Leukemias and Cancers Flashcards
What is malignancy?
Defined as the growth and proliferation of one or more clones of abnormal cells
Does malignant blood cells respond to normal control or feedback mechanisms?
No, also malignant blood cells produce substances that inhibit the proliferation of normal cells because the malignant cells fill the available space and normal cells will either be inhibited or crowded to the point of death
What events occur in the peripheral bloodas a result of malignant cells?
Decreases in red cells (anemia) and platelets (thrombocytopenia)
What happens if the malignant cells circulate in the peripheral blood?
The leukocyte count may be normal or increased
What happens if the malignant cells don’t circulate in the peripheral blood?
There is usually leukopenia
If leukemias and myeloproliferative disorders are gone untreated what will happen?
They will succum to infection secondary to severe granulocytopenia or bleeding secondary to lack of platelets.
What is granulocytopenia?
Implies a lack of granulocytes and may occur even if the total WBC count is increased because the WBCs are the leukemic/malignant cells that do not perform as normal cells
How are leukemias classified?
1) According to the stem cell line involved (myeloid or lymphoid) 2) Acute vs Chronic
What cells are involved in myeloid leukemias?
Granulocytes (neutrophils, eosinophils, or basophils), monocytes, erythrocytes, or megakaryocytes (precursors of platelets)
What cells are involved in lymphoid malignancies?
B cells or Tcells may either be leukemmias or lymphomas.
What is the difference between leukemias and lymphomas?
Leukemias = site of malignant transformation in the bone marrow; Lymphomas = site of malignant transformation in the lymph nodes
What will life span be like for people with acute leukemia?
it is measured in days or weeks.
What will the life span be like for people with chronic leukemias?
one to two years.
What is the onset of acute leukemias like?
Acute leukemias tend to run shorter more intense courses with patients seeking care within days of onset of signs and symptoms
What is the clinical progression of chronic leukemia like?
Chronic leukemia is slow and often patients take weeks or months before seeking medical care
Which leukemia tends to have greater numbers of blast cells in both the peripheral blood and bone marrow? Acute or Chronic?
Acute leukemia which also tend to demonstrate greater degrees of thrombocytopenia and anemia
What are the 2 types of acute leukemias?
Acute lymphoblastic leukemia (ALL), acute myelogenous leukemia (AML).
What is the difference between ALL and AML?
AML- primarily an adult disease (but may occur in all age groups) and have a slight predisposition for males. ALL- primarily a kids disease between ages 2-10.
What is the most common malignant disease in children?
Acute lymphoblastic leukemia
What are the signs and symptoms of acute leukemias?
1) acute illness 2) Bleeding 3) Infections 4) Gum hypertrophy 5) Bone and joint pain
What is bleeding like for acute leukemias?
usually in the skin and mucosal surfaces (gingival bleeding, epistaxis or menorrhagia)
What will infections be like for acute leukemias?
due to neutropenia and have the risk of infection (cellulitis, pneumonia, perirectal infections, septicemia) becoming high as the neutrophil count falls below 500.
What other problems (besides bleeding and infections) are seen with acute leukemias?
Gum hypertrophy, bone and joint pain.
What areas will commonly have bone pain with acute leukemias?
sternum and tibia.
What happens in severe cases of acute leukemias?
Impaired circulation resulting in headache, confusion, and dyspena (these are medical emergencies)
What will a physical exam be like for someone with acute leukemia?
pallor, purpura, petechiae, various signs of infection, gum hypertrophy, hepatomegaly, splenomegaly, and lymphadenopathy.
What will lab findings be for acute leukemia?
pancytopenia (an abnormal reduction in the number of red blood cells, white blood cells, and blood platelets in the blood), circulating blasts
What type of blasts will be circulating for ALL and AML?
ALL- lymphocytic. AML- myelocytic.
What will cause panctopenia with acute leukemias?
bone marrow is being replaced by other tissues so normal bone marrow volume goes down.
What will a CBC look like for acute leukemia?
Hard to say. Probably will be anemic. Probably increased WBC, but may be normal or increased (important to check differential). Platelets will probably be normal.
Name the 4 types of myeloproliferative disorders?
- polycythemia vera (PV). 2. Chronic myelogenous leukemia (CML). 3. Myelofibrosis (with myeloid metaplasia). 4. Essential thrombocythemia (ET).
