Haemotological malignancy

Question 1

What is the epidemiology of haematological malignancy?

Answer 1

○ Haematological Malignancies account for approximately 10% of all human cancers
○ They occur in all age groups, including children
○ Adult males are more commonly affected than females

Question 2

What is the epidemiology of Hodgkin disease?

Answer 2

• Has a peak incidence at 18-35 years

- One of the main causes is the Epstein Barr virus

Question 3

When is the peak incidence of non-hodgkins disease and AML?

Answer 3

70-80

Question 4

What is the pathogenesis of haematological malignancy?

Answer 4

○ Multi step process
○ Acquired genetic alterations to a long lived cell
○ Proliferative/survival advantage to that mutated cell
○ This produces the malignant clone
○ The malignant clone grows to dominate the tissue
- (e.g. bone marrow or lymph nodes)

Question 5

What type of cells cause myeloid malignancies?

Answer 5

• red cells
• Platalets
• Gram cells
• Monocytes

Question 6

What type of cells cause lymphoid malignancies?

Answer 6

> B-cell

> T-cell

Question 7

What is acute myeloid leukaemia?

Answer 7

Ongoing proliferation of myeloid cells with no end cells

Question 8

What is chronic myeloid leukaemia?

Answer 8

An increase in myeloid end cells in the blood

Question 9

What is acute lymphoid leukaemia?

Answer 9

Too much lymphoid progenitor and not enough end cells

Question 10

What is the difference between a leukaemia and a lymphoma?

Answer 10

○ Disease in the blood and bone marrow is called leukaemia
○ Disease in the lymphoid is called lymphoma
○ Some diseases can present in the blood and the lymphoid

Question 11

What are the major groups of haematological malignancies?

Answer 11

○ Acute Leukaemias
- Acute lymphoblastic leukaemia (ALL)
- Acute Myeloid Leukaemia (AML)
○ Chronic Leukaemias
- Chronic myeloid leukaemia (CML)
- Chronic lymphocytic leukaemia (CLL)
○ The malignant lymphomas
- Non-Hodgkin lymphoma (NHL)
- Hodgkin lymphoma (HL)
○ Multiple myeloma
○ Myelodysplastic syndromes (MDS)
○ The chronic myeloproliferative neoplasm (biologically malignant)

Question 12

Explain acute leukaemia?

Answer 12

• Leukemic cells do not differentiate
• Bone marrow failure
• Rapidly fatal if untreated
• Potentially curable
  □ E.g. childhood acute lymphoblastic leukaemia
  □ Good prognosis acute myeloid leukaemia treated with chemotherapy

Question 13

What are the clinical features of acute leukaemia?

Answer 13

□ Anaemia
□ Thrombocytopenic bleeding (Purpura and mucosal membrane bleeding)
□ Infection because of neutropenia (predominantly bacterial and fungal)

Question 14

Explain chronic leukaemia?

Answer 14

• Leukemic cells retain ability to differentiate
• Proliferation without bone marrow failure
• Survival for a few years
• Potentially curable with modern therapy
  □ E.g. Tyrosine Kinase inhibitors in CML

Question 15

What percentages of lymphomas present with nodal disease?

Answer 15

□ > 90% HL present with nodal disease

□ ~ 60% NHL present with purely nodal disease

Question 16

What are the different types of lymphadenopathies?

Answer 16

> Localised and painful
Localised and painless
Generalised and painful/ tender
Generalised and painless

Question 17

what causes loactlised and painful lymphadenopathy?

Answer 17

Bacterial infection in draining site

Question 18

what are the causes loaclised and painless lymphadenopathy

Answer 18

◊ Rare infections, catch scratch fever, TB
◊ Metastatic carcinoma from draining site- hard
◊ Lymphoma-rubbery
◊ Reactive, no cause identified

Question 19

What causes generalised painful lymphadenopathies?

Answer 19

Viral infections, EBV, CMV, hepatitis, HIV

Question 20

What are the causes of generalised painless lymphadenopathy?

Answer 20

◊ Lymphoma
◊ Leukaemia
◊ Connective tissue diseases, sarcoidosis
◊ Reactive, no cause identified
◊ Drugs

Question 21

What percentages of lymphomas present with extranodal disease?

Answer 21

~ 40% NHL present with an extranodal component, with or without nodal involvement

Question 22

What are the systemic features of lymphomas?

Answer 22

□ Fever
□ Drenching sweats
□ Loss of weight
□ Pruritis
□ Fatigue