, Sharma P, Das R.Anemia in malignancies: pathogenetic and diagnostic considerations.Hematology. 2015;20(1):18-25. doi:10.1179/1607845414Y.0000000161National Cancer Institute.Anemia: cancer treatment side effect.Xu H, Xu L, Page JH, et al.Incidence of anemia in patients diagnosed with solid tumors receiving chemotherapy, 2010-2013.Clin Epidemiol.2016;8:61-71. doi:10.2147/CLEP.S89480Penn Medicine.What is anemia?National Heart, Lung, and Blood Institute.Iron-deficiency anemia.Abuga KM, Nairz M, MacLennan CA, Atkinson SH.Severe anaemia, iron deficiency, and susceptibility to invasive bacterial infections.Wellcome Open Res. 2023;8:48. Published 2023 Feb 2. doi:10.12688/wellcomeopenres.18829.1International Myeloma Foundation.Tests to assess blood cells.Stanford Medicine.How is cancer diagnosed?Le CHH.The prevalence of anemia and moderate-severe anemia in the US population (NHANES 2003-2012).PLoS ONE. 2016;11(11):e0166635.Jimenez K, Kulnigg-Dabsch S, Gasche C.Management of iron deficiency anemia.Gastroenterol Hepatol (N Y).2015;11(4):241-50.Lebrun F, Klastersky J, Levacq D, Wissam Y, Paesmanns M.Intravenous iron therapy for anemic cancer patients: a review of recently published studies.Supportive Care in Cancer. 2017;25(7):2313-2319. doi:10.1007/s00520-017-3672-1Arnold AC, Raj SR.Orthostatic hypotension: a practical approach to investigation and management.Can J Cardiol. 2017;33(12):1725–8. doi:10.1016/j.cjca.2017.05.007Additional ReadingDeLoughery T.Iron deficiency anemia.Medical Clinics of North America. 2017;101(2):319-332. doi:10.1016/j.mcna.2016.09.004Kasper DL, Fauci AS, Hauser SL.Harrison’s Principles of Internal Medicine. New York: McGraw Hill Professional, 2015. Print.
22 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.MedlinePlus.Anemia.American Society of Hematology.Blood cancers.Wassie M, Aemro A, Fentie B.Prevalence and associated factors of baseline anemia among cervical cancer patients in Tikur Anbesa Specialized Hospital, Ethiopia.BMC Womens Health. 2021;21(1):36. doi:10.1186/s12905-021-01185-9American Cancer Society.Colorectal cancer signs and symptoms.Väyrynen JP, Tuomisto A, Väyrynen SA, et al.Preoperative anemia in colorectal cancer: relationships with tumor characteristics, systemic inflammation, and survival.Sci Rep. 2018;8(1):1126. doi:10.1038/s41598-018-19572-yAmerican Cancer Society.Kidney cancer.Otsubo R, Yano H, Itonaga H, Iwasaki K, Segawa K, Nagayasu T.Severe thrombocytopenia and anemia as an initial presentation of breast cancer: a case report.Clinical Case Reports. 2022;10(12):e6762.Liu L, Zhang J, Chen M, Ren S, Liu H, Zhang H.Anemia and thrombocytopenia as initial symptoms of occult breast cancer with bone marrow metastasis: a case report.Medicine (Baltimore). 2017;96(45):e8529.Dai D, Han S, Li L, et al.Anemia is associated with poor outcomes of metastatic castration-resistant prostate cancer, a systematic review and meta-analysis.American Journal of Translational Research. 2018;10(12):3877.Wei J, Xiang J, Hao Y, et al.Baseline anemia predicts a poor prognosis in patients with non-small cell lung cancer with epidermal growth factor receptor mutations: a retrospective study.BMC Pulmonary Medicine. 2022;22(1):381.Gaspar BL, Sharma P, Das R.Anemia in malignancies: pathogenetic and diagnostic considerations.Hematology. 2015;20(1):18-25. doi:10.1179/1607845414Y.0000000161National Cancer Institute.Anemia: cancer treatment side effect.Xu H, Xu L, Page JH, et al.Incidence of anemia in patients diagnosed with solid tumors receiving chemotherapy, 2010-2013.Clin Epidemiol.2016;8:61-71. doi:10.2147/CLEP.S89480Penn Medicine.What is anemia?National Heart, Lung, and Blood Institute.Iron-deficiency anemia.Abuga KM, Nairz M, MacLennan CA, Atkinson SH.Severe anaemia, iron deficiency, and susceptibility to invasive bacterial infections.Wellcome Open Res. 2023;8:48. Published 2023 Feb 2. doi:10.12688/wellcomeopenres.18829.1International Myeloma Foundation.Tests to assess blood cells.Stanford Medicine.How is cancer diagnosed?Le CHH.The prevalence of anemia and moderate-severe anemia in the US population (NHANES 2003-2012).PLoS ONE. 2016;11(11):e0166635.Jimenez K, Kulnigg-Dabsch S, Gasche C.Management of iron deficiency anemia.Gastroenterol Hepatol (N Y).2015;11(4):241-50.Lebrun F, Klastersky J, Levacq D, Wissam Y, Paesmanns M.Intravenous iron therapy for anemic cancer patients: a review of recently published studies.Supportive Care in Cancer. 