1 Flashcards
- Q. What occurs in multiple myeloma?
A. Accumulation of malignant plasma cells (B lymph) in the bone marrow leading to progressive bone marrow failure
- Q. What is the common presentation of multiple myeloma?
A. Tiredness and malaise, bone/back pain + fractures, infections
- Q. What characteristic product is produced in multiple myeloma?
A. Paraprotein
- Q. What systems are affected in multiple myeloma?
A. Renal failure
B. Destructive bone disease and hypercalcaemia
- Q. How does multiple myeloma effect bone density? Which cells are involved?
A. Increase bone resorption (osteoclasts), Decreased bone production (osteoblasts)
B. Uncoupling of resorption/production = rapid bone loss
- Q. Name 2 osteoclast activating factors and osteoblast inhibitory factor
A. Osteoclast activating factors: RANKL, MIP1-alpha, IL-3
B. Osteoblast inhibitory factors: Dkk-1, sFRP-3, HGF, TGF-beta1
Why is there renal impairment in multiple myeloma?
renal impairment –
- Malignant cells secrete/produce monoclonal proteins of varying types most commonly immunoglobulins (antibodies) and free light chains, resulting in abnormally high levels of proteins in the blood. The delicate structure of the kidney can be damaged by tubulopathtic effects of proteins or light chains.
- Hypercalcemia = nephrocalcinosis = leading to kidney failure
- Amyloidosis: high levels of amyloid protein, amyloid is excreted via the kidney – may cause damage
- (Hyperuricemia, recurrent infections, local infiltration of tumour cells, drug induced kidney failure may also contribute)
- Q. Which neuro symptoms may be multiple myeloma and why?
A. Anaemia/hypercalcemia – may manifest weakness, confusion and fatigue
B. Hyperviscosity of blood due to paraprotein – may manifest headache, visual and retinopathy
C. Spinal cord compression and infiltration of amyloid in peripheral nerves – may result in radicular pain, loss of bowel/bladder control
- Q. What imaging techniques are used in MM?
A. CT: first-line
B. MRI: good definition of bone/anatomy used to clarify ambiguous lesions, myeloma ‘pepper pot skull’, also used to assess spinal cord leisons
- Q. What are the three overlapping aims of treatment for MM?
A. Anti-myeloma treatment
a. combination chemotherapy e.g. CTD, MPT, HD-ASCT
B. Prevention and treatment of bone and tissue damage
a. Bisphosphonates, renal dialysis, MSCC treatment (radiotherapy, surgery), pain
C. Improve quality of life and survival
a. Infection prophylaxis and treatment, anaemia (EPO, transfusion)
- Q. What is lymphoma and where does it occur?
A. Malignant growth of WBCs B. Predominatly in lymph nodes C. Bone marrow, blood D. Liver, spleen E. Can occur anywhere
- Q. How does lymphoma present?
A. In a variety of ways: depending on system affected
B. Weight loss, night sweats, most commonly nodal disease
C. Also extra-nodal disease (malignant WBCs in other places)
D. Compression syndromes (DVT/swollen leg due to compression)
E. Systemic symptoms
- Q. How is lymphoma diagnosed?
A. Blood film & bone marrow
B.
Lymph node biopsy (often image guided)
C. Immunophenotyping
D. Cytogenetics: karyotype analysis, FISH
E. Blood film & bone marrow
F. i.e. diagnosis is complex
G. Staging: blood tests, CT scan, bone marrow biopsy, PET
- Q. What are the two main types of lymphoma?
A. Hodgkin’s lymphoma
B. Non-Hodgkin’s
- Q. Name the presentation of Hodgkin’s lymphoma
A. Painless lymphadenopathy, B symptoms (sweats, weightloss)
B. Diagnosis: Reed-Sternberg cell
C. Incidence: Hodgkin’s lymphoma affects younger people at a higher rate and has a bimodal peak rate