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Cancer care > Haematology > Flashcards

Haematology Flashcards

1
Q

What is cancer-associated thrombosis linked to

A

Lower life expectancy

Delayed cancer treatment

Decreased quality of life

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2
Q

What are the patient-related risk factors for cancer-associated thrombosis

A

Comorbidities

Varicose veins

Prior VTE

Hereditary thrombophilias

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3
Q

What are the tumour-related risk factors for cancer-associated thrombosis

A

Site of cancer (very high risk - stomach, pancreas, brain, high risk - lung, haem, gynae, renal, bladder)

Grade of tumour

Stage

Time since cancer diagnosis

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4
Q

What are the treatment-related risk factors for cancer-associated thrombosis

A

Chemotherapy (especially platinum-based)

Anti-angiogenesis agents

Hormone therapy

Surgery

Radiotherapy

Blood transfusion

Central venous catheter

Immobility and hospitalisation

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5
Q

What are the biomarkers for cancer-associated thrombosis

A

Haematological biomarkers (platelets, haemoglobin, leukocytes)

D-dimer, P-selectin

Thrombin generation potential

MP-tissue factor activity

CRP

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6
Q

What are the guidelines around cancer-associated thrombosis

A

LMWH for 3-6 months (as secondary prevention)

DOACs (if low risk of bleeding)

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7
Q

Explain the European co-operative oncology group (ECOG) performance stats

A

0 - fully active, no restrictions

1 - restricted physically strenuous activity

2 - ambulatory and capable of self care

3 - capable of limited self care, in bed/chair >50% of waking hours

4 - completely disabled

5 - dead

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8
Q

What are the characteristic features of myeloma

A

Plasma cell accumulation in bone marrow

Monoclonal proteins in serum/urine

Tissue damage

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9
Q

What is the defining feature of Hodgkin lymphoma

A

Reed-Sternberg cells (neoplastic B cells)

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10
Q

What type of anaemia do you tend to get in Hodgkin lymphoma

A

Normocytic, normochromic

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11
Q

How does the grade of lymphoma affect treatment outcomes

A

High grade - aggressive, possible to cure

Low grade - responds well to treatment, treat rather than cure

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12
Q

What is leukaemia

A

Cancer of particular lines of stem cells in bone marrow

Excessive production of a single type of abnormal white blood cell (suppression of other cell lines)

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13
Q

What do you find in the blood results of patients with leukaemia

A

Pancytopenia (anaemia, leukopenia, thrombocytopenia)

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14
Q

What are the peak ages of presentation for the different types of leukaemia

A

ALL - 5 - 45

CLL - > 55

CML - > 65

AML - > 75

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15
Q

How might a patient with leukaemia present

A

Fatigue

Fever

Failure to thrive (in children)

Pallor

Petechiae and abnormal bruising

Abnormal bleeding

Lymphadenopathy

Hepatosplenomegaly

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16
Q

What are the differentials for a non-blanching rash

A

Non-accidental injury

Leukaemia

Meningococcal septicaemia

Vasculitis

Henoch-Schonlein purpura

Idiopathic thrombocytopenia purpura

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17
Q

What are the investigations needed for a patient with suspected leukaemia

A

FBC (within 48 hrs)

Blood film

Lactate dehydrogenase (not specific)

Bone marrow biopsy (needed for definitive diagnosis, aspiration/trephine)

Chest X-ray

Lymph node biopsy

Lumbar puncture

Staging CT/MRI

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18
Q

What is acute lymphoblastic leukaemia

A

Malignancy in lymphocyte precursor cells

Acute proliferation of a single type of lymphocyte (usually B cells)

Get pancytopenia

Most common cancer in children

Associated with Down’s syndrome

Blood film (blast cells)

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19
Q

What is chronic lymphocytic laukaemia

A

Chronic proliferation of a single type of well-differentiated lymphocytes (usually B cells)

Presentation: often asymptomatic, infection, anaemia, bleeding, weight loss

Causes warm autoimmune haemolytic anaemia

Can transform into high grade lymphoma (Richter’s transformation)

Blood film - smudge/smear cells

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20
Q

What are the phases of chronic myeloid leukaemia

A

Chronic phase - lasts around 5 years, asymptomatic

Accelerated phase - abnormal cells take over bone marrow, symptomatic (anaemia, thrombocytopenia, immunocompromised)

Blast phase - high proportion of blast cells and blood , severe symptoms, often fatal

