Leukemias Flashcards
Chronic Leukemia deals with what type of cells?
Acute Leukemia deals with what types of cells?
more mature cells
young cells
What is the pathology behind acute leukemia?
3
What places will the cells infiltrate?
3
Malignancy of the hematopoietic progenitor cell
- Progenitor cells proliferate in an uncontrolled fashion and replace normal bone marrow
- The cells spill out into the blood were they are seen in large numbers
These cells may also infiltrate the liver,
spleen, and
lymph nodes causing enlargement
Etiology of acute leukemia?
6
The cause is unkown
Exposure to
- radiation,
- benzene,
- chemicals, and
- gases have increase incidence
- agressive treatment of hogdkins lymphoma with chemo
- Dysregulation of genes that regulate blood cell development and homeostasis
HOw are leukemias classified and what are those classifications?
2
Classified by their cell type and if they are “acute or chronic”
Lymphocytic and Myelogenous
Describe acute lymphocytic leukemia?
Involves immature lymphocytes and their progenitors that originate in bone marrow, but infiltrate the spleen, lymph nodes, and CNS
Describe acute Myelogenous leukemia?
Involves pluripotent myeloid stem cells in bone marrow and interfere with maturation of all blood cells including granulocytes, erythrocytes, and thrombocytes
Whats more common ALL or AML?
ALL five times more common
WHo is ALL most common in?
4
Peak incidence occurs between 2-5 years of age
More common among boys
Incidence is higher in Hispanic whites
Genetic and immunodeficiency syndromes increase risk
Contains a group of neoplasms composed of precursor B or T lymphocytes referred to as?
lymphoblasts
Where does the cancer occur in the line of cell production?
the common lymphoid progenitor stage
-both B and T lymphocytes
Early signs and symptoms of ALL?
4
- Fever
- Bleeding/Bruising
- Bone pain
- lymphadenopathy (50% of cases)
Why is there bone pain in ALL?
(accumulation of cells are multiplying and multiplying in the bone and it starts to spill out into the peripheral blood)
How is ALL different from lymphoma?
lymphoma does not deal with immature cells (lymphoblasts)
Where is the bone pain felt in ALL?
2
Bone pain to long bones Joint pain (rheumatologic vs leukemia)
As ALL progresses what symptoms present?
6
- headache
- continued bone pain
- lymphadenopathy
- Testicular enlargement
- mediastinal mass
- Peripheral blood abnormalities (anemia and/or thrombocytopenia)
How would we work up the testicular enlargement caused by ALL?
2
US and Bx(just take the whole thing out and biopsy it from there)
What is a complication that could occur with the mediastinal mass caused by ALL?
Large masses can narrow trachea
When working up the anemia/thrombocytopenia that is caused by ALL what should we look at in the lab?
4
- Need for bone marrow examination
- Atypical cells in peripheral blood
- Unexplained decrease in >1 peripheral blood element
- Unexplained lymphadenopathy or hepatosplenomegaly
HOw would we intially evaluate ALL?
3
Referral to pediatric cancer center
Bone marrow aspiration
Peripheral blood
How would we treat ALL?
3
- Remission induction (kill off all cancer cells with chemo)
- Consolidation/intensification
- Maintenance (low dose chemo just to maintain)
What are the three types of standard treatment for ALL?
3
Whats the prognosis for someone with ALL?
Chemotherapy
Stem cell transplant (only if chemo doesnt work)
Targeted therapy
5-year survival rate is about 85%
What is acute myelogenous leukemia characterized by?
- Group of hematopoietic neoplasms involving precursor cells committed to the myeloid line of cell development
- Characterized by clonal proliferation of myeloid precursors with reduced capacity to differentiate into more mature cellular elements
Where does the cancer occur in the line of cell production for AML?
Myleoblasts
What are the risk factors for AML?
3
- Environmental factors
- Genetic abnormalities
- Benign and malignant (mylodisplastic) hematologic diseases
What are the signs and symtpoms related to with AML?
Generally present with symptoms related to complications of pancytopenia
What body structures can be affected with symptoms of AML?
7
Fever Skin Eyes Oropharynx Organomegaly Joints Lymph
WIth AML what is the cause of symptoms associated with skin?
2
Reveals pallor (anemia) Petechiae or ecchymoses (thrombocytopenia)
WIth AML what is the cause of symptoms associated with eyes?
2
Fundus reveals hemorrhages or whitish plaques
Conjunctivae may be pale