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Medical Physiology > Leukemia > Flashcards

Leukemia Flashcards

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USMLE® Step 1 flashcards
1
Q

Do leukemias circulate?

A

Because they are circulating tumors, they are metastatic

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2
Q

Is radiation therapy best for leukemia?

A

NO because need full body radiation

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3
Q

Lymphoma are tumors that are located where?

TX?

A

tumor localized in lymph tissue

can use radiation therapy bc localized

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4
Q

is it true that Leukemia/lymphoma may be the same?

A

same tumors in different areas

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5
Q

Plasma Cell Myeloma
tumors localized or
B cells sit in bony structures

A

localized tumors

B cells sit in bony structures

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6
Q

non specific s/s

A

malase, weakness, fever, night sweats, infection

lymphadenopathy

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7
Q

When are these cancers disocvered

A

during normal cbc

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8
Q

Naming schemes for these cancers:

Major gatergory is cell type

A

Myeloid vs lymphoid

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9
Q

Lymphoi cell types give you what?

Myeloid cell types give you what cells

A

lymphoid- B cell, t cell, NK cells

myeloid- RBC, platelet

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10
Q

Myeloproliferative example

A

thrombocytosis
polycythemia

too many of particular cell type

cells are “normal” like rather than cancerous

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11
Q

thrombocytosis

A

too many platelets

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12
Q

Mylodisplastic

A

cells are less differentiatied

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13
Q

myelodysplastic/myeloproliferative

A

too many messed up/abnormal cells

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14
Q

Lymphoid neoplasms affect what cells?

A

B cell neoplasm
T & NK cell neoplasm

Hodgkin disease
Non hodgkin

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15
Q

Lymphoblastic/lymphocitic

A

precursor cell that became transformed with less fucntionality

lymphocitic—more normal have more normal function

more anaplastic cells = less functioning = more symptomatic

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16
Q

What are 3 Viral risk factors for these cancers?

A

Contracting HTLV-1, HIV & EBV

human t cell luekemia virus

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17
Q

What are other risk factors for these cancers?

A

RADIATION- damage to stem cells for breast cancer (as an example) can lead to leukemia after some years

CHEMICALS- smoking, benzene, bioflavinoids

DISEASES- MANY

downs/klienfelters also increased risk for leukemia

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18
Q

Diagnosing: clincially present how

A

Present w symp related to bone marrow suppression and organ dysfunction

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19
Q

What are some symptoms of bone marrow suppression

A

Leucopenia - lack of all functioning WBC
when you have leukemia have overabundance of whatever wbc is affected, leuekopenia here is talking about lack of functional WBC

Anemia- hematocrit less than 30%
Thrombocytopenia

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20
Q

Infiltration symptoms

A 
Lymphadenopathy 
extension of bone marrow out of marrow cavities and into joints  
      triggers pain, swelling 
weight loss, anorexia 
hepatomegaly, splenomegaly
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21
Q

Special symptoms:
Chrnoic myelogemous leukemia n

Acute myelogenous leukemia

acute lymphocytic leukemia

A

tenderness to sternum

Overgrown gums

menigial involement

22
Q

Key to diagnosis vs defninitive diagnosis

A

CBC

bone marrow/lymph node sample

23
Q

Chemotherapy treatment goal

A

Induce remission
remission induction- remove detectable neoplastic cells

Post remission- elminiate undetectable cells

Maintenance- prolong remission

STem cell transplat to rescue marrow

24
Q

Time period for remission?

A

6-7 years free of detectable cells

25
Q

PROBLEM with chemo

A

Drugs are specific for neoplasm but also very personalized to individual

drugs induce apoptosis

26
Q

Bone marrow transplant

A

reintorduce stem cells after chemo and radiation

27
Q

Allogeneic Transplant

Definition
Problem

A

Donation from matched donor

ID twin only way to get exact match

run risk of rejecting transplant AND graft vs host disease

can attack host body

28
Q

Autogous transplant

A

take out good stem cells
put them back

miss one tumor cell and cancer will be back

29
Q

Myeloid Neoplasms

What are they?

A

One or more stem cell become transformed, proliferate inside bone marrow

accumulate inside marrow until released inside circulation

cells are still multipotent
means they can still go down any path

30
Q

WHat are myeloproliferative diseases

A

Look normal and function normal

just too many cells

discovered on accident

31
Q

Myelodysplastic and AML cells morphology is?

A

cell morphology and functionally are abnromal

32
Q

Less normal cells = ?

A

less functional, more s/s worse prognosis

33
Q

Chronic Myeloid Leukemia Characteristics

- Onset?
- Special char?
- Cell chars
 - TREATMENT??
A

Onset is 40-50 yrs

Malignant granulocytes carry Philadelphia chromosome

Cells are normal, more mature and function more normal

High granulocyte count, splenomegaly

Treatment: does not respond to chemo very well d/t genetic change

Only tx is allogenic marrow tx, hopefully donor blood cells kill off cancer cells
use donor against you

autologous tx not very effective

Survival length is ~2 years

34
Q

What is the philadelphia chromosome?

How is it created?

