Leukaemia Flashcards
The following symptoms singly or in clusters may be indicative of a blood cancer:
pruritus recurrent infections abdominal pain bruising Select one: True False
The following symptoms singly or in clusters may be indicative of a blood cancer
pruritus recurrent infections abdominal pain bruising Select one: True Correct
he following symptoms and signs singly and in combination may suggest a haematological cancer and warrant a full examination, further investigation and possible referral: fatigue, drenching night sweats, fever, weight loss, pruritus, breathlessness, bruising, bleeding, recurrent infections, bone pain, alcohol-induced pain, abdominal pain, lymphadenopathy, splenomegaly.
A full-time GP may see two new diagnoses of haematological malignancies every year.
Select one:
True
False
A full-time GP may only see one or two new diagnoses of haematological malignancies every 2 years. This contributes to the difficulty in recognising its presentation.
10% of blood cancers are diagnosed via an emergency presentation.
Select one:
True
False
Of all haematological malignancies 33% are diagnosed via the emergency route, compared to 23% for all other cancers on average.
The aetiology of most haematological malignancies is not yet known.
Select one:
True
False
Ionising radiation, exposure to chemicals, smoking, industrial exposures including benzene, viral infections, genetic predisposition and Down’s syndrome are associated with an increased risk for one or more of these diseases, but for most patients there is as yet no identifiable cause for their disease.
Non-Hodgkin Lymphoma has the highest incidence for all blood cancers.
Select one:
True
False
Non-Hodgkin’s lymphoma is the largest disease group in terms of number of new cases, accounting for over 40% of all haematological malignancies in both men and women.
The NICE guidelines NG12 (2015) Suspected cancer: recognition and referral has lowered the threshold for the positive predictive value of a symptoms that should trigger a cancer assessment from 10% down to 5%
Select one:
True
False
The NICE guidelines NG12 Suspected cancer: recognition and referral has lowered the threshold for the positive predictive value of symptoms that should trigger a cancer assessment from 5 -10% to ≤3%.
The following fall into higher risk groups for Acute Lymphoblastic Leukaemia.
Select one or more:
a. Age less than 5 years
b. Trisomy 21
c. Afro-Caribbean
d. Exposure to alkylating agents
e. Female
Your answer is partially correct.
You have correctly selected 1.
ALL is the most common type of cancer to affect children. Higher risk groups include
1) Male
2) Age <5- Peak age of incidence occurs between the ages of 2-4 years
3) Caucasian
4) Down’s Syndrome - Patients with trisomy 21 have 10- to 20-fold risk of developing ALL compared with the general population
ALL has a relatively good prognosis. Almost all children will achieve a remission from their symptoms, and 85% will be completely cured.
Acute lymphoblastic leukaemia is most common in children and young adults.
Select one:
True
False
Acute lymphoblastic leukaemia (ALL) accounts for 12% of all leukaemias in the UK and accounts for 80% of cases in children. Approximately one in every 2000 children will develop it. About 85% of cases occur in children aged under 15, mostly between the ages of two and five years old. The risk then declines slowly until the mid-20s, and begins to rise again slowly after age 50.
ALL is most common in children and young adults, with 65% of cases diagnosed in people aged under 25. Overall, about four of every ten cases of ALL are in adults.
Chronic myeloid leukaemia (CML) predominantly affects people over 60 years.
Select one:
True
False
Chronic myeloid leukaemia (CML) predominantly affects people over 60 years, with a preponderance in males.
Full blood count is often normal in the presence of lymphoma.
Select one:
True
False
Full blood count is often normal in the presence of lymphoma.
Normochromic, normocytic anaemia, pancytopenia, neutrophilia, or eosinophilia may occur.
Anaemia can reflect lymphoma, bone marrow infiltration, or a background of chronic disease.
Which of the following are risk factors for lymphoma?
Select one or more:
a. HIV positive
b. Exposure to Human Papilloma virus (HPV)
c. Past history of Non-Hodgkin lymphoma
d. Being on long term immunosuppresants
e. Past history of an Epstein-Barr virus infection
All options except exposure to HPV represent risk factors for lymphoma. The age distribution for Hodgkin lymphoma has two peaks, the first in young adults and the second in old age. In the age range 15-24 years the incidence of disease is higher in females, but at all other ages the disease is more common in males.
Which of the following statements about Non-Hodgkin lymphoma are true?
Select one or more:
a. Tyrosine Kinase treatment improves 5 year survival rate to 80%
b. Peak incidence of Non-Hodgkin lymphoma is between 20 and 40 years
c. Peak incidence of Non-Hodgkin lymphoma is between 50 and 70 years
d. Non-Hodgkin lymphoma (NHL) is the most common haematological malignancy
e. Presentation is usually with a localised mass in the neck
Non-Hodgkin lymphoma (NHL) is the commonest haemological malignancy. About 80% of all lymphomas diagnosed are NHL. Peak incidence of non-Hodgkin’s lymphoma occurs between 50 and 70 years. Non-Hodgkin lymphoma (NHL) is typically disseminated at presentation. 40% of patients present with tumour outside lymph glands. Presenting features include painless generalised lymphadenopathy (in contrast the lymphadenopathy of Hodgkin’s disease is often localised to a single group of nodes). Rituximab is now used in the treatment of the two commonest lymphomas
Which of the following statements are true regarding Myeloma?
Select one or more:
a. Urine should be sent to check for Bence Jones Protein when Myeloma is suspected
b. Caucasians are effected more than Afro-Caribbean patients
c. The median age at presentation in UK is around 70 years
d. Monoclonal Gammopathy of unknown significance (MGUS) is a risk factor
e. Renal failure can occur due to paraproteinaemia
The median age for presentation of Myeloma in UK is around 70 years. It effects Afro-Caribbean patients more than Caucasians. Renal Failure occurs in 20 to 40% of patients due to direct tubular damage from excess protein load, dehydration, hypercalcemia, and the use of nephrotoxic medications. Risk factors include MGUS and Serum and Urine (to look for Bence Jones Protein)Electrophoresis is a useful investigation.
Adverse effects of chemotherapy include:
Select one or more:
a. Swelling in the face
b. Infertility
c. Mucositis from the mouth to the anus
d. Localised soreness of skin
e. Muscle cramps
The following are side effects seen with chemotherapy:
Symptoms of anaemia Bruising and bleeding Mucositis from the mouth to the anus Loss of libido depression Infertility Localised sore skin is seen with patients undergoing radiotherapy . Muscle cramps and facial swelling can be troublesome in patients on Imatanib/Glivec
The following are adverse effects associated with use of steroids in the treatment of some blood cancers:
Select one or more:
a. Osteoporosis
b. Hypokalaemia
c. Hypertension
d. Weight loss
e. Bruising
Your answer is correct.
The following are side effects associated with steroids.
Weight gain mood changes thinning skin which can bruise easily muscle weakness Cushing’s syndrome Osteoporosis Diabetes Hypertension It is important that patients on steroids for a long duration are monitored for and protected against these side effects.
