Haematological Malignancies Flashcards
Describe the epidemiology of haematological malignancies?
(sex, age)
Males > Females
All age groups, including children
List the 6 most common cancers?
- Breast
- Prostate
- Lung
- Bowel
- Melanoma skin cancer
- Non-Hodgkin lymphoma
Leukaemia and myeloma makes top 20 list
What is the most common group of blood cancers?
Non-Hodgkin lymphoma
Describe the pathogenesis of haematological malignancies?
- Acquired (NOT CONGENITAL) genetic alterations in a long lived cell
- Such as stem cell
- Proliferation/survival advantage to that mutated cell
- Produces malignant clone
- Malignant clone grows to dominate the tissue (such as bone marrow or lymph nodes)
How do stem cells divide?
Stem cells are self-renewal:
- When stem cell divides, one of the daughter cells are retained
- The other develops into another cell
Describe the growth of malignant stem cells?
- One cell is genetically altered over time
- Risk factors – radiation exposure, genetic congenital abnormality such as Down Syndrome
- This at first, after one mutation, is asymptomatic
- But with time a further mutation occurs and grows
- This continues, 3, 4, 5 mutations, then eventually the disease takes of as due to big growth advantage dominates the normal cells
What are risk factors for genetic alterations to cells?
- Risk factors – radiation exposure, genetic congenital abnormality such as Down Syndrome
How can haematological malignanices be grouped?
- Myeloid malignancies
- Acute myeloid leukaemia
- Myeloproliferative disorders
- Lymphoid malignancies
- Acute lymphoblastic leukaemia (ALL)
- Mature lymphoid malignancies
What are examples of myeloid malignancies?
- Acute myeloid leukaemia
- Myeloproliferative disorders
What are examples of lymphoid malignancies?
- Acute lymphoblastic leukaemia (ALL)
- Mature lymphoid malignancies
What does AML stand for?
Acute myeloid leukaemia
Describe the pathophysiology of AML?
- Genetic alterations happen to the myeloid progenitor
- So they divide and remain immature, never developing into mature blood cells
- Replace bone marrow
Describe the pathophysiology of myeloproliferative disorders?
- Genetic alteration occurs after stem cell stage after differentiate so lots of mature cells such as red blood cells or another blood cell
What does ALL stand for?
Acute lymphoblastic leukaemia
Describe the pathophysiology of ALL?
- Genetic alterations occur to lymphoid progenitor stem cell
- Which divides and does not differentiate further
What is the difference between leukaemia and lymphoma?
These are just descriptive terms, describing distribution of disease in body:
- If found predominantly in blood and bone marrow is called leukaemia
- If found in lymph nodes, or other organs like liver, then lymphoma
Term is used for how the disease most commonly presents
Describe the structure of a lymph node?
Where do B cells develop?
Germinal centre of lymph nodes
Describe the development of B cells?
- Released from bone marrow
- Enter germinal centre and exposed to antigen from antigen presenting cells
- Requires a lot of genetic rearrangement – potential for B cell lymphoma (most common kind)
- Emerge as plasma or memory B cells
What are different causes of lymphadenopathy?
- If localised and painful
- Bacterial infection in draining site
- Localised and painless
- Rare infections, catch scratch fever, TB
- Metastatic carcinoma from draining site – hard
- Lymphoma – rubbery
- Reactive, no cause identified
- Generalised and painful
- Viral infections, EBV, CMV, hepatitis, HIV
- Generalised and painless
- Lymphoma
- Leukaemia
- Connective tissue disease
- Reactive, no cause identified
- Drugs
What is lymphadenopathy?
Disease of the lymph nodes where they are abnormal in size or consistency
What is the cause of lymphadenopathy likely to be if it is localised and painful?
- Bacterial infection in draining site
What is the cause of lymphadenopathy likely to be if it is localised and painless?
- Rare infections, catch scratch fever, TB
- Metastatic carcinoma from draining site – hard
- Lymphoma – rubbery
- Reactive, no cause identified
What is the cause of lymphadenopathy likely to be if it is generalised and painful?
Viral infections, EBV, CMV, hepatitis, HIV
What is the cause of lymphadenopathy likely to be if it is generalised and painless?
- Lymphoma
- Leukaemia
- Connective tissue disease
- Reactive, no cause identified
- Drugs
Describe the presentation of lymphoma?
- Nodal disease
- Lymphadenopathy
- Extra-nodal disease
- Systemic symptoms
- Fever, drenching sweats, loss of weight, pruritus, fatigue
Summarise the different kinds of haematological malignancies?
- Acute laukaemias
- Acute lymphoblastic leukaemia (ALL)
- Acute myeloid leukaemia (AML)
- Chronic leukaemias
- Chronic myeloid leukaemia (CML)
- Chronic lymphocytic leukaemia (CLL)
- Malignant lymphomas
- Non-Hodgkin lymphoma (NHL)
- Hodgkin lymphoma (AL)
- Multiple myeloma
- Myelodysplastic syndromes (MDS)
- Chronic myeloproliferative diseases
What does CML stand for?
Chronic myeloid leukaemia
What does CLL stand for?
Chronic lymphocytic leukaemia
What does NHL stand for?
Non-Hodgkin lymphoma
What does AL stand for?
Hodgkin lymphoma
What does MDS stand for?
Myelodysplasic syndromes
