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HAEMATOLOGY > Cancers > Flashcards

Cancers Flashcards

1
Q

What are CD20 and CD3 markers for respectively?

A

CD20 is a B cell marker

CD3 is a T cell marker

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2
Q

What disease is IgG4 related?

A

Castlemans disease (causes lymphadenopathy)

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3
Q

Generalised lymphadenopathy suggest a systemic inflammatory process or widespread malignancy. Which malignancies should be highest on your list of differentials?

A

Lymphoma

Leukaemia

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4
Q

What are the surfaces of the spleen?

A

Diaphragmatic surface

Visceral surfaces; L kidney, gastric fundus, tail of the pancreases and splenic flexure of the colon

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5
Q

Describe the arterial supply and venous drainage of the spleen

A

Supplied by the splenic artery (branch of the coeliac axis)

Drained by the splenic vein (joins the SMV to form the portal vein)

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6
Q

What are some of the possible causes of splenomegaly?

A

Infection

Congestion

Haematological malignancies

Haemolytic anaemia

ITP

Myeloproliferative disorders

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7
Q

What are some of the possible causes of hyposplenism?

A

Splenectomy

Coeliac disease

Sickle-cell disease

Sarcoidosis

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8
Q

What are Howell-Jolly bodies indicative of?

A

Hyposplenism

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9
Q

What is meant by pancytopenia?

A

A deficiency of blood cells of all lineages

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10
Q

Give an example of an inherited marrow failure syndrome which results in pancytopenia. How does this condition present?

A

Faconi’s anaemia

Very rare
Macrocytosis, thrombocytopenia, neutropenia
Skeletal abnormalities and short stature
Café au lait spots
Hypogenitalia

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11
Q

What are some examples of causes of acquired primary bone marrow failure?

A

Idiopathic aplastic anaemia

Myelodysplastic syndromes

Acute leukaemia

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12
Q

What are some examples of causes of acquired secondary bone marrow failure?

A

Drugs

B12/ folate deficiency

HIV

Lymphoma

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13
Q

What are some of the clinical features of pancytopenia?

A

Anaemia (fatigue and SOB)

Neutropenia (infections)

Thrombocytopenia (bleeding)

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14
Q

What investigations should be done to establish the cause of pancytopenia?

A

FBC and blood film

B12 and folate

Virology

Autoantibody tests

Bone marrow examination

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15
Q

Pancytopenia can involve different marrow cellularities. In which conditions would you expect marrow to be HYPOcellular vs HYPERcellular?

A

HYPOcellular =
Aplastic anaemia

HYPERcellular =
myelodysplastic syndromes
B12/ folate deficiencies
Hypersplenism

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16
Q

How is pancytopenia managed?

A

Transfusions of red cells/ platelets/ neutrophils

Specific treatments for the underlying cause

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17
Q

Types of haematological malignancies are based on the anatomical site involved. Where do leukaemia, lymphoma and myeloma involve?

A

Leukaemia - blood
Lymphoma - lymph nodes
Myeloma - plasma cells in marrow

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18
Q

What type of leukaemia can affect blood AND lymph nodes?

A

Chronic lymphocytic leukaemia

acute leukaemia affect blood only

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19
Q

What are the lifespans for RBCs, neutrophils and platelets?

A

RBCs - 120 days

Neutrophils -7-8 hours

Platelets - 7-10 days

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20
Q

What are blasts?

A

Nucleated precursor cells

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21
Q

What are megakaryocytes?

A

Platelet precursors

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22
Q

What are haematopoietic cells?

A

Cells which are able to renew

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23
Q

What is the normal amount of free light chain production by normal plasma cells?

A

0.5g/ day

excess can leak into the urine as bence jones protein

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24
Q

What is meant by paraproteinaemia?

A

Presence of excessive amounts of myeloma protein or monoclonal gamma globulin in the blood

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25
Q

What are some of the possible causes of paraproteinaemia?

A

MGUS

Myeloma

Amyloidosis

Lymphoma

Chronic lymphocytic leukaemia

Plasmacytoma

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26
Q

What is myeloma?

A

Plasma cell malignancy

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27
Q

What is the premalignant condition that may develop into myeloma?

A

MGUS

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28
Q

How does myeloma present?

A

Hypercalcaemia; stones/ bones/ abdominal groans/ psychiatric moans/ thirst and dehydration

Bone pain and wedge compression fractures

29
Q

How is myeloma classified?

A

Classified by the type of antibody produced e.g IgA/ IgE etc. There may be light chains alone which is called Bence Jones myeloma.

30
Q

Which classification of myeloma is most associated with kidney damage?

A

Bence jones myeloma (free light chains)

Deposition of light chains causes cast nephropathy

31
Q

What symptoms should you ask about in a patient presenting with lymphadenopathy?

(these are all symptoms which may be suggestive of lymphoma or another cause)

A

Weight loss

Night sweats

Fever

Fatigue

Itch

Alcohol induced pain

32
Q

What is lymphoma?

A

A malignant proliferation of lymphocytes

33
Q

How does the lymphadenopathy feel in lymphoma?

