Cancer Flashcards
What does a high WCC + low platelets indicate?
Leukamia
S+S leukaemia
Thrombocytopenia = bruising Anaemia Leucopenia = infection Bone pain Fever Lymphadenopathy Hepatosplenomegaly
Management of ALL, CLL, AML + CML
ALL = chemo, radiotherapy for brain mets, stem cell transplant if recurrent CLL = chemo, mAbs, radiotherapy, stem cell transplant AML = chemo, stem cell transplant CML = TKi, interferon tablets, chemo, stem cell transplant
S+S Hodgkins lymphoma
Painless lymphadenopathy
Usually cervical - or axially, inguinal
Larger + firmer than benign nodes
Night sweats, weight loss + fever
Management + mode of monitoring of Hodgkins lymphoma, + which age group is more likely to get HL vs NHL?
Chemo +- RT
PET scanning for monitoring
NHL = childhood
HL = teens
S+S NHL
Mediastinal mass - can cause SVC obstruction
Lymphadenopathy
Pain from intestinal obstruction or intussusception
Extranodal disease: skin, oropharynx, gut, small bowel, bone, CNS, lung
Fatigue, weakness, fever, night sweats, weight loss
What blood results indicate CLL?
Anaemia + neutropenia + thrombocytopenia
What pattern of lymph node involvement is seen in Hodgkins vs NH lymphoma?
Hodgkin’s lymphoma tends to be localized (especially mediastinal) and spread to contiguous nodes, whereas non-Hodgkin’s is more likely to be peripheral, with extranodal involvement and noncontiguous spread
What are B symptoms?
night sweats, fevers, weight loss, and new palpable lymph nodes
Common in Hodgkins lymphoma
What virus is associated with Hodgkins vs NHL?
EBV = Hodgkins HIV = NHL
NHL originates from what type of cell?
B lymphocytes
What is the histological appearance of Burkitt’s lymphoma?
Sheets of lymphocytes interspersed with macrophages (starry sky appearance)
Investigations + management for NHL
Excision biopsy
Consider using FISH to diagnose B cell lymphomas
Offer FDG-PET-CT scan to confirm staging
What is multiple myeloma?
Multiple myeloma is a progressive malignant diseasecharacterized by proliferation of abnormal plasma cells in the bone marrow andabnormal monoclonal immunoglobulins (M proteins) in the blood.
Epidemiology of myeloma
It is slightly more common in men than in women, andis more common in people over 60 years of age than in younger people.
What factors indicate a poor prognosis in myeloma?
The prognosis is worse if the person has high levels of serumbeta-2microglobin, high plasma cell counts, diffuse multiple bone lesions, hypercalcaemia, very high levels of M protein in blood and urine, and renal impairment.
What are the complications of myeloma?
Pathological bone fractures. Spinal cord compression. Renal damage. Impaired resistance to infection. Anaemia. Bleeding disorders. Hyperviscosity of the blood.
What are the symptoms of myeloma?
Bone pain, often in the lower back.
Fatigue.
Confusion, muscle weakness, constipation, thirst, and polyuria (due to hypercalcaemia).
Weight loss.
Recurrent infection.
Headache, visual disturbance, cognitive impairment, mucosal bleeding, and breathlessness (due to hyperviscosity of the blood).
Sensory loss, paraesthesia, limb weakness, walking difficulty, sphincter disturbance, and spinal deformity (due to spinal cord compression).
ThinkCRAB: hyperCalcemia,Renal insufficiency,Anemia, andBone/Back pain
Investigation + management for suspected myeloma
FBC, calcium, ESR for anyone over 60 with bone pain or unexplained fractures
Arrange urgent serum electrophoresis + Bence Jones protein urine for pts >60 with hypercalcaemia or leukopenia + symptoms
Arrange X rays to rule out pathological fractures
Refer to haematologist within 2 weeks
Management = bisphosphonates, anemia tx, chemo, stem cell transplants
Histological appearance of myeloma
Fried egg appearance (proliferation of plasma cells)
What immunoglobulin does myeloma produce?
Myeloma produces immunoglobulin G (55%) or immunoglobulin A (25%)
What x ray findings suggest myeloma?
Round punched-out lytic bone lesions
What appearance is foundon a peripheral blood smear in myeloma?
Rouleaux formation, in which red blood cells appear to be stacked like poker chips
What is a lymphoma?
Malignant proliferations of lymphocytes
Accumulate in lymph nodes causing lymphadenopathy
RF for Hodgkins
Affected sibling EBV SLE Post transplant Obese HIV Smoking
RF for NHL
Chromosomal translocations Viruses = EBV, HTLV-1, HIV Pesticides Immunodeficiency Autoimmune disorders eg Sjogrens syndrome, Hashimoto's thyroiditis H pylori
What is a Pel-Ebstein fever?
Cyclical fever, long periods of normal temp (15-28 days) = lymphoma
Low vs high grade lymphomas
Low = indolent, often incurable, widely disseminated eg follicular lymphoma, MALT, lymphocytic lymphoma High = aggressive but curable, rapidly enlarging lymphadenopathy with systemic symptoms eg Burkitt's lymphoma, lymphoblastic, diffuse large B cells
What staging do you use for lymphomas?
Ann-Arbor staging
Stages 1-4 with A or B (B = systemic symptoms)
Complications of radiotherapy in lymphomas
Increased risk of: Second malignancies (solid tumours in breast, melanoma, sarcoma, stomach + thyroid) IHD Hypothyroidism Lung fibrosis
What is acute lymphoblastic leukaemia?
Bone marrow makes too many immature cells (lymphoblasts) Continue to divide + multiply but do not mature
What is chronic lymphoblastic leukaemia?
Increased number of near normal lymphocytes that don’t die off
What is acute myeloid leukaemia?
Bone marrow makes large numbers of immature cells from myeloid system (M0-7)
What is chronic myeloid leukaemia?
Abnormal stem cell multiples = increased neutrophils, basophils + eosinophils (all granulocytes)
Can cause myelofibrosis
RF for leukaemias
Radiation, past chemo or immunotherapy
Downs
Philadelphia chromosome
CML
Red flag S+S for leukaemias
Serious/ recurrent infections Blood clotting problems Anaemia Fever or chills Persistent fatigue/ weakness Weight loss Swollen lymph nodes Petechiae Night sweats Bone pain
Investigations for leukaemia
Bone marrow biopsy
Blood film
Lumbar puncture to check spread to CNS
What is a pepperpot skull appearance a sign of?
Multiple myeloma
What is TdT a marker for?
Terminal deoxynucleotidyl transferase (TdT)
Marker of pre-lymphocytes - indicates ALL or lymphoma
What are auer rods indicative of?
AML
What are myeloblasts (granulated blasts) indicative of?
AML
Where does ALL metastasise to?
CNS + testes
What do Howell-Jolly bodies signify?
Splenic atrophy
Common in sickle cell or coeliacs
