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Hematology > Cancer > Flashcards

Cancer Flashcards

1
Q

What does a high WCC + low platelets indicate?

A

Leukamia

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2
Q

S+S leukaemia

A 
Thrombocytopenia = bruising
Anaemia
Leucopenia = infection
Bone pain
Fever
Lymphadenopathy
Hepatosplenomegaly
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3
Q

Management of ALL, CLL, AML + CML

A 
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
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4
Q

S+S Hodgkins lymphoma

A

Painless lymphadenopathy
Usually cervical - or axially, inguinal
Larger + firmer than benign nodes
Night sweats, weight loss + fever

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5
Q

Management + mode of monitoring of Hodgkins lymphoma, + which age group is more likely to get HL vs NHL?

A

Chemo +- RT
PET scanning for monitoring
NHL = childhood
HL = teens

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6
Q

S+S NHL

A

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

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7
Q

What blood results indicate CLL?

A

Anaemia + neutropenia + thrombocytopenia

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8
Q

What pattern of lymph node involvement is seen in Hodgkins vs NH lymphoma?

A

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

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9
Q

What are B symptoms?

A

night sweats, fevers, weight loss, and new palpable lymph nodes
Common in Hodgkins lymphoma

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10
Q

What virus is associated with Hodgkins vs NHL?

A 
EBV = Hodgkins
HIV = NHL
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11
Q

NHL originates from what type of cell?

A

B lymphocytes

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12
Q

What is the histological appearance of Burkitt’s lymphoma?

A

Sheets of lymphocytes interspersed with macrophages (starry sky appearance)

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13
Q

Investigations + management for NHL

A

Excision biopsy
Consider using FISH to diagnose B cell lymphomas
Offer FDG-PET-CT scan to confirm staging

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14
Q

What is multiple myeloma?

A

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.

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15
Q

Epidemiology of myeloma

A

It is slightly more common in men than in women, andis more common in people over 60 years of age than in younger people.

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16
Q

What factors indicate a poor prognosis in myeloma?

A

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.

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17
Q

What are the complications of myeloma?

A 
Pathological bone fractures.
Spinal cord compression.
Renal damage.
Impaired resistance to infection.
Anaemia.
Bleeding disorders.
Hyperviscosity of the blood.
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18
Q

What are the symptoms of myeloma?

A

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

19
Q

Investigation + management for suspected myeloma

A

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

20
Q

Histological appearance of myeloma

A

Fried egg appearance (proliferation of plasma cells)

21
Q

What immunoglobulin does myeloma produce?

A

Myeloma produces immunoglobulin G (55%) or immunoglobulin A (25%)

22
Q

What x ray findings suggest myeloma?

A

Round punched-out lytic bone lesions

23
Q

What appearance is foundon a peripheral blood smear in myeloma?

A

Rouleaux formation, in which red blood cells appear to be stacked like poker chips

24
Q

What is a lymphoma?

A

Malignant proliferations of lymphocytes

Accumulate in lymph nodes causing lymphadenopathy

25
Q

RF for Hodgkins

A 
Affected sibling
 EBV 
SLE 
Post transplant 
Obese 
HIV 
Smoking
26
Q

RF for NHL

A 
Chromosomal translocations 
Viruses = EBV, HTLV-1, HIV 
Pesticides 
Immunodeficiency 
Autoimmune disorders eg Sjogrens syndrome, Hashimoto's thyroiditis 
H pylori
27
Q

What is a Pel-Ebstein fever?

A

Cyclical fever, long periods of normal temp (15-28 days) = lymphoma

28
Q

Low vs high grade lymphomas

A 
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
29
Q

What staging do you use for lymphomas?

A

Ann-Arbor staging

Stages 1-4 with A or B (B = systemic symptoms)

30
Q

Complications of radiotherapy in lymphomas

A 
Increased risk of: 
Second malignancies (solid tumours in breast, melanoma, sarcoma, stomach + thyroid) 
IHD 
Hypothyroidism 
Lung fibrosis
31
Q

What is acute lymphoblastic leukaemia?

A

Bone marrow makes too many immature cells (lymphoblasts) Continue to divide + multiply but do not mature

32
Q

What is chronic lymphoblastic leukaemia?

A

Increased number of near normal lymphocytes that don’t die off

33
Q

What is acute myeloid leukaemia?

A

Bone marrow makes large numbers of immature cells from myeloid system (M0-7)

34
Q

What is chronic myeloid leukaemia?

A

Abnormal stem cell multiples = increased neutrophils, basophils + eosinophils (all granulocytes)
Can cause myelofibrosis

35
Q

RF for leukaemias

A

Radiation, past chemo or immunotherapy
Downs
Philadelphia chromosome
CML

36
Q

Red flag S+S for leukaemias

A 
Serious/ recurrent infections 
Blood clotting problems 
Anaemia
 Fever or chills 
Persistent fatigue/ weakness 
Weight loss 
Swollen lymph nodes 
Petechiae 
Night sweats 
Bone pain
37
Q

Investigations for leukaemia

A

Bone marrow biopsy
Blood film
Lumbar puncture to check spread to CNS

38
Q

What is a pepperpot skull appearance a sign of?

A

Multiple myeloma

39
Q

What is TdT a marker for?

A

Terminal deoxynucleotidyl transferase (TdT)

Marker of pre-lymphocytes - indicates ALL or lymphoma

40
Q

What are auer rods indicative of?

A

AML

41
Q

What are myeloblasts (granulated blasts) indicative of?

A

AML

42
Q

Where does ALL metastasise to?

A

CNS + testes

43
Q

What do Howell-Jolly bodies signify?

A

Splenic atrophy

Common in sickle cell or coeliacs

Hematology (5 decks)

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