A

Chromosome is result of translocation

swapping b/w chromosome 9 and 22

Part where they are transplanted create a new “fusion gene” —- bcr/abl

35
Q

Precursor luekmeia see what kind of segmention

A

not as much segmented nuclei

36
Q

Acute Myeloid Leukemia affects who

Composes what % of Acute Leukemia

A

Primarily disorder of adult
~64 y/o

80% of acute leukemias are AML

37
Q 
AML 
       cell characteristics 
        What type of genetic problem is present?
         How many subtypes present? 
         Treatment?
A 
AML 
        Large NON SEGMENTED NUCLEI 
        Translocations/Inversions 
         * subtypes present M0-M7
          HIGHLY individualized
38
Q 
Lymphoid Neoplasms 
   Cause is what types of cells? (3 types)
   Cells in blood/bone marrow are what? 
   Cells in lymphoid tisue? 
    Classified how?
A

B, T, NK cells (lymphoid cells)
Circulating in bone marrow/blood-Leukemia Localized in lymphoid tissues are lymphomas
By cell type rather than stage but can have subgroups based on maturity

39
Q

Precursor Cell Neoplasms

vs

Mature Cell Neoplasms

A

Arrest development in early blast stage —lymphobalstic—early, less normal, less fucnitonal

Mature Cell Neoplasms - more differentiated, often in peripheral sites, more developed

40
Q

Chronic Lymphoid Leukemia
What percent of all US
What 2 versions
What type is more severe?

A 
30% of all US leukemia cases  
2 Versions 
        Malignant B cell precursor (95%) 
        T Cell Precursors (5%) 
T cell is more severe/agressive
41
Q

CLL
B Cell type usually symptomatic or no?
When symptomatic biggest tell?

Malignant cells invade lymphoid tissue
and bone marrow

Prognosis VARIES!

A

NO, usually asymptomatic
NO ANTIBODY PRODUCTION BC NO B CELLS

Go into lymph nodes, tonsils, appendix
Lymphadenopathy/ Enlarged spleen

Onset 65-70 y/o, survivability 8-24 yrs post dx

42
Q

Acute Lymphoblastic Leukemia

aka?
2 Versions
What kind of Abnormal cell?

Present as leukemias!

B cell type is what type of genetic issue?

A

aka Acute Lymphoblastic Lymphoma

B cell version 80%, T cell 20%
abnormal lymphoblasts-immature- early
precursor

B cell type is translocation error 
   Cells dont mature, accumulate in blood 
        and bone marrow 
    As they accumulate they stop 
        production of normal cells
43
Q

Acute Lymphoblastic Leukemia

Affects who the most?
Symptoms
Cure rate in children vs adult

A

CHILDREN

Bone pain!
Bruisng, fever, infections, fatigue, ab pain enlarged spleen, liver

80% cure rate in children, <10 in adults

44
Q

Hairy Cells Leukemia
Type of leukemia?
Prevelance?
Cell type: b or t?

A

Chronic, lymphocytic leukemia
Rare but highly treatable
B CELL PHENOTYPE–hairs on cells

early precursor cells more so than others thats why they are so big

may be sex linked?

45
Q

Plasma Cell Myeloma

Aka?
Malignant disorder of what kind of cell?
Invade bone, nodes, liver, spleen, kidneys
Men or women affected more?

A

Multiple Myeloma
Plasma Cells
Lots of tumor sites!!
Men

46
Q

Plasma Cell Myeloma

Start one cell that is transformed

Bence Jones Protein

A

Becomes dominant
so antibodies become monoclonal
all antibodies are coming from the
same plasma cell, lose the ability to
make other kinds of antibodies
Antibodies build up in bloodstream causes BENCE JONES PROTEINS

BJP: Light chains in urine- confirm dx
bone and renal damage,hypercalcemia
osteoclasts destroy bone

47
Q

Hodgkins Disease

It is a malignant lymphoma
   -Name defining feature 
   -Where do they come from
   -Spread and growth 
      pattern?
A

Defining feature is Reed Sternberg cells

RS cells- from b cells in lymph nodes

Grow and spread in a predictable manner
-metastasis occurs along
contiguous lymphatic
pathways

48
Q

What virus is found in RS cells frequently in Hodgkins disease?

A

EBV

49
Q

What are the two types of Hodgkin disease?

A
  • Rare lymphocyte predominance type

- Classical (4 subtypes)

50
Q 
Hodgkin Disease is usually asymptomatic? 
   name s/s? 
   Where does it BEGIN
    How is staging determined 
       how many stages?
A

Yes, early on

Lymph node enlargement, fever, night sweats, pruritus, weight loss, malaise

Begins in cervical nodes

Staging dependent on s/s and location of nodes 
    4 stages 
       1A no clinical symp 
       1B clinical symp at 
             staging
        2A asymptom, spread 
               to back 
         2B symptomatic, 
               spread to back still
          3A/3B...4A/4B ect just depends how far disseminated it is
51
Q

Non Hodgkins Lymphoma

What cell type?
clonal or nonclonal?

RS cells?

Spread pattern?

Etiology?

A

B,T, NK cell lymphoma
clonal

NO RS CELLS

Unpredictable

UNKNOWN

52
Q

Hodkins vs non hodgkins

Pattern of spread

Extranodal disease

SIte of Disease

Extent of Disease

B cell affected?

A

H: Contigous
NH: not

H: Uncommon
NH: more common: gi, testes, Bones

H: Medialstinal involvement, bone marrow and liver
NH: opposite

H: often localized
NH: not

H: Common
NH: uncommon

Medical Physiology (4 decks)

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