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Haematology > Malignancies > Flashcards

Malignancies Flashcards

1
Q

How do we identify normal progenitors / stem cells?

A

Cell surface antigens through immunophenotyping

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2
Q

What are the two main features of malignant haemopoeisis?

A

Increased number of abnormal dysfunctional cells

Loss of normal activity

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3
Q

In acute myeloid leukemia what occurs?

A

There is neoplastic proliferation of abnormal progenitors (blast cells)
Block in maturation and differentiation further down

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4
Q

In chronic myeloid leukemia, what occurs?

A

Proliferation of abnormal progenitors BUT there is still maturation and differentiation further down

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5
Q

List some potential causes of hematological malignancies:

A

Genetic Hits
Environmental interaction
Driver mutations
Recurrent cytogenetic abnormalities

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6
Q

Malignant haemopoeisis is poly / mono clonal?

A

Monoclonal

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7
Q

What is the significance of driver mutations in haem malignancy/

A

Driver mutations can select clones and confer a growth advantage to the cells

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8
Q

What type of leukaemia is histologically and clinically more aggressive ?

A

Acute

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9
Q

How does an acute leukemia typically present?

A

Bone marrow failure symptoms

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10
Q

List some features of histological aggression in leukaemia

A

Large cells
High nuclear - cytoplasmic ratio
Prominent nucleoli
Rapid proliferation

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11
Q

How is acute leukaemia defined?

A

> 20% of blasts in either the bone marrow or peripheral blood

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12
Q

`Which leukaemia is the most common childhood cancer?

A

Acute lymphoblastic leukaemia

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13
Q

How would ALL present?

A 
Bone marrow failure: anaemia, infections, bleeding
Bone pain
Lymphadenopathy 
Hepato - spleno - megaly
Orchidomegaly 
CNS involvement: meningism, CN palsies
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14
Q

What age group does acute myeloid leukemia affect?

A

Elderly >60y/o

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15
Q

What are some of the common infections seen in ALL?

A 
Pneumocystis pneumonia
Candidiasis 
Measles
CMV
VZV
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16
Q

What investigations are done for ALL?

A 
FBC - WCC raised despite neutropaenia
Blood film - blasts
Coagulation screen
Bone Marrow Aspirate 
CT / MRI for mediastinal lymphadenopathy
17
Q

What is seen on a blood film that is characteristic of AML?

A

Auer Rods

18
Q

What is required to make a definitive diagnosis of either AML/ALL?

A

Immunophenotyping

this defines the lineage of the abnormal cells

19
Q

What is trephine?

A

A piece of bone used to assess the cellularity of the bone marrow when an aspirate sample is sub-optimal

20
Q

What is the prognosis for ALL?

A

Children - 70-90% curative

Adults - 40% curative

21
Q

What is the definition of hematological remission?

A

<5% blasts in a normal regenerating bone marrow with no evidence of leukaemia in the blood and a normal / recovering blood count

22
Q

How is ALL treated?

A

Supportive therapies
Chemotherapy - remission induction
Allogenic Marrow transplants
Can last 2 - 3 years

23
Q

How is AML treated?

A

Intensive cycles of chemo lasting 5-10 days, every few weeks
Bone marrow transplant - HLA matched donors for allogenic transplant in 1st remission

24
Q

How is chemotherapy given in hematological patients?

A

Via a Hickman line

25
Q

What are some consequences of bone marrow suppression?

A

Anaemia
Neutropaenia - severe infections
Thrombocytopaenia - severe bleeding

26
Q

What type of infections are common in neutropaenic patients?

A

Gram Negative bacteria

27
Q

How are patients undergoing treatment managed for bacterial infections?

A

Broad spectrum antibiotics the minute the develop a neutropaenic fever

28
Q

Patients with a neutropaenic fever who are not responding to antibiotics may have what?

A

A fungal infection

29
Q

What is the cure rates for AML?

A

<60 y/o 40-50%

>60 y/o 10%

30
Q

What AML sub type is associated with disseminated intravascular coagulopathy ?

A

Chromosome translocation of c15:c17

31
Q

When might you see ring sideroblasts in a blood film?

A

In myelodysplastic syndromes

32
Q

What cells are characteristic of Hodgkin’s Lymphoma?

A

Reed-Sternberg cells

33
Q

What cells are most non Hodgkin’s lymphoma’s derived from?

A

B cells

34
Q

What is the most common form of Non-Hodgkin Lymphoma?

A

Diffuse large B cell lymphoma

35
Q

What is Burkitt’s Lymphoma?

A

Childhood disease

Characterised by jaw lymphadenopathy

36
Q

What is MALT?

A

Mucosa - associated - lymphoid - tissue

37
Q

What investigations are done for Lymphoma?

A

FBC and film
Marrow and lymph node biopsy
Staging - Ann Arbor system

38
Q

What type on Non-Hodgkin’s is more aggressive?

A

High grade

39
Q

What type on Non-Hodgkin’s is more likely to be curable?

A

High grade

Haematology (13 decks)

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