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Med 2 > Myeloma > Flashcards

Myeloma Flashcards

1
Q

What is the key process of myeloma?

A

Cancer of the plasma cells in the bone marrow
Plasma cells = activated B-lymphocytes that produce antibodies
Results in production of large amounts of specific paraprotein (M protein).

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2
Q

What are the risk factors for myeloma?

A

Old age
Male
Black ethnic origin
Family history
Obesity

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3
Q

What is a Bence-Jones protein in myeloma?

A

Free light chains in urine
Due to increase abnormal serum antibody levels.

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4
Q

Describe what happens to the plasma cell in myeloma

A

Cancer of single plasma cell
Genetic mutations - causes uncontrollable and excessive amounts of specific paraprotein to be released (paraproteinaemia)
This is often an abnormal antibody or part of the antibody (light chain)

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5
Q

What are the different grades of myeloma?

A

Monoclonal Gammopathy of Undetermined Significance
Smolder Multiple Myeloma
Multiple Myeloma

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6
Q

What is monoclonal gammopathy of undetermined significance?

A

Production of specific paraprotein without other features of myeloma/cancer
Often incidental
1% progress to myeloma per year
No symptos

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7
Q

What is smoldering multiple myeloma?

A

Abnormal plasma cells and paraproteins
No organ damage or symptoms
Greater risk of progression to myelomas (10% per year)

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8
Q

What is multiple myeloma?

A

Symptoms throughout the body
Blood is full of cancerous plasma cells and protein
Affects multiple bone marrow areas in the body

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9
Q

What is the typical prognosis of multiple myeloma?

A

4 year survival of 75%

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10
Q

What is the key presentation of myeloma?

A

Persistent bone pain e.g lower back
Pathological/low trauma fractures
Unexplained fatigue
Unexplained weight loss
Fever of unknown origin
Hypercalcaemia
Anaemia
Renal Impairement

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11
Q

What is the acronym for the key symptoms of multiple myeloma?

A

CRAB
HyperCalcemia
Renal Dysfunction
Anemia
Bone pain.

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12
Q

What is the pathophysiological process underpinning the bony symptoms of multiple myeloma?

A

Cytokines released from abnormal plasma cells.
Increased osteoclasts/suppresssed osteoblasts (inc Ca2+ reabsoprtion into blood)
Fragile patches of thin bone (osteolytic lesions) lead to pathological fractures -> vertebral bodies, skull, long bones, ribs

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13
Q

How does multiple myeloma affect the kidney?

A

Paraproteins deposited
Hypercalcaemia
Dehydration
Glomerulonephritis (inc cytokines from abnormal plasma cells)
myeloma Treatments
All contribute to renal dysfuncation

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14
Q

How does multiple myeloma lead to anaemia?

A

Cancerous plasma cells infiltrate the bone marrow -> suppress other blood cell lines - leads to pancytopaenia
This anaemia is normocytic and normochromic.

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15
Q

What bloods should be done for investigation multiple myeloma?

A

FBC (anaemia/leukopaenia)
Calcium (raised)
ESR (raised)
Plasma viscosity (raised)
U+Es
Blood film (Rouleaux formation = stacked rbcs)

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16
Q

What is included in a myeloma screen?

A

Serum protein electrophoresis (paraproteinaemia)
Serum-free light chain assay - abundant
Urine protein electrophoresis = Bence Jones Proteins

17
Q

What imaging may be done for suspected multiple myeloma?

A

Whole body MRI
Low dose CT
Skeletal x-ray survery

18
Q

What biopsy is done and why for suspected multiple myeloma?

A

Bone marrow - for definitive diagnosis and cytogenic testing.

19
Q

What is seen on the blood film of a patient with multiple myeloma?

A

Rouleaux formation - stacked rbcs

20
Q

What are the x-ray findings in multiple myeloma?

A

Well defined lytic lesions
Diffuse osteopaenia
Abnormal fractures
‘Raindrop skull’ -> rare caused by multiple lytic lesions

21
Q

What is the typical management plan for myeloma?

A

MDT - oncology and haematology
Relapse remitting course of disease so treatment aims for control not cure
Commonly chemotherapy followed by an autologous/allogenic stem cell transplant for a longer period of remission

22
Q

What additional management strategies are available for myeloma bone disease?

A

Bisphosphonates
Radiotherapy
Orthopaedic surgery +/- cement augmentation.

23
Q

What is hyperviscosity syndrome in myeloma?

A

Plasma viscosity increases as more protiens in the blood
Medical emergency - bleeding, retinal haemorrhage, stroke, heart failure

Med 2 (22 decks)

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