leukaemia and lymphoma Flashcards
what are the 4 groups of leukaemia?
chronic lymphocitic
chronic myeloid
acute lymphoblastic
acute myeloid
What do the terms acute and chronic denote?
- clinical behavior with acute being serious and life-threatening
- children tend to present with acute symptoms
what do the terms lymphocytic, lymphoblastic and myeloid show?
whether cancer is derived from lymphoid or myeloid cells.
blast indicates immature cells.
what is leukaemia?
- a group of cancers of bone marrow which prevent normal manufacturing of blood
- disseminated cancers of haemopoeitic system that can be of myeloid or lymphoid origin
How does leukaemia clinically present?
- anaemia
- neutropenia (unexplained infection)
- thrombocytopenia (low platelets)
- lymphadenopathy (neck lumps)
- splenomegaly/hepatomegaly due to reprocessing RBC at higher rate
- bone pain especially children
What stem cells produce lymphoid and myeloid stem cells?
pluripotent
what are myeloid cells?
megakaryoblasts, megakaryocytes/platelets, erythrocytes/RBC, monocytes, neutrophils, basophils, eosinophils
what are lymphoid cells?
NK cells, T cells, B cells
At what part in a cell line is cancer most aggressive?
The earlier in the cell line/less differentiated the cancer is the more aggressive (nearer lymphoid/myeloid stem cells)
cells are identified by cell surface markers
What is the pathogenesis of haematological malignancy?
- DNA mutation, usually translocation
- switching off of tumour suppressor genes or switching on of oncogenes
- clonal proliferation
- cancer cells with loss of apoptosis, loss of normal function and uncontrolled proliferation
what is the pathogenesis of leukaemia?
- clonal proliferation
- bone marrow is replaced by leukaemic cells
- patient cannot maintain normal blood homeostasis leading to marrow failure and organ infiltration
what are the signs and symptoms of anaemia?
symptoms- breathlessness, tired, easily fatigued, chest pain in adults
signs - pallor, signs of cardiac failure such as ankle swelling, nail changes (brittle, spoon nails - koilonychia)
How does neutropenia present?
infections associated with portal of entry
- tonsilitis, pharyngitis
- bronchitis, pneumonia
- thrush, obsesses perianal
- skin impetigo, cellulitis
reactivation of latent infections e.g. tuberculosis or herpes
increased severity, frequency and systemic infection
what are the signs and symptoms of neutropenia?
symptoms - recurrent infection, unusual severity of infection
signs- unusual patterns of infection and rapid spread, will respond to treatment but recur, signs of systemic involvement e.g. fever, chills, rigors
what are signs and symptoms of bleeding?
symptoms- bruises easily or spontaneously, minor cuts fail to clot,
gingival bleeding, nose bleeds, mennorhagia (abnormally heavy and long periods)
signs - bruising, petechiae (small purple dots from broken capillaries), bleeding/bruising following procedures
what is the peak age of acute lymphoblastic leukaemia?
- 4 (but can occur in adults)
- more than 80% of children are cured
what is the prevalence of acute lymphoblastic leukaemia?
25 per million per year
Describe common signs associated with acute lymphoblastic leukaemia?
- catabolic state leading to -fever, sweats and malaise
- lymphadenopathy
- tissue infiltration of leukaemic deposits
- develops over days or weeks
what is the prevalence of acute myeloid leukaemia?
25 cases per million per year
Describe survival of acute myeloid leukaemia affects?
- occurs at any age but more common in elderly
- 30-40% of under 60s cured
- 10% of over 70s cured
What is the peak age of chronic lymphocytic leukaemia and who will it affect?
- older adults >70
- affects males:females 2:1
- 70 per million
Describe chronic lymphocytic leukaemia and treatment.
- B cell clonal lymphoproliferative disease, with slow progression and usually asymptomatic
- may require no treatment or blast transformation
what is the most common leukaemia?
-chronic lymphocytic leukaemia
Describe chronic myeloid leukaemia and the clinical presentation.
increase in neutrophils and their precursors.
- fatigue
- weight loss
- sweating
- splenomegaly
- anaemia
- thrombocytopenia
95% will have Philadelphia chromosome
Describe the prevalence of chronic myeloid leukaemia.
15 cases per million
peak age of 50-70 but can occur at any age
slightly greater in males
what are the 2 types of lymphoma?
Hodgkin and non-Hodgkin lymphoma
what is the more common lymphoma?
