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Practice topics Exam 1 > Leukemias, Lymphomas, and Misc. > Flashcards

Leukemias, Lymphomas, and Misc. Flashcards

1
Q

Leukocytosis

A

increases leukocyte count

often a normal protective response

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2
Q

Leukopenia

A

Decrease in leukocyte count

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3
Q

Below ____ = risk of infection

A

1000/mm 3

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4
Q

Below ____ = life threatening

A

500/mm 3

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5
Q

Hematologic Neoplasias

A

Cancer which originates in hematologic tissues of the body - specifically from changes in the stem cells
Metastasis to bone marrow

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6
Q

Ex of hematologic neoplasia

A

Multiple myeloma
Leukemia
Polycythemia vera

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7
Q

How common is leukemia

A

9th most common cancer in US

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8
Q

Avg age of diagnosis for leukemia

A

66

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9
Q

Leukemias (Weissus Blut) is what

A

primary neoplasm is within the bone marrow

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10
Q

Lympho =

A

involving lymphoid tissue

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11
Q

Myelo =

A

involving hematopoietic stem cells

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12
Q

-blastic =

A

acute

immature cells

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13
Q

-cytic =

A

chronic

mature cells

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14
Q

Acute leukemias

A

accumulation of immature (blast) cells
Overcrowding of bone marrow
Anemia might be first s/s
Onset is abrupt

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15
Q

Common clinical findings with acute leukemia

A 
Anemia
Coagulopathy
DIC
Infection
Weight loss
Bone pain
Inc uric acid excretion
Liver, spleen, lymph node enlargement
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16
Q

Acute lymphoblastic leukemia (ALL) defined as

A

more than 30% lymphoblasts

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17
Q

Acute lymphoblastic leukemia (ALL) epidemiology

A

Accounts for 20% of all leukemias
Most common (57%) in those under 20 yrs
Median age diagnosis is 15

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18
Q

Acute lymphoblastic leukemia (ALL) 5 yr survival

A

68%
Children 95% attain remission, 80% long term survivial
Adults 40% long term

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19
Q

Acute Myelogenous Leukemia (AML)

A

Most common (35%)
Variety of subtypes
Peak diagnosis btw 60-70 yrs
Rare to occur in less than 40 yrs

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20
Q

Acute Myelogenous Leukemia (AML) - survivial (5 yr)

A

27%

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21
Q

Acute Myelogenous Leukemia (AML) - s/s

A

Typical manifestations
About 2% have neuro s/s including disorientation and HA
Might see CN problems

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22
Q

Acute Myelogenous Leukemia (AML) - treatment

A

Significantly high WBC count which can cause vascular damage secondary to occlusion
Chemotherapy - phased with the goal of achieving remission

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23
Q

Acute Myelogenous Leukemia (AML) - chemotherapy phased treatment

A

1 = Induction therapy - eradication of neoplastic cells
2 = Post Remission - delivery of additional drugs to inc eradication effects
3 = Consolidation therapy - stem cell or bone marrow replacement
Maintenance and supportive therapy

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24
Q

Chronic leukemias

A

slow onset with vague s/s
cells are well differentiated
some functional WBCs are being produced at the same time

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25
Q

Chronic myelogenous leukemia - epidemiology

A

15% of all leukemias

Almost exclusively an adult onset (2% in children)

26
Q

Chronic myelogenous leukemia - diagnosis

A

Philadelphia chromosome is diagnostic marker

27
Q

Chronic myelogenous leukemia - survival

A

overall 5 yr survival is 67%

dramatic inc since 2001 with new drug

28
Q

Chronic myelogenous leukemia - phases

A

1 chronic phase - lasts 2-3 yrs with mild symptoms (most are diagnosed in this phase)
2 accelerated phase - inc number of problems and severity of symptoms (4 yrs)
3 Blast phase - resembles the acute leukemia

29
Q

Chronic myelogenous leukemia - treatment

A

stem cell transplantation is curative but not everyone is a candidate (secondary to multisystem issues)
Biological therapies like interferon can induce remission or supress progression

30
Q

Chronic myelogenous leukemia - new drug

A 
imatinib mesylate (gleevac) 
Hugely expensive
31
Q

Chronic lymphocytic leukemia - epi

A

2nd most common type (28%)
Adults over 50
85% survivial rate

32
Q

Chronic lymphocytic leukemia - primary cell involved is

A

B cell therefore see side effects as suppression of humeral immunity

33
Q

Chronic lymphocytic leukemia - what is it

A

accumulation of mature but incompentent cells
Fatigue, lymphadenopathy
Opportunistic infections are often a hallmark of disease (75%)

34
Q

Chronic lymphocytic leukemia - treatment

A

hugely resistent to drugs
Treatment is more palliative in nature
Younger have more success with bone marow transplants

35
Q

Lymphoma

A

Cancers that develop in immune system
2 types
- Hodgkins disease
- Non-Hodgkins disease

36
Q

Hodgkins disease characterized by presence of what

A

Reed Sternberg cell (owl eyes)

37
Q

Hodgkins disease - epi

A

8% of all lymphomas
peak age 20-35
most common in young adult males

38
Q

Hodkins disease is considered an

A

immunodeficient disease

can metastasize to non lymph tissue but does so infrequently!

