Leukemia

Question 1

Define leukemias (AML, ALL, CML, CLL)

Answer 1

Organs normally have limited forms of tumours that arise-not blood cancers

Defined as chronic vs acute (based on speed of division-not duration)
and Myeloid vs lymphoid (predominant cell being overproduced)

ALL-acute lymphoblastic leukemias-B/T cell progenitor in BM-replace the cells in BM

CLL-chronic lymphoblastic leukemia-B lymphocyte cancer, fail to mature-monoclonal not functioning B cells replicate

AML-clonal expansion of early precursors in BM, Blood or medullary tissue (Acute premylogenous leukemias (APML-more aggressive)

CML-malignant clonal disorder of heamatopoetic stem cells in BM

Question 2

Aetiology and risk factors of Leukemias (AML, ALL, CML, CLL)

Answer 2

Many, depends on the Leukemias

Question 3

Signs and Sx of leukemias (ALL)

Answer 3

Acute vs chronic present v differently. Lymphoid vs myeloid present differently

Generally-FLAWS
ALL–
any age-but mainly under 20-80% of peadiatric leukaemia

typical Hx-seen in children

Sx related to cytopenias-
Thrombocytopenia-bruising/
anemia-dizziness, pallor, fatigue,
Neutropenia-fever, frequent infections

signs-enlarged lymph nodes -usually a PC
abdo pain-from spleen infiltration
Bone pain-bone infiltration

organomegaly-spleen, liver, kidney

T-ALL -medistinal masses (can cause vena cava obstruction)
B-all-abdo masses

Investigations-cytopenias-most common aneamia
Leukocytosis-can go up to 50
then aspirate and biopsy

Question 4

Investigations of Leukemias

Answer 4

Take a biopsy-either from affected organs (lymph node, deposits, spleen)-> nodes-> don’t leave wounds, can help for a lot of cancer diagnosis, but can be too subtle
can also excise node-scar, but optimal for lymphoma (architecture), TB, Metastaic cancer

or Bone marrow (aspirate from hip)–> can see the cells individual
can also take a core of bone -on top of that can get architecture of cells

Question 5

Signs and Sx of CLL

Answer 5

B-lymphycyte cancer-
present over 60

PC-swollen Lymph nodes (and nothing else)
FLAWS

typical Hx -smear smudge cells, warm agglutinins

advanced-anaemia, thrombocytopenia, neutropenia

exam-pallor, lymph nodes, hepatosplenomegaly

FBC-clonal (all the same) lymphocytosis (over 5)
then cytometry-standard
biopsy

Most common diagnoses/identified -routine blood test

Question 6

Signs and Sx of CML

Answer 6

Often asymptomatic like CLL-routine FBC is first of high WBC

peak 65-75 years old

FLAWS-
easy bruising/thrombocytopenia
rarer-aneamia-pallor, SOB,

typical History-philadelphia chromosome
massive splenomegaly

Exam-splenomegaly>hepatomegaly but both

Investigations-FBC-WBC over 100
45% also have anaemia

smear-shows a lot of neutrophils
Biopsy-crowded
cytology and biopsy

Question 7

Signs and Sx of AML

Answer 7

can resemble ALL-with just over abundance of cells

thrombocytopenia, anaemia
abdo and bone pain
abdo masses
skin rashes
SOB

exam-pallor, echymose, petichiae
Hepatosplenomegaly
skin/testicular masses
dental absesses, perianal infections

typical history-ayer rods and Sudan black stains

FBC-WBC over 100
thrombocytopenia, neutropenia, aneamia

film shows lots of blasts
biopsy and cytology to differentiate from ALL

subtype APML-more agressive
Film-aytypical pre-myelocytes in blood
creased, folded, bilobed myeloblast

PC-very similar to AML/ALL-but DIC/panycytopenia more common-emergency