What are myeloproliferative disorders?
Chronic leukemias.
Who is more likely to get polycythemia vera?
People over 50 and males>females.
What are the signs and symptoms of polycythemia vera?
symptoms related to expanded blood volume and increased viscosity like; headache, dizziness, tinnitus, blurred vision, fatigue, pruritis (itchiness) and epistaxis. Renal veins are engorged, ruddy cyanotic skin, hepatosplenomegaly, gout and thrombotic events.
What are the lab findings with Polycythemia vera?
Panmyelosis (Myeloid metaplasia with abnormal immature blood cells in the spleen and liver) erythrocytosis, granulocytic leukocytosis, thrombocytosis.
What will the thrombocyte count be like with polycythemia vera?
As high as 2000 when reference is (150-450).
What population is more likely to get Chronic myeloid (myelogenous) Leukemia (CML)?
Middle aged (average age 42 years) with males > female
What are the signs and symptoms of Chronic myeloid (myelogenous) Leukemia (CML)?
fatigue, malaise, weight loss, night sweats, low-grade fever, abdominal fullness (splenomegaly), sternal tenderness (marrow over expansion).
What are the lab findings like for CML?
Elevated WBC count with a distinct shift to the left, basophilia, possible anemias, variable platelet counts, philadelphia chromosome detectable.
What is a shift to the left?
Increase in the number of immature neutrophils in peripheral circulation called band cells or band neutrophils which is indicitive of an acute infection.
What is the philadelphia chromosome responsible for?
95%- CML. 5%- down syndrome.
What is myelofibrosis (with myeloid metaplasia)?
fibrotic replacement of bone marrow in response to increased secretion of platelet derived growth factor and this causes extramedullary hematopiesis and the hematopoisis is less competent.
What population is more likely to get myelofibrosis?
Male = female > 50 years old
What are the signs and symptoms of myelofibrosis (with myeloid metaplasia)?
abdominal fullness, fatigue (due to anemia).
What are the lab findings with myelofibrosis (with myeloid metaplasia)?
anemia with teardrop shaped (dacrocytes) RBC, Variable WBC count, variable platelet count with often bizarre shaped platelets.
What population is more likely to get Essential thrombocytosi?
Males = females greater than 50 years of age
What are the signs and symptoms of essential thrombocythemia (ET)?
thrombosis is most common problem and occurs in unusual places like mesenteric, hepatic,and portal veins. Bleeding due to too many platelets that spontaneously aggregate (epistaxis), GI bleeding, hemoptysis and fatigue. Splenomegaly is possible.
What are the lab findings like for ET?
Extreme elevation of platelets that are not functional (can be as high as 14,000 reference is 150-450), RBC count can be elevated, IDA (iron deficiency anemia) due to chronic bleeding.
Name 2 types of chronic lymphoproliferative leukemic disorders?
- Chronic lymphocytic leukemia (CLL). 2. Hairy cell leukemia (HCL).
Who is more likely to get chronic lympocytic leukemia?
males 2X greater than females and happens 90% of the time in people over 50.
What are the signs and symptoms of CLL?
immunosuppresion, bone marrow failure, lymphocytes inflitate organs, fatigue, reduced tolerance to exercise, hepatosplenomegaly, lymphadenopathy, (in more severe cases; brusing, pallor, fever, infections, weight loss, bone tenderness).
When will CLL be detected usually?
Most cases are detected incidentally via a routine CBC as symptoms develop insidiously.
What are the lab findings like for CLL?
Lymphoctyosis with mature appearace and are immunoincompentent, anemias and thrombocytopenia are mild early and may get worse.
Who is more likely to get hairy cell leukemias?
Males 5:1 with average age of onset at 55 years old.
What are the signs of HCL?
gradual onset of fatigue, weakness, abdominal fullness due to splenomegaly, infections, lymphadenopathy.
What are lab findings like for HCL?
Pancytopenia, anemia, thrombocytopenia, monocytopenia, and abnormal appearing B cells that look like hairy cells.
What are plasma cell dyscrasias?
Malignant disorders of the differentiated end-cells of B-lymphocytes, plasma cells and plasmatoid lymphocytes.
Name the 3 types of plasma cell dyscrasisa?
