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Y3 Content > Cancer > Flashcards

Cancer Flashcards

1
Q

Bladder cancers are what kind of cancers?

A

Most bladder cancers are transitional cell carcinomas

Rarely, bladder cancers may be squamous cell carcinomas associated with chronic inflammation (e.g. schistosomiasis)

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2
Q

What are the risk factors for bowel cancer?

A

Smoking

Dye stuffs (naphthylamines and benzidine)

Cyclophosphamide treatment

Pelvic irradiation

Chronic UTIs

Schistosomiasis

Being Male

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3
Q

What are the presenting symptoms of bladder cancer?

A

Painless macroscopic haematuria

Irritative/storage symptoms

Frequency

Urgency

Nocturia

Recurrent UTIs

  • occassionaly ureteral obstruction
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4
Q

What are the signs of bladder cancer on examination?

A
  • Commonly NO SIGNS
  • bimanual exam can be used for staging
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5
Q

What are the appropriate investigations for bladder cancer?

A

Cystoscopy - allows visualisation, biopsy or removal

Ultrasound

Intravenous urography

CT/MRI for staging

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6
Q

What is the most common type of breast cancer?

A

invasive ductal carcinoma

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7
Q

What are the risk factors for breast cancer?

A
  • genetics (BRCA genes)
  • age
  • oestrogen exposure
  • family history
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8
Q

What are the presenting symptoms of breast cancer?

A

Breast lump (usually painless)

Changes in breast shape

Nipple discharge (may be bloody)

Axillary lump

Symptoms of malignancy: weight loss, bone pain, paraneoplastic syndromes

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9
Q

What are the signs of breast cancer on examination?

A

Breast lump - firm, irregular, fixed to surrounding structures

Peau d’orange

Skin tethering

Fixed to chest wall

Skin ulceration

Nipple inversion

Paget’s disease of the nipple - eczema-like hardening of the skin on the nipple -> usually caused by ductal carcinoma in situ infiltrating the nipple

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10
Q

What are the appropriate investigations for breast cancer?

A
  • TRIPLE ASSESSMENT = clinical examination, imaging (ultrasound (< 35 yrs) or mammogram (> 35 yrs) ), tissue Diagnosis
  • Sentinel Lymph Node Biopsy
  • Staging - via CXR, liver ultrasound, CT (brain/thorax)
  • Bloods: FBC, U&Es, calcium, bone profile, LFTs, ESR
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11
Q

What are the risk factors for cholangiocarcinoma?

A

Ulcerative colitis + primary sclerosing cholangitis

Choledochal cyst (congenital conditions involving cystic dilatations of bile ducts)

Caroli disease (rare genetic condition in which you get dilatation of intrahepatic bile ducts)

Parasitic infection of biliary tract

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12
Q

What are the presenting symptoms of cholangiocarcinoma?

A

Obstructive jaundice symptoms = yellow sclera, pale stools, dark urine, pruritus

Abdominal pain or fullness

Systemic symptoms of malignancy = weight loss, malaise, anorexia

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13
Q

What are the signs of cholangiocarcinoma on examination?

A

Jaundice

Palpable gallbladder

Epigastric/RUQ mass

There may be hepatomegaly

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14
Q

What are the appropriate investigations for cholangiocarcinoma?

A
  • Bloods = FBC, U&Es, LFTs (high ALP + GGT), clotting screen, tumour markers
  • Endoscopy
  • Ultrasound
  • Staging - via CT, MRI, Bone Scan
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15
Q

What marker is used for pancreatic and cholangiocarcinoma diagnosis?

A
  • CA19-9
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16
Q

What are the risk factors for CNS tumours?

A

Ionising radiation

Immunosuppression (e.g. HIV)

Inherited syndromes (e.g. neurofibromatosis, tuberous sclerosis)

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17
Q

What are the presenting symptoms of CNS tumours?

A

o Presentation depends on the size and location of the tumour

Headache (worse in the morning and when lying down)

Nausea and vomiting

Seizures

Progressive focal neurological deficits

Cognitive and behavioural symptoms

Papilloedema

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18
Q

What are the appropriate investigations for CNS tumours?

A

Bloods - check CRP/ESR to eliminate other causes (e.g. temporal arteritis)

CT/MRI

Biopsy and tumour removal

Magnetic resonance angiography - define changing size and blood supply of the tumour

PET - distant mets are rare with primary CNS tumours

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19
Q

What is the most common type of colorectal cancer?

