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Cancer Care > Haematology > Flashcards

Haematology Flashcards

1
Q

What is Hodgkins Lymphoma

A

Cancer of B and T cells within the lymph tissue –> lead to clonal proliferation of lymphoid cells

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2
Q

What cells are present in Hodgkins lymphoma

A

Reed-sternberg cells = present histologically

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3
Q

How does lymphoma present

A

Typically painless lump in lower neck or supraclavicular area
Mediastinal masses are frequent –> chest discomfort, cough, dyspneoa
Hepatomegaly, Splenomegaly
SVCO
Paraneoplastic syndrome –> cerebellar degeneation, neuropathy, Guillan Barre syndrome
B symptoms
- Weight loss >10%
- night sweats
- unexplained fevers >38 degrees

Alcohol induced pain at sites of nodal disease occurs in <10%

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4
Q

Differentials for lymphoma

A 
other type of lymphoma
HIV/AIDS
Infective Mononucleosis 
Reactive lymph node 
TB 
Leukaemia 
Myeloma 
Sarcoidosis
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5
Q

What investigations should be done in suspected lymphoma?

A 
Bloods 
- FBC --> normocytic, normochronic anaemia, Leukopenia, neutrophilia
- ESR ->70 bad prognostic factor 
LFTs
LDH
HIV tests 
Lymph node biopsy 
CXR --> mediastinal lymphadenopathy 
CT CAP for staging 
BM biopsy for staging
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6
Q

What is the staging for lymphoma

A

Ann Arbor

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7
Q

What are the different stages of the Ann Arbor staging

A

Stage 1: involvement of one lymph node region
Stage 2: 2 or more lymph node regions on SAME SIDE of diaphragm
Stage 3: on both sides of diaphragm
Stage 4: involvement of extranodal sites e.g. liver, bone marrow, abdominal wall

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8
Q

What is the management of Hodgkins Lymphoma

A

Chemo and radiotherapy

Vaccinations

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9
Q

What are the complications of Hodgkins Lymphoma

A 
Secondary Solid tumours e.g. breast, lung 
Leukaemia especially AML
Complications of irradiation 
- hypothyroidism 
- cardiovascular disease 
Infertility
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10
Q

What are the complications of Non-Hodgkins Lymphoma

A 
Neutropenia, Anaemia, Thrombocytopenia
Bleeding, DIC 
SVCO
Tumour Lysis syndrome 
Spinal Cord Compression 
Chemo-related --> N&amp;V, fatigue 
Large pericardial effusion 
Pleural effusion/parenchymal lesions
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11
Q

How does low grade and high grade NHL present

A

Low grade

  • painless slow growing lump
  • systemic symptoms are end stage/advanced disease
  • splenomegaly and hepatomegaly

High grade
- rapidly growing, bulky lymphadenopathy
- systemic symptoms and extranodal more common –> night sweats, unexplained fevers, weight loss, fatigue etc
Hepatosplenomegaly
Burkitts –> large abdominal mass + symptoms of bowel obstruction

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12
Q

What are the risk factors for NHL

A

Viruses: EBV, HIV, Human T cell leukaemia virus
Kaposis sarcoma
Environmental: pesticides, hair dyes, solvents, paints, chemo
Immunodeficiency
Autoimmune disorders –> sjrogens, hashimotos

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13
Q

What are the differentials for NHL

A

Hodgkins lymphoma
Leukaemia
Metastatic malignant disease
Lymphadenopathy –> infection or connective tissue disease

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14
Q

In suspected NHL which investigations would you do

A 
FBC --> anaemia, thrombocytopenia, neurtropenia (may have thrombocytosis and lymphocytosis)
U+Es --> obstructive nephropathy, hypercalcaemia 
LFTs 
FISH/Cytogenetics --> Burkitts 
Serology - HIV, HTLV-1, Hep C
CXR
CT CAP
Lymph node biopsy
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15
Q

What is the management for NHL

A

Vaccinations - Men C, Hib, Pneumococcal, influenza
Chemo - Rituximab + predinosolone, cyclophosphoamide, vincristine, doxorubicin
Radiotherapy

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16
Q

What is myeloma

A

Cancer of the plasma cells
Overproduction of monoclonal antibodies (immunoglobulin/paraproteins)
IgG myeloma is the most common

17
Q

How may myeloma present

A 
Pathological fractures 
Recurrent infections (due to low WCCs)
Bleeding and bruising (low platelets) 
Anaemia and faitgue 
Bone pain 
Hyperviscosity symptoms --> dizziness, confusion, blurred vision 
Dehydration 
Signs and symptoms of hyerpcalcaemia
18
Q

What investigations are done in suspected myeloma

A 
Bloods 
FBC,
U+Es
LFTs 
ESR 
Serum electrophoresis 
Immunoglobulin levels 
Calcium and uric acid levels (bone profile) 
Urine sample --> bence jones proteins

X rayds if suspected fracture

19
Q

What are the diagnostic tests for myeloma

A

Bone marrow aspirate and trephine sample

Skeletal survey

20
Q

What are the effects on the kidney in myeloma

A

immunoglobulins cause tubular destruction and tubulo-interstitial inflammation

21
Q

What type of anemia would you expect in myeloma

A

Normocytic and normochromic

22
Q

What are the differentials for myeloma

A

Amyloidosis
NHL
CLL
Solitary plasmacytoma

23
Q

What is the management for myeloma

A

Vaccinations
induction chemo
elderly - bortezomib
young - high dose therapy and stem cell transplant
Analgesia –> NOT NSAIDS
corticosteroids for bone pain
Aciclovir may be given as prophylaxis due to immunodeficiency
Zoledronic acid - due to lytic bone lesions
Erythropoeitin analogues for anaemia

24
Q

What are the complications of myeloma

A 
Pathological fractures
Renal impairment 
Hypercalcaemia 
Immunodeficiency 
Anaemia

Cancer Care (2 decks)

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