Haematological Cancer Flashcards
What does the name leukaemia mean?
- leuk = leuocytes
- aemia = blood
What is leukaemia?
- malignant (uncontrolled) proliferation of primitive haematopoetic cells in the bone marrow
What does leukaemia do to the bone marrow?
- causes bone marrow failure
- bone marrow fills with blast cells
- poor maturation of RBCs causes anaemia
Does leukaemia affect just WBCs?
- no
- can affect WBCs, RBCs and platlets
When comparing leakaemia and lymphoma, which is a solid and which is a liquid tumour?
- leukaemia = liquid (blood)
- lymphoma = solid (lymph nodes)
When comparing leukaemia and lymphoma, which cells are generally affected?
- leukaemia = myeloid and lymphoid cells (all bone marrow cells)
- lymphoma = lymphoid cells
When looking at cell lines from the bone marrow we talk about haemopoietic stem cells, which are then able to differentiate into myeloid and lymphoid stem cells. What are myeloid stem cells?
- WBCs
- basophils, esoinophils, neutrophils, megakaryocyte (platelets), monocytes and erythrocytes (RBCs)
When looking at cell lines from the bone marrow we talk about haemopoietic stem cells, which are then able to differentiate into myeloid and lymphoid stem cells. What are lymphoid stem cells?
- Lymphocytes
- B cells, T cells and Natural killer cells
What genetic abnormalities are linked with leukaemia?
- down syndrome
- genetic twins
Drugs that are used to treat a disease can increase the risk of developing leukaemia, what cancer treatments can increase the risk of leukaemia?
- chemotherapy drugs
- radiology
What is the human T lymphotropic virus (HTLV-1)?
- virus similiar to HIV
- can cause leukaemia
In leukaemia there is an acute and chronic form. What are the 2 acute forms of leukaemia?
- acute lymphoblastic (blast = immature cells)
- acute myeloid
In leukaemia there is an acute and chronic form. What are the 2 chronic forms of leukaemia?
- chronic lymphocytic
- chronic myeloid
In acute lymphoblastic and acute myeloid leukaemia, are they dangerous and who do they generally affect?
- very agressive and rapid spreading
- younger patients
- immature cells affected (blasts = immature cells) in bone marrow
In chronic lymphocytic and chronic myeloid leukaemia, are they dangerous and who do they generally affect?
- generally gradual onset
- affect older patients
- mature cells affected in bone marrow
Which of the cells in the image below is a neutrophil?
- a is a neutrophil
- multi lobulated cell
Which of the cells in the image below is a eosinophil?
- b is esinophil
- stains very pink of H&E stain
Which of the cells in the image below is a basophil??
- c is basophil
- appears like a large platelet with no clear nucleus
Which of the cells in the image below is a monocyte?
- d is a monocyte
- nucleus looks like a kidney bean
Which of the cells in the image below is a lymphocyte?
- e is a lymphocyte
- nucleus fills most of the cell
Which of the cells in the image below is a blast cell?
- f is a blast cell
- irregular nuclear and cytoplasm has odd shape
What ages is acute lymphoblastic leukaemia most common in?
- childhood
- most common malignancy in children
What ages is acute myeloid leukaemia most common in?
- median age is 65
- can occur at any age
In bone marrow failure, common in leukaemia, what are 2 common signs that patients may present with, similar to asthma?
- fatigue
- breathlessness
Neutropenia is a common sign of bone marrow failure seen in leukaemia, what is neutropenia?
- infections and ulcers in the mouth
Thrombocytopenia is a common sign of bone marrow failure seen in leukaemia, what is thrombocytopenia?
- means lack of platelets
- bleeding in gums and under skin
Tissue infiltration is common in leukaemia, what is tissue infiltration?
- leukaemia can spread top other tissues
- common tissues include liver, meninges, testivles, skin
As leukaemia causes abnormal proliferation of all blood cells from the bone marrow, what will happen to the WBC number?
- rise
Leukostasis is common in leukaemia, what is leukostasis?
- stasis = slowing
- blood slows due to high WBCs
Disseminated intravascular coagulation (DIC) can cause bruising and bleeding, what is DIC?
- condition that causes blood clots
What is the most usual method for diagnosing leukaemia?
- bone marrow aspirate
What other methods, other than bone marrow aspirate can be used to diagnose leukaemia?
- genetic testing
- chromosomal analysis
- blood film/count
- immunophenotyping
What are the most common treatments for leukaemia?
- chemotherapy
- radiotheraphy
- immunotherapy
- monoclonal atnibodies
- bone marrow transplantation
When diagnosing a patient with leukaemia, what is the first thing you must decide before starting treatment?
- if disease can be cured or pallative care
When treating a patient with leukaemia that has anaemia, what is the most common treatment?
- blood transfusion
When treating a patient with leukaemia that has bleeding problems, what is the most common treatment?