A

adenocarcinoma

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20
Q

Describe the distribution of colorectal cancer.

A

60% - rectum and sigmoid

30% - descending colon

10% - rest of colon

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21
Q

What are the risk factors for colorectal cancer?

A

Western diet (e.g. red meat, alcohol)

Colorectal polyps

Previous colorectal cancer

Family history

IBD

Genetics (HNPCC or FAP)

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22
Q

What are the presenting symptoms of colorectal cancer?

A

o Left-Sided Colon and Rectum

  • change in bowel habit
  • rectal bleeding (blood or mucus mixed with the stools)
  • tenesmus (recurrent inclination to evacuate the bowels) due to a space-occupying tumour in the rectum

o Right-Sided Colon (presents later)

  • anaemia symptoms (lethargy)
  • weight loss
  • non-specific malaise
  • lower abdominal pain (rare)

o 20% of tumours will present as an EMERGENCY with pain and distension due to large bowel obstruction, haemorrhage or peritonitis due to perforation

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23
Q

What are the signs of colorectal cancer on examination?

A

Signs of Anaemia

Abdominal mass

Hepatomegaly and Ascites if metastatic

Low-lying rectal tumours may be palpable on DRE

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24
Q

What are the appropriate investigations for colorectal cancer?

A

o Bloods = FBC - anaemia, LFTs, Tumour markers (CEA)

o Stools = FOBT - used as a screening test

o Endoscopy = sigmoidoscopy or colonoscopy

o Double-Contrast Barium Enema

o Contrast CT for staging (Duke’s staging)

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25
Q

What is the most common type of gastric cancer?

A
  • adenocarcinoma
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26
Q

What are the risk factors for gastric cancer?

A

Smoked and processed foods

Smoking

Alcohol

Helicobacter pylori infection

Atrophic gastritis

Pernicious anaemia

Partial gastrectomy

Gastric polyps

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27
Q

What are the presenting symptoms of gastric cancer?

A

Often asymptomatic early

Early satiety

Epigastric discomfort

Systemic symptoms: weight loss, anorexia, nausea/vomiting

Dysphagia (in tumours of the gastric cardia)

Symptoms of metastases (e.g. ascites, jaundice)

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28
Q

What are the signs of gastric cancer on examination?

A

Epigastric mass

Abdominal tenderness

Ascites

Signs of anaemia

Virchow’s Node (aka Troisier’s sign = it is palpable)

Sister Mary Joseph’s Nodule (metastatic node on the umbilicus)

Krukenberg’s Tumour (ovarian metastases)

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29
Q

What are the appropriate investigations for gastric cancer?

A
  • Upper GI endoscopy
  • Bloods - FBC (check for anaemia), LFTs
  • CT/MRI - for staging
  • Endoscopic USS - assess depth of gastric invasion and lymph node involvement
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30
Q

What is hepatocellular carcinoma?

A

Primary malignancy of the liver parenchyma

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31
Q

What are the risk factors for hepatocellular carcinoma?

A

Chronic liver damage - alcoholic liver disease hepatitis C, autoimmune disease

Metabolic disease -> e.g. haemochromatosis

Aflatoxins -> e.g. cereals contaminated with fungi

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32
Q

What are the presenting symptoms of hepatocellular carcinoma?

A

o Symptoms of Malignancy = malaise, weight loss, loss of appetite

o History of Exposure to Carcinogens = high alcohol intake, hepatitis B or C/sexual activity/IV drug use), aflatoxins

o Abdominal distention

o Jaundice

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33
Q

What are the signs of hepatocellular carcinoma on examination?

A

o Signs of Malignancy = cachexia, lymphadenopathy

o Hepatomegaly (may be nodular)

o Jaundice

o Ascites

o Bruit over the liver

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34
Q

What are the appropriate investigations for hepatocellular carcinoma?

A

o Bloods = FBC, ESR, LFTs, clotting factors, alpha-fetoprotein (tumour marker for liver cancer, hepatitis serology

o Imaging = abdominal US and CT/MRI - GOLD STANDARD for staging

o Histology/Cytology

o Staging - via CT scan (chest/abdo/pelvis)

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35
Q

What are the risk factors for lung cancer?

