Haematological cancers

Question 1

What is leukaemia?

Answer 1

Cancer affecting blood and bone marrow

Question 2

What is lymphoma?

Answer 2

Cancer affecting lymph nodes

Question 3

What is acute lymphoblastic leukaemia (ALL)?

Answer 3

Malignancy of lymphoblasts (give rise to B & T cells)

Most common paediatric malignancy

Question 4

ALL commonly affects which group?

Answer 4

Children

associated w ionising x-rays during pregnancy, Down’s

Question 5

What are the clinical presentations of ALL? (3)

Answer 5

Peripheral lymphadenopathy
CNS INVOLVEMENT (eg facial palsy)
SVC obstruction: RED FACE, DILATED SUPERFICIAL CHEST VEINS

Question 6

ALL affects B cells in which age group?

Answer 6

Children

Question 7

ALL affects T cells in which group?

Answer 7

Adults

Question 8

What are the investigations for ALL? (3)

Answer 8

FBC: anaemia, thrombocytopenia, neutropenia
CXR & CT scan: look mediastinal & abdominal lymphadenopathy
Lumbar puncture: looks for CNS involvement

Question 9

What is the treatment for ALL? (3)

Answer 9

Chemotherapy
Steroids
Intrathecal drugs eg methotrexate

Question 10

What three risk factors would give a poor prognosis for ALL?

Answer 10

Adult
Male
Philadelphia chromosome

Question 11

What is acute myeloid leukaemia (AML)?

Answer 11

Cancer of myeloblasts (gives rise to basophils, neutrophils, eosinophils)

Question 12

AML commonly affects which group?

Answer 12

Adults 40+

Question 13

What are the clinical presentations for AML? (2)

Answer 13

Peripheral lymphadenopathy

GUM HYPERTROPHY

Question 14

What are the investigations for AML? (2)

Answer 14

FBC: anaemia, thrombocytopenia, neutropenia

Bone marrow biopsy: AUER RODS

Question 15

What is the treatment for AML? (3)

Answer 15

Chemotherapy
Steroids
Sibling matched allogeneic bone marrow transplant

Question 16

How would you differentiate between ALL and AML? (2)

Answer 16

AML have Auer rods on BM biopsy

ALL have CNS involvement

Question 17

What is one sign seen only in AML and not ALL?

Answer 17

Gum hypertrophy

Question 18

What is chronic lymphocytic leukaemia (CLL)?

Answer 18

Cancer of B cells

Question 19

CLL commonly affects which groups? (2)

Answer 19

Adults 70+

Ppl w low immunity

Question 20

What are the clinical presentations for CLL? (2)

Answer 20

Often ASYMPTOMATIC

ENLARGED, RUBBERY NON-TENDER NODES

Question 21

How would you investigate CLL? (2)

Answer 21

FBC: HIGH LYMPHOCYTES, then anaemia, neutropenia, thrombocytopenia
Blood film: SMALL, MATURE LYMPHOCYTES

Question 22

How would you manage CLL? (2)

Answer 22

Watch + wait - consider treatment if symptomatic

FLUDARABINE + RITUXIMAB +/- CYCLOPHOSPHAMIDE

Question 23

What is chronic myeloid leukaemia (CML)?

Answer 23

Cancer of neutrophils, basophils, eosinophils, macrophages

Question 24

CML commonly affects which groups?

Answer 24

Adults 40-60

Question 25

What are the clinical presentations for CML? (2)

Answer 25

Massive hepatoSPLENOMEGALY

May have gout, abdominal enlargement

Question 26

How would you investigate CML? (2)

Answer 26

FBC: anaemia, RAISED MYELOID CELLS, WBC

Reverse transcriptase PCR: PHILADELPHIA CHROMOSOME t(9;22)

Question 27

How would you treat CML?

Answer 27

Tyrosine kinase inhibitor - IMATINIB