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My Haem Cue Cards > Cancers > Flashcards

Cancers Flashcards

1
Q

b cell maturation occurs in the

A

bone marrow

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2
Q

t cell maturation occurs in the

A

thymus

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3
Q

primary lymphoid tissues

A

bone marrow

thymus

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4
Q

secondary lymphoid tissue

A 
Lymph nodes
Spleen
Tonsils (Waldeyer’s ring)
Epithelio-lymphoid tissues
Bone marrow
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5
Q

what is ascites of lipid rich lymph called?

A

chylous ascites

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6
Q

describe the pathway of lymph through the peripheral sinus

A

Afferent channels drain lymph through the capsule in to the peripheral sinus
Lymph filters through the node
An efferent vessel leaves from the hilum

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7
Q

where can lymph drain to

A

cisterna chyli / thoracic duct
L jugular, subclavian or bronchomediastinal trunks
R jugular, subclavian or bronchomediastinal trunks

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8
Q

Arterial and venous vessels serving the node enter/exit at the

A

hilum

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9
Q

Lymph is filtered within the ….. before return to the blood stream

A

node parenchyma

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10
Q

main cells contained in lymph node

A 
b 
t 
nk
macrophages
apcs
dendritic 
endothelial
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11
Q

what are the two types of t cells?

A

helper and cytotoxic

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12
Q

what is a marker of a b cell?

A

cd20

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13
Q

what is a marker of a t cell?

A

cd3

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14
Q

systemic inflammatory lymphadenopathy usually caused by

A

viruses (can be widespread malignancy)

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15
Q

what are the main malignancies involving the lymph node

A

lymphoma

leukaemia

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16
Q

sarcoidosis may mask …. in a lymph node

A

malignancy

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17
Q

Superficial lymphadenopathy may be the first sign of

A

malignancy

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18
Q

a predominant b cell response is usually

A

autoimmune onditions or infection

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19
Q

a predominant phagocytic response is usually

A

draining a tumour site

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20
Q

a predominant t cell response is usually

A

viral or drugs such as phenytoin

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21
Q

what is the normal weight and size of the spleen?

A

150-200g and 12x7x3cm

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22
Q

arterial and venous supply of spleen

A

splenic artery and vein

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23
Q

what are the main structures of the spleen?

A

white pulp red pulp and capsule

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24
Q

red pulp contains

A

sinusoids and cords

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25
Q

what are sinusoids

A

fenestrated
lined by endothelial cells
supported by hoops of reticulin

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26
Q

whats the main function of the spleen?

A

Detect, retain and eliminate unwanted, foreign or damaged material
Facilitate immune responses to blood borne antigens

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27
Q

describe the structure and function of the white pulp

A

White pulp comprises the peri-arteriolar lymphoid sheath (PALS).
CD4+ lymphoid cells
This is expanded by lymphoid follicles
May show reactive changes as in lymph node
Antigen reaches white pulp via the blood.
APCs in the white pulp present antigen to immune reactive cells
When stimulated by antigen, T and B cell responses may occur

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28
Q

what symptoms can patients experience fi they have an enlarged splee?

A

Dragging sensation in LUQ
Discomfort with eating
Pain if infarction

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29
Q

what is the triad seen in hypersplenism?

A
  1. splenomegaly
  2. fall in one or more cellular components of blood
  3. correction of cytopenias by splenectomy
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30
Q

what is the main cause of the features occurring in splenomegaly?

A

Features mainly from reduced red pulp function
Howell-Jolly bodies
Other red cell abnormalities

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31
Q

what is a Howell jolly body?

A

nuclear remnants in an erythrocyte

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32
Q

define clone

A

daughter cells derived from the same precursor cell

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33
Q

polyclonal

A

multiple clones exist under normal conditions

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34
Q

monoclonal

A

in malignant haemopoeisis there is domination by a single clone

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35
Q

what is Philadelphia chromosome?

A

abn in chromosome 22 seen in leukaemia (mainly cml)- it is an abnormal clonal marker

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36
Q

what is aplastic anaemia?

A

lymphocyte activation and an autoimmune reaction against haemopoietic stem/progenitor cells/ bone marrow failure affecting production of red cells, neutrophils and platelets

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37
Q

pancytopenia

A

deficiency in rbcs wbcs and platelets

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38
Q

Likely cell of origin for CML

A

stem cells

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39
Q

Likely cell of origin for AML

A

multipotent progenitors

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40
Q

Likely cell of origin for acute leukaemias

A

MEP or GMP (precursors of erythrocytes platelets granulocytes and macrophages)

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41
Q

Likely cell of origin for acute lymphoblastic leukaemias

A

precursors for wbcs - t/b/nk/ dendritic

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42
Q

Likely cell of origin for lymphoma

A

lymph node

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43
Q

Likely cell of origin for myeloma

A

plasma cell

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44
Q

In B12/folate deficiency, there are fewer rounds of cellular division in the more mature erythroblast compartments as ….. is affected

A

nuclear maturation

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45
Q

normal cytoplasmic maturation and haemoglobin accumulation despite B12/folate deficiency t/f

A

t

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46
Q

why is there anaemia in b12 and folate deficiency

A

Although the amount of Hb per cell is adequate (since cytoplasmic maturation is unaffected), there are fewer cells in total as cell division in the earlier compartments had been affected; hence the anaemia.

