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Haematology > Malignancy > Flashcards

Malignancy Flashcards

1
Q

What protein is expressed by haematopoetic stem cells on immunohistochemistry?

A
  • CD34
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2
Q

Define acute leukaemia?

A
  • proliferation of abnormal progenitors with block in differentiation/maturation
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3
Q

Define chronic myeloproliferative disorders?

A
  • proliferation of abnormal progenitors but no differentiation/maturation block
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4
Q

What are driver mutations?

A
  • clone cells selected
  • normal haemopoeis = polyclonal
  • malignant haemopoesis = monoclonal
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5
Q

Describe passenger mutations

A
  • do not confer a growth advantage

- happen to be present

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6
Q

Haematological malignancy types based on lineage

A
  • myeloid

- lymphoid

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7
Q

Haematological malignancy types based on developmental stage

A
  • primitive (acute lymphoblastic, chronic myeloid)

- mature (chronic lymphoblastic, myeloma, acute myeloid)

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8
Q

Leukaemia means?

A
  • malignancy of blood
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9
Q

Lymphoma means

A
  • malignancy of lymph nodes
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10
Q

Myeloma means?

A
  • malignancy of plasma cells
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11
Q

Types of acute leukaemia?

A
  • acute myeloid leukaemia

- acute lymphoblastic leukaemia

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12
Q

What is acute leukaemia?

A
  • rapidly progressive
  • malignancy of clonal cells
  • defects in marrow / blood maturation
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13
Q

Which is the commonest leukaemia in children

A
  • acute lymphoblastic anaemia
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14
Q

How might ALL present?

A
  • anaemia
  • bleeding
  • bone pain
  • infection
  • CNS involvement
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15
Q

How might AML present?

A
  • Older patient
  • secondary or de novo
  • aneamia
  • infection
  • gum infiltration
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16
Q

Name a complication of AML?

A
  • Disseminated intravascular coagulation
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17
Q

Auer rods suggest?

A
  • acute myeloid leukaemia
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18
Q

What is a test to confirm between ALL and AML?

A
  • Immunophenotyping
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19
Q

What are immunoglobulins?

A
  • produced by b-cells and plasma cells
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20
Q

What is the structure of immunoglobulins?

A
  • 2 heavy

- 2 light

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21
Q

Where can immunoglobulins be found?

A
  • on the B cell surface

- in blood (released by plasma cells)

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22
Q

Name some monomer immunoglobulins?

A
  • IgD
  • IgE
  • IgG
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23
Q

Name dimer immunoglobulins?

A
  • IgA
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24
Q

Name a pentamer immunoglobulin?

A
  • IgM
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25
Q

What forms the variable region of an immunoglobulin?

A
  • V D J
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26
Q

What is the name given to the cell when a B cell travels back to the bone marrow

A
  • plasma cell
27
Q

What are plasma cells

A
  • factory cell

- produce a large amount of antibodies

28
Q

How are plasma cells recognised under the microscope?

A
  • blue cytoplasm

- pale perinuclear areas (Golgi apparatus)

29
Q

Polyclonal increase in immunoglobulins may be a result of what?

A
  • infection
  • autoimmune
  • malignancy
  • liver disease
30
Q

Monoclonal rise in immunoglobulins may be suggestive of?

A
  • marker of underlying disorder

- called paraproteins

31
Q

How are immunoglobulins detected?

A
  • serum electrophoresis

- quantifies by serum immunofixation

32
Q

What are bence jones proteins?

A
  • usual light chain immunoglobulin precipitates

- detected in the urine electropheresis

33
Q

What conditions are paraproteins seen in?

A
  • MGUS
  • Myeloma
  • Amyloidosis
  • Lymphoma
34
Q

What are paraproteins

A

Monoclonal immunoglobulins

35
Q

What is myeloma?

A
  • plasma cell malignancy
36
Q

How does myeloma affect the body?

A
  • direct tumour cell effect
  • bone lesions
  • increased calcium
  • bone pain
  • marrow failure
  • paraprotein mediated
  • renal failure
  • immune suppression
  • hyperviscosity
  • amyloid
37
Q

What is the commonest myeloma?

A
  • IgG
38
Q

How is myeloma classified?

A
  • by immunoglobulin
  • IgG is most common
  • IgA
  • Bence jones
39
Q

Symptoms of hypercalcaemia?

A
  • stones
  • bones
  • abdominal groans
  • psychiatric moans
  • kidney impairmetn
40
Q

How is cast nephropathy treated?

A
  • hydration
  • steroids
  • chemo
41
Q

Treatment of myeloma?

A
  • chemotherapy
  • dexamethasone
  • cyclophosphamide
  • monoclonal antibodies
  • opiates
  • radiotherapy
  • bishopshonates
42
Q

What does MGUS stand for?

A
  • monoclonal gammopathy of underdetermined significance
43
Q

How is MGUS diagnosed?

A
  • paraprotein <30g/l
  • plasma cells <10%
  • no myeloma end organ damage
44
Q

What causes the symptoms of AL amyloidosis?

A
  • misfold of amyloid protein to form an insoluble beta pleated sheet
  • accumulation in multi organ systems
45
Q

How is AL amyloidosis diagnosed?

A
  • Organ biopsy with Congo red stain

- SAP scan

46
Q

Waldenstrom’s macroglobulinaemia symptoms?

A
  • IgM paraprotein leads to hyperviscosity symptoms
47
Q

Treatment of waldenstroms macrotgloblinaemia?

A
  • plasmapheresis

- chemotherapy

48
Q

Define remission?

A
  • no detectable cancer cells

- may relapse

49
Q

Cytotoxic drugs can either be ___ or ___

A
  • cell cycle specific

- non-cell cycle specific

50
Q

Name examples of cell cycle specific drugs?

A
  • antimetabolites (methotrexate)

- mitotic spindle inhibitors

51
Q

Name non-cell cycle specific drugs?

A
  • alkylating agents
  • platinum derivatives
  • cytotoxic antibiotics
52
Q

Immediate cytotoxic drug effects?

A
  • bone marrow suppression
  • gut mucosal damage
  • alopecia
53
Q

Vina alkaloids may cause?

A
  • neuropathy
54
Q

Anthracyclines may cause

A
  • cardiotoxicity
55
Q

Cis-platinum may cause?

A
  • nephrotoxicity
56
Q

Long term side effects of chemotherapy

A
  • infertility
  • secondary malignancy
  • cardiomyopathy (anthracyclines)
57
Q

What may be a reason why chemotherapy fails to work?

A
  • tumour slow turn over

- drug resistant mechanisms

58
Q

What limits intensifying chemotherapy?

A
  • limited by myelosuppression
59
Q

What may be used to overcome myelosuppression in chemotherapy?

A
  • haematopoietic growth factors (G-CSF)
  • Monoclonal antibodies
  • bone marrow transplantation
60
Q

Name an example monoclonal antibody that may be used in combination with chemotherapy?

A
  • rituximab

- targets malignant protein

61
Q

What could be a target treatment in myeloma?

A
  • biological agent

- proteasome inhibitor

62
Q

What is a good treatment option in CML and how does it work?

A
  • tyrosine kinase inhibitor
  • targets specific to cancer cell
  • molecularly targeted
63
Q

3 types of immune therapy

A
  • bone marrow transplant
  • T cells from donor
  • adoptive immunotherapy (using patients own cells to mark cancer as foreign)

Haematology (14 decks)

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