A

Smoking

Asbestos exposure

Other occupational exposure: polycyclic hydrocarbons, nickel, radon

Atmospheric pollution

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36
Q

What are the primary symptoms of lung cancer?

A
  • May be asymptomatic
  • Cough
  • Haemoptysis
  • Chest pain
  • Recurrent pneumonia
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37
Q

What symptoms can arise due to local invasion in lung cancer?

A

Brachial plexus invasion –> shoulder/arm pain

Left recurrent laryngeal nerve invasion –> hoarse voice and bovine cough

Dysphagia

Arrhythmias

Horner’s syndrome

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38
Q

What symptoms can arise due to metastatic spread in lung cancer?

A

Weight loss

Fatigue

Fractures

Bone pain

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39
Q

What are the signs of lung cancer on examination?

A

May be NO SIGNS

Fixed monophonic wheeze/stridor (suggesting that there is a single obstruction)

Signs of lobar collapse or pleural effusion

Signs of metastases (e.g. supraclavicular lymphadenopathy or hepatomegaly)

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40
Q

What are the appropriate investigations for lung cancer?

A

o Diagnosis = CXR, sputum cytology, bronchoscopy with brushings or biopsy, CT/US-guided percutaneous biopsy, lymph node biopsy

o Staging - requires CT/MRI of head, chest and abdomen. PET scans may also be useful

o Bloods = FBC, U&Es, calcium (hypercalcaemia is a common feature), ALP (raised with bone metastases), LFTs

o Pre-Op - ABG and pulmonary function tests

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41
Q

Define neutropenic sepsis.

A

development of sepsis in a patient with neutropenia

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42
Q

What is the diagnostic criteria for neutropenic sepsis?

A

Temperature > 38 degrees - however patients can have neutropenic sepsis without a fever because they may be on anti-pyretic medications or steroids

Neutrophil count < 0.5 x 109 /L

43
Q

What are the 2 types of neutropenia?

A
  • incidental
  • febrile = temperature > 38.5 or two consecutive readings of > 38 for two hours and an absolute neutrophil count < 0.5 x 109 /L
44
Q

How are incidental neutropenias’ further categorised?

A

o Congenital

  • ethnic variation, cyclical neutropenia in children (all VERY RARE)

o Acquired

  • decreased/ineffective neutrophil production: bone marrow infiltration, aplastic anaemia, B12/folate deficiency, chemotherapy, radiotherapy
  • accelerated turnover: Felty’s syndrome, hypersplenism, malaria
  • others: toxoplasmosis, dengue fever
45
Q

What are the presenting symptoms of neutropenic sepsis?

A

o Check history for:

  • high-risk features: active cancer, recent chemotherapy, use of immunosuppressants or immunosuppressive illness (e.g. HIV)
  • CKD
  • recent blood products
  • intravascular devices (e.g. central line)
46
Q

What are the signs of neutropenic sepsis on examination?

A

Signs of infection may be minimal

Pyrexia

Features of infective endocarditis

Lymphadenopathy

Skin rashes

47
Q

What are the appropriate investigations for neutropenic sepsis?

A

FBC (check neutrophil level)

Blood cultures (check for sepsis)

Others - blood film, D-dimer (for DIC), U&Es, creatinine, LFTs

48
Q

What are the risk factors for pancreatic cancer?

A

Age

Being Male

Smoking

Diabetes mellitus

Chronic pancreatitis

Dietary (low intake of fresh fruit and vegetables)

Genetics/Hereditary (MEN, HNPCC, FAP)

49
Q

What are the presenting symptoms of pancreatic cancer?

A

Often non-specific initially

Anorexia

Malaise

Nausea

Epigastric pain

Weight loss

Diabetes mellitus

Jaundice

50
Q

What are the signs of pancreatic cancer on examination?

A
  • Weight loss
  • Epigastric tenderness or mass
  • Jaundice and a palpable gallbladder (Courvoisier’s law - a palpable gallbladder with painless jaundice is unlikely to be due to gallstones)
  • If metastatic spread –> hepatomegaly
  • Trousseau’s Sign of Malignancy (low calcium sign that causes hand spasms when a cuff is left inflated for 3+ minutes) - superficial thrombophlebitis
51
Q

What are the appropriate investigations for pancreatic cancer?