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21
Q

Which genetic abnormality is associated with CML

A

Philadelphia chromosome

9:22 translocation

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22
Q

What is acute myeloid leukaemia

A

Most common acute leukaemia in adults

Sometimes due to transformation from a myeloproliferative disorder

Blood film - high proportion of blast cells, Auer rods in cytoplasm

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23
Q

What is the management for leukaemia

A

MDT support

Chemotherapy

Steroids

Radiotherapy

Bone marrow transplant

Surgery

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24
Q

What is lymphoma

A

Cancer of lymphocytes in lymphatic system

Cancer cells proliferate in lymph nodes

Get lymphadenopathy

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25
Q

What is the age distribution of Hodgkin lymphoma

A

Bimodal (20, 75)

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26
Q

What are the risk factors for developing Hodgkin lymphoma

A

HIV

EBV

Autoimmune conditions (rheumatoid arthritis, sarcoidosis)

Family history

27
Q

How might a patient with Hodgkin lymphoma present

A

Lymphadenopathy (non-tender, rubbery)

Pain in lymph nodes when drinking alcohol

B symptoms

Other: fatigue, itching, shortness of breath, abdominal pain, recurrent infections

28
Q

What are the investigations for a patient with Hodgkin lymphoma

A

LDH

Lymph node biopsy (Reed-Sternberg cells - abnormally large B cells, multiple nuclei and nucleoli)

Staging CT/MRI

29
Q

Explain the Ann Arbor staging

A

For lymphomas

Stage 1 - 1 lymph node area

Stage 2 - Multiple lymph node areas, one side of diaphragm

Stage 3 - Multiple lymph node areas, both sides of diaphragm

Stage 4 - Widespread, extra-nodal involvement

30
Q

What is the management for Hodgkin lymphoma

A

Chemotherapy (risk of leukaemia and infertility)

Radiotherapy (risk of other cancers, damage to tissue, hypothyroidism)

31
Q

What are some common types of Non-Hodgkin lymphoma

A

Follicular (most common low-grade type)

Burkitt

MALT (associated with H pylori infection)

Diffuse large B cell

32
Q

What are the risk factors for developing non-Hodgkin lymphoma

A

HIV

EBV

H pylori

Hep B, Hep C

Exposure to pesticides

Family history

33
Q

What are the management options for non-Hodgkin lymphoma

A

Watchful waiting

Chemotherapy

Monoclonal antibodies (usually rituximab)

Radiotherapy

Stem cell transplant

34
Q

What is myeloma

A

Cancer of plasma cells (B cells that produce antibodies)

Multiple myeloma: myeloma affecting multiple areas around the body

Can get infiltration of bone marrow (anaemia, neutropenia, thrombocytopenia)

35
Q

What is monoclonal gammopathy of undetermined significance (MGUS)

A

Excess in 1 type of antibody/antibody component without features of myeloma/cancer

Often incidental finding

Needs routine monitoring

Can become myeloma

36
Q

What is the pathophysiology of myeloma

A

Genetic mutation causing rapid and uncontrolled multiplication of cancerous plasma cells

One type of immunoglobulin massively high (monoclonal paraprotein)

37
Q

What is myeloma bone disease

A

Increased osteoclast activity, suppressed osteoblast activity (imbalance in bone metabolism)

Commonly in: skull, spine, long bones, ribs

Osteolytic lesions in bone (get pathological fractures)

Hypercalcaemia (bone reabsorption)

38
Q

What causes myeloma renal disease

A

Immunoglobulins blocking flow through tubules

Hypercalcaemia

Dehydration

Medications (bisphosphonates)

39
Q

Why do you get hyperviscosity in myeloma

A

Extra proteins in blood, make it more viscous

Get: easy bruising, easy bleeding, loss of sight (vascular eye disease), purplish palmar erythema, heart failure

40
Q

What are the risk factors for developing myeloma

A

Older age

Male

Black ethnicity

Family history

Obesity

41
Q

What are the investigations for myeloma

A

Everyone over 60 with: bone pain, unexplained fractures

FBC (low WCC)

Calcium (raised)

ESR (raised)

Plasma viscosity (raised)

Serum protein electrophoresis

Urine Bence-Jones proteins, serum-free light chain assay, serum immunoglobulins

Bone marrow biopsy

Staging CT/MRI

Skeletal survey (punched out lesions, lytic lesions, raindrop skull)

42
Q

What is involved in the management of myeloma

A

MDT support

Chemotherapy plus: bortezomid, thalidomide, dexamethasone

Stem cell transplant

VTE prophylaxis

Managing bone disease: bisphosphonates (suppress osteoclast activity), radiotherapy, orthopaedic surgery, cement augmentation

