Haematological cancers

Question 1

What are the different classifications of blood cancers?

Answer 1

Acute Vs. Chronic
Lymohoblastic/cytic Vs. myeloid
Lymphomas

All WBCs are myeloid except B and T lymphocytes

Question 2

What is associated with ALL?

Answer 2

Ionising radiation during pregnancy
Down’s syndrome
Childhood

Question 3

What are the symptoms of ALL?

Answer 3

Anaemia (low Hb), infection (low WCC), bleeding (low platelets)
Hepato/splenomegaly
Lymphadenopathy (mediastinal)
CNS involvement - CN palsies, meningism

Question 4

What tests should be done for suspected ALL?

Answer 4

Blood film - blast cells
CT/CXR - lymphadenopathy
Lumbar puncture - CNS involvement

Question 5

How is ALL treated?

Answer 5

Remission induction: Vincristine, predinisolone
CNS prophylaxis: methotrexate, RT
Maintenance: As above with mercaptopurine as well (monthly)
Marrow transplantation

Question 6

What is associated with AML?

Answer 6

Down’s
Long term complication of CT (for lymphoma)
Myelodysplastic states

Question 7

What are the symptoms of AML?

Answer 7

Anaemia, infection, bleeding, DIC (release of thromboplastin)
Hepato/splenomegaly
Gum hypertrophy
Skin involvement

Question 8

What tests should be done for suspected AML?

Answer 8

Biopsy - Auer rod differentiate it from ALL

Raised WCC, blasts normally in the marrow

Question 9

How is AML treated?

Answer 9

Chemotherapy: intensive (leads to neutropenia and low platelets) - daunorubicin, cytarabine
Bone marrow transplant

Question 10

What do tests show to indicate myelodysplastic syndromes?

Answer 10

Pancytopenia, low reticulocytes, increased marrow cellularity

Question 11

How are myelodysplastic syndrome treated?

Answer 11

RBC/platelet transfusions
Erythropoietin
Stem cell transplant

Question 12

What medication should be given with CT for AML?

Answer 12

Allopurinol (for gout)

Raised levels of urate following tumour lysis

Question 13

What is associated with CML?

Answer 13

Male
40-60 years
Philadelphia chromosome - BCR-ABL gene

Question 14

What is the philadelphia chromosome?

Answer 14

Reciprocal translation of long arms of 9 and 22

Produces a fusion forming gene -> tyrosine kinase activity

Question 15

What are the symptoms of CML?

Answer 15

Weightloss, fever, sweats
Gout (purine breakdown), bleeding, abdominal discomfort
Splenomegaly, hepatomegaly, anaemia, bruising

Question 16

What tests should be done for CML?

Answer 16

High Wbc, B12, urate

Low/normal Hb, platelets

Question 17

How is CML treated?

Answer 17

Imatinib - for Philadelphia chromsome
(dasatinib, nilotinib, bosutinib, also hydroxycarbamide)
Stem cell transplant and ALL treatment

Question 18

What is CLL associated with?

Answer 18

Most common

Mutations, trisomies, deletions

Question 19

What are the symptoms of CLL?

Answer 19

May be none
Anaemia, infection prone, weight loss, sweats, anorexia
Enlarged, rubbery, non-tender nodes
Spleno/hepatomegaly

Question 20

What tests should be done for CLL?

Answer 20

Raised lymphocytes

AI haemolysis, marrow infiltration, low Hb, neutrophils, platelets

Question 21

How is CLL treated?

Answer 21

Fludaribine, retuximab, cyclophosphamide
Steroids for AI haemolysis
RT for spleno/hepatomegaly
Stem cell transplant

Question 22

What cells are found in Hodgkin’s lymphone (HL)?

Answer 22

Reed-Sternberg cells (have 2x mirror image nuclei)

CD15 markers

Question 23

What are the associations of HL?

Answer 23

Young adults, elderly

Affected sibling, EBV, SLE, post-transplant

Question 24

What are the symptoms of HL?

Answer 24

Enlarged, non-tender ‘rubbery’ superficial lymph nodes (cervical, axillary)
Fever, weight loss, night sweats, pruritis, lethargy
Lymphadenopathy, cachexia, anaemia, spleno/hepatomegaly

Question 25

What tests should be done HL?

Answer 25

Lymph node excision biopsy Bloods - high ESR, low Hb High LDH - high cell turnover

Question 26

How is HL treated?

Answer 26

RT with short courses of Chemo Longer courses of chemo - ABVD Adriamycin, bleomycin, vinblastine, dacarbazine

Question 27

What are some associations with non-Hodgkin's lymphoma (NHL)?

Answer 27

Normally B cell lymphomas Immunodeficiency - HIV, drugs H.pylori, toxins, congenital

Question 28

What are the symptoms of NHL?

Answer 28

Superficial lymphadenopathy Extranodal disease: - gastric MALT (H. pylori) - non-MALT gastric lymphomas - Small bowel lymphomas Fever, night sweats, weight loss (less common than HL) Pancytopenia - anaemia, infection bleeding (low platelets)

Question 29

What tests should be done for NHL?

Answer 29

Bloods - LDH = increased cell turnover | Marrow and node biopsy

Question 30

How is NHL managed?

Answer 30

RT - localised disease Chlorambucil - diffuse disease IFN-a/retuximab - remission maintenance High grade: R-CHOP Retuximab, cyclophosphamide, hydroxydaunorubicin, vincristine, prednisolone

Question 31

What Abs are found in myeloma?

Answer 31

IgG or IgA

Question 32

What are the symptoms of myeloma?

Answer 32

``` Osteolytic bone regions - backache Hypercalcaemia Anaemia, neutropenia, thrombocytopenia Recurrent bacterial infections Renal impairment ```

Question 33

What do tests for myeloma show?

Answer 33

Normocytic, normochromic anaemia | High ESR, urea, creatinine, calcium

Question 34

How is myeloma treated?

Answer 34

CT - lenalidomide, bortezomib, dexamethasone Bisphosphonate Treat symptoms Stem cell transplant