Week 20 - Case 1,2,3 Flashcards
what should happen if someone as B symptoms of fever, weight loss, night sweats and a neck lump
referred to the haematologist as an urgent 2 week wait referral
does leukaemia present with lymphadenopathy
rarely - this is more in keeping with lymphoma
what are the characterisitcs of Reed-Sternberg cells
large cells that are either multi-nucleated cells, or have bilobed nuclei
where are lymphocytes present
in the circulation, bone marrow, lymph noes and other organs that form the reticulo-endothelial system, such as the liver and spleen
how are Non-Hodgkin’s lymphoma characterised
by diffuse, or nodular abnormal lymphocytes
what are the types of Hodgkin’s lymphoma
nodular sclerosis
mixed cellularity
lymphocyte depleted
what are the types of non hodkins lymphoma
High grade e.g. Diffuse Large B-cell Lymphoma & Burkitt’s Lymphoma
Lymphocyte-rich Low-grade: Follicular lymphoma
what are low grade tumours
these tumours grow slowly and may not require treatment for long periods
when they do need treatment, they are likely ro respond well to chemotherapy, but thet are very rarely cured
follicular lymphomas are low grade non-hodgkin lymphoma
what is the common used clincial staging system
the Ann Arbor System
what are the stages of the Ann Arbor system
Stage 1 : One group of lymph nodes is affected.
Stage 2: Two or more groups of nodes are affected, but the lymphoma is restricted to one side of the diaphragm only.
Stage 3: Lymphadenopathy is evident on both sides (above and below) of the diaphragm.
Stage 4: The lymphoma has spread beyond the lymph nodes to other organs such as the spleen, bone marrow, liver or lungs.
why is a letter code added to each of the above stages
A or B is added to indicate whether or not the patient has systemic symptoms such as weight loss, fevers, or night sweats
what is radiotherapy
the use of ionising radiation to treat malignant disease
what does radiotherapy preferentially treat
dividing cells and can be targeted to include the tumour and avoid normal tissue
what are the late side effects of treatment
risk of second cancers, and cardiac or hormonal problems, depending on what treatments patients recieve
is follicular NHL curable
no
what does the term purpura describe and what does it signify
purpura is the appearance of a non-blanching purple-red spots of the skin
it signifies bleeding vessels near the surface and can also occur in the mucous membrane
what are larger purpura called
ecchymoses
what size are petechiae normally
normally <1cm in size
if a bone marrow biopsy shows >20% blasts what is the most likely diagnosis
confirms the diagnosis of acute myeloblastic leukaemia (AML)
can ALL present with blasts
ALL can also present with blasts
in acute forms of leukaemia what is the peripheral blood film dominated bt
the immature cells which will be referred to as acute myeloblastic or lymphoblastic leukaemia
when does ALL develop
when a B/T precursor stage lymphoid progenitor cell becomes genetically altered through somatic changes and undergoes uncontrolled prolideration
when is ALL usually diagnosied
in those aged under 20 yeats
what is a key risk factor for CLL
being over 60 years old
what is CLL diagnosed by
full blood count with differential, blood smear showing smudge cells, and flow cytometry
when does incidence of CML peak
65-74 years
how is diagnosis of CML confirmed
Diagnosis should be confirmed by the presence of the Philadelphia chromosome and/or the BCR-ABL1 transcripts in peripheral blood or bone marrow cells.
what kind of sepsis can chemotherapy make more lilely
Chemotherapy can have an effect on your bone marrow, reducing the amount of neutrophils made. This can put patients at an increased risk of infection and neutropenic sepsis. It is essential that this is recognised early, and that he receives intravenous antibiotics within 1 hour.
what is the management of neutropenic sepsis
IV tazocin
blood transfusion
intravenous fluids
what is Filgrastim
a recombinant human granulocyte colony stimulating factor that stimulates the production of neutrophils
what does a combination of back pain, normochromic anaemia and hypercalcaemia make you concerned about
malignancy
this would include spinal metastasis, from a yet unknown primary or multiple myeloma
what is pamidronate
a bisphosphonate used to treat hypercalcaemia
what are the classcial symptoms of myeloma
CRaB
Hypercalcaemia
renal impairment
anaemia
bony lesions
when should serum calcium levels always be interpreted
after correction for albumin
how does symptomatic hypercalcaemia present
with confusion, disorientation, muscle weakness, constipation, anorexia, polyuria and polydipsia
in newly diagnosed myeloma patients, what percentage have renal impairement and why
20-40%
typically due to light chain deposition within the distal and collecting renal tubules, or hypercalcaemia
what kind of imaging is used to identify lytic lesions in myeloma
MRI
what are detected in the urine of patients with multiple myeloma
Bence Jones proteins - monoclonal globulins
what is diagnosis of multiple myeloma based on
serum and urine protein electrophoresis, bone marrow examination and whole body low dose CT demonstrating lytic lesions
what is shown in the bone marrow that confirms the diagnosis of multiple myeloma
monoclonal plasma cells in the marrow - approximately 20%
Which is the most common haematological malignancy in the UK?
Non-Hodgkin’s Lymphoma.
13,413 new cases in UK 2013.
What factors are important in the choice of chemotherapy in a 30 year old man with lymphoma?
patient wishes
past medical history
histology
What factors have been shown to be strongly associated with development of haematological malignancies?
infection
unknown
previous treatment for cancer
reduced immunity
Which of the following conditions can be cured?
Advanced stage follicular lymphoma
Classical Hodgkin’s lymphoma.
Multiple Myeloma.
Diffuse large B cell Lymphoma.
Acute myeloid leukaemia.
classical Hodgkin’s lymphoma
Diffuse large B cell lymphoma
acute myeloid leukaemia
what is primary myelofibrosis
chronic progressive pyeloproliferative neoplasm
what is the median survival of primary myelofibrosis
approximately 6 years
what are the hallmarks of primary myelofibrosis
bone marrow fibrosis, extramedullary haemotopoeisis, leukoerythroblastosis, and splenomegaly
what should be considered as treatment for patients with symptomatic and/or high risk primary myelofibrosis
treatment with Janus Kinase inhibitors and haemopoieitc stem cell transplants
what is death in primary myelofibrosis usually due to
due to bone marrow failure (haemorrhage, anaemia or infection), transformation to acute leukaemia, portal or pulmonary hypertension, heart failure, cachexia, or severe myeloid metaplasia with organ damage.
what is secondary/reactive myelofibrosis
fibrosis in the bone marrow due to another disorder, drug treatment or toxic agent
what are the risk factors for myelofibrosis
radiation exposure
industrial solvent exposure
age >65 years
cytogenetic abnormalities
