Oncology Flashcards by Zahir Ijaz

Sign of asplenism/hyposplenism

Howell Jolly bodies on blood film
(RBCs don’t have nuclei, but when they’re developing they do). So these are the remnants of RBC nuclei that’re normally removed by the spleen.

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What is lymphoma- basic

lymph system is part of immune system that contains WBCs. Cancer in lymphatic system.

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Hodgkin’s Lymphoma blood film finding

Reed-Sternberg Cells
(bi lobed multinucleated lymph cells, Owl’s eye appearance)

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How are lymphomas staged

Ann Arbor staging- basically are the affected nodes above or below the diaphragm

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lymphoma complications and management

increased infection risk, cancer spreading

surgery
chemo and radiotherapy

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Hodgkin’s Lymphoma symptoms

B symptoms: Fever, night sweats, unexplained weight loss >10% in 6 months.
Other symptoms- fatigue, itching, cough, SOB, Abdo pain, recurrent infections
Painless, gradual rubbery lump- lymphadenopathy. Pain when they drink w/ alcohol
Mediastinal mass -> dry cough or SVCO
Hepatosplenomegaly and/or pruritus

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Risk factors for Hodgkin’s lymphoma

young adult and elderly
Epstein barr virus
HIV
Immunosuppression

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Hodgkin’s lymphoma diagnosis

excision biopsy

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Hodgkin’s lymphoma treatment

chemotherapy and radiotherapy adjunct
ABVD
Adriazamycin
Bleomycin
Vinblastine
Dacarbazine

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Non Hodgkin’s lymphoma symptoms

painless lymphadenopathy
constitutional B symptoms- occur later in NHL than in HL
Weight loss
palpable abdo mass
testicular mass
fever

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NHL risk factors

HIV (susceptible to EBV), immunosuppression, H pylori, coeliac disease

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What is leukaemia

Cancer of cells in the bone marrow. Genetic mutation in one of the precursor cells in the bone marrow leads to excess production of a single type of abnormal WBC. Leads to suppression of the other cell lines causes underproduction of other cell types- pancytopenia.

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Leukaemia presentation

Fatigue
Fever
Failure to thrive (kids)
Pallor - anaemia
Petechiae and abnormal bruising- thrombocytopenia
Abnormal bleeding
Lymphadenopathy
Hepatosplenomegaly

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leukaemia complications

spread of cancer
increased risk of infections
type of anaemia where immune system attacks RBCs

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leukaemia management

MDT
chemo
stem cell marrow transplant
radiotherapy

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Acute Lymphoblastic Leukaemia (ALL)- what is it? Associated w/ what?

Most common childhood malignancy
Lymphoid progenitor cells (ie mostly B cells but can be T cells) that don’t mature (blast cells) and keep proliferating. Can fill up the bone marrow- blocking normal haematopoetic stem cell function -> marrow failure and infiltrate lymphoid tissues around the body. Associated w/ Down’s

ALL symptoms

Fatigue- not enough RBCs
Dyspnoea
Angina
Recurrent infections- not enough WBCs
Petechiae, nose/gum bleeds (not enough platelets)
Hepatomegaly
Lymphadenopathy
Bone pain
CNS symptoms

ALL diagnosis

Blood film- shows blast cells (large) and marrow aspiration w/ high blast cells
LDH is often raised leukaemia
Bone marrow biopsy

Acute myeloid Leukaemia (AML)- what is it?

Most common acute leukaemia in adults. Myeloid progenitor cells (should become RBCs, platelets or non lymphoid WBCs) that don’t mature and proliferate

AML features

Anaemia: pallor, lethargy, weakness
Neutropenia
Thrombocytopenia: bleeding
Splenomegaly
Bone pain
Infections, easy bleeds and anaemia

AML blood film findings

high proportion of blast cells. These blast cells can have Auer rods (needle shaped structures in the cell body)

Chronic Myeloid Leukaemia (CML) - what is it

uncontrolled proliferation of myeloid cells. Has 3 phases:
Chronic- often asymptomatic
Accelerated - when abnormal blast cells take up a high proportiopn of the cells in the bone marrow and blood. Pts become more symptomatic - develop anaemia and thrombocytopenia.
Blast - involves an even higher proportion of blast cells in the blood. Severe symptoms and pancytopenia. Often fatal

What cytogenic phase is characteristic of CML?

Philadelphia chromosome, which is a translocation of genes bwt chromosomes 9 and 22.

CML symptoms

Chronic and slowly developing symptoms such as fatigue, fever, sweats and weight loss
Anaemia- lethargy
Gout
Bleed easily
Splenomegaly

CML blood film findings

immature and mature myeloid cells. Also have a v high WBC w/ all cell types (except lymphocytes which'll be low)

CML treatment

Treat w/ tyrosine kinase inhibitors- eg imatinib In final phase it's managed like ALL w/ usually stem cell transplant

Chronic lymphocytic leukaemia (CLL)- what is it?

Most common leukaemia and is the malignant proliferation of incompetent but matured B cells. Usually affects over 70s

CLL presentation

often asymptomatic but may have infections, anaemia, malaise, weight loss, night sweats, hepatosplenomegaly, painless lymphadenoapthy Death happens due to infection or transformation to Richter's lymphoma (worse version of CLL)

CLL blood film appearance

smear or smudge cells- aged/fragile ~WBCs rupture and leave a smudge on the film

CLL treatment

Mostly chemo, TKIs, steroids if all else fails use allogenic stem cell transplants

Multiple myeloma - what is it?

Haematological malignancy of mature plasma cells (activated B cells). It secretes excess monoclonal antibody. 2nd most common haematological malignancy

Multiple Myeloma risk factors

Age Family history Black African Male Obesity

Multiple myeloma symptoms

CRABBI Calcium- elevated (due to increased osteoclast activity) Renal failure (dysfunctional plasma cells release lots of immunoglobulin that can block flow thru the tubules Anaemia - invade the bone marrow and prevent RBC generation Bone lesions/pain- increased osteoclast activity caused by cytokines released from the plasma cells and the bone stromal cells when they're in contact w/ the plasma cells. Leads to lytic lesions and can cause fractures as the bone is weak. Bleeding- thrombocytopenia Infection- neutropenia Other symptoms: spinal cord compression, hyperviscosity of plasma, recurrent infections

Multiple myeloma investigations

BLIP Bence Jones monoclonal proteins (found in urine or serum via electrophoresis- remnants of antibodies produced by plasma cells) serum free Light chain assay serum Immunoglobulins serum Protein electrophoresis Bone marrow biopsy is necessary to confirm the diagnosis Imaging for bone lesions- whole body MRI, CT, skeletal survey (xray)

Multiple myeloma x ray signs

punched out lesions lytic lesions raindrop skull- caused by many punched out (lytic) lesions throughout the skull that give the appearance of raindrops splashing on a surface

Multiple myeloma management

control disease usually relapsing remitting MDT first line involves a combo of chemo w/ Bortezomid, Thalidomide, Dexamethasone Stem cell transplants VTE prophylaxis Myeloma bone disease management: Bisphopsohnates- suppress osteoclast activity Radiotherapy to improve pain Cement augmentation involves injecting cement into vertebral fractures or lesions and can improve spine stability and pain

Multiple myeloma complications

Infection Pain Renal failure Anaemia Hypercalcaemia Peripheral neuropathy Spinal cord compression Hyperviscosity