Haematological conditions

Question 1

What is haematology?

Answer 1

the branch of medicine concerned with the study of the cause, prognosis, treatment, and prevention of diseases related to blood

Question 2

What is lymphoma?

Answer 2

a type of blood cancer that develops within the lymphatic system and lymphocytes
this can lead to uncontrolled growth of lymphocytes

Question 3

Name the four types of lymphoma.

Answer 3

Hodgkin lymphoma (2,107 people each year)
non-Hodgkin lymphoma (14,100 people each year)
small lymphocytic
lymphoma skin and CNS lymphoma

Question 4

What is the prevalence of lymphoma compared to other cancers?

Answer 4

6th most common cancer

Question 5

What is myeloma?

Answer 5

a blood cancer arising from plasma cells

Question 6

Name two types of myeloma.

Answer 6

light chain myeloma

non-secretory myeloma

Question 7

What is the prevalence of myeloma in the UK?

Answer 7

24,000
accounts for 15% of blood cancers, and 2% of all cancers
mainly affects people over 65 years

Question 8

What is leukaemia?

Answer 8

cancer of the body’s blood-forming tissues, including the bone marrow and the lymphatic system

Question 9

Name the four types of leukaemia.

Answer 9

acute myeloid (myelogenous) leukaemia (AML)
chronic myeloid (myelogenous) leukaemia (CML)
acute lymphocytic (lymphoblastic) leukaemia (ALL)
chronic lymphocytic leukaemia (CLL)

Question 10

What is the incidence and prevalence of leukaemia in the UK?

Answer 10

10,084 cases each year

12th most common cancer

Question 11

What are myelodysplastic syndromes?

Answer 11

a group of cancers in which immature blood cells in the bone marrow do not mature

Question 12

Name the five myelodysplastic syndromes.

Answer 12

refractory anaemia (RA)
refractory anaemia with ringed sideroblasts (RARS)
refractory anaemia with excess blasts (RAEB)
refractory cytopenia with multilineage dysplasia (RCMD)
refractory cytopenia with multilineage dysplasia and ringed sideroblasts (RCMD-RS)

Question 13

What is the incidence of myelodysplastic syndromes in the UK?

Answer 13

estimated 4/100,000 each year

increases to 30/100,000 each year for people >70 years

Question 14

What is myeloproliferative neoplasm?

Answer 14

a group of rare blood cancers in which excess erythrocytes, leucocytes, or platelets are produced in the bone marrow

Question 15

Name the six types of myeloproliferative neoplasm.

Answer 15

chronic myelogenous leukaemia
polycythemia vera
primary myelofibrosis (also called chronic idiopathic myelofibrosis)
essential thrombocythemia
chronic neutrophilic leukaemia
chronic eosinophilic leukaemia

Question 16

What is the incidence of myeloproliferative neoplasm in the UK?

Answer 16

estimated 1/100,000

most people affected >60 years

Question 17

What are six common signs and symptoms of non-Hodgkin’s lymphoma?

Answer 17

swelling of the face
enlargement of lymph nodes (especially in neck, axilla, and groin)
abdominal pain, distention, bloating, and constipation
loss of appetite, diarrhoea, and potential weight loss
shortness of breath, chest pain, difficulty breathing and coughs due to enlargement and swelling of the lymph nodes in the chest
pain and swelling surrounding lymph nodes and vital organs (including liver, stomach, kidneys, spleen)

Question 18

What is an excision biopsy?

Answer 18

the first diagnostic procedure for people with suspected non‑Hodgkin’s lymphoma at first presentation
the whole lesion or mass is removed and tested

Question 19

What is a needle core biopsy?

Answer 19

undertaken if the risk of a surgical procedure outweighs the potential benefits of an excision biopsy
if diagnosis is not possible after a needle core biopsy, an excision biopsy is offered (if surgically feasible) in preference to a second needle core biopsy

Question 20

What are gene testing strategies?

Answer 20

utlising FISH (fluorescence in situ hybridisation) to identify an MYC rearrangement in all people newly presenting with histologically high‑grade B‑cell lymphoma

Question 21

Name one of the recommended methods of staging B-cell lymphoma?

Answer 21

FDG‑PET‑CT (fluorodeoxyglucose‑positron emission tomography‑CT)

Question 22

How can FDG-PET0CT be used to stage B-cell lymphoma?

Answer 22

stage 1 - diffuse large B‑cell lymphoma by clinical and CT criteria
stage 1 or localised stage II follicular lymphoma if disease is thought to be encompassable within a radiotherapy field
stage 1 or 2 Burkitt lymphoma with other low‑risk features

Question 23

What is the suggested treatment for follicular lymphoma?

Answer 23

first line - local radiotherapy, or ‘watch and wait’
advanced stage may start with rituximab or combination with other medications to target cancers
autologous stem cell transplantation for people with follicular lymphoma in second or subsequent remission

Question 24

What is the suggested treatment for MALT lymphoma?

Answer 24

first-line - ‘watch and wait’ alongside H. pylori eradication therapy
chemotherapy with rituximab or gastric radiotherapy if first-line treatment is ineffective

Question 25

What is the suggested treatment for large B-cell lymphoma?

Answer 25

first-line - radiotherapy at 30 Gy to the specific sites

offered pre- or post-immunotherapy treatment

Question 26

What is the suggested treatment for mantle cell lymphoma?

Answer 26

first-line - chemotherapy with rituximab
advanced stages involve the use of immunochemotherapy
‘watch and wait’ approach can be undertaken if no progression