Exam 5 Flashcards
- Leukemia affects all ages.
- It’s a malignant disorder of blood, bone marrow, lymph system and the spleen.
- No single cause - combo of factors including mutation of DNA and environmental triggers…
– Chemical agents: such as benzene (in gas) and alkalating chemo agents
– Radiation: high levels, found in nuclear disasters, and the cancers that are treated with radiation therapy.
– Viruses: Human T cell leukemia virus type I - found in Japan and Caribbean.
Acute has immature hematopoietic cells that continuously replicate.
Chronic involves mature WBCs and has a steady onset.
What are myeloblasts precursors of?
Granulocytes and monocytes
What are lymphocytic cells precursors of?
T and B lymphocytes
This type of leukemia is the most common type in children. It involves immature lymphocytes and has S/S of: Fever Bleeding/bruising Weakness Fatigue Joint/bone pain
Acute Lymphocytic Leukemia (key tip was immature = acute, lymphocytes = lymphocytic)
** Often see CNS complications d/t the invasion of immature cells into the arachnoid tissues of the brain:
s/s - - Increased ICP, N/V, lethargy
This can also occur in those over the age of 50.
This type of leukemia makes up for 80% of acute leukemia in adults:
Acute Myelogenous Leukemia (AML)
More common in adults over the age of 60.
-- s/s: Infection Bleeding (both d/t high levels of myeloblasts) Fatigue Weakness HA Mouth sores Anemia (aka acute nonlymphoblastic anemia (ANLL))
This type of leukemia involves mature neoplastic granulocytes, and a Philadelphia chromosome that is found in 90-95% diagnosed:
Chronic Myelogenous Leukemia (CML)
The Philadelphia chromosome is a genetic chromosome that interferes with cell growth (this chromosome has also been found in AML and ALL)
This type is found in older adults and is considered rare in children.
These cells can move into the blood and invade the spleen and liver which leads to organ damage.
No s/s in the beginning (for up to years) then progresses to a more acute phase called “blastic” phase… the treatment at this point is aggressive.
This fourth type of leukemia involves mature appearing lymphocytes whom are inactive, lymphadenopathy, and a higher incidence in men over the age of 65:
Chronic Lymphocytic Leukemia (CLL)
This is the most common type of CHRONIC leukemia in adults.
The lymphocytes invade the bone, liver, and spleen. There is also some lymph involvement.
They may be asymptomatic but if there are s/s:
Chronic fatigue
Anorexia
Splenomegaly
When the lymph nodes are enlarged they can apply pressure on the nerves. As the disease progresses, they can experience pain and/or paralysis. If in the mediastinal region it can affect the lungs and cause pulmonary complications.
How is leukemia diagnosed, what labs, etc?
What are some S/S?
Blood tests:
- CBC:
- RBCs, their shape and size. Hgb, Hct
- WBCs
- Platelets
- Bone marrow aspiration with or without biopsy.
Biopsy is definitive. Done at posterior iliac crest
S/S:
- Anemia
- Thrombocytopenia
- Depending on the type of leukemia… high WBCs or low WBCs and dependent on what stage the pt is in.
- If high WBC (>100,000 cells/mL) this can cause blockages and infarctions
What treatment modalities are used for leukemia?
What are the phases of the treatment?
Chemotherapy.
- Induction (aggressive tx to bring remission: s/s of severe bone marrow suppression = neutropenia, thrombocytopenia, anemia)
- Post Induction
- Intensification-high dose tx after induction (can last several months)
- Consolidation-once remission established (given a few more treatments of a high dose to ensure all dead)
- Post Induction
- Maintenance (lower dose tx for prolonged periods): given ev. 3-4 weeks. The best drugs are mixed to prevent resistance, decrease drug toxicity, and stop cell growth in different phases.
What are some other treatments available for leukemia?
- Corticosteroids
- Radiation therapy
- Biological and targeted therapy
- HSCT : Hematopoietic Stem Cell Transplantation
Radiation - Can be directed toward specific organ(s), and cranial for those with CNS involvement (in ALL).
Biologic - Uses immune system to create an environment that’s unfavorable to CA cells. By boosting or manipulating it in some way. Ex: cytokines, monoclonal antibodies (end in “mab”) in vaccines are most successful. They attack CA cells with particular antibody.
Targeted Therapy - Interferes w/CA growth by targeting specific cell receptors in tumor growth. This is nice because it does less harm to the “normal” cells of the body.
HSCT - bone marrow transplant can also be used as a tx option donor type or own cells to produce in the bone marrow.
Like leukemia, this type of CA has neoplasms that originate in the bone marrow and lymph system:
Lymphoma.
Two types:
Hodgkin’s and Non-Hodgkin’s lymphoma
What are some risk factors of Hodgkin’s?
Where does is normally originate from?
What type of cell is characteristic of Hodgkin’s?
- Epstein Barr virus (mono)
- HIV infection
- Occupational toxins
- Genetics
Will typically originate from one location in the lymph system… majority stems from cervical nodes (80%). They then spread and invade the lungs, spleen, and the liver.
Reed-Sternberg cells are characteristic of Hodgkin’s, they are very distinct as they are large and multi-nucleated.
Is Hodgkin’s more common in men or women?
What type of cell originated malignancy of the immune system is it?
Men
B-cell originated malignancy of the immune system.
Most frequent lymphoma in the western world, accounting for about 11% of all lymphomas.
Risk factors: Epstein Barr Virus, HIV infection, Occupational Toxins, and Genetics
What do “B” symptoms imply?
What do these symptoms consist of?
A poorer prognosis.
- Fever > 100.4 (38 C), Chills
- Drenching night sweats
- Weight loss exceeding 10% in 6 months
- Fatigue
- Tachycardia
When the disease starts out above the diaphragm, it can be contained for some time… when below, it spreads to other organs, esp the liver.
