Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine 2 - 08 Breast Cancer > 4 Haematological Malignancies > Flashcards

4 Haematological Malignancies Flashcards

1
Q

Describe the difference between leukaemia and lymphoma

A

The main difference between lymphocytic leukemias and lymphomas is that:

  • in leukemia, the cancer cells are mainly in the bone marrow and blood
  • while in lymphoma they tend to be in lymph nodes and other tissues
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Give some examples of myeloid neoplasms

A
  • Acute myeloid leukaemia (AML)
  • Chronic myeloid leukaemia (CML)
  • Myeloproliferative neoplasms (MPN)
  • Myelodysplastic syndromes (MDS)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Give some examples of Lymphoid neoplasms

A
  • Acute lymphoblastic leukaemia (ALL)
  • Chronic lymphoblastic leukaemia (CLL)
  • Plasma cell disorders (Myeloma)
  • Non-Hodgkin’s Lymphoma e.g. Hodgkin’s disease
  • T-cell lymphoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe acute leukemia

A

Leukemia = malignancy of bone marrow

  • Results in very rapid cell growth
  • May fill marrow before spilling out into the blood
  • May present with High WBC (not always - can be low level)
  • Presents with bone marrow failure\

May arise from pre-existing conditions e.g. Myelodysplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe bone marrow failure (it is a clinical presentation of leukemia)

A

Bone marrow failure

  • Anaemia - tiredness, fatigue, pallor
  • Thrombocytopenia - bleeding, bruising
  • Neutropenia - infections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe the origin of acute myeloid leukaemia (AML)

A
  • There is a defect in the common myeloid progenitor cells (they have not differentiated properly, and keep on growing - myeloblast)
  • Morphology:
    > Cells can be monomorphic, pleomorphic, inclusions, anomalies like inclusion bodies, and atypical granules
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe acute lymphoblastic leukemia (ALL)

A

It is the most common malignancy in children

  • peak incidence in children from ages 4-5
  • May present with cytopenia’s or chest masses
  • 90% can be brought into remission with induction chemotherapy
  • 85% cured
  • High relapse rates in older children and boys (Testes and CNS are ‘sanctuary sites’)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Name the origin of acute lymphoblastic leukemia (ALL)

A
  • Common lymphoid progenitor (defects)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the morphology of acute lymphoblastic leukemia

A

Different from the myeloid blast - more monoblastic - they resemble lymphocyte
- Differences in chromatin, structures of nucleus, and differences in nucleus:cytoplasm ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

List common symptoms of acute leukemia

A
  • Systemic (weight loss, fever, frequent infections)
  • Lungs (easy SoB)
  • Muscular (weakness - low Hb)
  • Bones or Joints (pain or tenderness)
  • Psychological (fatigue, loss of appetite)
  • Lymph nodes (swelling, invasion)
  • Spleen and/or liver (enlargement - invasion)
  • Skin (night sweats, easy bleeding, and bruising, purplish patched or spots)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

List the treatment principles for acute leukemia

A
  • Delay in treatment makes infective complications worse

- Commence chemotherapy immediately on diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe common treatment for acute myeloid leukemia (AML)

A

strong IV chemotherapy in short, sharp bursts

  • younger patients may have a better prognosis as they can tolerate high dose chemotherapy better
  • older patients may receive gentler palliative chemotherapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe common treatment for acute lymphoblastic leukemia (ALL)

A

A mix of strong chemotherapy and persisting milder tablets to prevent relapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe chronic myeloid leukemia (CML)

A

Chronic leukaemia’s present with high white cells but not usually due to bone marrow failure

  • it is due to a gene; t(9:22) = Philadelphia chromosome
  • gene fusion produces BCR-ABL fusion protein > leads to tyrosine kinase activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe some clinical presentations of chronic myeloid leukemia (CML)

A
  • High WBC (+/- leukostasis)
  • Splenomegaly
  • Priapism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the treatment of chronic myeloid leukaemias (CML)

A

Treatment now involves specific inhibition of the tumour cell-specific enzyme

  • by the drug Imatinib
  • It blocks the BCR-ABL protein - reverts DNA change > treat patient (blocking of the TK activity)
  • Does not need a lot of chemotherapy
17
Q

Describe myeloproliferative neoplasms (MPNs)

A

They present with an excess of mature cells in the blood
> Polycythaemia Ruba Vera (PRV)
> Essential thrombocytopenia (ET)
- Both PRV/EV may progress to myelofibrosis or acute leukaemia

Due to mutations affecting the JAK/STAT (JAK2 [tyrosine kinase], CALR, MPL)

It may cause stroke or heart attack due to abnormal clotting

18
Q

What is Polycythaemia Ruba Vera (PRV), and what is it a clinical presentation of?

A

excess red cells

- myeloproliferative neoplasms

19
Q

What is Essential thrombocytopenia (ET), and what is it a clinical presentation of?

A

excess platelets

- myeloproliferative neoplasms

20
Q

State the origin of myeloproliferative neoplasms (MPN)

A

Comes from more mature progenitors (megakaryocyte, myeloblast, common myeloid progenitor - depends on which cell is affected)

21
Q

Describe myelodysplastic syndromes (MDS)

A

It is the disordered maturation of blood cells in the bone marrow
- Bone marrow dysplasia can affect any or all cell lines (e.g. isolated thrombocytopenia or pancytopenia)

The pre-leukemic stage can progress to acute leukemia with time

22
Q

How are myelodysplastic syndromes (MDS) detected and diagnosed?