Non-Hodgkin lymphoma is more common than Hodgkin with a ration of 6:1
what is lymphoma?
clonal proliferation of lymphocytes usually arising in a lymph node or surrounding tissues. A solid tumour but some cells may disseminate in blood.
What is the prevalence of lymphoma?
200 million cases per year
Describe the symptoms of lymphoma
fever swelling of face and neck swollen lymph nodes lump in neck, armpit or groin excessive sweating at night weight loss itchiness loss of appetite breathlessness weakness
Where does tissue proliferation occur in lymphoma?
somatic tissues
What is involved in lymphoma staging?
- imaging such as CT/MRI to check number of lymph nodes involved, site, extra nodal and systemic involvement.
- staging shows extent and depends whether tumour is present on both sides of diaphragm
- predict prognosis and treatment
How does Hodgkin lymphoma clinically present?
painless lymphadenopathy
Reed-Sternberg cell - lymphocytic giant cell seen on biopsy
fever night sweats weightless itching infection
What is the peak age of Hopkins lymphoma?
15-40 years
what gender does Hopkins lymphoma affect mostly?
males - on a ratio to females of 2:1
describe the prognosis of Hodgkins Lymphoma.
stage 1 and 2 - 90% cure prognosis
stage 3 and 4 50-70% cure prognosis
elderly do less well
What are the 2 types of Non-Hodgkin lymphoma and which is most common?
B cell - 85%
T cells - 15%
What age group will Non-Hodgkins lymphoma affect?
Any age and causes less pain in elderly
What are the causes of Non-Hodgkins lymphoma?
- microbial factors e.g. epstein barr virus, HIV, H. pylori
- autoimmune diseased e.g. Sjogren’s syndrome, PUD, Rheumatoid arthritis
- Immunosuppression e.g. AIDS, post-transplant
- elimination of issue can cause lymphoma to go into remission
How will Non-Hodgkins lymphoma present?
- widely disseminated lymphadenopathy
- symptoms of bone marrow failure
- fever sweat etc are LESS common in NHL than HL
- extra nodal disease particularly with oropharyngeal involvement and Waldeyer’s ring
Describe the prognosis of non-Hodgkins lymphoma.
- 50% will relapse after treatment
- poor prognosis
- aggressive disease
- indolent and heard to cure
what is multiple myeloma?
- haemopoeitic derived cancer
- malignant proliferation of cancer cells
- produces an abundance of antibodies
What is the prevalence and mean age of diagnosis of multiple myeloma?
- 50 per million per year
- mean age at diagnosis is 70
Describe the features of multiple myeloma.
- Monoclonal antibodies in blood and urine
- lytic bone lesions lead to pain and fracture
- excess plasma cells in bone marrow leads to marrow failure
- bone pain
- renal failure
- amyloidosis (abnormal paraprotein build up)
What is the treatment for haematological malignancies?
- Chemotherapy
- radiotherapy
- monoclonal antibodies to target specific cells
- haemopoeitic stem cell transplant
- supportive therapy
Describe the 4 phases of treatment in haematological malignancy.
Induction - high level treatment
Remission - normal bone marrow, no disease evidence
maintenance and consolidation - low level treatment
relapse - 4 stages repeat
What does supportive therapy involve?
- nutrition
- psychological and social support
- prevention and treatment of infection
- managing therapy side effects
- correcting blood component deficit with transfusion
- pain control
What does chemotherapy target?
targets cells with a high turnover rate
what are the disadvantages of chemotherapy?
causes unwanted effects in tissue with a normal high turnover rate
long term risk of oncogenesis in surviving patients
-side effects include hair loss, nausea, vomiting and tiredness
What is radiotherapy?
A beam of ionising radiation is directed from outside the body and has cytotoxic effect on cells
what are the disadvantages of radiotherapy?
Healthy surrounding tissue is also irradiated but this can be minimised by spatial positioning, targeting and dosing techniques
risk of inducing late cancers
Describe how monoclonal cell antibodies are used.
monoclonal cell antibodies are produced artificially
they use CD antigens on white cells
they target interleukin messaging and growth factors
What is an allogenic haemopoeitic stem cell transplant?
stem cells are from live donor, sibling or a stranger with genetic match
What is an autologous haemopoeitic stem cell transplant?
stem cells are from the patient
what will a haemopoeitic stem cell transplant achieve?
eradication of malignant cells and the host marrow with total body irradiation
what are the risks of a haemopoeitic stem cell transplant?
10% mortality rate
patient will die if bone marrow does not take as no ability to make blood
graft failure and total marrow failure
life threatening infection
graft versus host disease where new bone marrow attacks and damages tissue