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47
Q

NK cells are

A

antiviral or tumour fighters

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48
Q

do platelets have a nucleus

A

no

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49
Q

meaning of blasts

A

nucleated precursor cell

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50
Q

polypoid

A

megakaryocyte

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51
Q

what is maturation?

A

descendents acquire functional properties and may stop proliferating

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52
Q

Embryonically, haemopoietic stem cells originate in the

A

mesoderm

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53
Q

Circulating committed progenitors detectable as early as week

A

5

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54
Q

Yolk sac, the first site of erythroid activity, stops by week

A

10

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55
Q

Liver starts haematopoesis by week

A

6

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56
Q

bone marrow starts haematopoesis by week

A

16

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57
Q

what are the non haemopoietic cells of the bone marrow

A

eg adipocytes (fat cells), ‘fibroblasts’ osteoclasts, osteoblasts

58
Q

Formed blood cells can pass through …. in endothelial cells to enter circulation

A

fenestrations

59
Q

associated with sinusoidal dilatation and increased blood flow

A

release of red cells

60
Q

red marrow

A

active

61
Q

yellow marrow

A

inactive and fatty

62
Q

Neutrophil precursor maturation is regulated by

A

GCSF

63
Q

…… regulates growth and development of megakaryocytyes from their precursors

A

thrombopoeiten

64
Q

cd34

A

haemopoeitic stem cell

65
Q

cd3

A

t lymphocyte

66
Q

cell cycle specific agents are

A

tumour specific

duration more important than dose

67
Q

classes of cell cycle specific agents

A

Antimetabolites
impair nucleotide synthesis / incorporation

Mitotic spindle inhibitors

68
Q

what are the three types of antimetabolites

A

methotrexate
6-Mercaptopurine / Cytosine arabinoside / Fludarabine
hydrocyurea

69
Q

which enzyme associatied with folate metabolism is used as a target for chemo

A

dihydrofolate reductase

70
Q

which enzyme associatied with nucleotide synthesis is used as a target for chemo

A

ribonucleotide reductase/

adenosine deaminase

71
Q

eg of mitotic spindle inhibitors

A

Vinca alkaloids
vincristine / vinblastine

Taxotere (Taxol)

72
Q

non cell cycle specific agents are

A

non tumour specific
damage normal stem cells
dose more important than duration

73
Q

non cell cycle specific agents

A 
alkylating agents (chlorambucil)
platinum derivatives (cisplatin) 
cytotoxic antibiotics (anthracyclines)
74
Q

what are the general side effects of cytotoxic drugs

A

Bone marrow suppression
Gut mucosal damage
Hair loss (alopecia)

75
Q

Vinca alkaloids side effects

A

neuropathy

76
Q

anthracyclines side effects

A

cardiotoxicity

77
Q

cis platinum side effects

A

nephrotoxicity

78
Q

alkylating side effects

A

infertility

secondary malignancy

79
Q

how do you biopsy lymph node

A

take the full thing out

80
Q

nodular sclerosing

A

hodgkins

81
Q

how do you confirm if a patient has lymphoma/leukaemia

A

immunohistochemistry

82
Q

CD20 +ve cells in

A

follicular NHL

83
Q

CD30 +ve Reed Sternberg Cells in

A

hodgkins disease

84
Q

T(14:18)

A

follicular nhl

85
Q

T(11:14) in

A

mantle cell NHL

86
Q

b cell lymphoma recats well to

A

ibrutinib

87
Q

what are the two classifications of nhl

A

t and b

88
Q

what are the two types of b cell nhl

A

low and high grade

89
Q

inherited marrow failure syndromes occur due to defects in

A

dna repair/ ribosomes

90
Q

what is the main inherited marrow failure syndrome

A

fanconis anaemia

91
Q

acquired primary bone marrow failure causes

A

aplastic anaemia
myelodysplastic syndromes
acute leukaemia

92
Q

aplastic anaemia involves b or t cells?

A

t cells

93
Q

myelodysplasia syndromes have the tendency to develop into

A

AML

94
Q

what is seen in myelodysplastic syndromes?

A

dysplasia
hypercellular marrow
increased apoptosis

95
Q

how do we identify normal, more mature non lymphoid cells?

