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phase 2 (again) > Haem cancers > Flashcards

Haem cancers Flashcards

1
Q

Define myeloma

A

Malignant proliferation of plasma cells in the bone marrow. Increased Ig secretion and lytic bone lesions

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2
Q

Pathology of myeloma

A
  1. Increased osteoclast activity (next to myeloma cells) - lytic bone lesions and hypercalcaemia
  2. Ig secretion - renal problems and hyperviscosity
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3
Q

Clinical features of myeloma

A

CRAB

  • Calcium (hypercalcaemia) - stones, groans, bones and psychic groans, thirst constipation, nausea
  • Renal impairment - oedema, decreased UO, dehydration
  • Anaemia + neutropaenia + thrombocytopaenia - recurrent bacterial infection
  • Bone disease - osteolytic bone lesions (backache, fractures), pepperpot skull, OP
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4
Q

Investigations for myeloma

A
  1. Bloods - reduced Hb, WCC, increased Ca, U&E, ESR
  2. Xray (first line) - pepperpot skull, vertebral collapse, lytic punched out lesions
  3. Serum protein electrophoresis - Ig monoclonal band
  4. Serum urine electrophoresis - Bence-Jones’ protein
  5. Bone marrow biopsy - increased plasma cells
  6. Blood film - rouleaux stacks
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5
Q

Management of myeloma

A
  1. Chemo
    - CTD (8 cycles) - cyclophosphamide, thalidomide, dexamethasone
    - VAD (6 cycles) - velcade, adriamycine, dexamethasone
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6
Q

Management of myeloma complications

A
  1. Hypercalcaemia - IV fluids
  2. AKI - fluids/dialysis
  3. Hyperviscosity - plasmapheresis
  4. Spinal cord compression - MRI, dexamethasone
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7
Q

Supportive treatment of myeloma

A
  1. Anaemia - transfusion
  2. Bone pain - analgesia + bisphosphonates
  3. Infections - Abx, regular Ig infusions
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8
Q

Define Hodgkin’s lymphoma

A

Malignant proliferation of mature lymphocytes in the lymphatic system. Reed-Stenberg cells.

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9
Q

Epidemiology of Hodgkin’s lymphoma

A

Peaks in young adults and the elderly

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10
Q

Causes of Hodgkin’s lymphoma

A
  1. Primary + secondary immunodeficiency
  2. Autoimmune
  3. Infection - EBV
  4. Obesity, FHx
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11
Q

Staging (Ann Harbour) of Hodgkin’s lymphoma

A
  1. Single node or site
  2. > 2 nodes on the same side of diaphragm
  3. > 2 nodes on both sides of diaphragm
  4. Disseminated/diffuse
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12
Q

‘A’ symptoms of Hodgkin’s lymphoma

A

Enlarged, painless, non-tender rubbery lymph nodes. Worsen with alcohol (can become painful)

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13
Q

B symptoms of Hodgkin’s lymphoma

A
  1. Fever
  2. Night sweats
  3. Weight loss
  4. Lethargy/malaise
    B symptoms have worse prognosis
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14
Q

Management of Hodgkin’s lymphoma

A
  1. 1-2a = brief chemo/radiotherapy
  2. 2b-4 = longer cycles of chemo
  3. BMT for relapse
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15
Q

Signs of Hodgkin’s lymphoma

A
  1. Anaemia
  2. Hepatosplenomegaly
  3. Lymphadenopathy
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16
Q

Investigations of Hodgkin’s lymphoma

A
  1. Lymph node biopsy - Reed-Stenberg cells
  2. FBC
  3. CT chest, abdo, pelvis for staging
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17
Q

Define non-hodgkin’s lymphoma

A

Any lymphoma that isn’t hodgkin’s lymphoma

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18
Q

Epidemiology of non-hodgkin’s lymphoma

A

> 40y

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19
Q

Types of non-hodgkin’s lymphoma

A
  1. Low grade : follicular
  2. High grade : diffuse large cell B lymphoma
  3. Very high grade : Burkitt’s lymphoma
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20
Q

Pathology of non-hodgkin’s lymphoma

A

70% B cell. Clonal expansion of lymphocytes

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21
Q

Signs and symptoms of non-hodgkin’s lymphoma

A

Similar to hodgkin’s lymphoma

  1. GI involvement (if small bowel lymphoma) - abdo pain, diarrhoea, vomiting
  2. Skin involvement if T cell lymphoma
22
Q

Investigations for non-hodgkin’s lymphoma

A
  1. Lymph node biopsy
  2. CT
  3. FBC
23
Q

Management of non-hodgkin’s lymphoma

A

Same as hodgkin’s lymphoma + rituximab + steroids

24
Q

Define leukaemia

A

All cancers of white blood cells

25
Q

4 types of leukaemia

A
  1. Acute myeloid leukaemia
  2. Acute lymphoblastic leukaemia
  3. Chronic myeloid leukaemia
  4. Chronic lymphocytic leukaemia
26
Q

Define ALL

A

Acute malignant transformation of lymphocytic blast cells (no maturation at all). More common in children.

