malignant haematology Flashcards
what is leukemia
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
describe the difference between chronic and acute leukemia
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
what happens as the increased numbers of blast cells are produced
the normal blood cells are replaced, leading to anaemia, impaired immunity, and platelet deficiency meaning there is easy bleeding
effects of leukemia
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
what are the four leukemia subtypes
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
which leukemia subtype is associated with down syndrome
acute lymphoblastic
what are the non specific symptoms of leukemia
- fatigue
- fever
- weight loss
- easy bruising and bleeding
- abnormal infections
- lymphadenopathy
how is leukemia diagnosed
via blood tests, bone marrow biopsies, and scans
how is leukemia managed
led by specialist haematology oncology MDT
- mainly chemotherapy
- targeted therapies
- bone marrow transplant, immunosuppression
what is chemotherapy
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
what does chemotherapy do
kills fast growing cancer cells, and targets healthy cells that grow and divide quickly
which cells are affected by chemotherapy aside from the cancer cells
oral mucosa
gut mucosa
hair cells
what are the general side effects of chemotherapy
hair loss
nausea
infertility
diarrhoea
bone marrow suppression
immunosuppression
cardiac toxicity
oral mucositis
depression or anxiety
what is lymphoma
a cancer affected the white blood cells in the lymphatic system whereby the lymph nodes because abnormally large and painless
what are the two mai types of lymphoma
Hodgkins lymphoma
non hodgkin lymphoma
which type of lymphoma is the most common
non Hodgkin
what is the key presenting symptoms of lymphoma
lymphadenopathy, where the lymph nodes become non tender, rubbery and feel pain with alcohol
what are the constitutional symptoms of lymphoma
fever
night sweats
weight loss
what is cancer staging
determining the size and spread of a cancer
how is lymphoma diagnosed
a lymph node biopsy, identification of reed Sternberg cells in Hodgkins lymphoma
CT, MRI and PET scans
how is lymphoma managed
chemotherapy
radiotherapy
targeted therapy
stem cell transplant
what is the targeted therapy for managing lymphoma
targets b cells
what is myeloma
a cancer affecting the plasma cells (b cells producing antibodies)
what happens with myeloma
over production of one specific protein called a paraprotein, causing organ and tissue impairment. the paraproteins are present in the urine
what are the key features of myeloma
increased calcium
renal impairment
anaemia
bone lesions
why does multiple myeloma cause renal impairment
the paraprotein clogs the kidneys and prevents it from filtering like it normally does
what does multiple myeloma present as
unexplained fever
weight loss
fatigue
anaemia
renal impairment
bone pain
pathological fractures
rarely presents in the mouth
what is raindrop skull
this is when there are myeloma deposits in the bone in the skull
how can multiple myeloma be managed
there is no cure, the management instead focuses on disease control.
chemotherapy
stem cell transplant
biphosphonates
what are biphosphonates
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
what are the disease features of haematological malignancies
easy bleeding
low immunity
anaemia
gingival swelling
presentation of myeloma in the mandible
how does easy bleeding from haematological malignancies present in the mouth
petechiae
haemorrhage after extraction
spontaneous gingival bleeding
how does low immunity associated with haematological malignancies manifest in the mouth
candidosis infection
herpes simplex virus
what is petechiae
small bruises on the roof of the mouth
what is leukopenia
lack of white blood cells leading to impaired immunity
what is neutropenia
lack of neutrophils in the blood
how does anaemia present in the mouth
pallor
what is ecchymosis
bruises
what causes herpetic gingivostomatitis
herpes simplex virus
what are the oral side effects of chemotherapy
mucositis
dry mouth, leading to caries risk, taste disturbance, dysphagia
infection, fungal, viral, vulnerable
easy bleeding - thrombocytopenia
what are the oral side effects of radiotherapy
dry mouth
osteoradionecrosis of jaw
fibrosis
what is trismus
restriction in the range of motion of the jaw
what is gvhd
graft vs host disease
what is fibrosis
scarring of the muscles of mastication, meaning cannot open the mouth enough
what causes fungal infection in the mouth and how to manage
reduced salivary flow and immunosuppression
managed via topical anti fungals
what causes lichen plants and erythema multiform in the mouth and how to manage
drug reactions
manage by referral to secondary or tertiary care services
what causes caries and how to manage
reduced salivary flow and high calorie dietary supplements
managed via high fluoride toothpaste, fluoride varnishes, and tailored oral hygiene instruction
what causes osteonecrosis and how to manage
anti resorptive, anti angiogenic, and immunosuppressive effects
managed via chlorhexidine rinses and referral to secondary, tertiary care services
what causes bleeding tendency in the mouth and how to manage
thrombocytopenia, managed via haematological screening prior to invasive procedures
what causes mucositis and ulceration, how to manage it
leukopenia, manage via analgesics, crushed ice, benzyldamine rinses.
what causes xerostomia and altered taste and how to manage it
reduced salivary flow and diffusion of tt into oral cavity. idk what tt is. manage via frequent sips of water, and oral lubricants.