39
Q

Hodgkins disease - stages - stage 1

A

signle node region or a single extra lymphatic site

survivial is 90%

40
Q

Hodgkins disease - stages - stage 2

A

Two or more nodes on one side of the diaphragm

41
Q

Hodgkins disease - stages - stage 3

A

involved tissue both sides of diaphragm

42
Q

Hodkins disease - stages - stage 4

A

Multifocal involvement including extra lymphatic involvement

43
Q

Hodskins disease - lymphadenopathy =

A

firm, rubbery, usually not tender or painful

more than 1cm in diameter

44
Q

Hodgkins disease s/s

A 
Night sweats - severe
Intermittent fever
Weight loss of more than 10% in 6 months
Pruritis
Pain and/or neuro s/s in extremities
CNS s/s and symtpoms are NOT common
45
Q

Hodgkins prognosis

A

Highly curable
5 yr survival is 85% (avg)
stages 1 and 2 have 93%
Age is a factor

46
Q

Hodgkins treatment

A

Stage 1 and 2 radiation with supplemental chemo
Satge 3 aggressive chemo
Stage 4 Multiagent drug regimen

47
Q

Non hodgkins lymphoma is what

A

hetergenous group of lymphoproliferative malignancies
7th most common cancer in US
significant inc since 1970 - secondary to increase in HIV

48
Q

Non hodgkins lymphoma - epi

A

95% occur after age 45
M more than F
Typically diagnosed 65-74 yrs
Survival rate 71%

49
Q

Non hdgkins lymphoma - course

A

Bx and spread not as predicitive as hodgkins
tends to spread to extranodal sites (spleen, GI, bone)
Clinical course varies depending on subtype

50
Q

Subtypes of Nonhodgkins lymphoma

A 
Low grade (follicular) lymphoma AKA indolent
Intermediate grade (indolent)
High grade (aggresive)
51
Q

Non hodgkins lymphoma - s/s

A 
painless lymphadenopathy
fever
fatigue, night sweats
spread to extranodal areas
visceral and structural obstruction or impingement s/s
52
Q

Non hodgkins lymphoma - tx

A 
Chemo
Biological/immunotherapy - hormonal, interferon
Radiation
Plasmapheresis
Stem cell transplant
53
Q

Disseminated Intravascular Coagulation (DIC) is what? and what is it commonly seen with?

A

Hyper or over activation of the coagulation system
Acquired platelet malfunction
Sepsis, trauma, ob/gyn complication, leukemia complication

54
Q

Disseminated Intravascular Coagulation (DIC) - pathology

A

Coagulation leads to thrombosis formation
Deposits of fibrin due to activation of fibrolytic system
Fibrinolysis impaired
Because there is clotting widespread, clotting factors within both intrinsic and extrinsic pathways are used up
Hemorrhage occurs
Thrombi develop as clotting factors are depleted

55
Q

Disseminated Intravascular Coagulation (DIC) - clinical features

A 
Unexpected bleeding from all body openings
Hematomas, petechieae
Swelling
Mottled/cold hands and feet
Resp distress
Neuro issues
Hypotension, tachycardia
Renal issues
56
Q

Disseminated Intravascular Coagulation (DIC) - diagnosis

A

clinical diagnosis confirmed with lab tests

57
Q

Disseminated Intravascular Coagulation (DIC) - treatment

A

directed at the cause
Heparin may be used to get rid of clots
Blood product replacement therapy can be used (transufion)
Can be fatal!
Monito lab test frequently with PT - generally seen bedisde

58
Q

Hematopoietic stem cell transplant

A

blood (or bone marrow) source
Umbiical cord
Allogenic vs. Autologous

59
Q

Hematopoietic stem cell transplant - who

A

Pt about to undergo aggressive chemo or high dose radiation

Certain hematological neoplasias

60
Q

Hematopoietic stem cell transplant - s/s

A 
Severe immunosuppression
weakness
fatigue
cardiac and liver toxicity (from the drugs)
hemorrhage
myopathy and osteoporosis
risk for integumentary breakdown
61
Q

Hematopoietic stem cell transplant - beforehand

A

Pre-transplant assessment and education is recommended

62
Q

Hematopoietic stem cell transplant - PT

A 
Typically they will be deconditioned (we wont see them until long time after transplantation) 
pulmonary sys dec
Energy conservation
Pt education on safety
Regular and close monitor of labs
Infection control procedures

Practice topics Exam 1 (15 decks)

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