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Yr5 Haematology > Cancer > Flashcards

Cancer Flashcards

1
Q

What is a myeloma?

A

Plasma cell dyscrasia
Due to malignant proliferation of plasma cells
i.e neoplasm of BM plasma cells occurs during terminal differentiation of B cells to plasma cells

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2
Q

What 2 outcomes can happen from myeloma formation?

A
  • Diffuse BM infiltration → bone destruction (↑osteoclast/ ↓osteoblast → ↑Ca2+) + marrow failure
  • Secretion of Ig/paraprotein→ organ dysfunction esp. renal
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3
Q

What are the risk factors for myeloma?

A

70yo
Afro-carribbean
RAS & oncogene mutation

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4
Q

What are the sub-classifications of myeloma?

A 
Classified by Ab produced
IgG: Most commpon
IgA
IgM
IgD
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5
Q

What are the Sx of myeloma?

A 
BONE: 
Backache (COMMON)
Bone pain
Pathological #
Vertebral collapse
HyperCa 
BLOOD:
Anaemia → lethargy
Neutropenia → Recurrent infections
Thrombocytopenia → Bleeding/bruising
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6
Q

What are the signs of multiple myeloma?

A 
CRAB
C: Ca↑↑ (polyuria, polydipsia, N&V)
R: Renal failure
A: Anaemia
B: Bone lesions
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7
Q

How does renal impairment occur in myeloma?

A

Light Ig chain deposit w/ Tamm-Horsfall protein in distal loop of Henle

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8
Q

How is myeloma investigated?

A
  • Blood: FBC, ↑Urea ↑Creat ↑Ca2, ALP, ↓Hb, Persistently ↑ESR
  • Blood Film: Rouleaux formation (red cells stack on each other = ↑ESR)
  • Serum electrophoresis: MONOCLONAL PROTEIN BAND
  • Urine electrophoresis: BENCE JONES PROTEIN
  • Marrow Aspirate + Trephine biopsy
  • Skeletal survey: CXR/Spine/Skull/pelvis
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9
Q

What are the radiological signs of myeloma?

A

Lytic bone lesions (pepper-pot skull)
Vertebral collapse
Fractures
Osteoporosis

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10
Q

What is the diagnostic criteria for myeloma?

A

Symptomatic: ALL 3=

1) Monoclonal plasma cells in marrow ≥10%
2) Monoclonal protein in serum/urine (if non-secretory; need ≥30% monoclonal plasma cells in BM)
3) Evidence of myeloma-related organ or tissue impairment: CRAB Sx

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11
Q

How is myeloma managed?

A 
CHEMO: Intensive or low intensity
Bisphosphonates = Bone- help ↓#/pain
Transfusion + EPO
Fluids = Renal failure
Abx = Infection
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12
Q

What needs regular monitoring in someone with myeloma?

A 
Every 2-3m:
FBC
Creatinine
Ca2+
Serum/urine EP
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13
Q

What is the diagnosis if ↑paraprotein but do not meet the diagnostic criteria for myeloma?

A

MGUS

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14
Q

What is Hodgkin’s lymphoma?

A

Malignant proliferation of lymphocytes

Accumulate in LN & peripheral blood/organs

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15
Q

What are the risk factors for Hodgkin’s lymphoma?

A

Male
Young
Infection: EBV
Autoimmune: SLE, Post-transplant

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16
Q

How does Hodgkin’s lymphoma present?

A

LYMPHADENOPATHY- 75% painless, non-tender, rubbery, superficial, asymmetrical

3 B Sx required:

  • Fever >38
  • Weight loss >10% (in 6m)
  • Night sweats
  • Spleno/hepatomegaly
17
Q

How is Hodgkin’s lymphoma investigated?

A

-Tissue biopsy:
1) LN EXCISIONAL BIOPSY
2) USS guided needle biopsy
Histology: Reed-Sternberg cells
-Bloods: ↑ESR or ↓Hb (poor prog), ↑LDH
-CXR/PET/CT: Staging

18
Q

What are the histological classifications of Hodgkin’s lymphoma?

A

A) Nodular sclerosis- Most common 70%, LACUNAR cells
B) Mixed cellularity- GOOD prognosis, REED-STERNBERG cells
C) Lymphocyte predominate- BEST prognosis
D) Lymphocyte depletion- WORST prognosis

19
Q

What is used to stage Hodgkin’s lymphoma?

A

Ann Arbor System

20
Q

How is Hodgkin’s lymphoma managed?

A 
Chemo: ABVD
A: Adrimycin
B: Bleomycin
V: Vinblastine
D: Dacarbazine
21
Q

What is non-Hodgkin’s lymphoma?

A

ALL lymphomas without Reed-Sternberg cells
Typically derived from B-cell lines
Diffuse large B-cell lines most common

22
Q

What are the types of non-Hodgkin’s lymphoma?

A

75% Nodal

25% Extra-nodal

23
Q

What are the causes of non-Hodgkin’s lymphoma?

A

Immunodeficiency: Chemo, HIV, H.Pylori, Toxins, EBV

Congenital

24
Q

In which (Hodgkin’s/non-Hodgkin’s) are B symptoms more common?

A

Hodgkin’s

25
Q

What are the Sx of non-Hodgkin’s lymphoma in different organs?

A

Superficial lymphadenopathy = 75%
SKIN = Sezary syndrome (T-cell lymphoma)
OROPHARYNX = Odynophagia, obstructed breathing (Waldeyer’s ring lymphoma)
Pancytopenia = BM involvement

26
Q

What are the types of gut lymphoma?

A

MALT: Caused by H.Pylori, Gastric Ca w/systemic Sx (fever, sweats), Tx: Triple therapy
Non-MALT
S.bowel: Immunoproliferative MALT/ enteropathy/Coeliac related, abdo pain, ↓weight

27
Q

How is non-Hodgkin’s lymphoma investigated?

A

1) Marrow biopsy

2) Staging: CXR/CT/PET

28
Q

How is non-Hodgkin’s lymphoma managed?

A

Low grade: INDOLENT + INCURABLE

High grade: AGGRESSIVE + CURABLE, R-CHOP regimen

29
Q

What are types of low grade non-hodgkin’s lymphoma?

A

Follicular
Marginal zone
MALT

30
Q

What are types of high grade non-hodgkin’s lymphoma?

A

Burkitt’s

31
Q

What does a blood film of Burkitt’s lymphoma look like?

A

Starry sky appearance

32
Q

What are the complications of lymphoma?

A

Tumour lysis syndrome

33
Q

What are the signs seen in someone post-splenectomy or with hyposplenism?

A 
SHATP
S: Siderotic granules
H: Howell- Jolly bodies
A: Acanthocytes
T: Target cells
P: Pappenheimer bodies

Yr5 Haematology (6 decks)

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