Cancers Flashcards
What are CD20 and CD3 markers for respectively?
CD20 is a B cell marker
CD3 is a T cell marker
What disease is IgG4 related?
Castlemans disease (causes lymphadenopathy)
Generalised lymphadenopathy suggest a systemic inflammatory process or widespread malignancy. Which malignancies should be highest on your list of differentials?
Lymphoma
Leukaemia
What are the surfaces of the spleen?
Diaphragmatic surface
Visceral surfaces; L kidney, gastric fundus, tail of the pancreases and splenic flexure of the colon
Describe the arterial supply and venous drainage of the spleen
Supplied by the splenic artery (branch of the coeliac axis)
Drained by the splenic vein (joins the SMV to form the portal vein)
What are some of the possible causes of splenomegaly?
Infection
Congestion
Haematological malignancies
Haemolytic anaemia
ITP
Myeloproliferative disorders
What are some of the possible causes of hyposplenism?
Splenectomy
Coeliac disease
Sickle-cell disease
Sarcoidosis
What are Howell-Jolly bodies indicative of?
Hyposplenism
What is meant by pancytopenia?
A deficiency of blood cells of all lineages
Give an example of an inherited marrow failure syndrome which results in pancytopenia. How does this condition present?
Faconi’s anaemia
Very rare
Macrocytosis, thrombocytopenia, neutropenia
Skeletal abnormalities and short stature
Café au lait spots
Hypogenitalia
What are some examples of causes of acquired primary bone marrow failure?
Idiopathic aplastic anaemia
Myelodysplastic syndromes
Acute leukaemia
What are some examples of causes of acquired secondary bone marrow failure?
Drugs
B12/ folate deficiency
HIV
Lymphoma
What are some of the clinical features of pancytopenia?
Anaemia (fatigue and SOB)
Neutropenia (infections)
Thrombocytopenia (bleeding)
What investigations should be done to establish the cause of pancytopenia?
FBC and blood film
B12 and folate
Virology
Autoantibody tests
Bone marrow examination
Pancytopenia can involve different marrow cellularities. In which conditions would you expect marrow to be HYPOcellular vs HYPERcellular?
HYPOcellular =
Aplastic anaemia
HYPERcellular =
myelodysplastic syndromes
B12/ folate deficiencies
Hypersplenism
How is pancytopenia managed?
Transfusions of red cells/ platelets/ neutrophils
Specific treatments for the underlying cause
Types of haematological malignancies are based on the anatomical site involved. Where do leukaemia, lymphoma and myeloma involve?
Leukaemia - blood
Lymphoma - lymph nodes
Myeloma - plasma cells in marrow
What type of leukaemia can affect blood AND lymph nodes?
Chronic lymphocytic leukaemia
acute leukaemia affect blood only
What are the lifespans for RBCs, neutrophils and platelets?
RBCs - 120 days
Neutrophils -7-8 hours
Platelets - 7-10 days
What are blasts?
Nucleated precursor cells
What are megakaryocytes?
Platelet precursors
What are haematopoietic cells?
Cells which are able to renew
What is the normal amount of free light chain production by normal plasma cells?
0.5g/ day
excess can leak into the urine as bence jones protein
What is meant by paraproteinaemia?
Presence of excessive amounts of myeloma protein or monoclonal gamma globulin in the blood
What are some of the possible causes of paraproteinaemia?
MGUS
Myeloma
Amyloidosis
Lymphoma
Chronic lymphocytic leukaemia
Plasmacytoma
What is myeloma?
Plasma cell malignancy
What is the premalignant condition that may develop into myeloma?
MGUS
How does myeloma present?
Hypercalcaemia; stones/ bones/ abdominal groans/ psychiatric moans/ thirst and dehydration
Bone pain and wedge compression fractures
How is myeloma classified?
Classified by the type of antibody produced e.g IgA/ IgE etc. There may be light chains alone which is called Bence Jones myeloma.
Which classification of myeloma is most associated with kidney damage?
Bence jones myeloma (free light chains)
Deposition of light chains causes cast nephropathy
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)
Weight loss
Night sweats
Fever
Fatigue
Itch
Alcohol induced pain
What is lymphoma?
A malignant proliferation of lymphocytes
How does the lymphadenopathy feel in lymphoma?
Non-tender
Rubbery soft and smooth
How is lymphoma classified?
