Leukaemia and Lymphoma

Question 1

Which cells originate from myeloid stem cells?

Answer 1

Neutrophils
Basophils
Eosinophils
Monocytes
Platelets
Erythrocytes (red blood cells)

Question 2

Which cells originate from lymphoid stem cells?

Answer 2

B cells
T cells

Question 3

What are the characteristics of cancer cells?

Answer 3

Uncontrolled proliferation
Loss of apoptosis
Loss of normal function/products

Question 4

What 3 things might someone present with if they have leukaemia?

Answer 4

Anaemia
Neutropenia (infection)
Thrombocytopenia (bleeding)

Question 5

What signs and symptoms might someone have if they present with anaemia?

Answer 5

Breathlessness
Tiredness
Easily fatigued
Chest pain/angina
Pale
Signs of cardia failure- breathlessness, ankle swelling
Nail changes- brittle nails, Koilonychia

Question 6

What signs and symptoms might someone present with if they have neutropenia?

Answer 6

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

Question 7

What signs and symptoms would suggest a patient has issues with bleeding?

Answer 7

Bruises easily or spontaneously
Minor cuts fail to clot
Gingival bleeding or nose bleeds
Menorrhagia

Question 8

What is acute lymphoblastic leukaemia?

Answer 8

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.

Question 9

What are the signs and symptoms of acute lymphoblastic leukaemia?

Answer 9

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

Question 10

Who is involved in the MDT for ALL patients?

Answer 10

Paediatric oncologist
Paediatric haematologist
Paediatric dentist
GMP
Paediatric cancer nurse specialist
Play specialists
Psychologist
Social workers

Question 11

What is the likely management of ALL patients?

Answer 11

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.

Question 12

What is a consequence of Chemotherapy that will be of interest to you as a dentist?

Answer 12

Deranged blood profiles
Immunosuppression

Question 13

If an ALL patient requires dental treatment during their cancer treatment, who should you consult with?

Answer 13

Paediatric dentist
Oncologist

Question 14

Describe the oral problems associated with ALL treatment?

Answer 14

Oral mucositis
Dry mouth
Increased caries rate
Infection
Gingival hyperplasia and bleeding gums
ORN, MRONJ
Trismus

Question 15

What considerations would you think about when planning treatment for a patient with an ALL diagnosis?

Answer 15

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

Question 16

What is acute myeloid leukaemia?

Answer 16

Occurs at any age but most commonly in the elderly.
Similar presentation to ALL.

Question 17

What is Chronic lymphocytic leukaemia?

Answer 17

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.

Question 18

What is chronic myeloid leukaemia?

Answer 18

Increase in neutrophils and their precursors.
Peak incidence at 50-70 years old.
Fatigue, weight loss, sweating, anaemia, bleeding, splenomegaly.

Question 19

In broad terms, what is lymphoma?

Answer 19

Clonal proliferation of lymphocytes arising in a lymph node or associated tissue.

Solid tumour but some cells in the blood.

Question 20

What is Hodgkin lymphoma?

Answer 20

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.

Question 21

What is Non-Hodgkin lymphoma?

Answer 21

Both B and T cell types.
Occurs in any age.

Question 22

What is the aetiology of non-hodgkin lymphoma?

Answer 22

Microbial factors- EBV, HIV, H.Pylori.
Autoimmune disease associated- Sjogren’s, rheumatoid arthritis, peptic ulcer disease.
Immunosuppression- AIDS, post-transplant.

Question 23

What signs and symptoms might someone present with in NHL?

Answer 23

Lymphadenopathy- often disseminated
Extra-nodal disease- oropharyngeal involvement
Waldeyer’s ring- noisy breathing and sore throat
Symptoms of marrow failure
Fever, sweat less common

Question 24

What treatment modalities may be required for a haematological malignancy?

Answer 24

Chemotherapy
Radiotherapy
Monoclonal antibodies
Stem cell transplant