2017;25(7):2313-2319. doi:10.1007/s00520-017-3672-1Arnold AC, Raj SR.Orthostatic hypotension: a practical approach to investigation and management.Can J Cardiol. 2017;33(12):1725–8. doi:10.1016/j.cjca.2017.05.007Additional ReadingDeLoughery T.Iron deficiency anemia.Medical Clinics of North America. 2017;101(2):319-332. doi:10.1016/j.mcna.2016.09.004Kasper DL, Fauci AS, Hauser SL.Harrison’s Principles of Internal Medicine. New York: McGraw Hill Professional, 2015. Print.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
MedlinePlus.Anemia.American Society of Hematology.Blood cancers.Wassie M, Aemro A, Fentie B.Prevalence and associated factors of baseline anemia among cervical cancer patients in Tikur Anbesa Specialized Hospital, Ethiopia.BMC Womens Health. 2021;21(1):36. doi:10.1186/s12905-021-01185-9American Cancer Society.Colorectal cancer signs and symptoms.Väyrynen JP, Tuomisto A, Väyrynen SA, et al.Preoperative anemia in colorectal cancer: relationships with tumor characteristics, systemic inflammation, and survival.Sci Rep. 2018;8(1):1126. doi:10.1038/s41598-018-19572-yAmerican Cancer Society.Kidney cancer.Otsubo R, Yano H, Itonaga H, Iwasaki K, Segawa K, Nagayasu T.Severe thrombocytopenia and anemia as an initial presentation of breast cancer: a case report.Clinical Case Reports. 2022;10(12):e6762.Liu L, Zhang J, Chen M, Ren S, Liu H, Zhang H.Anemia and thrombocytopenia as initial symptoms of occult breast cancer with bone marrow metastasis: a case report.Medicine (Baltimore). 2017;96(45):e8529.Dai D, Han S, Li L, et al.Anemia is associated with poor outcomes of metastatic castration-resistant prostate cancer, a systematic review and meta-analysis.American Journal of Translational Research. 2018;10(12):3877.Wei J, Xiang J, Hao Y, et al.Baseline anemia predicts a poor prognosis in patients with non-small cell lung cancer with epidermal growth factor receptor mutations: a retrospective study.BMC Pulmonary Medicine. 2022;22(1):381.Gaspar BL, Sharma P, Das R.Anemia in malignancies: pathogenetic and diagnostic considerations.Hematology. 2015;20(1):18-25. doi:10.1179/1607845414Y.0000000161National Cancer Institute.Anemia: cancer treatment side effect.Xu H, Xu L, Page JH, et al.Incidence of anemia in patients diagnosed with solid tumors receiving chemotherapy, 2010-2013.Clin Epidemiol.2016;8:61-71. doi:10.2147/CLEP.S89480Penn Medicine.What is anemia?National Heart, Lung, and Blood Institute.Iron-deficiency anemia.Abuga KM, Nairz M, MacLennan CA, Atkinson SH.Severe anaemia, iron deficiency, and susceptibility to invasive bacterial infections.Wellcome Open Res. 2023;8:48. Published 2023 Feb 2. doi:10.12688/wellcomeopenres.18829.1International Myeloma Foundation.Tests to assess blood cells.Stanford Medicine.How is cancer diagnosed?Le CHH.The prevalence of anemia and moderate-severe anemia in the US population (NHANES 2003-2012).PLoS ONE. 2016;11(11):e0166635.Jimenez K, Kulnigg-Dabsch S, Gasche C.Management of iron deficiency anemia.Gastroenterol Hepatol (N Y).2015;11(4):241-50.Lebrun F, Klastersky J, Levacq D, Wissam Y, Paesmanns M.Intravenous iron therapy for anemic cancer patients: a review of recently published studies.Supportive Care in Cancer. 2017;25(7):2313-2319. doi:10.1007/s00520-017-3672-1Arnold AC, Raj SR.Orthostatic hypotension: a practical approach to investigation and management.Can J Cardiol. 2017;33(12):1725–8. doi:10.1016/j.cjca.2017.05.007
MedlinePlus.Anemia.
