malignant haematology

Question 1

what is leukemia

Answer 1

a group of blood cancers affecting a particular line of stem cells in the bone marrow, leading to an unregulated production.
the bone marrow produces a high amount of immature blast cells, leading to loss of bone marrow function.

there is acute and chronic leukaemia, coming from both myeloid or lymphoid lineage

Question 2

describe the difference between chronic and acute leukemia

Answer 2

acute leukemia comes on very fast, with more severe symptoms and a less favourable outcome than acute.

chronic is slower and sometimes does not require any form of treatment

Question 3

what happens as the increased numbers of blast cells are produced

Answer 3

the normal blood cells are replaced, leading to anaemia, impaired immunity, and platelet deficiency meaning there is easy bleeding

Question 4

effects of leukemia

Answer 4

blast cells propagate, displace normal cell development.

rbc deficiency leading to anaemia
white blood cell deficiency, leading to impaired immunity
platelet deficiency leading to easy bleeding

Question 5

what are the four leukemia subtypes

Answer 5

acute lymphoblastic, seen most often in kids under 5

acute myeloid leukemia seen in adults

chronic lymphocytic leukemia, seen in older adults

chronic myeloid leukemia, caused by Philadelphia chromosome

Question 6

which leukemia subtype is associated with down syndrome

Answer 6

acute lymphoblastic

Question 7

what are the non specific symptoms of leukemia

Answer 7

• fatigue
• fever
• weight loss
• easy bruising and bleeding
• abnormal infections
• lymphadenopathy

Question 8

how is leukemia diagnosed

Answer 8

via blood tests, bone marrow biopsies, and scans

Question 9

how is leukemia managed

Answer 9

led by specialist haematology oncology MDT

• mainly chemotherapy
• targeted therapies
• bone marrow transplant, immunosuppression

Question 10

what is chemotherapy

Answer 10

a cancer treatment where medicine is used to kill cancer cells, usually intravenous

this halts or slows the growth of cancer cell, which grow and divide quickly

Question 11

what does chemotherapy do

Answer 11

kills fast growing cancer cells, and targets healthy cells that grow and divide quickly

Question 12

which cells are affected by chemotherapy aside from the cancer cells

Answer 12

oral mucosa
gut mucosa
hair cells

Question 13

what are the general side effects of chemotherapy

Answer 13

hair loss
nausea
infertility
diarrhoea
bone marrow suppression
immunosuppression
cardiac toxicity
oral mucositis
depression or anxiety

Question 14

what is lymphoma

Answer 14

a cancer affected the white blood cells in the lymphatic system whereby the lymph nodes because abnormally large and painless

Question 15

what are the two mai types of lymphoma

Answer 15

Hodgkins lymphoma
non hodgkin lymphoma

Question 16

which type of lymphoma is the most common

Answer 16

non Hodgkin

Question 17

what is the key presenting symptoms of lymphoma

Answer 17

lymphadenopathy, where the lymph nodes become non tender, rubbery and feel pain with alcohol

Question 18

what are the constitutional symptoms of lymphoma

Answer 18

fever
night sweats
weight loss

Question 19

what is cancer staging

Answer 19

determining the size and spread of a cancer

Question 20

how is lymphoma diagnosed

Answer 20

a lymph node biopsy, identification of reed Sternberg cells in Hodgkins lymphoma

CT, MRI and PET scans

Question 21

how is lymphoma managed

Answer 21

chemotherapy
radiotherapy
targeted therapy
stem cell transplant

Question 22

what is the targeted therapy for managing lymphoma

Answer 22

targets b cells

Question 23

what is myeloma

Answer 23

a cancer affecting the plasma cells (b cells producing antibodies)

Question 24

what happens with myeloma

Answer 24

over production of one specific protein called a paraprotein, causing organ and tissue impairment. the paraproteins are present in the urine

Question 25

what are the key features of myeloma

Answer 25

increased calcium renal impairment anaemia bone lesions

Question 26

why does multiple myeloma cause renal impairment

Answer 26

the paraprotein clogs the kidneys and prevents it from filtering like it normally does

Question 27

what does multiple myeloma present as

Answer 27

unexplained fever weight loss fatigue anaemia renal impairment bone pain pathological fractures rarely presents in the mouth

Question 28

what is raindrop skull

Answer 28

this is when there are myeloma deposits in the bone in the skull

Question 29

how can multiple myeloma be managed

Answer 29

there is no cure, the management instead focuses on disease control. chemotherapy stem cell transplant biphosphonates

Question 30

what are biphosphonates

Answer 30

medicines that stop the bone from getting broken down. as a result, they are important for the healing of the jaw they can cause medication related osteonecrosis of the jaw

Question 31

what are the disease features of haematological malignancies

Answer 31

easy bleeding low immunity anaemia gingival swelling presentation of myeloma in the mandible

Question 32

how does easy bleeding from haematological malignancies present in the mouth

Answer 32

petechiae haemorrhage after extraction spontaneous gingival bleeding

Question 33

how does low immunity associated with haematological malignancies manifest in the mouth

Answer 33

candidosis infection herpes simplex virus

Question 34

what is petechiae

Answer 34

small bruises on the roof of the mouth

Question 35

what is leukopenia

Answer 35

lack of white blood cells leading to impaired immunity

Question 36

what is neutropenia

Answer 36

lack of neutrophils in the blood

Question 37

how does anaemia present in the mouth

Answer 37

pallor

Question 38

what is ecchymosis

Answer 38

bruises

Question 39

what causes herpetic gingivostomatitis

Answer 39

herpes simplex virus

Question 40

what are the oral side effects of chemotherapy

Answer 40

mucositis dry mouth, leading to caries risk, taste disturbance, dysphagia infection, fungal, viral, vulnerable easy bleeding - thrombocytopenia

Question 41

what are the oral side effects of radiotherapy

Answer 41

dry mouth osteoradionecrosis of jaw fibrosis

Question 42

what is trismus

Answer 42

restriction in the range of motion of the jaw

Question 43

what is gvhd

Answer 43

graft vs host disease

Question 44

what is fibrosis

Answer 44

scarring of the muscles of mastication, meaning cannot open the mouth enough

Question 45

what causes fungal infection in the mouth and how to manage

Answer 45

reduced salivary flow and immunosuppression managed via topical anti fungals

Question 46

what causes lichen plants and erythema multiform in the mouth and how to manage

Answer 46

drug reactions manage by referral to secondary or tertiary care services

Question 47

what causes caries and how to manage

Answer 47

reduced salivary flow and high calorie dietary supplements managed via high fluoride toothpaste, fluoride varnishes, and tailored oral hygiene instruction

Question 48

what causes osteonecrosis and how to manage

Answer 48

anti resorptive, anti angiogenic, and immunosuppressive effects managed via chlorhexidine rinses and referral to secondary, tertiary care services

Question 49

what causes bleeding tendency in the mouth and how to manage

Answer 49

thrombocytopenia, managed via haematological screening prior to invasive procedures

Question 50

what causes mucositis and ulceration, how to manage it

Answer 50

leukopenia, manage via analgesics, crushed ice, benzyldamine rinses.

Question 51

what causes xerostomia and altered taste and how to manage it

Answer 51

reduced salivary flow and diffusion of tt into oral cavity. idk what tt is. manage via frequent sips of water, and oral lubricants.