6 Leukemia, Lymphoma, MM

Question 1

What are the three B symptoms?

Answer 1

• Weight loss
• Fever
• Night sweats

Question 2

Leukemia is CA of what (2)?

Answer 2

• Bone marrow

- Lymphatic system

Question 3

What are the four types of Leukemia?

Answer 3

• Acute Myeloid Leukemia (AML)
• Chronic Myeloid Leukemia (CML)
• Acute Lymphoblastic Leukemia/Lymphoma (ALL)
• Chronic Lymphocytic Leukemia (CLL)

Question 4

What is the most common type of Leukemia in ADULTS? What is the median age?

Answer 4

Acute Myeloid Leukemia (AML)

- Age 65 years

Question 5

What cancer is associated with chemical exposure/radiation or myelodysplastic syndrome (MDS) as risk factors?

Answer 5

Acute Myeloid Leukemia (AML)

Question 6

What do labs for Acute Myeloid Leukemia (AML) show?

Answer 6

Pancytopenia

Question 7

How do you calculate ANC and what is the normal range?

Answer 7

ANC = WBC x % neutrophils

- Normal ANC is 2500-7000

Question 8

What two findings will be seen on peripheral smear/bone marrow aspiration and biopsy for Acute Myeloid Leukemia (AML)?

Answer 8

• Auer rods

- Leukemic blasts

Question 9

What two factors will improve prognosis for Acute Myeloid Leukemia (AML)?

Answer 9

• Younger age

- No comorbidities

Question 10

What syndrome is at risk for progression to AML?

Answer 10

Myelodysplastic Syndrome (MDS)

Question 11

What two diseases are often asymptomatic and found routinely on CBC?

Answer 11

• Myelodysplastic Syndrome (MDS)

- Chronic Myeloid Leukemia (CML)

Question 12

What is the only possible cure for Myelodysplastic Syndrome (MDS)?

Answer 12

Donor bone marrow transplant

Question 13

What condition is considered an oncologic emergency and associated with high mortality rate?

Answer 13

Tumor Lysis Syndrome

Question 14

What might cause Tumor Lysis Syndrome?

Answer 14

Chemotherapy initiation (within 1 day)

Question 15

What cancer is associated with BCR-ABL1/Philadelphia chromosome?

Answer 15

Chronic Myeloid Leukemia (CML)

Question 16

What are the three phases of Chronic Myeloid Leukemia (CML), and in which phase are patients most commonly diagnosed?

Which of the three has the best prognosis?

Answer 16

1. Chronic phase: most common (85% diagnosed here) AND best prognosis
2. Accelerated phase
3. Blast crisis phase

Question 17

What is the only possible cure for Chronic Myeloid Leukemia (CML)?

Answer 17

Donor stem cell transplant

Question 18

What three complications should be considered with Chronic Myeloid Leukemia (CML), and which two are considered an emergency?

Answer 18

• Tumor lysis syndrome = emergency
• Hyperviscosity syndrome
• Hyperleukocytosis = emergency

Question 19

What is the most common type of Leukemia in CHILDREN? What is the median age?

Answer 19

Acute Lymphoblastic Leukemia/Lymphoma (ALL)

- Ages 2-5 years

Question 20

What are the three subtypes of Acute Lymphoblastic Leukemia/Lymphoma (ALL), and which is most common?

Answer 20

• Precursor B-cell ALL: most cases of childhood ALL
• T-cell ALL
• Mature B-cell ALL aka Burkitt cell

Question 21

Of the three subtypes of Acute Lymphoblastic Leukemia/Lymphoma (ALL), which two have the more favorable prognosis?

Which of the three typically presents at an older age?

Answer 21

The two B-cells:

• Precursor B-cell ALL
• Mature B-cell ALL aka Burkitt cell
• T-cell ALL: older age

Question 22

What five symptoms are most commonly associated with Acute Lymphoblastic Leukemia/Lymphoma (ALL)?

Answer 22

• LAD
• Hepatosplenomegaly
• Pallor
• Bone/MSK pain
• Fever

Question 23

What finding will be seen on peripheral smear/bone marrow aspiration and biopsy for Acute Lymphoblastic Leukemia/Lymphoma (ALL)?

Answer 23

Lymphoblasts

Question 24

Of the four types of leukemia, which is seen ONLY in adults? What is the median age?

Answer 24

Chronic Lymphocytic Leukemia (CLL)

- Age 70 years

Question 25

Which type of cancer involves B-cell lymphocytosis?

