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BDS2 diseases of human systems > leukaemia and lymphoma > Flashcards

leukaemia and lymphoma Flashcards

1
Q

what are the 4 groups of leukaemia?

A

chronic lymphocitic
chronic myeloid
acute lymphoblastic
acute myeloid

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2
Q

What do the terms acute and chronic denote?

A
  • clinical behavior with acute being serious and life-threatening
  • children tend to present with acute symptoms
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3
Q

what do the terms lymphocytic, lymphoblastic and myeloid show?

A

whether cancer is derived from lymphoid or myeloid cells.

blast indicates immature cells.

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4
Q

what is leukaemia?

A
  • 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
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5
Q

How does leukaemia clinically present?

A
  • anaemia
  • neutropenia (unexplained infection)
  • thrombocytopenia (low platelets)
  • lymphadenopathy (neck lumps)
  • splenomegaly/hepatomegaly due to reprocessing RBC at higher rate
  • bone pain especially children
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6
Q

What stem cells produce lymphoid and myeloid stem cells?

A

pluripotent

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7
Q

what are myeloid cells?

A

megakaryoblasts, megakaryocytes/platelets, erythrocytes/RBC, monocytes, neutrophils, basophils, eosinophils

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8
Q

what are lymphoid cells?

A

NK cells, T cells, B cells

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9
Q

At what part in a cell line is cancer most aggressive?

A

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

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10
Q

What is the pathogenesis of haematological malignancy?

A
  • 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
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11
Q

what is the pathogenesis of leukaemia?

A
  • clonal proliferation
  • bone marrow is replaced by leukaemic cells
  • patient cannot maintain normal blood homeostasis leading to marrow failure and organ infiltration
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12
Q

what are the signs and symptoms of anaemia?

A

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)

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13
Q

How does neutropenia present?

A

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

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14
Q

what are the signs and symptoms of neutropenia?

A

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

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15
Q

what are signs and symptoms of bleeding?

A

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

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16
Q

what is the peak age of acute lymphoblastic leukaemia?

A
  • 4 (but can occur in adults)

- more than 80% of children are cured

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17
Q

what is the prevalence of acute lymphoblastic leukaemia?

A

25 per million per year

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18
Q

Describe common signs associated with acute lymphoblastic leukaemia?

A
  • catabolic state leading to -fever, sweats and malaise
  • lymphadenopathy
  • tissue infiltration of leukaemic deposits
  • develops over days or weeks
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19
Q

what is the prevalence of acute myeloid leukaemia?

A

25 cases per million per year

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20
Q

Describe survival of acute myeloid leukaemia affects?

A
  • occurs at any age but more common in elderly
  • 30-40% of under 60s cured
  • 10% of over 70s cured
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21
Q

What is the peak age of chronic lymphocytic leukaemia and who will it affect?

A
  • older adults >70
  • affects males:females 2:1
  • 70 per million
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22
Q

Describe chronic lymphocytic leukaemia and treatment.

A
  • B cell clonal lymphoproliferative disease, with slow progression and usually asymptomatic
  • may require no treatment or blast transformation
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23
Q

what is the most common leukaemia?

A

-chronic lymphocytic leukaemia

24
Q

Describe chronic myeloid leukaemia and the clinical presentation.

A

increase in neutrophils and their precursors.

  • fatigue
  • weight loss
  • sweating
  • splenomegaly
  • anaemia
  • thrombocytopenia

95% will have Philadelphia chromosome

25
Q

Describe the prevalence of chronic myeloid leukaemia.

A

15 cases per million
peak age of 50-70 but can occur at any age
slightly greater in males

26
Q

what are the 2 types of lymphoma?

A

Hodgkin and non-Hodgkin lymphoma

27
Q

what is the more common lymphoma?

A

Non-Hodgkin lymphoma is more common than Hodgkin with a ration of 6:1

28
Q

what is lymphoma?

A

clonal proliferation of lymphocytes usually arising in a lymph node or surrounding tissues. A solid tumour but some cells may disseminate in blood.

29
Q

What is the prevalence of lymphoma?

A

200 million cases per year

30
Q

Describe the symptoms of lymphoma

A 
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
31
Q

Where does tissue proliferation occur in lymphoma?

A

somatic tissues

32
Q

What is involved in lymphoma staging?

A
  • 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
33
Q

How does Hodgkin lymphoma clinically present?

A

painless lymphadenopathy

Reed-Sternberg cell - lymphocytic giant cell seen on biopsy

fever
night sweats 
weightless
itching 
infection
34
Q

What is the peak age of Hopkins lymphoma?

A

15-40 years

35
Q

what gender does Hopkins lymphoma affect mostly?

A

males - on a ratio to females of 2:1

36
Q

describe the prognosis of Hodgkins Lymphoma.

A

stage 1 and 2 - 90% cure prognosis

stage 3 and 4 50-70% cure prognosis

elderly do less well

37
Q

What are the 2 types of Non-Hodgkin lymphoma and which is most common?

A

B cell - 85%

T cells - 15%

38
Q

What age group will Non-Hodgkins lymphoma affect?

A

Any age and causes less pain in elderly

39
Q

What are the causes of Non-Hodgkins lymphoma?

A
  • 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
40
Q

How will Non-Hodgkins lymphoma present?

A
  • 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
41
Q

Describe the prognosis of non-Hodgkins lymphoma.

A
  • 50% will relapse after treatment
  • poor prognosis
  • aggressive disease
  • indolent and heard to cure
42
Q

what is multiple myeloma?

A
  • haemopoeitic derived cancer
  • malignant proliferation of cancer cells
  • produces an abundance of antibodies
43
Q

What is the prevalence and mean age of diagnosis of multiple myeloma?

A
  • 50 per million per year

- mean age at diagnosis is 70

44
Q

Describe the features of multiple myeloma.

A
  • 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)
45
Q

What is the treatment for haematological malignancies?

A
  • Chemotherapy
  • radiotherapy
  • monoclonal antibodies to target specific cells
  • haemopoeitic stem cell transplant
  • supportive therapy
46
Q

Describe the 4 phases of treatment in haematological malignancy.

A

Induction - high level treatment

Remission - normal bone marrow, no disease evidence

maintenance and consolidation - low level treatment

relapse - 4 stages repeat

47
Q

What does supportive therapy involve?

A
  • nutrition
  • psychological and social support
  • prevention and treatment of infection
  • managing therapy side effects
  • correcting blood component deficit with transfusion
  • pain control
48
Q

What does chemotherapy target?

A

targets cells with a high turnover rate

49
Q

what are the disadvantages of chemotherapy?

A

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

50
Q

What is radiotherapy?

A

A beam of ionising radiation is directed from outside the body and has cytotoxic effect on cells

51
Q

what are the disadvantages of radiotherapy?

A

Healthy surrounding tissue is also irradiated but this can be minimised by spatial positioning, targeting and dosing techniques

risk of inducing late cancers

52
Q

Describe how monoclonal cell antibodies are used.

A

monoclonal cell antibodies are produced artificially

they use CD antigens on white cells

they target interleukin messaging and growth factors

53
Q

What is an allogenic haemopoeitic stem cell transplant?

A

stem cells are from live donor, sibling or a stranger with genetic match

54
Q

What is an autologous haemopoeitic stem cell transplant?

A

stem cells are from the patient

55
Q

what will a haemopoeitic stem cell transplant achieve?

A

eradication of malignant cells and the host marrow with total body irradiation

56
Q

what are the risks of a haemopoeitic stem cell transplant?

A

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

BDS2 diseases of human systems (19 decks)

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