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BREAST CANCER > LEUKEMIA AND MULTIPLE MYELOMA > Flashcards

LEUKEMIA AND MULTIPLE MYELOMA Flashcards

1
Q

What is Leukemia?

A

LEUKEMIA = #1 CHILD CANCER
= group of blood diseases
-Develops during formation of blood and lymphocyte production

The bone marrow is making abnormal white blood cells = leukemic cells
Leukemic cells are abnormal and do not die when they should, .:. They crowd together
This causes interference with normal processes , and explain impaired production of RBCs, WBCs and platelets.

If a decrease of formation of RBCs occurs = anemia (fatigue, pallor)
If low in platelets = Thrombocytopenia .:. EASY BRUISING, EPISTAXIS (NOSE BLEEDING EASILY)
If low in WBCs = Neutropenia (increased chance of having INFECTIONS)

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2
Q

What are the clinical symptoms of Leukemia?

A

-INFECTION!!!!
-Fatigue
-Pallor
-Bleeding
If Brain is affected:
-Headaches
-Vomiting
-Confusion
-Loss of muscle control
-Seizures

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3
Q

What are the 3 factors determining the classification of Leukemia?

A
  • Lymphocytic, arising from other cells in bone marrow
    1. Natural history
    2. Cell maturation
    3. Dominant cell line
  • Myelogenous, arising directly or indirectly from hematopoietic stem cells
  • Acute, progresses QUICKLY, sudden Undifferentiated cells in bone marrow
  • Chronic, SLOWER progression, asymptomatic for years, uncontrolled expansion of mature cells
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4
Q

What are the 3 main type of cells involved in Leukemia?

A

-RBCs or Erythrocytes, which carry OXYGEN to tissues in body

-WBCs or Leukocytes, which help fight INFECTION
Composed of:
Eosinophils (Granulocytes)
Neutrophils
Basophils
Monocytes (Agranulocytes)
Lymphocytes

-Platelets, which help to form BLOOD CLOTTING and control bleeding

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5
Q

What are the 3 symptoms due to Leukemic cells interfering with normal cell processes?

A
  • Anemia, decrease in RBCs, fatigue, pallor
  • Neutropenia, decrease WBCs, INFECTION
  • Thrombocytopenia, decrease platelets count, low clotting factor, easy bruising, epitaxis (nose bleeding) and petechiae (red or purple dots).
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6
Q

What is the epidemiology of Acute Lymphocytic Leukemia (ALL)?

A
  • Most common

- Mostly 2-5 yrs old

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7
Q

What is the etiology of Acute Lymphocytic Leukemia (ALL)?

A

-Previous Radiation exposure
-Hereditary factors:
sibling with ALL or Bloom’s syndrome

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8
Q

What are some characteristics of Acute Lymphocytic Leukemia (ALL)?

A
  • Sudden onset
  • Rapid Progression
  • Fever
  • Pallor
  • Fatigue
  • Bone pain
  • SPLEENOMEGALY
  • Recurrent infection

Diagnosis: CBC and bone marrow aspiration (if > 25% of the CBC are Leukoblasts = Leukemia)

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9
Q

What is the typical treatment for Acute Lymphocytic Leukemia (ALL)?

A
  • Radiotherapy: 12 Gy/ 3 days BID
  • Chemotherapy
  • Bone Marrow Transplant (BMT)

75% complete remission
Survival 12-18 months for patients with complete remission

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10
Q

What is the epidemiology of Acute Myelogenous Leukemia (AML)?

A
  • Onset > 40 yrs old
  • M>F ratio
  • Sudden onset
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11
Q

What is the etiology of Acute Myelogenous Leukemia (AML)?

A

Similar to ALL:
-Previous Radiation exposure
-Hereditary factors:
sibling with ALL or Bloom’s syndrome

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12
Q

What are the characteristics of Acute Myelogenous Leukemia?

A
  • Symptoms are FLU-LIKE
  • Fatigue
  • Pallor
  • Petechiae
  • Neutropenia

Diagnosis:

  • CBC
  • Bone marrow biopsy
  • Presence of AUER RODS (which are azurophilic granular material) in myeloids cells
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13
Q

What is the typical treatment for Acute Myelogenous Leukemia?

A
  • Chemotherapy
  • Radiotherapy
  • Bone Marrow Transplant (BMT)

Survival: 12-24 months for patients with complete remission

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14
Q

What is the epidemiology of Chronic Lymphocytic Leukemia (CLL)?

A
  • Onset 70 yrs old

- M 2 : 1 F

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15
Q

What is the etiology of Chronic Lymphocytic Leukemia (CLL)?