American Society of Hematology.Blood cancers.
Wassie M, Aemro A, Fentie B.Prevalence and associated factors of baseline anemia among cervical cancer patients in Tikur Anbesa Specialized Hospital, Ethiopia.BMC Womens Health. 2021;21(1):36. doi:10.1186/s12905-021-01185-9
American Cancer Society.Colorectal cancer signs and symptoms.
Väyrynen JP, Tuomisto A, Väyrynen SA, et al.Preoperative anemia in colorectal cancer: relationships with tumor characteristics, systemic inflammation, and survival.Sci Rep. 2018;8(1):1126. doi:10.1038/s41598-018-19572-y
American Cancer Society.Kidney cancer.
Otsubo R, Yano H, Itonaga H, Iwasaki K, Segawa K, Nagayasu T.Severe thrombocytopenia and anemia as an initial presentation of breast cancer: a case report.Clinical Case Reports. 2022;10(12):e6762.
Liu L, Zhang J, Chen M, Ren S, Liu H, Zhang H.Anemia and thrombocytopenia as initial symptoms of occult breast cancer with bone marrow metastasis: a case report.Medicine (Baltimore). 2017;96(45):e8529.
Dai D, Han S, Li L, et al.Anemia is associated with poor outcomes of metastatic castration-resistant prostate cancer, a systematic review and meta-analysis.American Journal of Translational Research. 2018;10(12):3877.
Wei J, Xiang J, Hao Y, et al.Baseline anemia predicts a poor prognosis in patients with non-small cell lung cancer with epidermal growth factor receptor mutations: a retrospective study.BMC Pulmonary Medicine. 2022;22(1):381.
Gaspar BL, Sharma P, Das R.Anemia in malignancies: pathogenetic and diagnostic considerations.Hematology. 2015;20(1):18-25. doi:10.1179/1607845414Y.0000000161
National Cancer Institute.Anemia: cancer treatment side effect.
Xu H, Xu L, Page JH, et al.Incidence of anemia in patients diagnosed with solid tumors receiving chemotherapy, 2010-2013.Clin Epidemiol.2016;8:61-71. doi:10.2147/CLEP.S89480
Penn Medicine.What is anemia?
National Heart, Lung, and Blood Institute.Iron-deficiency anemia.
Abuga KM, Nairz M, MacLennan CA, Atkinson SH.Severe anaemia, iron deficiency, and susceptibility to invasive bacterial infections.Wellcome Open Res. 2023;8:48. Published 2023 Feb 2. doi:10.12688/wellcomeopenres.18829.1
International Myeloma Foundation.Tests to assess blood cells.
Stanford Medicine.How is cancer diagnosed?
Le CHH.The prevalence of anemia and moderate-severe anemia in the US population (NHANES 2003-2012).PLoS ONE. 2016;11(11):e0166635.
Jimenez K, Kulnigg-Dabsch S, Gasche C.Management of iron deficiency anemia.Gastroenterol Hepatol (N Y).2015;11(4):241-50.
Lebrun F, Klastersky J, Levacq D, Wissam Y, Paesmanns M.Intravenous iron therapy for anemic cancer patients: a review of recently published studies.Supportive Care in Cancer. 2017;25(7):2313-2319. doi:10.1007/s00520-017-3672-1
Arnold AC, Raj SR.Orthostatic hypotension: a practical approach to investigation and management.Can J Cardiol. 2017;33(12):1725–8. doi:10.1016/j.cjca.2017.05.007
DeLoughery T.Iron deficiency anemia.Medical Clinics of North America. 2017;101(2):319-332. doi:10.1016/j.mcna.2016.09.004Kasper DL, Fauci AS, Hauser SL.Harrison’s Principles of Internal Medicine. New York: McGraw Hill Professional, 2015. Print.
DeLoughery T.Iron deficiency anemia.Medical Clinics of North America. 2017;101(2):319-332. doi:10.1016/j.mcna.2016.09.004
Kasper DL, Fauci AS, Hauser SL.Harrison’s Principles of Internal Medicine. New York: McGraw Hill Professional, 2015. Print.
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