Haematological malignancy Flashcards
Can children be affected by haematological malignancy?
Yes
What is the commonest cancer in children?
Acute lymphoblastic leukemia
What age is the peak incidence for Hodgkin lymphoma?
20-30
What time of year do we see Hodgkin lymphoma most?
Spring
What is the pathogenesis of haematological malignancy?
Multi step process
Acquired genetic alterations in a long lived cell
Proliferative/survival advantage to that mutated cell
This produces a malignant clone
Malignant clone grows to dominate the tissue
What cell does malignancy originate in?
Haematopoietic stem cell
Memory cells
What is important about haematopoietic stem cells?
They are pluripotent
They are self renewing
How are the stem cells self renewed?
One daughter cell is given up to become a specific cell, one remains as a stem cell
What malignancies are considered myeloid malignancies?
Red cells
Platelets
Granulocytes
Monocytes
What happens if there is excessive proliferation without differentiated cells leaving the marrow?
The bone marrow fails - acute myeloid leukemia
What happens in the blood as a result of acute myeloid leukemia?
Cytopenia
What is a myeloproliferative disorder?
Excessive proliferation leading to differentiated myeloid cells
What is acute lymphoblastic leukemia?
Excessive proliferation of immature lymphoid cells without differentiation
Where do mutation events occur in Mature lymphoid malignancy?
In the mature lymphoid cell
What are differences between leukemia and lymphoma?
Leukemia is in blood and bone marrow
Lymphoma is in lymphoid tissue
How does chronic lymphocytic luekemia usually present?
Raised white cell count over a period of time without other symptoms
What are differences between acute and chronic leukemia?
Acute cells do not differentiate, chronic cells do
Acute leads to marrow failure, chronic has proliferation without marrow failure
Acute is rapidly fatal if untreated, chronic is survivable for a few years
Both are potentially curable, but chronic required more modern therapy
What is used to treat chronic myeloid leukemia?
Tyrosine kinase inhibitors
What are different areas of lymph nodes?
Medulla
Cortex
Paracortex
B-cell follicle - germinal centre, mantle zone, marginal zone
Where do B cells mature?
Germinal centre in lymph node
What is somatic hypermutation?
B cell divides rapidly to mature and be able to destroy antigens correctly
What is the origin of most lymphomas?
B-cell mutations
How do lymphomas present?
Lymphadenopathy - not always malignant
Systemic symptoms - fever, drenching sweat. loss of weight, pruritis, fatigue
Extranodal disease
What should be considered with lymphadenopathy presentation?
Localised and painful - likely bacterial infection in draining site
Localised and painless - rare infections ie TB, Metastatic carcinoma from draining site (hard), Lymphoma (rubbery), reactive (no cause identified)
Generalised and painful - viral infections ie glandular fever, HIV, Hep
Generalised and painless - Lymphoma, Leukemia, connective tissue diseases, reactive with no cause identified, drugs