43
Q

What are the complications of myeloma

A

Infection

Pain

Renal failure

Anaemia

Hypercalcaemia

Peripheral neuropathy

Spinal cord compression

Hyperviscosity

44
Q

What is the mnemonic for the effects of myeloma

A

CRAB

Calcium high

Renal impairment

Anaemia

Bone disease

45
Q

What are myeloproliferative disorders

A

Due to uncontrolled proliferation of a single type of stem cell

Bone marrow cancers

3 main types: primary myelofibrosis, polycythaemia vera, essential thrombocythaemia

Can progress to AML

Associated mutations: JAK2, MPL, CALR

46
Q

What is primary myelofibrosis

A

Proliferation of haematopoietic stem cells

47
Q

What is polycythaemia vera

A

Proliferation of erythroid cells

48
Q

What is essential thrombocythaemia

A

Proliferation of megakaryocytes

49
Q

What is myelofibrosis

A

Can be caused by any of the myeloproliferative disorders

Proliferation of cell lines causes fibrosis in bone marrow (in response to cytokines, replaced by scar tissue)

Start to get extramedullary haematopoiesis (in liver or spleen, get portal hypertension and spinal cord compression)

50
Q

How might a patient with a myeloproliferative disorder present

A

Often initially asymptomatic

B symptoms

Signs of underlying complication: anaemia, splenomegaly, portal hypertension, low platelets, thrombosis, raised RBCs, low WCC

Key signs of polycythaemia vera: conjunctival pallor, ‘ruddy’ complexion, splenomegaly

51
Q

What are the investigations needed for myeloproliferative disorders

A

FBC: myeloma (anaemia, leukocyte disturbances, platelet disturbances), polycythaemia vera (high Hb), primary thrombocythaemia (high platelets)

Blood film (tear-shaped RBCs in myelofibrosis)

Bone marrow biopsy

Genetic testing

52
Q

What is the management for primary myelofibrosis

A

Monitoring (for mild, asymptomatic disease)

Allogenic stem cell transplant

Chemotherapy

Supportive management

53
Q

What is the management for polythaemia vera

A

Venesection

Aspirin (reduce thrombus formation)

Chemotherapy

54
Q

What is the management for thrombocythaemia

A

Aspirin (reduce thrombus formation)

Chemotherapy

55
Q

What is non-small cell lung cancer

A

80% of lung cancers

Includes: adenocarcinomas, large-cell carcinomas

56
Q

What is small cell lung cancer

A

20% of lung cancers

Contain neurosecretory granules (release neuroendocrine hormones, can get paraneoplastic syndromes)

Poor prognosis

57
Q

How might a patient with lung cancer present

A

Shortness of breath

Cough

Haemoptysis

Finger clubbing

Recurrent pneumonia

Weight loss

Lymphadenopathy (usually supraclavicular)

58
Q

What investigations are needed for lung cancer

A

Chest X-ray

Staging CT

PET CT

Bronchoscopy

Histology

59
Q

What chest X-ray signs can be suggestive of lung cancer

A

Hilar enlargement

Peripheral opacity (visible lesion)

Pleural effusion

Lung collapse

60
Q

What are the extra-pulmonary manifestations of lung cancer

A

Recurrent laryngeal nerve palsy (hoarse voice)

Phrenic nerve palsy (shortness of breath)

SVCO (Pemberton’s sign)

Horner’s syndrome (ptosis, anhidrosis, miosis)

SIADH (ectopic ADH from cancer, get hyponatraemia)

Cushing’s syndrome (ectopic ACTH)

Hypercalcaemia (ectopic PTH)

Limbic encephalitis

Lamberton-Eaton myasthenic syndrome

61
Q

What is limbic encephalitis

A

Small cell lung cancer causes production of antibodies against brain

Symptoms: short-term memory loss, hallucinations, confusion, seizures

62
Q

What is Lambert-Eaton myasthenic syndrome

A

Antibodies produced against small cell lung cancer

Also target motor neurones

Reduced tendon reflexes

Proximal muscle weakness (extraocular muscles - diplopia/ptosis, slurred speech, dysphagia)

63
Q

What is mesothelioma

A

Malignancy of mesothelial cells of pleura

Strong link to asbestos inhalation (up to 45 year latency)

Very poor prognosis (usually palliative)

64
Q

What is the management of lung cancer

A

MDT discussion

Surgery (lobectomy, segmentectomy, wedge resection)

Radiotherapy (curative in NSCLC if early enough)

Chemotherapy (adjuvant or palliative)

Endobronchial stenting/debulking (palliative)

Cancer care (8 decks)

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