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Path - Haematology > Haemato-oncology 3 > Flashcards

Haemato-oncology 3 Flashcards

1
Q

• What is a lymphoma?

A

A cancer that affects the lymphocytes that proliferate in the lymph nodes

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2
Q

• How do we classify lymphomas?

(Hodgkin and Non-Hodgkin)

  • which one contains reed-sternberg cells? (what do they look like)
  • when is peak incidence of age?

non-hodgkin can be divided into?

A

o Hodgkin lymphoma:

  • Presence of Reed Sternberg cells (large multinucleated cells that have an owl’s appearance.)
  • Two peaks of incidence, young and old.

o Non-Hodgkin lymphoma

  • Absence of Reed Sternberg cells
  • Can be sub-divided into high grade or low grade
  • Higher incidence with age

HOdgkin - Owl(reed-sternberg)

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3
Q

• What is the difference between high and low grade non-Hodgkin lymphoma?

Rate of growth
Curability
Responsiveness to treatment

A

High Grade

Fast
Curable
Well

Low Grade

Slow
Incurable
Poor, only treat if symptomatic

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4
Q

How do people with lymphoma present?

A
  1. Painless lymphadenopathy (enlarged lymph nodes).
  2. B symptoms:
    a. Drenching night sweats (absolutely soaked)
    b. Unexplained fevers >38°C
    c. Weight loss >10% in last 6 months
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5
Q
  • What Ix do you do for diagnosing lymphoma?

* What do you want to know once you have the diagnosis - spread?

A

Lymph node biopsy

How much it has spread, by doing a CT or a PET scan and potentially a bone marrow biopsy to see if its spread into there.

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6
Q

• How do you stage lymphoma?

Said Staging is graded from I-IV, what does it mean?

You also get a letter (A or B) what does that mean?

A

The Ann Arbor staging:

I - 1 lymph node
II - 2 lymph nodes on same side of diaphragm
III - on both sides of diaphragm
IV - widespread

A = no B symptoms 
B = B symptoms
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7
Q

Non-Hodgkin Lymphoma Treatment

For Low grade lymphoma?

For High grade lymphoma:

  • Stage 1a?
  • Stage IIa-IV?

RCHOP chemo is used for high grade - what does this mean?

  • What is the main risk with this chemotherapy - what day do they present?
  • What happens if someone on this chemotherapy phones in and says they have a fever?
A

o Usually nothing apart from monitoring if there are no symptoms

o Stage 1A = 4 rounds of chemo (RCHOP) every 3 weeks + radiotherapy
o Anything else Stage IIA-IV = 6-8 rounds of RCHOP chemo (every 3 weeks)

  • rituximab,
  • cyclophosphamide,
  • hydroxydaunorubicin,
  • oncovin,
  • prednisolone.

Neutropenic sepsis usually days 7-10 (because you knock down all the white cells in the body).

You need to get antibiotics in them within an hour.

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8
Q

Hodgkin Lymphoma Treatment

  • What is the survival with Hodgkin lymphoma?
  • How is Hodgkin’s lymphoma treated?

A, B, V, D

• What is the main worry about the treatment of Hodgkin lymphoma?

A

> 85% @ 5 years

ABVD chemotherapy +/- radiotherapy

adriamycin
bleomycin
vinblastine
dacarbazine

The long term effects. You can get secondary malignancies (lung/breast cancer)

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9
Q

• Which infection can lead to Hodgkin lymphoma?

A

Epstein Barr virus infection,

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10
Q

• What is the major risk factors for Non-Hodgkin lymphoma?

A

Autoimmune diseases, HIV/AIDS, HTLV1

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11
Q

• What is a myeloma?

A

A cancer of the plasma cells

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12
Q

• What are plasma cells?

A

Differentiated B cells that make antibodies (immunoglobulins) to fight infection.

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13
Q
  • What goes wrong in myeloma?
  • What is the normal age group for this condition?
  • Can we cure it?
A

A single plasma cells gets out of control and divides in a malignant fashion. This gives rise to many cells that are genetically identical. All these plasma cells secrete the same immunoglobulins called PARAPROTEINS

ELDERLY

people who get it tend to be old, they often can’t handle extreme chemotherapy and so the cancer is incurable.

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14
Q

Monoclonal gammopathy of undetermined significance (MGUS):

  • serum paraprotein of?
  • clonal bone marrow plasma cells of?
  • do we monitor them?
  • end organ damage?
A

i. Serum paraprotein of <30g/L and
ii. <10% of clonal bone marrow plasma cells. (5% is normal)
In other words, you have MGUS when you have something wrong and have paraprotein but do not meet the criteria to be called myeloma yet.

monitor every 6 months

also no end organ damage

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15
Q

Smouldering Myeloma:

  • serum paraprotein of?
  • clonal bone marrow plasma cells of?
  • do we monitor them?
  • end organ damage?
A

i. Serum paraprotein of >30g/L and
ii. 10-60% of plasma cells in your bone marrow
iii. BUT you do not have any evidence of organ damage

monitor every 3 months

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16
Q

Myeloma

  • serum paraprotein of?
  • clonal bone marrow plasma cells of?
  • end organ damage?
  • CRABI

What does a lytic bone lesion look like?

A 
This is when you have the same as above but WITH evidence of end organ damage. This may be any one of:
     C – hypercalcaemia
     R – renal impairment
     A – anaemia
     B – lytic bone lesions

In the head, it can give a pepper-pot skull appearance (see radiograph). In long bones, you get areas of degradation, which puts you at increased risk of low-impact fractures.

17
Q

• How do you treat myeloma?

C
D
T
B

A

A mixture of:

  1. Chemotherapy (cyclophosphamide)
  2. Steroids (dexamethasone)
  3. Immunomodulatory drugs (e.g. thalidomide!)
  4. Proteasome inhibitors (causes cell death - bortezomib
18
Q

• What are the complications of myeloma and how do you manage these?

Renal impairment (50%)
Hypercalcaemia (30%)
Hyperviscosity syndrome (Medical Emergency)
Spinal cord compression (5%)

A

Saline rehydration with 3 litres daily through drip. Stop nephrotoxix drugs (NSAIDs). Administer high dose dexamethasone

due to bone lysis - give bisphosphonates (prevent bone resorption)

paraprotein means that blood doesn’t flow properly through the narrow small blood vessels (usually eye and brain) meaning you get blurred vision
do plasma exchange or venesection (bleed patient + give back saline to dilute paraprotein)

due to lytic lesion - give steroids and do MRI to confirm then radiotherapy

Path - Haematology (9 decks)

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