11.4 Introduction to Haematologic Malignancies Flashcards
What is leukaemia?
Malignant process involving excess of clonal white blood cells
Acute vs chronic leukaemia
Excess:
Acute: immature cells; “blasts”
Chronic: end-stage cells
Leukaemia vs lymphoma
Leukemia: affects circulating WBCs
Lymphoma: localised to lymph nodes
What is the incidence of haematological malignancies in adults?
20%
List some risk factors for haematological malignancies
- Smoking
- Genetic abnormalities
- Family history
- Exposure to carcinogens/radiation
- Viral infections (e.g. Epstein Barr Virus)
Indolent vs aggressive lymphoma; which is curable, and which is incurable?
Indolent: slow cellular accumulation (incurable)
Aggressive: rapid cellular division (curable)
Why is the term “metastasis” not commonly used in the context of lyphoma or leukaemia?
- Lymphocytes usually migrate around the body
- Therefore, the movement of these cells is not metastasis, but regular movement
“Infiltrate” vs “involved with” in terms of haematological malignancies
Infiltrate: a cancerous lymphocyte has moved to an area where it does not belong (e.g. lymph node cell in skin)
Involved with: cancerous lymphocyte in an area that it is local to
What percentage of cells in the peripheral blood/bone marrow must be blast cells for a diagnosis of acute lymphoblastic leukaemia?
> =20%
What structure(s) differentiate between hodgkins and non-hodgkins lymphoma?
Reed-Sternberg cell (multinucleated giant cell made of lymphocytes)
Hodgkins has one, non-hodgkins doesn’t.
Which type of lymphocytes does hodgkin’s lymphoma affect? Therefore, is it acute or chronic?
- Affects B lymphocytes (mature)
- Therefore, it is chronic
List cancers in B cells, T cells, and NK cells in order from most to least common
- B Cells (85%)
- T Cells (15%)
- NK Cells (<1%)
How are indolent haematological malignancies most commonly found?
- Incidentally
- They are found on routine blood tests, or when imaging
- After all, if they are not causing the patients any symptoms (since the cells are slow replicating), how would we notice them?
How can lymphoma cause splenomegaly?
- Lymphocytes are homed to the spleen
- As they rapidly proliferate, the spleen is enlarged
What are some signs of aggressive lymphoma?
- Rapidly enlarging lymphadenopathy
- High cell turnover = high LDH
- Bone marrow infiltration would cause anaemia, thrombocytopaenia, neutropaenia
- Constituional symptoms (explained on another card)
Is bone pain more common in lymphoma or multiple myeloma?
Myeloma
What are constitutional B symptoms?
- Fever (>38.3°C)
- Drenching night sweats
- Weight loss (>10% body weight over few months) -> intentional or unintentional
What is the most common form of lymphoma?
Diffuse large B cell lymphoma (DLBCL)
Is DLBCL aggressive or indolent?
Aggressive
Typical blood work results for DLBCL
- Mild anaemia
- LDH 450
What scans are performed in patients with suspected lymphoma? Why?
- PET scan: activity in tissues
- CT scan: anatomy
Nodal vs extranodal blood/lymph cancers
Nodal: Isolated within lymph nodes and spleen
Extranodal: Anything outside of this
Ann arbor staging classifies the spread of lyphoma. What are stage 1, 2, 3, and 4?
Stage 1: 1 site of disease
Stage 2: 2+ site on same side of diaphragm
Stage 3: Disease on both sides of diaphragm
Stage 4: Widespread involvement of extralymphoid sites
Explain the concept of sanctuary sites. Where are these sites located?
Sanctuary sites are areas where it is difficult for anti-cancer drugs to penetrate due to barriers. These include the brain, the eyes, and the testes