27
Q

Pathology of ALL

A

Uncontrolled proliferation of T/B cells -> takes up space in bone marrow (anaemia, thrombocytopaenia, neutropaenia) + blasts in the peripheral blood and aggregation in liver, spleen, lymph nodes and thymus (T cells)

28
Q

Causes of ALL

A
  1. Philadelphia chromosome t(9:22) translocation

2. 20x higher risk with Down’s syndrome

29
Q

Symptoms of ALL

A
  1. Fatigue
  2. Bleeding
  3. Palpitations
  4. Infections
  5. Bone pain
  6. Abdominal fullness (from hepatosplenomegaly)
30
Q

Signs of ALL

A
  1. Hepatosplenomegaly
  2. Anaemia
  3. Cranial nerve palsies
  4. Lymphadenopathy
31
Q

Investigation of ALL

A
  1. Blood smear - blast cells (small)
  2. Bone marrow biopsy
  3. Lumbar puncture - CNS involvement
  4. FBC - low RBC, PLT
  5. Clotting screen - DIC possibility
32
Q

Management of ALL

A
  1. Chemo - intrathecal (spine)
  2. Methotrexate
  3. Steroids for maintenance
  4. BMT - during first remission
  5. Supportive - IV fluids/blood/platelets
  6. Treat infection
33
Q

Define AML

A

Acute malignant transformation of myeloid blast cells. More common in older adults/elderly

34
Q

Causes of AML

A
  1. Transform from myelodysplasia

2. Genetic - chromosomal mutations

35
Q

RF AML

A
  1. Radiation

2. Alkylating chemo

36
Q

Symptoms of AML

A
  1. Fatigue
  2. Bleeding
  3. Palpitations
  4. Recurrent infections
37
Q

Signs of AML

A
  1. Hepatosplenomegaly
  2. Anaemia
  3. Gum hypertrophy
38
Q

Investigations for AML

A
  1. Blood smear - AUER RODS
  2. FBC - low RBC, PLT
  3. Bone marrow biopsy
  4. Clotting screening - DIC risk
39
Q

Management of AML

A
  1. Chemo (with breaks to allow bone regeneration)
  2. Steroids - maintenance
  3. Supportive treatment - IV fluids/blood/platelets
  4. Treat infection
40
Q

Define CLL

A

Chronic lymphocytic leukaemia - chronic malignant transformation of mature lymphocytes that have escaped apoptosis. Most common leukaemia in the west

41
Q

Pathology of CLL

A

Uncontrollable proliferation of T/B lymphocytes -> can lead to autoimmune haemolysis.

42
Q

Signs and symptoms of CLL

A
  1. Often asymptomatic -> anaemia, bleeding, infection, sweats, anorexia
  2. Enlarged rubbery non-tender lymph nodes (lymphadenopathy)
  3. Hepatosplenomegaly
43
Q

Investigations for CLL

A
  1. FBC: low RBC, high lymphocytes
  2. Blood smear - smudge cells
  3. Genetic testing (11q/17p)
44
Q

Management of CLL

A

INCURABLE

  1. Chemo for advanced
  2. Radiotherapy can help lymphadenopathy + splenomegaly
  3. Rituximab
  4. Stem cell transplant
45
Q

Define CML

A

Chronic myeloid leukaemia - chronic malignant proliferation of mature myeloid cells. The cells divide too quickly. More common in the elderly

46
Q

Cause + progression of CML

A 
1. Philadelphia gene -> BCR-ABL fusion gene -> tyrosine kinase activity affected
Insidious onset (3-4y) -> blast formation -> AML -> rapid death
47
Q

Symptoms of CML

A
  1. Fever
  2. Weight loss
  3. Sweating
  4. Tiredness
  5. Bleeding
48
Q

Signs of CML

A
  1. Anaemia
  2. Bruising
  3. Infection
  4. Massive splenomegaly
49
Q

Investigations of CML

A
  1. FBC
  2. Cytogenetics : karotype, FISH (fluorescent in situ hybridisation), PCR
  3. Blood smear - granulocytes
50
Q

Management of CML

A
  1. 1st line: imatinib (tyrosine kinase inhibitor)
  2. In acute stage - chemo - hydroxycarbamide
  3. Stem cell transplant (only cure, significant mortality, younger patients)

phase 2 (again) (24 decks)

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