Leukaemia and Lymphoma Flashcards
Which cells originate from myeloid stem cells?
Neutrophils
Basophils
Eosinophils
Monocytes
Platelets
Erythrocytes (red blood cells)
Which cells originate from lymphoid stem cells?
B cells
T cells
What are the characteristics of cancer cells?
Uncontrolled proliferation
Loss of apoptosis
Loss of normal function/products
What 3 things might someone present with if they have leukaemia?
Anaemia
Neutropenia (infection)
Thrombocytopenia (bleeding)
What signs and symptoms might someone have if they present with anaemia?
Breathlessness
Tiredness
Easily fatigued
Chest pain/angina
Pale
Signs of cardia failure- breathlessness, ankle swelling
Nail changes- brittle nails, Koilonychia
What signs and symptoms might someone present with if they have neutropenia?
Infections associated with portals of entry to the body
Mouth
Throat- tonsillitis, pharyngitis
Chest- bronchitis, pneumonia
Skin- impetigo, cellulitis
Perianal- thrush, abscesses
Reactivation of latent infections.
Recurrent infection
Unusual severity of infection
Unusual pattern of infection and rapid spread
Fever
Chills
What signs and symptoms would suggest a patient has issues with bleeding?
Bruises easily or spontaneously
Minor cuts fail to clot
Gingival bleeding or nose bleeds
Menorrhagia
What is acute lymphoblastic leukaemia?
Common in paediatric patients- peak age is 4 years old.
Acute suggests that the leukaemia develops quickly.
In ALL, the bone marrow makes too many lymphoid blasts cells- these cells are immature and grow/divide rapidly and build up in the blood and bone marrow.
The leukaemia cells eventually spread into other parts of the body
- liver, spleen, CNS, lymph nodes.
What are the signs and symptoms of acute lymphoblastic leukaemia?
Breathlessness
Paleness
Fatigue
Bruising or bleeding easily for no reason
High temperature
Swollen lymph nodes
Bone pain
Loss of appetite
Fullness in tummy
Irritability
Swollen testicles in boys
Who is involved in the MDT for ALL patients?
Paediatric oncologist
Paediatric haematologist
Paediatric dentist
GMP
Paediatric cancer nurse specialist
Play specialists
Psychologist
Social workers
What is the likely management of ALL patients?
Chemotherapy- kills cancer cells, prevents them from spreading around the body.
Stem cell transplant or bone marrow transplant to replace the cells that have been killed during chemotherapy and radiotherapy.
What is a consequence of Chemotherapy that will be of interest to you as a dentist?
Deranged blood profiles
Immunosuppression
If an ALL patient requires dental treatment during their cancer treatment, who should you consult with?
Paediatric dentist
Oncologist
Describe the oral problems associated with ALL treatment?
Oral mucositis
Dry mouth
Increased caries rate
Infection
Gingival hyperplasia and bleeding gums
ORN, MRONJ
Trismus
What considerations would you think about when planning treatment for a patient with an ALL diagnosis?
Increased bleeding risk
Increased infection risk- remove any potential sources of infection
Prevention is key
Timing of appointments- work around cancer treatment
Anxiety and fatigue with healthcare
Wider social and familial circumstances
What is acute myeloid leukaemia?
Occurs at any age but most commonly in the elderly.
Similar presentation to ALL.
What is Chronic lymphocytic leukaemia?
B-cell clonal lymphoproliferative disease.
Usually in patients older than 70 years old.
More common in males than females
Mostly asymptomatic and discovered on routine blood tests.
What is chronic myeloid leukaemia?
Increase in neutrophils and their precursors.
Peak incidence at 50-70 years old.
Fatigue, weight loss, sweating, anaemia, bleeding, splenomegaly.
In broad terms, what is lymphoma?
Clonal proliferation of lymphocytes arising in a lymph node or associated tissue.
Solid tumour but some cells in the blood.
What is Hodgkin lymphoma?
Peak incidence of 15-40 years old.
Painless lymphadenopathy, typically cervical.
Fluctuate in size of lymph nodes
Pain in nodes with alcohol
Fever
Night sweats
Weight loss
Itching
Infection
Histology- Reed Sternberg cells
- giant cells that originate from B cells.
What is Non-Hodgkin lymphoma?
Both B and T cell types.
Occurs in any age.
What is the aetiology of non-hodgkin lymphoma?
Microbial factors- EBV, HIV, H.Pylori.
Autoimmune disease associated- Sjogren’s, rheumatoid arthritis, peptic ulcer disease.
Immunosuppression- AIDS, post-transplant.
What signs and symptoms might someone present with in NHL?
Lymphadenopathy- often disseminated
Extra-nodal disease- oropharyngeal involvement
Waldeyer’s ring- noisy breathing and sore throat
Symptoms of marrow failure
Fever, sweat less common
What treatment modalities may be required for a haematological malignancy?
Chemotherapy
Radiotherapy
Monoclonal antibodies
Stem cell transplant