- Multiple myeloma. 2. Waldenstrom macroglobulinemia. 3. Monoclonal gammopathy of undetermined significance (idiopathic monoclonal gammopathy).
What are the signs and symptoms of multiple myeloma like?
Low back pain is the most common initial symptom.
What is happening with multiple myeloma?
a clonal proliferation of malignant plasma cells that begins in the bone marrow and dissemiates to involve multiple bony and visceral sites.
Multiple myeloma is the most common malignant disease of what?
Plasma cells.
Who is most likely to get multiple myeloma?
People over 50 and is as common as 2-3 per 100,000.
What happens when the malignant prolferation of a single clone of a plasma cell (multiple myeloma) infiltrates the marrow?
Thrombocytopenia- bleeding, leukopenia- infections, pancytopenia- anemia (weakness and fatigue).
What happens when the malignant prolferation of a single clone of a plasam cell (multiple myeloma) destroyes skeletal tissue?
Osteoclastic activating factor, expanding plasmacytomas, pathological fractures, lytic bone lesions- which leads to hypercalemia, osteopenic changes- bone pain.
How will multiple myeloma change proteins?
decreases normal immunoglobulins- infections. Also creates abnormal proteins like bence-jones which leads to kidney failure, and monoclonal gammopathy which leads to hyperglobulinemia and M-spike on SPEP (serum protein electrophoresis).
What are the common clinical findings seen with multiple myeloma?
skeletal pain, infections, anemia, kidney dysfunction, hyperviscosity syndrome.
What skeletal pain is most common with multiple myeloma?
persistant, non-mechanical low back and thorax most common
What infections are most common with multiple myeloma?
Pulmonary are most common such as H. Influenza and streptococcus pneumoniae
What effects from anemia are experienced by those with multiple myeloma?
Progressively worsening fatigue and weakness and pallor
What causes the kidney dysfunction with multiple myeloma?
due to eventual renal failure d/t myeloma kidney
What will hypervisocity syndrome lead to?
mucosal bleeding, vertigo, nausea, visual distrubances, and altered mental status.
What are the hematolgy lab tests like for multiple myeloma?
Normacytic and normochromic anemai, rouleaux formation, WBC and platelet counts are normal if early in the disease, late will show pancytopenia.
What are the serology lab tests like for multiple myeloma?
Markedly elevated ESR due to hypergammaglobulinemia.
Will serology labe tests for multiple myeloma that show elevated ESR due to hypergammaglobulinemia be a good way to diagnose Multiple myeloma?
No.
What will routine serum protein tests show for multiple myeloma?
increased total protein, increased globulin, decreased A/G ratio due to increased globulins and will have normal albumin, hypercalcemia in about 10% of patients, azotemia (increased Blood urea nitrogen(BUN)), increased uric acid as renal failure develops.
Since there are increased amounts of globulins seen with multiple myeloma a serum protein electrophorisis should be done to determine what type of globulins are increased and what will they be?
Gamma globuins - IgG will show the M-spike seen in 80% of multiple myeloma patients.
How is a bence-jones protein detected?**
Not on a routine urinalysis, but is found on urine electrophoresis or heat precipitation tests.
How common are bence-jones proteins with multiple myeloma?
75% of patients with MM will have them.
What are the differences between patients with bence-jones proteins and without?
With = light chain myeloma and is a more aggressive malignancy. Without = non-secretory myeloma- very uncommon but is not commonly aggressive.
What type of protein is bence-jones?
M-paraprotein.
What will a routine urinalysis show for multiple myeloma patients?
Proteinuria (albumin), hematuria, hyaline casts, renal tubular epithelial cells, cellular casts as renal failure develops.
What is the definitive way to diagnose someone with multiple myeloma?
Bone marrow aspiration.
What can causive ketones in the urine besides diabetic ketoacidosis?
Anorexia and being febrile
What can cause creatinine levels to fluctuate besides kidney function?
Muscle mass changes
What is the most common malignacy of bone marrow causing back pain?
Multiple Myeloma
What are some essentials of diagnosis of multiple myeloma?
1) Bone pain, often in the spine 2) Monoclonal paraprotein by serum or urine protein eletrophoresis or immunofixation 3) Abnormal plasma cells > 20% bone marrow
