Haematological cancers Flashcards
Types of haematological malignancy
Leukaemia Lymphoma Myeloma Myeloproliferative neoplasms Myelodysplastic syndromes
Types of myeloid malignancies
Acute myeloid leukaemia
Chronic myeloproliferative neoplasms
Types of lymphoid malignancies
Acute lymphoblastic leukaemia
Chronic lymphoblastic leukaemia
Lymphoma
Difference between leukaemia and lymphoma
Bone marrow affected - leukaemia
Predominantly nodal or organ-based - lymphoma
Presentation of haematological malignancy
Anaemia - fatigue, SOBOE
Thrombocytopenia - easy bruising and bleeding - nose bleeds and gum bleeding, petechial rash
Neutropenia - recurrent infection
Lumps
Splenomegaly
FLAWS - fever, lethargy, appetite loss, weight loss, sweating at night
Hypercalcaemia - Fatigue, abdo pain, N+V, constipation, confusion, headaches, polydipsia and polyuria
Viscous blood - ischaemic event, visual disturbances
Where is hypercalcaemia commonly seen?
In myeloma or high-grade lymphoma
Investigations for haematological malignancies
Bloods - FBC, U+E, LFT, CRP, bone profile - Ca2+
Blood film
Reticulocyte count and haematinics
Special bloods - LDH, urate, B2M - tumour markers
- IgG +/- serum free light chain assay
- PB immunophenotyping
CT CAP - staging
PET - lymphoma/ myeloma
MRI spone/pelvis - myeloma
Tissue biopsy
BM aspirate and trephine
Acute vs chronic leukaemia
Acute - affects hematopoietic stem cells or the common myeloid/lymphoid progenitor cells(immature cells)
Chronic - affects the derivatives of the myeloid or lymphoid progenitor cells (differentiated mature cells)
Histological signs of malignancy
Big nucleolus
Hyperchromic
Mitotic bodies
Polymorphic
Acute lymphoblastic leukaemia pathophysiology
Proliferation of lymphoid blasts - B or T cells
Acute lymphoblastic leukaemia presentation
Pancytopenia symptoms - visual disturbances, headaches, ischaemic events
Bone pain
+/- lymphadenopathy
Why does bone pain occur
Increase in the generation of blood cells but the bone marrow cannot expand therefore there is increased pressure
Treatment of acute lymphoblastic leukaemia
Multi-drug chemotherapy
Does not cross the blood brain or blood testicular barrier therefore given prophylactic injections to scrotum and CSF
Acute myeloid leukaemia presentation
Pancytopenia
Treatment of acute myeloid leukaemia
Intensive or non-intensive treatments available
Allogenic stem cell transplant if young
Chronic myeloid leukaemia pathophysiology
Caused by cytogenic translocation t9:22 Philadelphia
Due to BCR- ABL
Increase in all myeloid cells including basophils
Progression of chronic myeloid leukaemia
Chronic phase - accelerated - blast crisis
Presentation of chronic myeloid leukaemia
High white cell count
Splenomegaly
Treatment of chronic myeloid leukaemia
Tyrosine kinase inhibitors - imatinib
- normal life expectancy and long remission
Chronic lymphocytic leukaemia pathophysiology
Causes a high no. of mature B lymphocytes
Presentation of chronic lymphocytic leukaemia
Relapsing and remitting
Can have nodal or splenic disease
Causes immune dysregulation:
- autoimmune haemolytic anaemia
- immune thrombocytopenic purpura
Recurrent infection due to immunoglobulins being used up
Treatment of chronic lymphocytic leukaemia
Watch and wait - start treatment if symptomatic or high WCC
Chemotherapy or targetted immunobiologics
Staging of chronic lymphocytic leukaemia
Rai/Binet staging
Plasmacytomas
Solid tumours made of an accumulation of plasma cells
MGUS
Monoclonal gammopathy of undetermined significance:
- Paraprotein < 30g/l
- Clonal bone marrow plasma cells < 10%
- Absence of CRAB or amyloidosis
- May not progress to myeloma but requires monitoring
- Does not require a routine screen as very common
Amyloidosis
Extracellular tissue deposition of fibrils (beta pleated sheets)
Can affect kidneys, liver, heart, Gi tract or peripheral nervous system
Staining for amyloidosis
Congo red
Acute myeloid leukaemia histology
Lots of blast cells >20%
TdT +ve
Lymphoblast therefore ALL
Findings for AML
Myeloperoxidase +ve
Auer rods
Complication of acute myeloid luekaemia
DIC - medical emergency
Myelodysplastic syndrome pathophysiology
Abnormal accumulation of blasts in bone marrow
< 20% therefore not AML
Myelodysplastic syndrome features
Pancytopenia as cells not developing properly
Myelodysplastic syndrome presentation
Anaemia - fatigue
Low WCC - recurrent infection
Low platelets - increased bleeding and bruising
Complications of myelodysplastic syndrome
Progression to AML