A

morphology
cell surface antigens
enzyme expression

96
Q

glycophorin A

A

red cell

97
Q

myeloperoxidase

A

neutrophils

98
Q

how do we recognise cell surface antigens?

A

immunophenotyping

99
Q

Malignant haemopoiesis is usually characterised by

A

increased numbers of abnormal & dysfunctional cells

loss of normal activity

100
Q

what is aml?

A

Proliferation of abnormal progenitors

with block in differentiation/maturation

101
Q

what is cml?

A

Proliferation of abnormal progenitors,
but NO differentiation/maturation block
(e.g. Chronic Myeloid Leukaemia)

102
Q

normal haemopoesis is monoclonal/polyclonal

A

polyclonal

103
Q

malignant haemopoesis is monoclonal/polyclonal

A

monoclonal

104
Q

Guthrie cards used in

A

all

105
Q

types of haematological malignancies are based on

A

Based on lineage
Based on developmental stage (precursor) within lineage
Based on anatomical site involved

106
Q

lineage split into

A

myeloid or lymphoid

107
Q

myeloid

A

platelets or erythrocytes (CMP)

108
Q

lymphoid

A

NK T B dendritic cells (CLP)

109
Q

lymphoid and affecting the Pro lymphoid cells

A

ALL

110
Q

lymphoid and affecting the B NK T cells

A

CLL

111
Q

lymphoid and affecting the plasma cell

A

myeloma

112
Q

what produces plasma cells

A

b cells

113
Q

blood involvement

A

leukaemia

114
Q

Lymph node involvement with lymphoid malignancy

A

lymphoma

115
Q

what are features of histological aggression ?

A

large cells with high nuclear-cytoplasmic ratio, prominent nucleoli, rapid proliferation

116
Q

what are features of clinical aggression?

A

rapid progression of symptoms

117
Q

Acute leukaemias (in contrast to chronic leukaemias) present with

A

failure of normal bone marrow function

118
Q

acute leukaemia

A

Rapidly progressive clonal malignancy of the marrow/blood with maturation defect(s)

Defined as an excess of ‘blasts’ (≥20%) in either the peripheral blood or bone marrow

Decrease/loss of normal haemopoietic reserve

119
Q

what are the types of acute leukaemia?

A

aml

all

120
Q

ALL is a malignant disease of

A

primitive lymphoid cells (lymphoblasts)

121
Q

what is the most common childhood cancer

A

all

122
Q

all presentation

A

due to marrow failure (anaemia, infections, bleeding)
leukaemic effects: high count with obstruction of circulation, involvement of areas outside the marrow and blood (extra-medullary) e.g. CNS, testis
Bone pain

123
Q

more common in the elderly

A

aml

124
Q

DIC/ gum infiltration

A

AML

125
Q

blood film in acute leukaemia

A

reduction in normal

presence of abnormal cells with high n:c ratio

126
Q

auer rod

A

aml

127
Q

what makes the definitive diagnosis between aml and all

A

immunophenotyping

128
Q

what is trephine

A

(piece of bone)-enables better assessment of cellularity and helpful when aspirate sub-optimal

129
Q

what is a hickman line?

A

central venous catheter most often used for the administration of chemotherapy or other medications, as well as for the withdrawal of blood for analysis

130
Q

chemo is a marrow suppressant: what are the problems with this?

A

anaemia
neutropenia (infection)
thrombocytopenia (bleeding)

131
Q

if neutropenic fever (chemo and infection) think

A

gram negative

132
Q

anthracyclines cause

A

cardiomyopathy

133
Q

Philadelphia chromosome seen in ….. allows for …… as targeted therapy

A

all

kinase inhibitors

134
Q

An AML sub-type (acute promyelocytic leukaemia) has a specific chromosomal translocation t(…..) and is associated with a …..

A

15;17

coagulopathy

135
Q

myelo

A

bone marrow lineage(s)

granulocytes, red cells & platelets

136
Q

proliferative

A

to grow or multiply by rapidly producing new tissue, parts, cells, or offspring

137
Q

what are myeloproliferative disorders

A

Clonal haemopoietic stem cell disorders with an increased production of one or more types of haemopoietic cells

138
Q

In contrast to acute leukaemia, in chronic myeloproliferative disorders ….. is relatively preserved

A

maturation

139
Q

BCRABL1 positive

A

chronic myeloid leukaemia (overproduction of granulocytes)

140
Q

BCRABL1 negative

A

idiopathic myelofibrosis
PRV
essential thrombocythaemia

141
Q 
High Granulocyte count
				
High Red cell count / haemoglobin
				
High Platelet count
				
Eosinophilia/basophilia

Splenomegaly

Thrombosis in an unusual place

A

myeloproliferative disorder

My Haem Cue Cards (6 decks)

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