A

Non-tender

Rubbery soft and smooth

34
Q

How is lymphoma classified?

A

Hodgkin’s

Non-hodgkin’s;
B-NHL; high grade and low grade
T-NHL

35
Q

Which is more likely to be curable, low or high grade NHL?

A

High grade is more likely to be curable as it is more sensitive to chemotherapy

Low grade are slow growing but not curable

36
Q

What investigations should be done for myeloma?

A

Immunohistochemistry

Immunohistochemistry

Genetic analysis

Biopsy

Imaging

37
Q

What are the treatment options for myeloma?

A

Chemotherapy

Radiotherapy

Stem cell transplantation

38
Q

What is leukaemia?

A

Malignancy of the marrow/ blood with maturation defects

39
Q

Which type of malignancy involves an excess of blasts in either the peripheral blood or the bone marrow?

A

Leukaemia

40
Q

What happens to haemopoietic reserve in leukaemia?

A

There is decreased normal haemopoiesis reserve (low platelets, neutrophils and anaemia)

This is because there is an excess of blasts - too many primitive cells and not enough mature cells

41
Q

Which type of acute leukaemia is more common in elderly patients?

A

Acute myeloid leukaemia (AML)

42
Q

Which type of acute leukaemia is the most common childhood cancer?

A

Acute lymphoblastic leukaemia (ALL)

43
Q

What investigations should be done for acute leukaemia?

A

Blood count and film

Coagulation screen

Immunophenotyping by flow cytometry (this clarifies the lineages involved)

44
Q

What would be the expected blood film appearance in acute leukaemia?

A

Abnormal blasts

high nuclear: cytoplasmic ratio

45
Q

Auer Rods in the blood film is indicative of which type of leukaemia?

A

Acute myeloid leukaemia

46
Q

How is acute lymphoblastic leukaemia managed?

A

Chemotherapy of varying intensity over 2-3 years

47
Q

How is acute myeloid leukaemia managed?

A

Intensive chemotherapy - between 2-5 cycles over several months - requires prolonged hospitalisation

48
Q

What are the treatment options for myeloma?

A

Chemotherapy

Monoclonal antibody therapy

Autologous haematopoietic stem cell transplant (AHSCT)

Symptom control

49
Q

What is AL amyloidosis?

A

A rare disorder involving small plasma cell clones

There is a mutation in light chains

50
Q

How is AL amyloidosis investigated?

A

Organ biopsy - congo red stain

51
Q

How is AL amyloidosis managed?

A

Chemotherapy

52
Q

What is waldenstrom’s macroglobulinaemia (IgM paraprotein)?

A

Clonal disorder of cells intermediate between a lymphocyte and a plasma cell

Involves characteristic IgM paraprotein

53
Q

What are some of the clinical features of Waldenstrom’s macroglobulinaemia?

A

Fatigue

Visual disturbance

Confusion

Coma

Bleeding

Cardiac failure

54
Q

How is Waldenstrom’s macroglobulinaemia managed?

A

Chemotherapy

Plasmapheresis

55
Q

How does plasmapheresis work?

A

Removes the patient plasma and replaces it with donor plasma

56
Q

Patients with acute leukaemia are more likely to suffer from sepsis due to which classification of bacteria

A

Gram negative

57
Q

For cell cycle specific chemotherapy agents, what is more important; duration of exposure or dose?

A

Duration of exposure

58
Q

For non-cell cycle specific chemotherapy agents, what is more important; duration of exposure or dose?

A

Dose

59
Q

What are some of the general side effects of cytotoxic drugs?

A

Bone marrow suppression

Gut mucosal damage

Hair loss

(immediate affects are on rapidly dividing organs)

60
Q

What specific side effect are vinca alkaloids (cytotoxic chemotherapy agents) associated with?

A

Neuropathy

61
Q

What specific side effect is cis-platinum (cytotoxic chemotherapy agent) associated with?

A

Nephrotoxicity

62
Q

What specific side effect are anthracyclines (cytotoxic chemotherapy agents) associated with?

A

Cardiotoxicity / cardiomyopathy

63
Q

Which cytotoxic chemotherapy agents are associated with infertility as a long-term side effect?

A

Alkylating agents

64
Q

What is meant by autologous Vs allogeneic stem cell transplantation?

A

Autologous stem cell transplantation uses the patients own stem cells

Allogeneic stem cell transplantation is from a sibling or someone unrelated

65
Q

What are some of the characteristics of multiple myeloma?

A

Osteolytic lesions

Increased infections

Monoclonal IgG or IgA paraprotein bands

66
Q

What would happen to calcium, phosphate and ALP levels in a patient with myeloma without metastasis?

A

High calcium

Normal/ high phosphate

Normal ALP

67
Q

What is the mechanism of action of rituximab? Which condition is it used to treat?

A

Tyrosine kinase inhibitor that inhibits BCR-ABL-1 protein

This protein is unique to chronic myeloid leukaemia

68
Q

What is the mechanism of action of rituximab? Which condition is this used to treat?

A

Rituximab is a monoclonal antibody against CD20 which is expressed on B cells and B cell lymphomas

HAEMATOLOGY (10 decks)

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