Hodgkin’s
Non-hodgkin’s;
B-NHL; high grade and low grade
T-NHL
Which is more likely to be curable, low or high grade NHL?
High grade is more likely to be curable as it is more sensitive to chemotherapy
Low grade are slow growing but not curable
What investigations should be done for myeloma?
Immunohistochemistry
Immunohistochemistry
Genetic analysis
Biopsy
Imaging
What are the treatment options for myeloma?
Chemotherapy
Radiotherapy
Stem cell transplantation
What is leukaemia?
Malignancy of the marrow/ blood with maturation defects
Which type of malignancy involves an excess of blasts in either the peripheral blood or the bone marrow?
Leukaemia
What happens to haemopoietic reserve in leukaemia?
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
Which type of acute leukaemia is more common in elderly patients?
Acute myeloid leukaemia (AML)
Which type of acute leukaemia is the most common childhood cancer?
Acute lymphoblastic leukaemia (ALL)
What investigations should be done for acute leukaemia?
Blood count and film
Coagulation screen
Immunophenotyping by flow cytometry (this clarifies the lineages involved)
What would be the expected blood film appearance in acute leukaemia?
Abnormal blasts
high nuclear: cytoplasmic ratio
Auer Rods in the blood film is indicative of which type of leukaemia?
Acute myeloid leukaemia
How is acute lymphoblastic leukaemia managed?
Chemotherapy of varying intensity over 2-3 years
How is acute myeloid leukaemia managed?
Intensive chemotherapy - between 2-5 cycles over several months - requires prolonged hospitalisation
What are the treatment options for myeloma?
Chemotherapy
Monoclonal antibody therapy
Autologous haematopoietic stem cell transplant (AHSCT)
Symptom control
What is AL amyloidosis?
A rare disorder involving small plasma cell clones
There is a mutation in light chains
How is AL amyloidosis investigated?
Organ biopsy - congo red stain
How is AL amyloidosis managed?
Chemotherapy
What is waldenstrom’s macroglobulinaemia (IgM paraprotein)?
Clonal disorder of cells intermediate between a lymphocyte and a plasma cell
Involves characteristic IgM paraprotein
What are some of the clinical features of Waldenstrom’s macroglobulinaemia?
Fatigue
Visual disturbance
Confusion
Coma
Bleeding
Cardiac failure
How is Waldenstrom’s macroglobulinaemia managed?
Chemotherapy
Plasmapheresis
How does plasmapheresis work?
Removes the patient plasma and replaces it with donor plasma
Patients with acute leukaemia are more likely to suffer from sepsis due to which classification of bacteria
Gram negative
For cell cycle specific chemotherapy agents, what is more important; duration of exposure or dose?
Duration of exposure
For non-cell cycle specific chemotherapy agents, what is more important; duration of exposure or dose?
Dose
What are some of the general side effects of cytotoxic drugs?
Bone marrow suppression
Gut mucosal damage
Hair loss
(immediate affects are on rapidly dividing organs)
What specific side effect are vinca alkaloids (cytotoxic chemotherapy agents) associated with?
Neuropathy
What specific side effect is cis-platinum (cytotoxic chemotherapy agent) associated with?
Nephrotoxicity
What specific side effect are anthracyclines (cytotoxic chemotherapy agents) associated with?
Cardiotoxicity / cardiomyopathy
Which cytotoxic chemotherapy agents are associated with infertility as a long-term side effect?
Alkylating agents
What is meant by autologous Vs allogeneic stem cell transplantation?
Autologous stem cell transplantation uses the patients own stem cells
Allogeneic stem cell transplantation is from a sibling or someone unrelated
What are some of the characteristics of multiple myeloma?
Osteolytic lesions
Increased infections
Monoclonal IgG or IgA paraprotein bands
What would happen to calcium, phosphate and ALP levels in a patient with myeloma without metastasis?
High calcium
Normal/ high phosphate
Normal ALP
What is the mechanism of action of rituximab? Which condition is it used to treat?
Tyrosine kinase inhibitor that inhibits BCR-ABL-1 protein
This protein is unique to chronic myeloid leukaemia
What is the mechanism of action of rituximab? Which condition is this used to treat?
Rituximab is a monoclonal antibody against CD20 which is expressed on B cells and B cell lymphomas
