BLOOD CANCERS Flashcards
What is the most common leukaemia in children?
Acute Lymphoblastic Leukaemia
Which leukaemia is associated with Down Syndrome?
Acute Lymphoblastic Leukaemia
What is the most common leukaemia in adults?
Chronic Lymphocytic Leukaemia
What is the likely diagnosis if smudge/smear cells are seen on blood film?
Chronic Lymphocytic leukaemia
Which leukaemia is known to undergo Richter’s transformation into lymphoma?
Chronic Lymphocytic leukaemia
Which leukaemia is associated with warm haemolytic anaemia?
Chronic Lymphocytic leukaemia
Which leukaemia has three phases?
What are they?
Chronic Myeloid leukaemia has 3 phases
- Chronic phase (5 years usually asymptomatic, patients may be incidentally diagnosed on high white cell count)
- Accelerated phase (anaemia, thrombocytopenia, immunocompromised)
- Blast phase (severe symptoms and pancytopenia. often fatal)
What cytogenic change occurs that is characteristic of Chronic Myeloid leukaemia?
The Philadelphia chromosome
What haematological malignancy is most commonly associated with the Philadelphia chromosome?
Chronic Myeloid chromosome
What haematological malignancy is associated with auer rods?
Acute Myeloid leukaemia
What is the most common acute adult leukaemia?
Acute Myeloid leukaemia
What can present before Acute Myeloid leukaemia?
Acute Myeloid leukaemia can be the result of a transformation from a myeloproliferative disorder.
What are the different types of leukaemias and what age groups are they associated with ?
ALL CeLLmates have CoMmon AMbitions
- <5 and >45: Acute Lymphoblastic Leukaemia
- >55: Chronic Lymphocytic Leukaemia
- >65: Chronic Myeloid leukaemia
- >75: Acute Myeloid leukaemia
What would you expect to see on the blood film of someone with Acute Myeloid leukaemia?
blast cells
with auer rods
What age does Hodgkin’s Lymphoma generally present?
bimodal age distribution with peaks around 20 years and 75 years
What is the key presenting symptom of lymphoma?
Lymphadenopathy
They are non-tender and feel “rubbery”
What would you expect to see on a lymph node biopsy of a patient with Hodgkin’s lymphoma?
Reed-Sternberg cell
What staging system is used for Hodgkin’s and non-Hodgkin’s lymphoma?
Briefly discuss
The Ann Arbor staging system
importance on whether affected nodes are above or below the diaphragm or are both above AND below the diaphragm(Stage 3)
What is Burkitt lymphoma and what is it associated with?
A non-Hodgkin’s lymphoma
associated with EBV, malaria and HIV
What is MALT lymphoma and what is it associated with?
MALT lymphoma is a non-Hodgkin’s lymphoma that affects the mucosa-associated lymphoid tissue, usually around the stomach
Associated with H. pylori
What is diffuse large B cell lymphoma and how does it normally present?
A non-Hodgkin’s lymphoma
often presents as a rapidly growing painless mass in patients over 65 years
What is myeloma?
What is multiple myeloma?
Myeloma is a cancer of the plasma cells (a type of B lymphocyte that produces antibodies). Cancer in a specific type of plasma cell ersults in large quantities of a single type of antibody being produced.
Multiple myeloma is where myeloma affects multiple areas of the body.
What is monoclonal gammopathy of undetermined significance? (MGUS)
An excess of a single type of antibody or antibody components without features of myeloma or cancer.
It’s an incidental finding and as the name suggests its significance is unclear so patients are often followed up to monitor
What is smouldering myeloma?
Where there is progression of MGUS with higher levels of antibodies or antibody components.
It is premalignant and more likely to progresss to myeloma than MGUS
What is Waldenstrom’s macroglobulinaemia?
A smouldering myeloma where there is excessive IgM specifically
What are the key features of myeloma?
CRAB
- C-Calcium (elevated)
- R- Renal failure
- A- Anaemia (normocytic, normochromic) from replacement of bone marrow
- B- Bone lesions and bone pain
What investigations would you do and what results would you expect if you suspected myeloma?
NICE Guidelines suggest suspecting myeloma esp. in anyone over 60 y/o with persistent bone pain, esp. back pain or an unexplained fracture.
- FBC (low white blood cell count in myeloma)
- Calcium (raised in myeloma)
- ESR (raised in myeloma)
- Plasma viscosity (raised in myeloma)
If any of these are positive or myeloma is still suspected do an urgent serum protein electrophoresis and a urine Bence-Jones protein test.
After initial investigations, what other investigations do NICE recommend carrying out to investigate myeloma?
BLIP
- Bence-Jones protein (request urine electrophoresis)
- L- serum-free Light chain assay
- I- serum Immunoglobulins
- P- serum Protein electrophoresis
NB: you cannot exclude myeloma with one investigation
‘Myeloma usually takes a relapsing and remitting course’
T/F
True
What is a myeloproliferative disorder?
A condition which occurs due to uncontrolled proliferation of a single type of stem cell. They are considered a type of bone marrow cancer.
What are the three myeloproliferative disorders to remember?
- Primary myelofibrosis
- Polycythaemia vera
- Essential thrombocythaemia
What condition may myeloproliferative disorders progress to?
Acute myeloid leukaemia
The following genetic conditions are associated with what condition?
- JAK2
- MPL
- CALR
Which of these can affect Tx options?
Myeloproliferative disorders
JAK2 can be the target of JAK2 inhibitors such as ruxolitinib
What would you expect to see on the FBC of someone with polycythaemia vera?
Raised Hb
What would you expect to see on the FBC of someone with primary thrombocythaemia?
Raised platelet count
What would you expect to see on the blood film of someone with myelofibrosis?
‘teardrop-shaped RBCs’
How are patients with primary myelofibrosis managed?
- mild disease may be just monitored
- Allogenic stem cell transplantation (can be curative but carries risk)
- Chemo (help control the disease, improve symptoms and slow progression but is not curative on its own)
- Supportive management (of the anaemia, splenomegaly and portal hypertension)
How are patients with polycythaemia vera managed?
- Venesection can be used to keep the Hb in the normal rnage
- Aspirin
- Chemo
How are patients with essential thrombocythaemia managed?
- Aspirin
- Chemo