- platelet transfusions
- provide coagulation factors
- hormones in women to stop menstrul cycle
Patients with leukaemia have low WBCs and are therefore at an increased risk of infections, what is the most common treatment?
- antibiotics
- personal hygiene
Patients with leukaemia need a lot of blood samples taken and blood given. To help this leukaemia patients are given a indwelling hickman line, what is this?
- blood tube fed into subclavian vein
- near to heart
What is induction chemotherapy?
- first line of drugs given to patients to normalise bone marrow
Following induction drug therapy, patients are given consolidation therapy, what is this?
- further chemotherapy
- leukaemia cells will not be detectable anywhere in the body if treatment is successful
What is allogenic transplantation that is used if induction and consolidation therapy is unsuccessful?
- patients are given bone stem cells from healthy donor
Does acute lymphoblastic leukaemia or acute myeloid leukaemia have a worse prognosis?
- diagnosis can be good if caught early
- acute lymphoblastic leukaemia has better prognosis
- poorer outcomes in older (>60 years) males
In acute lymphoblastic anaemia what % of children are cured?
- >80%
What is the most common form of malignancy in childhood?
- Acute lymphoblastic leukaemia (ALL)
In Acute lymphoblastic leukaemia, the most common malignancy in childhood, what leukocytes cells can be affected?
- B and T cells
- immune system is severely depleted
In acute lymphoblastic leukaemia, the most common malignancy in childhood, a cut off for the number of blasts affected is used as a diagnosis tool. What is the cut off for diagnosis of acute lymphoblastic leukaemia?
- >20% of WBC are blasts
In acute lymphoblastic leukaemia patients B cells can be affected which can cause Bone marrow failure and a Big spleen. How can remember what 2 main things can happen to a patient with B cell acute lymphoblastic leukaemia remember this?
- B is for Bone marrow failure
- B is for Big spleen
- B cells affected
In acute lymphoblastic leukaemia patients T cells can be affected. This is most common in Teenage boys and causes Thoracic lymphadenopathy. How can i remember this?
- T is for Teenage boys
- T is for Thoracic lymphadenopathy
- T is for T cells
In acute meloid leukaemia what % of blasts must be present in the bone marrow?
- >20% of blasts in bone marrow
In acute meloid leukaemia what are two common diagnostic features that can be seen on blood films in ALL patients?
- auer rods (crystals in cytoplasm of blasts)
- granules that stain for positive for Myeloperoxidase
In acute meloid leukaemia (A.M_._L) how can you remember the 3 things to diagnose a patient, not including >20% blasts using the mnemonic A.M.L?
- A = auer rods
- M = myeloperoxidase
- L = leukaemia in older patients
Acute promyelocytic leukaemia (APL) is a variant of acute myeloid leukaemia (AML). What is APL?
- comes from promyelocytic cell line
- activates coagulation pathway and uses all coagulation factors
- patients bleed severly
- high risk of disseminated intravascular coagulation
How can acute promyelocytic leukaemia (APL), a variant of acute myeloid leukaemia (AML) be treated?
- all– trans– retinoic acid (ATRA)
- anti-cancer treatment
Who does chronic lymphocytic leukaemia mainly affect and is there a good prognosis?
- very common in older patients (mean 70 years)
- good median survival
In chronic lymphocytic leukaemia, which leukocytes are more commonly affected?
- B cells
- numbers can be high
In chronic lymphocytic leukaemia, how do patients generally present?
- incidental finding
- asymptomatic
- lymphadenopathy
- splenomegaly
- infections
- anaemia
How can you test a patient for chronic lymphocytic leukaemia?
- coombes test is +
- genetic analysis
- can cross over with lymphoma
In chronic myeloid leukaemia, what patients are most affected?
- older patients (mean age 50 years)
In chronic myeloid leukaemia, what % of blast cells present in the bone marrow would classify a patient as having chronic chronic myeloid leukaemia?
- <10% of blasts in bone marrow
- if it enters >20% this is crisis and prognosis is poor
In chronic myeloid leukaemia, the whole myeloid line can be affected, which cells are in the myeloid cell line these?
- RBCs
- Megacaryocytes
- Monocytes
- WBCs (granulocytes)
In chronic myeloid leukaemia, there is a large diversity of WBCs seen on blood smears which can present with what symptoms?
- fatigue
- breathlessness
- fever/sweats
- weight loss
In chronic myeloid leukaemia, what chromosome abnormality is always present?
- Philadelphia chromosome (t(9;22))
- chromosomes 9 and 22 undergo translocation
- causes over production of tyrosine kinase signalling
- malignant cell proliferation
In chronic myeloid leukaemia, what drug has been shown to be effective at putting patients into remission?
- imatinib
What is hairy cell leukaemia?
- form of chronic lymphocytic leukaemia
- B cells affected and look hairy
- very responsive to treatment 90% remission
