Oncology Flashcards
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.
What is lymphoma- basic
lymph system is part of immune system that contains WBCs. Cancer in lymphatic system.
Hodgkin’s Lymphoma blood film finding
Reed-Sternberg Cells
(bi lobed multinucleated lymph cells, Owl’s eye appearance)
How are lymphomas staged
Ann Arbor staging- basically are the affected nodes above or below the diaphragm
lymphoma complications and management
increased infection risk, cancer spreading
surgery
chemo and radiotherapy
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
Risk factors for Hodgkin’s lymphoma
young adult and elderly
Epstein barr virus
HIV
Immunosuppression
Hodgkin’s lymphoma diagnosis
excision biopsy
Hodgkin’s lymphoma treatment
chemotherapy and radiotherapy adjunct
ABVD
Adriazamycin
Bleomycin
Vinblastine
Dacarbazine
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
NHL risk factors
HIV (susceptible to EBV), immunosuppression, H pylori, coeliac disease
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.
Leukaemia presentation
Fatigue
Fever
Failure to thrive (kids)
Pallor - anaemia
Petechiae and abnormal bruising- thrombocytopenia
Abnormal bleeding
Lymphadenopathy
Hepatosplenomegaly
leukaemia complications
spread of cancer
increased risk of infections
type of anaemia where immune system attacks RBCs
leukaemia management
MDT
chemo
stem cell marrow transplant
radiotherapy
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