A
  • NOT ASSOCIATED WITH RADIATION EXPOSURE!
  • Hereditary factor
  • Immune deficiencies
  • Viruses
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16
Q

What are the characteristics of Chronic Lymphocytic Leukemia (CLL)?

A

-Insidious onset (gradual progression with no apparent symptoms)
-Slow progression
Symptoms:
-Malaise
-Fever
-Night sweats
-Weight loss
-Lymphadenopathy
-Spleenomegaly

17
Q

What is the typical treatment for Chronic Lymphocytic Leukemia (CLL)?

A

-No optimal treatment:
-No benefit of treatment for early stages
-For advanced stages:
Radiotherapy
Chemotherapy
Surgery (spleenectomy)

Survival: 10-12 years if early stage

18
Q

What is the epidemiology of Chronic Myelogenous Leukemia (CML)?

A

-Affects 20-40 yrs old

19
Q

What is the etiology of Chronic Myelogenous Leukemia (CML)?

20
Q

What are the characteristics of Chronic Myelogenous Leukemia (CML)?

A

-CML usually develops into a AML after 4-6 years!

Detection: PHILADELPHIA CHROMOSOME ALMOST ALWAYS PRESENT!

Symptoms:
-Early:
mild and non-specific
Malaise
Sweats
Bruising
-Late (after 3-4 years)
BLAST CRISIS
Increase leukemic blast cells
Fever
Bone pain
Weight loss >10% in 6 months
Spleenomegaly
21
Q

What is the typical treatment of Chronic Myelogenous Leukemia (CML)?

A

Radiotherapy
Chemotherapy
Bone Marrow Transplant (BMT)

Survival: No Cure, approx. 1 year

22
Q

What are the 3 main functions of Total Body Irradiation (TBI)?

A
  • Immunosuppression to allow engraftment of donor Bone Marrow.
  • Eradication of malignant cells
  • Eradication of cell populations with genetic disorders.
23
Q

What are 3 beam techniques for TBI?

A
  • Single source short SSD,
  • Head rotation
  • Horizontal beam large SSD

AP/PA 12 Gy/6 fx (3 days BID)+ boost to testes 400 cGy/1-2 fx
This boost is done because testes and brain are a sanctuary for tumor cells
Side effects
-acute: nausea and vomiting
-late: pneumonitis, cataracts, hepatic or renal dysfunction, growth retardation

24
Q

What is the rationale of Bone Marrow Transplant?

A
  • harvest of healthy bone marrow from a suitable donor, usually long bones ie.iliac crest
  • healthy bone marrow is infused into patient, whose bone marrow previously has been destroyed by chemo +/- radiation.
  • transplanted bone marrow fills bone marrow cavities and supply normal and healthy hematopoietic cells.
25
Q

What are the two type of BMT?

A
  • Allogenic BMT, from a compatible donor

- Autologous BMT, patient’s own bone marrow infused

26
Q

What aspects are important after a BMT?

A

2-4 weeks are critical

  • Extraordinary precautions taken to
  • Minimize infection, bacteria or virus contact
  • Patients spend 4-8 weeks in hospital
27
Q

What is the epidemiology of Multiple Myeloma?

A
  • 35-43% of bone tumors
  • affects middle age and older adults
  • Rare < 35 yrs
  • M = F
28
Q

What is the etiology of Multiple Myeloma?

A
  • long standing PAGET’S DISEASE (a bone disorder of bone remodeling process)
  • Hyperparathyroidism, abnormal parathyroid gland causing loss of CALCIUM in the bones
  • Chronic osteomyelitis, an infection of bone or bone marrow
29
Q

What are the prognostic factors for Multiple Myeloma?

A
  • Worst if >65 yrs
  • Anemia
  • Hypercalcemia
  • Elevated M-Protein
30
Q

What are the clinical presentations of Multiple Myeloma?

A
  • Bone pain
  • Infection
  • Bleeding
  • Fatigue
  • Hypercalcemia (50%)
  • Anemia, thrombocytopenia, granulocytopenia (33%)
31
Q

What are the diagnostic tools for Multiple Myeloma?

A

-History
-X-rays to see bone lesions (where MM attacks the most)
In fact osteolytic lesions appear as holes in x-rays
-Protein studies
-Skeletal survey
-Bone Marrow biopsy

32
Q

What is the typical treatment for Multiple Myeloma?

A

-Chemotherapy
-Radiotherapy
Used for pain control, palliation because MM is incurable
Radiotherapy prevents fractures of bones, used if localized or to relief spinal cord compression.

BREAST CANCER (9 decks)

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