A

o Bloods -> CA 19-9, CEA elevation, obstructive jaundice features (high bilirubin, high ALP, deranged clotting)

o Imaging -> Ultrasound, CT with/without guided biopsy, MRI/MRCP, ERCP (may allow biopsy, bile cytology and stenting)

52
Q

What are the risk factors for prostrate cancer?

A

Age

Afro-Caribbean

Family history

Dietary factors

Occupational exposure to cadmium

53
Q

What are the presenting symptoms of prostrate cancer?

A

o Often ASYMPTOMATIC

o Lower Urinary Tract Obstruction -> frequency, hesitancy, poor stream, terminal dribbling, nocturia

o Metastatic Spread -> bone pain, cord compression, systemic symptoms (malaise, anorexia, weight loss), paraneoplastic syndromes (e.g. hypercalcaemia)

54
Q

What are the signs of prostate cancer on examination?

A

Asymmetrical hard nodular prostate

Loss of midline sulcus

55
Q

What are the appropriate investigations for prostate cancer?

A

o Bloods = FBC, U&Es, PSA (not a specific), acid phosphatase, LFTs, bone profile

o CT/MRI Scan - assesses extent of local invasion and lymph node involvement

o Transrectal Ultrasound and Needle Biopsy

o Isotope Bone Scan - check for bone metastases

56
Q

What are the common types of renal cell cancer?

A

Renal clear cell carcinoma (80%)

Papillary carcinoma (10%)

Transitional cell carcinoma (10%)

57
Q

What are the risk factors for renal cell cancer?

A

o Inherited conditions -> von Hippel-Lindau disease = mutation in the von Hippel-Lindau protein causing headaches, balance issues, dizziness, limb weakness, vision problems and high blood pressure

o Tuberous sclerosis = rare genetic disease that causes benign tumours to grow in the brain and other organs (e.g. skin, kidneys, lungs, eyes)

o Polycystic kidney disease

o Familial renal cell cancer

o Smoking

o Chronic dialysis

58
Q

What is von Hippel-Lindau Disease?

A
  • am mutation in the von Hippel-Lindau protein
  • causes headaches, balance issues, dizziness, limb weakness, vision problems and high blood pressure
59
Q

What is Tuberous Sclerosis?

A
  • a rare genetic disease that causes benign tumours to grow in the brain and other organs (e.g. skin, kidneys, lungs, eyes)
60
Q

What are the presenting symptoms of renal cell cancer?

A

o Triad of Symptoms = Haematuria, Flank pain, Abdominal mass

  • renal cell carcinoma presents late with 90% of people being asymptomatic
  • transitional cell carcinoma presents eariler with haematuria

o Systemic Signs of Malignancy = Weight loss, Malaise, Paraneoplastic syndromes (e.g. fever, hypercalcaemia, polycythaemia)

61
Q

What are the signs of renal cell cancer on examination?

A

Palpable renal mass

Hypertension

Plethora

Anaemia

A left-sided tumour can obstruct the left testicular vein as it joins the left renal vein, and cause a Left-sided Varicocoele

62
Q

What are the appropriate investigations for renal cell cancer?

A

o Urinalysis - haematuria, cytology

o Bloods - FBC, U&Es, calcium, LFTs, high ESR (in 75%)

o Abdominal Ultrasound = First-line investigation - can distinguish between solid masses and cystic structures

o CT/MRI -> useful for staging -> Robson Staging

63
Q

What are the types of testicular cancer?

A

Seminomas - 50%

Non-seminomatous germ-cell tumours and teratomas - 30%

RARE: gonadal stromal tumours (Sertoli and Leydig cell tumours) and non-Hodgkin’s lymphoma

64
Q

What are the risk factors for testicular cancer?

A

Mal-descended testes

Ectopic testes

Atrophic tests

65
Q

What are the presenting symptoms of testicular cancer?

A

Swelling or discomfort of the testes

Backache due to para-aortic lymph node enlargement

Lung metastases -> SOB, haemoptysis

66
Q

What are the signs of testicular cancer on examination?

A

Painless, hard testicular mass

There may be a secondary hydrocoele

Lymphadenopathy (e.g. supraclavicular, para-aortic)

Gynaecomastia (tumour produces hCG)

67
Q

What are the approproate investigations for testicular cancer?

