Cancer Flashcards
(33 cards)
What is a myeloma?
Plasma cell dyscrasia
Due to malignant proliferation of plasma cells
i.e neoplasm of BM plasma cells occurs during terminal differentiation of B cells to plasma cells
What 2 outcomes can happen from myeloma formation?
- Diffuse BM infiltration → bone destruction (↑osteoclast/ ↓osteoblast → ↑Ca2+) + marrow failure
- Secretion of Ig/paraprotein→ organ dysfunction esp. renal
What are the risk factors for myeloma?
70yo
Afro-carribbean
RAS & oncogene mutation
What are the sub-classifications of myeloma?
Classified by Ab produced IgG: Most commpon IgA IgM IgD
What are the Sx of myeloma?
BONE: Backache (COMMON) Bone pain Pathological # Vertebral collapse HyperCa BLOOD: Anaemia → lethargy Neutropenia → Recurrent infections Thrombocytopenia → Bleeding/bruising
What are the signs of multiple myeloma?
CRAB C: Ca↑↑ (polyuria, polydipsia, N&V) R: Renal failure A: Anaemia B: Bone lesions
How does renal impairment occur in myeloma?
Light Ig chain deposit w/ Tamm-Horsfall protein in distal loop of Henle
How is myeloma investigated?
- Blood: FBC, ↑Urea ↑Creat ↑Ca2, ALP, ↓Hb, Persistently ↑ESR
- Blood Film: Rouleaux formation (red cells stack on each other = ↑ESR)
- Serum electrophoresis: MONOCLONAL PROTEIN BAND
- Urine electrophoresis: BENCE JONES PROTEIN
- Marrow Aspirate + Trephine biopsy
- Skeletal survey: CXR/Spine/Skull/pelvis
What are the radiological signs of myeloma?
Lytic bone lesions (pepper-pot skull)
Vertebral collapse
Fractures
Osteoporosis
What is the diagnostic criteria for myeloma?
Symptomatic: ALL 3=
1) Monoclonal plasma cells in marrow ≥10%
2) Monoclonal protein in serum/urine (if non-secretory; need ≥30% monoclonal plasma cells in BM)
3) Evidence of myeloma-related organ or tissue impairment: CRAB Sx
How is myeloma managed?
CHEMO: Intensive or low intensity Bisphosphonates = Bone- help ↓#/pain Transfusion + EPO Fluids = Renal failure Abx = Infection
What needs regular monitoring in someone with myeloma?
Every 2-3m: FBC Creatinine Ca2+ Serum/urine EP
What is the diagnosis if ↑paraprotein but do not meet the diagnostic criteria for myeloma?
MGUS
What is Hodgkin’s lymphoma?
Malignant proliferation of lymphocytes
Accumulate in LN & peripheral blood/organs
What are the risk factors for Hodgkin’s lymphoma?
Male
Young
Infection: EBV
Autoimmune: SLE, Post-transplant
How does Hodgkin’s lymphoma present?
LYMPHADENOPATHY- 75% painless, non-tender, rubbery, superficial, asymmetrical
3 B Sx required:
- Fever >38
- Weight loss >10% (in 6m)
- Night sweats
- Spleno/hepatomegaly
How is Hodgkin’s lymphoma investigated?
-Tissue biopsy:
1) LN EXCISIONAL BIOPSY
2) USS guided needle biopsy
Histology: Reed-Sternberg cells
-Bloods: ↑ESR or ↓Hb (poor prog), ↑LDH
-CXR/PET/CT: Staging
What are the histological classifications of Hodgkin’s lymphoma?
A) Nodular sclerosis- Most common 70%, LACUNAR cells
B) Mixed cellularity- GOOD prognosis, REED-STERNBERG cells
C) Lymphocyte predominate- BEST prognosis
D) Lymphocyte depletion- WORST prognosis
What is used to stage Hodgkin’s lymphoma?
Ann Arbor System
How is Hodgkin’s lymphoma managed?
Chemo: ABVD A: Adrimycin B: Bleomycin V: Vinblastine D: Dacarbazine
What is non-Hodgkin’s lymphoma?
ALL lymphomas without Reed-Sternberg cells
Typically derived from B-cell lines
Diffuse large B-cell lines most common
What are the types of non-Hodgkin’s lymphoma?
75% Nodal
25% Extra-nodal
What are the causes of non-Hodgkin’s lymphoma?
Immunodeficiency: Chemo, HIV, H.Pylori, Toxins, EBV
Congenital
In which (Hodgkin’s/non-Hodgkin’s) are B symptoms more common?
Hodgkin’s
