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Finals > Haematology CANCERS > Flashcards

Haematology CANCERS Flashcards

1
Q

What is hodgekin’s lymphoma/ disease

and non-hodgekins’s lymphoma?

Whats the difference?

A
  • Lymphoma = cancer of lymphocytes (NK, T & B cells)
  • Accumulate in lymph nodes causing lymphadenopathy

Hodgekin’s;

  • Microscopy; Reed-Sternberg cells

Non-hodgekin’s;

  • All lymphomas without Reed-Sternberg cells
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2
Q

Hodgekin’s lymphoma

  • S+Sx
  • I
  • T
A

​S+Sx

  • Enlarged, painless, non-tender, ‘rubbery’ superficial lymph nodes
    • Typ cervical (+ axillary, inguinal)
    • May inc/ dec in size
  • Systemic “B” symptoms
    • Fever, weight loss, night sweats, pruritus, lethargy
  • Alcohol = lymph pain
  • Bulky = SVC/ bronchial obstruction

I

  • Normo anaemia
  • CT ChestPelvisAbdoNeck (see involved nodes)
  • CT:PET shows scar (responce to T)
  • Lymph node biopsy: Reed-Sternberg, Owl Eyes

T

  • Sperm banking/ oocyte harvesting
  • Chemo (curative)
  • Adjuvant radio to local residual disease
  • Autologous/ Allogenei stem cell transplant
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3
Q

Non-Hodgekin’s lymphoma

  • Aetiology
    • Inherited
    • Acquired
    • HTLV-1
    • EBV
    • H. pylori
  • Presentation
A

Aetiology

  • Inherite: Ataxia telangiectasia
  • Aquired: HIV, immunosuppressive, IBD
  • Human T Lymphotrophic virus: T Lymphoma
  • EBV: Burkitt lymphoma
  • H. pylor: MALT lymphoma

Presentation

  • Superficial LAD
  • Waldeyer’s ring Oropharynx
  • ​SKIN (Human T Lymphotrophic virus: T Lymphoma)

B symptoms less common

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4
Q

Staging of Non and Hodgekins Lymphoma

A

Ann Arbor staging for both

  1. single LN
  2. two+ on 1side of the diaphragm
  3. two+ on both sides of the diaphragm
  4. Involves extralymphatic site (eg bone marrow)
  • A - No systemic symptoms
  • B - Presence of systemic symptoms
  • S=Spleen, E=Extranodal, X=>10cmBulky

Systemic symptoms = B symptoms

HISTOLOGY just for Hodgekin’s Lymphoma

  1. Lymphocyte Predominent (10-20%RS)
  2. Nodular Sclerosis (RS in collagen) 70%
  3. Mixed cellularity (RS50:50Lymphocytes)
  4. Lymphocyte depleted
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5
Q

Myeloma

  • Pathophysiology
  • Presentation + Investigations + Treatment
A

Aetiology

  • Clonal Plasma B-lymphoyte proliferation
  • Produce Paraprotein Ig’s + Bence-Jones protein (light chain)

Presentation + Investigations + Treatment

  • Ca2+
    UP
    IV Fluids
  • Renal failure
    Low EPO, Urine: Bence-Jones
    Give EPO
  • Anaemia
    FBC, Normo.. Film: ROULEAU formation
  • Bone pain (back) + Lytic lesions
    XR skeletal survey
    Bisphosphonates

Ig’s LOW except paraprotein
Protein electrophoresis: Bence Jones protein

+Chemotherapy (Thalidomide + Bortezomib) (extends time before relapse)

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6
Q

Polycythemia Vera

  • Pathophysiology
  • Classic presentation
  • Investigations
  • Treatment
A

60s - male - JAK2 mutation

Post-shower Pruritis, plethoric

  • FBC + Film: High haematocrit + Myeloids
  • Low serum Ferritin (demand)
  • Low EPO and ESR (zeta potential)
  • JAK2 mutation
  1. Phlebotomy + Low dose Aspirin
  2. Hydroxycarbamide
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7
Q

Essential Thrombocytosis

  • Pathophysiology
  • Classic presentation
  • Investigations
  • Treatment
A

Primary high PLTS >450x109/L for >2months

  • High PLTs - Headache, erthyromelalgia
  • Dysfunction PLTs - Epistaxis, bruising
  • Film: Giant PLTS + Clumps
  • Bone Marrow Trephine: Megakaryocytes
  • JAK2

Low risk: Aspirin

High risk: Hydroxyurea, IFNa

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8
Q

Myelofibrosis

  • Pathophys
  • Presentation
  • Investigations
A

Prolif Stem Cells + Fibrosis of BM (megakaryocyte GFs++Fibroblasts) -> underproduction

  • Bone pain + LOW all cells
  • Film: Tear drop RBCs POIKILOCYTES
  • Aspirate DRY tap
  • BM Trephine: Fibrosis
  • JAK2
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9
Q

AML

  • Diagnostic criteria
  • Presentation
  • Investigation
A

WHO Dx: >20% Myeloblasts (blood/ BM)

  • Film: Pancytopenia with BLASTs!
  • Blast infiltration: Gum hypertrophy/ Gingivitis

BM Asp/ Biop: Myeloperoxidase stain

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10
Q

Myelodysplastic Syndrome

  • Define
  • Presentation
  • Investigations
  • Treatment
A

MyeloBlasts cant develop/ mature cells abnormal

Presentation similar to Myeloid

BLASTS >2-3% (<20% or its AML)

Treatment: Transfusion

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11
Q

CML

  • Essential aetiology
  • Presentation
  • Investigations
A

t(9:22) Philadelphia chromosome (bcr-abd gene produces Tyrosine Kinase)

  1. Chronic phase (asymp, splenomeg)
  2. Acelerated phase (low PLTs, dodgy WBC signs)
  3. MyeloBLAST crisis (in BM causing bone pain)
  • FISH: Phildelphia t(9:22)
  • MyeloBLASTS!
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12
Q

ALL

A

3yrs age - RFs: radiation/ trisomys (worse in boys, elder)

  • Film: Pancytopenia with BLASTs!
  • BM Asp/ Biop: Tdt Antigen
  • CNS involvement
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13
Q

CLL

  • Pathophysiology
  • Presentation
  • Investigations
A

B-Lymphocytes, Adults

  • LAD: Small cell lymphoctic lymphoma
    • C: Rickter transformation to Diffuse Bcell Lymphoma
  • Lmyphocytosis + FRAGILE SMUDGE CELLS
  • Hypogammaglobinaemia
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Finals (23 decks)

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