A

o Bloods - FBC, U&Es, LFTs, tumour markers (a-fetoprotein, b-hCG, LDH)

o Urine Pregnancy Test - will be positive if the tumour produces b-hCG

o CXR to check for cannonball lung metastases

o Testicular Ultrasound

o CT Abdomen and Thorax - allows staging -> Royal Marsden Hospital Staging

68
Q

Define Tumour Lysis Syndrome (TLS).

A

A group of metabolic abnormalities that can occur as a complication during treatment of cancer, where large amounts of tumour cells are lysed at the same time by treatment, releasing their contents into the bloodstream.

69
Q

What cancers treatment most commonly causes tumour lysis syndrome?

A
  • lymphomas and leukaemias
  • commonly these are poorly differentiated
70
Q

What are the risk factors for tumour lysis syndrome?

A

o Tumour Characteristics - high cell turnover rate, rapid growth rate, high tumour bulk

o Patient Characteristics - baseline serum creatinine, renal insufficiency, dehydration

o Chemotherapy Characteristics - chemo-sensitive tumours (e.g. lymphoma) tends to have a higher risk

71
Q

What are the presenting symptoms and signs on examination of tumour lysis syndrome?

A

o Hyperkalaemia -> Arrhythmias, Severe Muscle Weakness and Paralysis

o Hyperphosphataemia -> Acute Kidney Failure because of deposition of calcium phosphate crystals in the kidney parenchyma

o Hypocalcaemia -> forms calcium phosphate, so serum calcium drops -> Tetany, Parkinsonism, Myopathy, Sudden Mental Incapacity

o Hyperuricaemia -> Gout

o Lactic Acidosis

72
Q

What are the appropriate investigations for tumour lysis syndrome?

A

o Check the levels of all the metabolites that are deranged (potassium, phosphate, calcium, uric acid)

o Monitor for Symptoms: Increased serum creatinine, Arrhythmia, Seizure

73
Q

What are the risk factors for oesophgeal cancer?

A

o Squamous Cell Carcinoma = Alcohol, Tumour, Plummer-Vinson syndrome, Achalasia, Scleroderma, Coeliac disease, Nutritional deficiencies, Dietary toxins (e.g. nitrosamines)

o Adenocarcinoma = GORD, Barrett’s oesophagus

74
Q

What are the presenting symptoms of oesophageal cancer?

A

Often ASYMPTOMATIC

Progressive dysphagia (initially worse for solids)

Regurgitation

Cough

Choking after food

Voice hoarseness

Odynophagia (painful swallowing)

Weight loss

Fatigue (due to iron deficiency anaemia)

75
Q

What are the clinical signs of oesophageal cancer on examination?

A

o There may be NO SIGNS

o Metastatic disease may cause:

  • Supraclavicular lymphadenopathy
  • Hepatomegaly
  • Hoarseness
  • Signs of bronchopulmonary involvement
76
Q

What are the appropriate investigations for oesophageal cancer?

A

o Endoscopy - brushing and biopsy

o Imaging - Barium swallow and CXR

o Staging = CT chest and abdo

o Other = Bronchoscopy, LFTs, ABGs

77
Q

Define acute myeloid leukaemia?

A

Malignancy of primitive myeloid lineage white blood cells (myeloblasts) with proliferation in the bone marrow and blood.

78
Q

What are the presenting symptoms of AML?

A

o Symptoms of Bone Marrow Failure:

  • Anaemia = lethargy, dyspnoea
  • Bleeding = due to thrombocytopaenia or DIC
  • Opportunistic or recurrent infections

o Symptoms of Tissue Infiltration

  • Gum swelling or bleeding
  • CNS involvement = headaches, nausea, diplopia
79
Q

What are the clinical signs of AML on examination?

A

o Signs of Bone Marrow Failure = Pallor, Cardiac flow murmur, Ecchymosis, Bleeding, Opportunistic or recurrent infections (e.g. fever, mouth ulcers, skin infections)

o Signs of Tissue Infiltration = Skin rashes, Gum hypertrophy, Deposit of leukaemic blasts in the eye, tongue and bone (RARE)

80
Q

What are the appropriate investigations for AML?

A

o Bloods = FBC (low Hb, low platelets, variable WCC), High uric acid, High LDH, Clotting studies, fibrinogen and D-dimers (to check for DIC)

o Blood Film = Myeloblasts

o Bone Marrow Aspirate or Biopsy = Hypercellular with > 20% blasts

o Immunophenotyping = antibodies against surface antigens used to classify the lineage of the abnormal clones

o Cytogenetics

o Immunocytochemistry

81
Q

Define Chronic Lymphocytic Leukaemia (CLL).

A

Characterised by progressive accumulation of functionally incompetent lymphocytes, which are monoclonal in origin. There is an overlap between CLL and non-Hodgkin’s lymphoma.

82
Q

What are the presenting symptoms of CLL?

A

o Asymptomatic - 40-50% of cases are diagnosed following routine blood tests

o Systemic Symptoms = Lethargy, Malaise, Night sweats

o Symptoms of Bone Marrow Failure = Recurrent infections, Herpes zoster infection, Easy bruising or bleeding

83
Q

What are the clinical signs of CLL on examination?

A

o Non-tender lymphadenopathy

o Hepatomegaly

o Splenomegaly

o LATE STAGE signs of bone marrow failure = Pallor, Cardiac flow murmur, Purpura/ecchymosis

84
Q

What are the appropriate investigations for CLL?

A

o Bloods = FBC (lymphocytosis, low Hb, low platelets, low serum Ig)

o Blood Film = Small lymphocytes with thin rims of cytoplasm, Smudge cells

o Bone Marrow Aspirate or Biopsy = Lymphocytic replacement of normal marrow

o Cytogenetics

- CLL may be associated with autoimmune phenomena such as haemolytic anaemia (warm agglutinins) or thrombocytopaenia

85
Q

Define Chronic Myeloid Leukaemia.

A

Chronic myeloblastic leukaemia is a malignant clonal disease characterised by proliferation of granulocyte precursors in the bone marrow and blood, distinguished from AML by its slower progression.

86
Q

What are the presenting symptoms of CML?

A

o ASYMPTOMATIC in 40-50% of cases - diagnosed on routine blood count

o Hypermetabolic Symptoms = Weight loss, Malaise, Sweating

o Bone Marrow Failure Symptoms = Lethargy, Dyspnoea, Easy bruising, Epistaxis, Abdominal discomfort and early satiety

Rare symptoms = Gout, Hyperviscosity symptoms (visual disturbance, headaches, priapism), Blast crisis with symptoms of AML and ALL

87
Q

What are the clinical signs of CML?

A

o SPLENOMEGALY - most common physical finding (90% of cases)

o Signs of bone marrow failure = Pallor, Bleeding, Ecchymosis

88
Q

What are the appropriate investigations for CML?

A

o Bloods = FBC (high WCC, low Hb, high basophils/neutrophils/eosinophils, high/normal/low platelets, high uric acid, high B12 and transcobalamin I)

o Blood Film = Immature granulocytes

o Bone Marrow Aspirate or Biopsy = Hypercellular with raised myeloid-erythroid ratio

o Cytogenetics = Philadelphia chromosome

89
Q

Define Hodgkin’s lymphoma.

A

Lymphomas are neoplasms of lymphoid cells, originating in the lymph nodes or other lymphoid tissues. Hodgkin’s lymphoma (15% of all lymphomas) is diagnosed histopathologically by the presence of Reed-Sternberg Cells (binucleate lymphocytes).

90
Q

What is the cause of Hodgkin’s lymphoma?

A

o UNKNOWN - Likely to be an environmental trigger in a genetically susceptible individual

  • EBV genome has been detected in 50% of Hodgkin’s lymphomas
91
Q

What are the presenting symptoms of Hodgkin’s lymphoma?

A

o Painless enlarging mass - most commonly in the neck, can also be in the axilla or groin -> mass may become painful after alcohol ingestion

o Secondary symptoms = Fever (if cyclical it is referred to as Pel-Ebstein fever), Night sweats, Weight loss > 10% body weight in the past 6 months

o Other symptoms = Pruritis, Cough, Dyspnoea

92
Q

What are the clinical signs of Hodgkin’s lymphoma?

A

Non-tender firm rubbery lymphadenopathy (may be cervical, axillary or inguinal)

Splenomegaly (or sometimes, hepatosplenomegaly)

Skin excoriations

Signs of intrathoracic disease (e.g. pleural effusion, superior vena cava obstruction)

93
Q

What are the appropriate investigations for Hodgkin’s lymphoma?

A

o Bloods = FBC (anaemia of chronic disease, leucocytosis, high neutrophils, high eosinophils, lymphopaenia in advanced disease), High ESR and CRP

o Lymph Node Biopsy

o Bone Marrow Aspirate and Trephine Biopsy

o Imaging - CXR, CT, PET

o Ann Arbor Staging

94
Q

Define non-Hodgkin’s lymphoma.

A

Lymphomas are malignancies of lymphoid cells originating in lymph nodes or other lymphoid tissues. Non-Hodgkin’s lymphomas are a diverse group consisting of:

  • 85% B cell
  • 15% T cell and NK cell forms
95
Q

What are the risk factors for non-Hodgkin’s lymphoma?

A

o Complex process involving the accumulation of multiple genetic lesions

o The changes in the genome in certain lymphoma subtypes have been associated with the introduction of foreign genes via oncogenic viruses (e.g. EBV and Burkitt’s lymphoma)

o Other risk factors = Radiotherapy, Immunosuppressive agents, Chemotherapy, HIV, HBV, HCV, Connective tissue disease (e.g. SLE)

96
Q

What are the presenting symptoms of non-Hodgkin’s lymphoma?

A

o Painless enlarging mass (in neck, axilla or groin)

o Systemic Symptoms (occurs less frequently than in Hodgkin’s) = Fever, Night sweats, Weight loss, Symptoms of hypercalcaemia,

o Symptoms related to organ involvement = Extranodal disease is MORE COMMON in NHL than in Hodgkin’s lymphoma, Skin rashes, Headache, Sore throat, Abdominal discomfort, Testicular swelling

97
Q

What are the clinical signs of non-Hodgkin’s lymphoma on examination?

A

o Painless firm rubbery lymphadenopathy

o Skin rashes - Mycosis fungoides (looks like a fungal infection but is in fact a cutaneous T-cell lymphoma)

o Abdominal mass

o Hepatosplenomegaly

o Signs of bone marrow involvement:

o Anaemia

o Infections

o Purpura

98
Q

What are the appropriate investigations for non-Hodgkin’s lymphoma?

A

o Bloods = FBC (anaemia, neutropaenia, thrombocytopaenia), High ESR and CRP, Calcium may be raised, HIV, HBV and HCV serology

o Blood Film = Lymphoma cells may be visible in some patients

o Bone Marrow Aspiration and Biopsy

o Imaging - CXR, CT, PET

o Lymph Node Biopsy - allows histopathological evaluation, immunophenotyping and cytogenetics

o Staging - Ann-Arbor

99
Q

Define multiple myeloma.

A

Haematological malignancy characterised by proliferation of plasma cells resulting in bone lesions and the production of a monoclonal immunoglobulin (paraprotein, usually IgG or IgA).

100
Q

What are the risk factors of multiple myeloma?

A

UNKNOWN

Possible viral trigger

Chromosomal aberrations are frequent

Associated with ionising radiation, agricultural work or occupational chemical exposures

101
Q

What are the presenting symptoms of multiple myeloma?

A

o May be an INCIDENTAL finding on routine blood tests

o Bone Pain - usually in the back and ribs -> sudden and severe bone pain may be caused by a pathological fracture

o Infections - often recurrent

o General = Tiredness, Thirst, Polyuria, Nausea, Constipation, Mental change (due to hypercalcaemia)

o Hyperviscosity = Bleeding, Headaches, Visual disturbance

102
Q

What are clinical signs multiple myeloma on examination?

A

o Pallor

o Tachycardia

o Flow murmur

o Signs of heart failure

o Dehydration

o Purpura

o Hepatosplenomegaly

o Macroglossia

o Carpal tunnel syndrome

o Peripheral neuropathies

103
Q

What the appropriate investigations for multiple myeloma?

A

o Bloods = FBC (low Hb, normochromic normocytic), High ESR/CRP, U&Es (high creatinine, high Ca2+), Normal ALP

o Blood Film = Rouleaux formation with bluish background

o Serum or Urine Electrophoresis = Serum paraprotein, Bence-Jones protein (monoclonal immunoglobulin light chain)

o Bone Marrow Aspirate and Trephine = High plasma cells (usually > 20%)

o Chest, Pelvic or Vertebral X-Ray = Osteolytic lesions without surrounding sclerosis, Pathological fractures

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