Answer 25

Chronic Lymphocytic Leukemia (CLL)

Question 26

Which two symptoms are often seen with Chronic Lymphocytic Leukemia (CLL)?

Answer 26

- Organomegaly (lymph, spleen, liver) | - Skin involvement

Question 27

What are the two stages of Chronic Lymphocytic Leukemia (CLL), and how do you differentiate between the two (think symptoms)?

Answer 27

- Indolent stage: often asymptomatic | - Advanced stage/Terminal phase: inclusion of B symptoms

Question 28

Of the cancers we discussed in class, what is the only one where observation is considered appropriate treatment? When/with what stage is this considered?

Answer 28

Asymptomatic or early stage 1 of Chronic Lymphocytic Leukemia (CLL)

Question 29

Lymphoma is CA of what? Provide five examples of organs which might be affected?

Answer 29

CA of lymphocytes - Lymph nodes - Spleen - Thymus - Bone marrow - Tonsils/adenoid

Question 30

What are the two types of Lymphoma? Which is more common?

Answer 30

- Hodgkin Lymphoma (HL) | - Non-Hodgkin Lymphoma (NHL): more common

Question 31

What cancer involves EBV as a possible risk factor?

Answer 31

Hodgkin Lymphoma (HL)

Question 32

What finding will be seen on peripheral smear for Hodgkin Lymphoma (HL)?

Answer 32

Reed-Sternberg cells

Question 33

What three symptoms may be seen with both Hodgkin Lymphoma (HL) and Non-Hodgkin Lymphoma (NHL)?

Answer 33

- Painless LAD - Mediastinal mass - B symptoms

Question 34

What is the recommended treatment for Hodgkin Lymphoma (HL), and what two potential progressions/complications should be considered?

Answer 34

Combination chemotherapy + radiation | - Can lead to other cancer or heart disease

Question 35

What cancer involves severe pain after alcohol?

Answer 35

Hodgkin Lymphoma (HL)

Question 36

What is the age range affected by Hodgkin Lymphoma (HL)? What is the median age affected by Non-Hodgkin Lymphoma (NHL)?

Answer 36

- HL: 15-34 years | - NHL: 66 years

Question 37

What are the two stages of Non-Hodgkin Lymphoma (NHL), and how does the tumor in each stage progress?

Answer 37

- Indolent stage = slow-growing mass | - Advanced stage = rapidly growing mass

Question 38

What three diagnostic tools can be used for Non-Hodgkin Lymphoma (NHL)?

Answer 38

- Biopsy (prefer 2+ cm lymph nodes) - CT/PET scan - Bone marrow aspiration and biopsy

Question 39

How does treatment differ for the the two stages of Non-Hodgkin Lymphoma (NHL)?

Answer 39

- Indolent = radiation alone | - Aggressive = chemotherapy

Question 40

Which cancer involves the malignancy of plasma cells?

Answer 40

Multiple Myeloma (MM)

Question 41

Which cancer is more commonly seen in African Americans?

Answer 41

Multiple Myeloma (MM)

Question 42

What four symptoms are often associated with Multiple Myeloma (MM)?

Answer 42

- Back pain - Neurologic changes - Bone pain - Fatigue

Question 43

What diagnostic tool can be an early indication of malignancy for Multiple Myeloma (MM), and what two findings are often seen?

Answer 43

Protein Electrophoresis shows: - Paraproteins (in blood = hyperviscosity; in urine = renal failure) - M spike

Question 44

What cancer is associated with anemia and Rouleaux formation?

Answer 44

Multiple Myeloma (MM)

Question 45

What could be found in the urine of a patient with Multiple Myeloma (MM)?

Answer 45

Bence-Jones proteins

Question 46

What two findings could be seen on axial skeleton x-rays of a patient with Multiple Myeloma (MM)?

Answer 46

- Lytic lesions | - Generalized osteoporosis

Question 47

What does CRAB stand for and what cancer is it associated with?

Answer 47

Multiple Myeloma (MM) - Calcium - Renal insufficiency - Anemia - Bone lesions

Question 48

What condition involves bleeding from mucous membranes, visual issues from retinopathy, neuro sx? What cancer is it often associated with?

Answer 48

Hyperviscosity syndrome | - Associated with Multiple Myeloma (MM)

Question 49

What treatment is recommended for a patient with Multiple Myeloma (MM), and why?

Answer 49

IV bisphosphonates to prevent bone mass loss