Malignancies Flashcards
What are the types of haematological malignancies
Myeloid
Lymphoid
define acute leukaemia
Rapidly progressive clonal malignancy of the marrow/blood with maturation defect(s)
defined as 20% or more blasts in either the peripheral blood or bone marrow
Decrease/loss of normal haemopoietic reserve
what is the most common childhood cancer
Acute Lymphoblastic Leukaemia
how would ALL and AML present?
due to marrow failure (anaemia, infections, bleeding)
leukaemic effects: high WCC and involvement of extra-medullary areas e.g. CNS, lymph nodes sometimes causing venous obstruction
Bone pain
AML subgroups may present with DIC or Gum infiltration
what investigations would you do for acute leukaemia?
- Blood count and film
2. Coagulation screen
what do abnormal cells look like on blood film?
(‘Blasts’) with a high nuclear:cytoplasmic ratio
Auer Rod
in acute myeloid leukaemia
why would a bone aspirate be done?
1) Morphology
(what do the cells look like?)
2) Immunophenotype (by flow-cytometry)
(are there lineage-specific proteins on the cell-surface?)
Even if cells from AML and ALL look alike, they will express lineage-associated proteins: immunophenotyping is required for a definitive diagnosis
3) Cytogenetics
Diagnostic utility
Prognostic significance
4) Trephine (piece of bone)-enables better assessment of cellularity and helpful when aspirate sub-optimal
what is the treatment for leukeamia
Multi-agent chemotherapy
ALL -can last up to 2-3 years
- Different phases of treatment of varying intensity (induction, consolidation, intensification, maintenance)
- Targeted treatments in certain subsets
AML -Normally intensive
- Between 2-4 cycles of chemotherapy (5-10 days of chemotherapy followed by 2-4 weeks of recovery)
- Prolonged hospitalisation
what is the prognosis of the different types of leukaemia
Childhood ALL >85-90% cure rates*
Adult ALL ~ 30%-40%*
Adult AML 60y ~ 10% or less
