Oncology

Question 1

What are the types of leukaemia?

Answer 1

ALL: 25%
AML: 5%
CML: Rare

Question 2

What ages are affected by each type of leukaemia?

Answer 2

ALL: 2-6yrs
AML: <2yrs
CML: <1yr & teens

Question 3

What are the signs & symptoms of ALL?

Answer 3

Days-weeks
Pancytopenia
Bone marrow expansion
Lymphadenopathy
Petechiae
Pallor
Fatigue
Limp
Airway obstruction
Bruising
Pleural effusion
Joint swelling/pain

Question 4

How is ALL investigated?

Answer 4

BM: Biopsy, cytogenetics, morphology, immunophenotype
H&E Blood Film
CXR: Mediastinal disease
Bloods: Anaemia, neutropenia
Testicular exam (swelling)

Question 5

How is AML investigated?

Answer 5

BM Biopsy

Bloods: Low neutrophils, prolonged PTT

Question 6

What are the signs & symptoms of CML?

Answer 6

Non-specific
Fever
Night sweats
Hepatosplenomegaly

Question 7

What are the signs & symptoms of AML?

Answer 7

Fatigue
Bleeding
Bruising
SOB
Infection
Lymphadenopathy

Question 8

How is ALL treated?

Answer 8

Induction: 4 weeks
Dexamethasone, weekly IV Vincristine. IV Daunorubicin,
CNS involvement: Intrathecal Methotrexate
BM transplant
Maintenance for 2y: Oral Methotrexate & 4weekly Vincristine IV bolus

Question 9

How is AML treated?

Answer 9

60% survival
4-5 courses intensive myoablative Chemo
High risk: Complete remission failure after 2y should have BMT in 1st remission
Stem Cell transplant

Question 10

What is CML associated with?

Answer 10

Philadelphia Chromosome

t(9;22)

Question 11

What are the RFs for AML?

Answer 11

Trisomy 21 (x30 higher than average)

Question 12

What is the pathophysiology of ALL?

Answer 12

Accumulation in the BM of immature B & T lymphocyte precursor cells (blast cells)
Eventually normal blood cell affected
Results in reduction in no. of RBCs, normal white cells & platelets

Question 13

What is the pathophysiology of AML?

Answer 13

Malignant proliferation of myeloid precursors

Granulocytes/ Monocytes/ neutrophils

Question 14

What are the 2 types of lymphoma?

Answer 14

Non-Hodgkins Lymphoma: Most high grade

Hodgkins Lymphoma

Question 15

What are the RFs for NHL?

Answer 15

Immunosuppressed

EBV

Question 16

How does NHL present?

Answer 16

Progressive painless lymphadenopathy
B symptoms (fever, night sweats, weight loss)

Question 17

How is NHL investigated?

Answer 17

BM Aspirate
LP
CT/PET
Peritoneal Aspirate
Exclusional biopsy

Question 18

How is NHL managed?

Answer 18

Chemo
RT
Monoclonal antibodies

Question 19

What is the prognosis of NHL & Hodgkins?

Answer 19

NHL: >70% survival
H: >90% 5yr

Question 20

What are the RFs of Hodgkin’s lymphoma?

Answer 20

EBV
HIV
Immunosuppression

Question 21

How does Hodgkin’s lymphoma present?

Answer 21

Progressive painless lymphadenopathy (80% cervical)
B symptoms (fever, night sweats, weight loss)
Hepatosplenomegaly

Question 22

How is Hodgkin’s lymphoma investigated?

Answer 22

Histology: Reed-Sternberg cells (double nuclei) from B lymphocytes
Lymph node biopsy
EBV Serology
Bloods: ESR
Stage4: Isotope bone scan

Question 23

How is NHL and Hodgkin’s lymphoma staged?

Answer 23

NHL: St Jude staging
H: Ann Arbor staging

Question 24

How is NHL classified?

Answer 24

Lymphoblastic: Anterior mediastinal mass, disease may be present in bone, BM, skin, CNS, liver, kidney, spleen
Mature B cell: Burkitt, abdo, head&neck, BM, CNS, may grow rapidly
Large Cell: diffuse large cell, aplastic, extranodal sites (Skin & bone), CNS & BM rare, painful lymphadenopathy

Question 25

What is the St Judes system?

Answer 25

I: Single site/nodal area
II: Regional nodes/ abdominal disease
III: Disease on both sides of diaphragm
IV: Bone marrow/ CNS disease

Question 26

How is Hodgkin’s lymphoma treated?

Answer 26

Stage 1: May be cured, short course chemo or RT
Stage 2-4: Combination chemo (alkylating agents, steroids, anthracyclines), RT for bulky mediastinal disease/ residual disease