A

It is easy to diagnose if a chromosomal abnormality is detected or if disorganization of marrow is severe
- May be hard to distinguish from reactive marrow changes e.g. from rheumatoid arthritis, chronic infection, or other systemic illness

23
Q

Describe common lymphoblastic leukaemia (CLL)

A

Relatively common (3000 cases/year in the UK)

  • increases with age
  • majority of patient die of unrelated conditions

Usually presents accidentally on a routine FBC for other reasons, but may present with Lymphadenopathy

24
Q

Describe the morphology of common lymphoblastic leukaemia (CLL)

A
  • Lymphocytes look similar to normal cells but there are just too many
  • They are also more fragile than normal lymphocytes
25
Q

Describe the origin of common lymphoblastic leukaemia (CLL)

A
  • Later on in differentiation of lymphoid progenitor (next cell line)
26
Q

Describe non-Hodkin Lymphoma

A

Lymphoma is a sold cancer (cancer of lymph glands, not in blood)

  • It is usually a grouping of a variety of different disease entities all showing tumour growth of lymphoid cells
  • 30% occur outside lymph nodes
  • More common in elderly
  • Some may be related to viruses e.g. EBV, HTLV, HHV8, HIV
  • Some related to chemical exposure
  • Some related to sunlight exposure
27
Q

List some common symptoms of lymphoma (Non-Hodgkins lymphoma)

A

B symptoms or lymphadenopathy are usual clues to lymphoma

  • Asymptomatic
  • Systemic symptoms (weight loss, fatigue, night sweats, pleuritis)
28
Q

Describe Hodgkin’s lymphoma

A

It is strictly a subtype of Non-Hodgkin’s lymphoma

  • Related to EBV infection
  • 2 age peaks - teens/the early 20s and elderly
  • Age peaks may be related to where EBV has integrated into the lymphocyte DNA - closer or further away from the proto-oncogene

The bulk of tumor in HD is ‘normal’ white cells reacting to the presence of tumor cells

29
Q

Describe the origin of Hodgkin’s lymphoma

A

Neoplastic cell is Reed-Sternberg cell

  • they are multinucleated,
  • with prominent nuclei,
  • appear much larger than other cells

There are different types of HD, occurring due to varying amount of Reed-Sternberg cell.
- The more the number of the R-S cell, the worse the prognosis

30
Q

List clinical signs and symptoms of Hodgkin’s lymphoma

A
  • Presents with B symptoms + continuous nodal spread
  • Isolated lymphadenopathy
  • Symptoms can depend on where mass is growing, as it can compress different structures
    (in the mediastinum, enlarged nodes > compress vessels > mediastinal syndromes in abdomen compresses ureters > affects kidney > renal failure
    or, enlarged nodes can compress nerves in the spinal cord)
  • Generic systemic symptoms > cells produce cytokines (syndromes + symptoms of fever, weight loss, sweats, pleuritis, and fatigue)
31
Q

Describe how a diagnosis of lymphoma may be carried out

A
  • History of weight loss, fevers, night sweats
  • Scan or examination suggesting lymphadenopathy
  • Biopsy is vital (no biopsy = no diagnosis) - > can either take the whole lymph node out > or good proportion (e.g. not fine needle aspiration, need better representation for differentials)

PETCT scan used to stage tumour extent and to gauge the response to therapy

32
Q

Describe what multiple myeloma is

A

It is an immunosecretory disorder

  • A condition of abnormal plasma cells, that proliferate without control
  • And as a result, the plasma cells produce the same form of antibody (instead of multiple forms of antibodies that normal plasma cells would)

Due to this, you can detect a disproportionate amount of a single type of immunoglobulin (this is a ‘PARAPROTEIN’)

Different types of myeloma exist:
- IgG and IgA myelomas are the most common

33
Q

What is a paraprotein, and how can it be used in the detection of myelomas

A
  • Monoclonal antibody (mAb), in myelomas, the same type of immunoglobulin is produced (large proportion are the same)
  • These paraproteins can be detected in a urine test
34
Q

What are the conditions to confirm a myeloma

A

2 out of 3 of these conditions must be met:

  1. Plasma cells in marrow > 10%
  2. Detectable paraprotein in blood or urine
  3. Lytic lesion on MRI (seen on the bone)
35
Q

What are the exceptions to the conditions to confirm a myeloma

A

Exceptions:

  • Paraprotein alone = MGUS (monoclonal gammopathy of uncertain significance)
  • IgM paraprotein = Waldenstorms or lymphoma, not myeloma
36
Q

Describe the origin of myelomas

A

Latest differentiation stage of B cells

37
Q

List symptoms of myelomas

A
  • Hypercalcaemia - because of bone remodelling without control, releasing Calcium into the blood
  • Renal failure - the proteins secreted by myeloma can intoxicate the kidney
  • Marrow failure (anaemia, neutropenia and thrombocytopenia); can be due to the expansion of myeloma cells in marrow leading to marrow failure
  • Bone pain: constant remodelling + lytic lesions
38
Q

List some diagnostic tools in Haematological Malignancies

A
  • Blood test (FBC)
  • Bone marrow biopsy (morphology, flow cytometry, cytogenetics, molecular)
  • CT, PET scans
  • MRI scans
  • Tissue biopsy

Medicine 2 - 08 Breast Cancer (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions