Cancer Flashcards
Bladder cancers are what kind of cancers?
Most bladder cancers are transitional cell carcinomas
Rarely, bladder cancers may be squamous cell carcinomas associated with chronic inflammation (e.g. schistosomiasis)
What are the risk factors for bowel cancer?
Smoking
Dye stuffs (naphthylamines and benzidine)
Cyclophosphamide treatment
Pelvic irradiation
Chronic UTIs
Schistosomiasis
Being Male
What are the presenting symptoms of bladder cancer?
Painless macroscopic haematuria
Irritative/storage symptoms
Frequency
Urgency
Nocturia
Recurrent UTIs
- occassionaly ureteral obstruction
What are the signs of bladder cancer on examination?
- Commonly NO SIGNS
- bimanual exam can be used for staging
What are the appropriate investigations for bladder cancer?
Cystoscopy - allows visualisation, biopsy or removal
Ultrasound
Intravenous urography
CT/MRI for staging
What is the most common type of breast cancer?
invasive ductal carcinoma
What are the risk factors for breast cancer?
- genetics (BRCA genes)
- age
- oestrogen exposure
- family history
What are the presenting symptoms of breast cancer?
Breast lump (usually painless)
Changes in breast shape
Nipple discharge (may be bloody)
Axillary lump
Symptoms of malignancy: weight loss, bone pain, paraneoplastic syndromes
What are the signs of breast cancer on examination?
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
What are the appropriate investigations for breast cancer?
- 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
What are the risk factors for cholangiocarcinoma?
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
What are the presenting symptoms of cholangiocarcinoma?
Obstructive jaundice symptoms = yellow sclera, pale stools, dark urine, pruritus
Abdominal pain or fullness
Systemic symptoms of malignancy = weight loss, malaise, anorexia
What are the signs of cholangiocarcinoma on examination?
Jaundice
Palpable gallbladder
Epigastric/RUQ mass
There may be hepatomegaly
What are the appropriate investigations for cholangiocarcinoma?
- Bloods = FBC, U&Es, LFTs (high ALP + GGT), clotting screen, tumour markers
- Endoscopy
- Ultrasound
- Staging - via CT, MRI, Bone Scan
What marker is used for pancreatic and cholangiocarcinoma diagnosis?
- CA19-9
What are the risk factors for CNS tumours?
Ionising radiation
Immunosuppression (e.g. HIV)
Inherited syndromes (e.g. neurofibromatosis, tuberous sclerosis)
What are the presenting symptoms of CNS tumours?
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
What are the appropriate investigations for CNS tumours?
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
What is the most common type of colorectal cancer?
adenocarcinoma
Describe the distribution of colorectal cancer.
60% - rectum and sigmoid
30% - descending colon
10% - rest of colon
What are the risk factors for colorectal cancer?
Western diet (e.g. red meat, alcohol)
Colorectal polyps
Previous colorectal cancer
Family history
IBD
Genetics (HNPCC or FAP)
What are the presenting symptoms of colorectal cancer?
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
What are the signs of colorectal cancer on examination?
Signs of Anaemia
Abdominal mass
Hepatomegaly and Ascites if metastatic
Low-lying rectal tumours may be palpable on DRE
What are the appropriate investigations for colorectal cancer?
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)
What is the most common type of gastric cancer?
- adenocarcinoma
What are the risk factors for gastric cancer?
Smoked and processed foods
Smoking
Alcohol
Helicobacter pylori infection
Atrophic gastritis
Pernicious anaemia
Partial gastrectomy
Gastric polyps
What are the presenting symptoms of gastric cancer?
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)
What are the signs of gastric cancer on examination?
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)
What are the appropriate investigations for gastric cancer?
- Upper GI endoscopy
- Bloods - FBC (check for anaemia), LFTs
- CT/MRI - for staging
- Endoscopic USS - assess depth of gastric invasion and lymph node involvement
What is hepatocellular carcinoma?
Primary malignancy of the liver parenchyma
What are the risk factors for hepatocellular carcinoma?
Chronic liver damage - alcoholic liver disease hepatitis C, autoimmune disease
Metabolic disease -> e.g. haemochromatosis
Aflatoxins -> e.g. cereals contaminated with fungi
What are the presenting symptoms of hepatocellular carcinoma?
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
What are the signs of hepatocellular carcinoma on examination?
o Signs of Malignancy = cachexia, lymphadenopathy
o Hepatomegaly (may be nodular)
o Jaundice
o Ascites
o Bruit over the liver
What are the appropriate investigations for hepatocellular carcinoma?
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)
What are the risk factors for lung cancer?
Smoking
Asbestos exposure
Other occupational exposure: polycyclic hydrocarbons, nickel, radon
Atmospheric pollution
What are the primary symptoms of lung cancer?
- May be asymptomatic
- Cough
- Haemoptysis
- Chest pain
- Recurrent pneumonia
What symptoms can arise due to local invasion in lung cancer?
Brachial plexus invasion –> shoulder/arm pain
Left recurrent laryngeal nerve invasion –> hoarse voice and bovine cough
Dysphagia
Arrhythmias
Horner’s syndrome
What symptoms can arise due to metastatic spread in lung cancer?
Weight loss
Fatigue
Fractures
Bone pain
What are the signs of lung cancer on examination?
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)
What are the appropriate investigations for lung cancer?
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
Define neutropenic sepsis.
development of sepsis in a patient with neutropenia
What is the diagnostic criteria for neutropenic sepsis?
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
What are the 2 types of neutropenia?
- incidental
- febrile = temperature > 38.5 or two consecutive readings of > 38 for two hours and an absolute neutrophil count < 0.5 x 109 /L
How are incidental neutropenias’ further categorised?
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
What are the presenting symptoms of neutropenic sepsis?
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)
What are the signs of neutropenic sepsis on examination?
Signs of infection may be minimal
Pyrexia
Features of infective endocarditis
Lymphadenopathy
Skin rashes
What are the appropriate investigations for neutropenic sepsis?
FBC (check neutrophil level)
Blood cultures (check for sepsis)
Others - blood film, D-dimer (for DIC), U&Es, creatinine, LFTs
What are the risk factors for pancreatic cancer?
Age
Being Male
Smoking
Diabetes mellitus
Chronic pancreatitis
Dietary (low intake of fresh fruit and vegetables)
Genetics/Hereditary (MEN, HNPCC, FAP)
What are the presenting symptoms of pancreatic cancer?
Often non-specific initially
Anorexia
Malaise
Nausea
Epigastric pain
Weight loss
Diabetes mellitus
Jaundice
What are the signs of pancreatic cancer on examination?
- 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
What are the appropriate investigations for pancreatic cancer?
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)
What are the risk factors for prostrate cancer?
Age
Afro-Caribbean
Family history
Dietary factors
Occupational exposure to cadmium
What are the presenting symptoms of prostrate cancer?
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)
What are the signs of prostate cancer on examination?
Asymmetrical hard nodular prostate
Loss of midline sulcus
What are the appropriate investigations for prostate cancer?
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
What are the common types of renal cell cancer?
Renal clear cell carcinoma (80%)
Papillary carcinoma (10%)
Transitional cell carcinoma (10%)
What are the risk factors for renal cell cancer?
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
What is von Hippel-Lindau Disease?
- am mutation in the von Hippel-Lindau protein
- causes headaches, balance issues, dizziness, limb weakness, vision problems and high blood pressure
What is Tuberous Sclerosis?
- a rare genetic disease that causes benign tumours to grow in the brain and other organs (e.g. skin, kidneys, lungs, eyes)
What are the presenting symptoms of renal cell cancer?
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)
What are the signs of renal cell cancer on examination?
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
What are the appropriate investigations for renal cell cancer?
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
What are the types of testicular cancer?
Seminomas - 50%
Non-seminomatous germ-cell tumours and teratomas - 30%
RARE: gonadal stromal tumours (Sertoli and Leydig cell tumours) and non-Hodgkin’s lymphoma
What are the risk factors for testicular cancer?
Mal-descended testes
Ectopic testes
Atrophic tests
What are the presenting symptoms of testicular cancer?
Swelling or discomfort of the testes
Backache due to para-aortic lymph node enlargement
Lung metastases -> SOB, haemoptysis
What are the signs of testicular cancer on examination?
Painless, hard testicular mass
There may be a secondary hydrocoele
Lymphadenopathy (e.g. supraclavicular, para-aortic)
Gynaecomastia (tumour produces hCG)
What are the approproate investigations for testicular cancer?
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
Define Tumour Lysis Syndrome (TLS).
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.
What cancers treatment most commonly causes tumour lysis syndrome?
- lymphomas and leukaemias
- commonly these are poorly differentiated
What are the risk factors for tumour lysis syndrome?
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
What are the presenting symptoms and signs on examination of tumour lysis syndrome?
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
What are the appropriate investigations for tumour lysis syndrome?
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
What are the risk factors for oesophgeal cancer?
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
What are the presenting symptoms of oesophageal cancer?
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)
What are the clinical signs of oesophageal cancer on examination?
o There may be NO SIGNS
o Metastatic disease may cause:
- Supraclavicular lymphadenopathy
- Hepatomegaly
- Hoarseness
- Signs of bronchopulmonary involvement
What are the appropriate investigations for oesophageal cancer?
o Endoscopy - brushing and biopsy
o Imaging - Barium swallow and CXR
o Staging = CT chest and abdo
o Other = Bronchoscopy, LFTs, ABGs
Define acute myeloid leukaemia?
Malignancy of primitive myeloid lineage white blood cells (myeloblasts) with proliferation in the bone marrow and blood.
What are the presenting symptoms of AML?
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
What are the clinical signs of AML on examination?
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)
What are the appropriate investigations for AML?
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
Define Chronic Lymphocytic Leukaemia (CLL).
Characterised by progressive accumulation of functionally incompetent lymphocytes, which are monoclonal in origin. There is an overlap between CLL and non-Hodgkin’s lymphoma.
What are the presenting symptoms of CLL?
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
What are the clinical signs of CLL on examination?
o Non-tender lymphadenopathy
o Hepatomegaly
o Splenomegaly
o LATE STAGE signs of bone marrow failure = Pallor, Cardiac flow murmur, Purpura/ecchymosis
What are the appropriate investigations for CLL?
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
Define Chronic Myeloid Leukaemia.
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.
What are the presenting symptoms of CML?
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
What are the clinical signs of CML?
o SPLENOMEGALY - most common physical finding (90% of cases)
o Signs of bone marrow failure = Pallor, Bleeding, Ecchymosis
What are the appropriate investigations for CML?
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
Define Hodgkin’s lymphoma.
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).
What is the cause of Hodgkin’s lymphoma?
o UNKNOWN - Likely to be an environmental trigger in a genetically susceptible individual
- EBV genome has been detected in 50% of Hodgkin’s lymphomas
What are the presenting symptoms of Hodgkin’s lymphoma?
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
What are the clinical signs of Hodgkin’s lymphoma?
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)
What are the appropriate investigations for Hodgkin’s lymphoma?
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
Define non-Hodgkin’s lymphoma.
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
What are the risk factors for non-Hodgkin’s lymphoma?
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)
What are the presenting symptoms of non-Hodgkin’s lymphoma?
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
What are the clinical signs of non-Hodgkin’s lymphoma on examination?
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
What are the appropriate investigations for non-Hodgkin’s lymphoma?
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
Define multiple myeloma.
Haematological malignancy characterised by proliferation of plasma cells resulting in bone lesions and the production of a monoclonal immunoglobulin (paraprotein, usually IgG or IgA).
What are the risk factors of multiple myeloma?
UNKNOWN
Possible viral trigger
Chromosomal aberrations are frequent
Associated with ionising radiation, agricultural work or occupational chemical exposures
What are the presenting symptoms of multiple myeloma?
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
What are clinical signs multiple myeloma on examination?
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
What the appropriate investigations for multiple myeloma?
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
