2. Leukaemia and Lymphoma

Question 1

Haematological malignancies result in (2)

Answer 1

Clonal proliferation

Formation of cancer cells

Question 2

How do cancer cells form (3)

Answer 2

Uncontrolled proliferation
Loss of apoptosis
Loss of normal function/products

Question 3

Causes of haematological malignancies

Answer 3

Abnormalities during cell divisions, specifically DNA mutations (translocation)

Question 4

Types of acute lymphoid malignancies

Answer 4

Acute lymphoblastic leukaemia

Question 5

Types of chronic lymphoid malignancies (4)

Answer 5

Chronic lymphoblastic leukaemia
Hodgkin’s lymphoma
Non-Hodgkin’s lymphoma
Multiple myeloma

Question 6

Types of acute myeloid malignancies

Answer 6

Acute myeloid leukaemia

Question 7

Types of chronic myeloid malignancies (2)

Answer 7

Chronic myeloid leukaemia

Myeloproliferative disorders

Question 8

What are myeloproliferative disorders

Answer 8

Pre-neoplastic overproduction of blood cells/components

Question 9

Definition of leukaemia (2)

Answer 9

Group of cancers of the bone marrow

Prevent normal manufacture of blood

Question 10

Patogenesis of leukaemia (3)

Answer 10

Clonal proliferation
Replacement of marrow
Increasing marginalisation of productive normal marrow (marrow failure, organ infiltration)

Question 11

Clinical presentation of leukaemia (6)

Answer 11

Anaemia
Neutropenia
Thrombocytopenia
Lymphadenopathy
Splenomegaly, hepatomegaly
Bone pain (especially in kids)

Question 12

Progressive symptoms of anaemia (4)

Answer 12

Breathlessness
Tiredness
Easily fatigued
Chest pain/angina

Question 13

Signs of anaemia (3)

Answer 13

Pallor
Signs of cardiac failure (ankle swelling, breathlessness)
Nail changes (brittle nails, koilonychia)

Question 14

Clinical presentations of neutropenia (2)

Answer 14

Infections associated with portals of entry

Reactivation of latent infections

Question 15

Symptoms of neutropenia (2)

Answer 15

Recurrent infection

Unusual severity of infection

Question 16

Signs of neutropenia (3)

Answer 16

Unusually patterns of infection with rapid spread
Response to treatment but then recurrence of infection
Signs of systemic involvement (fever, rigorous, chills)

Question 17

Neutropenia investigations

Answer 17

Unusual pathogens, usually bacterial (usually low pathogenicity organisms)

Question 18

Symptoms of thrombocytopenia (4)

Answer 18

Bruise easily/spontaneously
Minor cuts fail to clot
Gingival/nose bleeding
Menorrhagia

Question 19

Signs of thrombocytopenia (4)

Answer 19

Bruising
Petechiae
BoP
Bleeding/bruising following procedures

Question 20

Features of acute lymphoblastic leukaemia, ALL (3)

Answer 20

Results in a catabolic state (fever, sweats, malaise)
Lymphadenopathy
Tissue infiltration

Question 21

Features of acute myeloid leukaemia, AML (3)

Answer 21

Similar to ALL
Results in a catabolic state (fever, sweats, malaise)
Lymphadenopathy
Tissue infiltration

Question 22

Features of chronic lymphocytic leukaemia, CLL (3)

Answer 22

B-cell clonal lymphoproliferative disease
Mostly asymptomatic
Usually slow progression, not requiring treatment

Question 23

Features of chronic myeloid leukaemia, CML (3)

Answer 23

Occurs in neutrophils and their precursors
95% of patients have ‘Philadelphia’ chromosome
Fatigue, weight losses eating, anaemia, bleeding, splenomegaly

Question 24

Definition of lymphoma (2)

Answer 24

Clonal proliferation of lymphocytes arising in a lymph node or associated tissue
Usually a solid tumour but contains some blood cells

Question 25

Types of lymphoma (2)

Answer 25

Hodgkin lymphoma | Non-Hodgkin lymphoma

Question 26

Lymphoma investigations (3)

Answer 26

CT PET MRI

Question 27

Requirements of lymphoma staging (3)

Answer 27

Number of nodes involved and site Extra-nodal involvement Systemic symptoms

Question 28

Presentation of Hodgkin lymphoma, HL (3)

Answer 28

Painless lymphadenopathy (typically cervical) Fever, night sweats, weight loss, itching Infection

Question 29

Presentation of Non-Hodgkin lymphoma, NHL (3)

Answer 29

Causes - microbial factors strongly implicated, autoimmune disease, immunosuppression Lymphadenopathy (often widely disseminated) Extra-nodal disease more common (Waldeyer's ring) Symptoms of marrow failure

Question 30

Definition of multiple myeloma

Answer 30

Malignant proliferation of plasma cells

Question 31

Features of multiple myeloma (3)

Answer 31

Monoclonal paraprotein in blood and urine Lytic bone lesions --> pain and fracture Excess plasma cells in bone marrow --> bone marrow failure

Question 32

Clinical presentation of multiple myeloma (4)

Answer 32

Infection Bone pain Renal failure Amyloidosis

Question 33

Treatment of haematological malignancies (4)

Answer 33

Chemotherapy Radiotherapy Monoclonal antibodies Haematopoietic stem cell transplantation

Question 34

Haematological malignancies usually undergo the process of (4)

Answer 34

Induction Remission Maintenance and consolidation Relapse

Question 35

Function of chemotherapy

Answer 35

Target cells with a high turnover rate

Question 36

Side effects of chemotherapy (5)

Answer 36

``` Hair loss Vomiting Nausea Tiredness Risk of oncogenesis in surviving patients ```

Question 37

Function of radiotherapy (2)

Answer 37

Cytotoxic effect of ionising radiation | Irradiation of tumour cells and adjacent healthy tissue

Question 38

Advantage of monoclonal antibodies

Answer 38

Specific to cancer cell antigens

Question 39

Types of haematopoietic stem cell transplantation (2)

Answer 39

Allogenic (from liver donor) | Autologous (self-transplant)