Haematological cancers

Question 1

Types of haematological malignancy

Answer 1

Leukaemia 
Lymphoma 
Myeloma 
Myeloproliferative neoplasms 
Myelodysplastic syndromes

Question 2

Types of myeloid malignancies

Answer 2

Acute myeloid leukaemia

Chronic myeloproliferative neoplasms

Question 3

Types of lymphoid malignancies

Answer 3

Acute lymphoblastic leukaemia

Chronic lymphoblastic leukaemia
Lymphoma

Question 4

Difference between leukaemia and lymphoma

Answer 4

Bone marrow affected - leukaemia

Predominantly nodal or organ-based - lymphoma

Question 5

Presentation of haematological malignancy

Answer 5

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

Question 6

Where is hypercalcaemia commonly seen?

Answer 6

In myeloma or high-grade lymphoma

Question 7

Investigations for haematological malignancies

Answer 7

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

Question 8

Acute vs chronic leukaemia

Answer 8

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)

Question 9

Histological signs of malignancy

Answer 9

Big nucleolus
Hyperchromic
Mitotic bodies
Polymorphic

Question 10

Acute lymphoblastic leukaemia pathophysiology

Answer 10

Proliferation of lymphoid blasts - B or T cells

Question 11

Acute lymphoblastic leukaemia presentation

Answer 11

Pancytopenia symptoms - visual disturbances, headaches, ischaemic events

Bone pain

+/- lymphadenopathy

Question 12

Why does bone pain occur

Answer 12

Increase in the generation of blood cells but the bone marrow cannot expand therefore there is increased pressure

Question 13

Treatment of acute lymphoblastic leukaemia

Answer 13

Multi-drug chemotherapy

Does not cross the blood brain or blood testicular barrier therefore given prophylactic injections to scrotum and CSF

Question 14

Acute myeloid leukaemia presentation

Answer 14

Pancytopenia

Question 15

Treatment of acute myeloid leukaemia

Answer 15

Intensive or non-intensive treatments available

Allogenic stem cell transplant if young

Question 16

Chronic myeloid leukaemia pathophysiology

Answer 16

Caused by cytogenic translocation t9:22 Philadelphia
Due to BCR- ABL

Increase in all myeloid cells including basophils

Question 17

Progression of chronic myeloid leukaemia

Answer 17

Chronic phase - accelerated - blast crisis

Question 18

Presentation of chronic myeloid leukaemia

Answer 18

High white cell count

Splenomegaly

Question 19

Treatment of chronic myeloid leukaemia

Answer 19

Tyrosine kinase inhibitors - imatinib

- normal life expectancy and long remission

Question 20

Chronic lymphocytic leukaemia pathophysiology

Answer 20

Causes a high no. of mature B lymphocytes

Question 21

Presentation of chronic lymphocytic leukaemia

Answer 21

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

Question 22

Treatment of chronic lymphocytic leukaemia

Answer 22

Watch and wait - start treatment if symptomatic or high WCC

Chemotherapy or targetted immunobiologics

Question 23

Staging of chronic lymphocytic leukaemia

Answer 23

Rai/Binet staging

Question 24

Plasmacytomas

Answer 24

Solid tumours made of an accumulation of plasma cells

Question 25

MGUS

Answer 25

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

Question 26

Amyloidosis

Answer 26

Extracellular tissue deposition of fibrils (beta pleated sheets)

Can affect kidneys, liver, heart, Gi tract or peripheral nervous system

Question 27

Staining for amyloidosis

Answer 27

Congo red

Question 28

Acute myeloid leukaemia histology

Answer 28

Lots of blast cells >20%

Question 29

TdT +ve

Answer 29

Lymphoblast therefore ALL

Question 30

Findings for AML

Answer 30

Myeloperoxidase +ve

Auer rods

Question 31

Complication of acute myeloid luekaemia

Answer 31

DIC - medical emergency

Question 32

Myelodysplastic syndrome pathophysiology

Answer 32

Abnormal accumulation of blasts in bone marrow

< 20% therefore not AML

Question 33

Myelodysplastic syndrome features

Answer 33

Pancytopenia as cells not developing properly

Question 34

Myelodysplastic syndrome presentation

Answer 34

Anaemia - fatigue

Low WCC - recurrent infection

Low platelets - increased bleeding and bruising

Question 35

Complications of myelodysplastic syndrome

Answer 35

Progression to AML