Cancers Flashcards by Molly Richard

What are CD20 and CD3 markers for respectively?

CD20 is a B cell marker

CD3 is a T cell marker

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What disease is IgG4 related?

Castlemans disease (causes lymphadenopathy)

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Generalised lymphadenopathy suggest a systemic inflammatory process or widespread malignancy. Which malignancies should be highest on your list of differentials?

Lymphoma

Leukaemia

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What are the surfaces of the spleen?

Diaphragmatic surface

Visceral surfaces; L kidney, gastric fundus, tail of the pancreases and splenic flexure of the colon

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Describe the arterial supply and venous drainage of the spleen

Supplied by the splenic artery (branch of the coeliac axis)

Drained by the splenic vein (joins the SMV to form the portal vein)

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What are some of the possible causes of splenomegaly?

Infection

Congestion

Haematological malignancies

Haemolytic anaemia

ITP

Myeloproliferative disorders

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What are some of the possible causes of hyposplenism?

Splenectomy

Coeliac disease

Sickle-cell disease

Sarcoidosis

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What are Howell-Jolly bodies indicative of?

Hyposplenism

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What is meant by pancytopenia?

A deficiency of blood cells of all lineages

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Give an example of an inherited marrow failure syndrome which results in pancytopenia. How does this condition present?

Faconi’s anaemia

Very rare
Macrocytosis, thrombocytopenia, neutropenia
Skeletal abnormalities and short stature
Café au lait spots
Hypogenitalia

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What are some examples of causes of acquired primary bone marrow failure?

Idiopathic aplastic anaemia

Myelodysplastic syndromes

Acute leukaemia

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What are some examples of causes of acquired secondary bone marrow failure?

Drugs

B12/ folate deficiency

HIV

Lymphoma

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What are some of the clinical features of pancytopenia?

Anaemia (fatigue and SOB)

Neutropenia (infections)

Thrombocytopenia (bleeding)

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What investigations should be done to establish the cause of pancytopenia?

FBC and blood film

B12 and folate

Virology

Autoantibody tests

Bone marrow examination

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Pancytopenia can involve different marrow cellularities. In which conditions would you expect marrow to be HYPOcellular vs HYPERcellular?

HYPOcellular =
Aplastic anaemia

HYPERcellular =
myelodysplastic syndromes
B12/ folate deficiencies
Hypersplenism

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How is pancytopenia managed?

Transfusions of red cells/ platelets/ neutrophils

Specific treatments for the underlying cause

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Types of haematological malignancies are based on the anatomical site involved. Where do leukaemia, lymphoma and myeloma involve?

Leukaemia - blood
Lymphoma - lymph nodes
Myeloma - plasma cells in marrow

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What type of leukaemia can affect blood AND lymph nodes?

Chronic lymphocytic leukaemia

acute leukaemia affect blood only

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What are the lifespans for RBCs, neutrophils and platelets?

RBCs - 120 days

Neutrophils -7-8 hours

Platelets - 7-10 days

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What are blasts?

Nucleated precursor cells

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What are megakaryocytes?

Platelet precursors

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What are haematopoietic cells?

Cells which are able to renew

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What is the normal amount of free light chain production by normal plasma cells?

0.5g/ day

excess can leak into the urine as bence jones protein

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What is meant by paraproteinaemia?

Presence of excessive amounts of myeloma protein or monoclonal gamma globulin in the blood

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What are some of the possible causes of paraproteinaemia?

MGUS Myeloma Amyloidosis Lymphoma Chronic lymphocytic leukaemia Plasmacytoma

What is myeloma?

Plasma cell malignancy

What is the premalignant condition that may develop into myeloma?

MGUS

How does myeloma present?

Hypercalcaemia; stones/ bones/ abdominal groans/ psychiatric moans/ thirst and dehydration Bone pain and wedge compression fractures

How is myeloma classified?

Classified by the type of antibody produced e.g IgA/ IgE etc. There may be light chains alone which is called Bence Jones myeloma.

Which classification of myeloma is most associated with kidney damage?

Bence jones myeloma (free light chains) Deposition of light chains causes cast nephropathy

What symptoms should you ask about in a patient presenting with lymphadenopathy? (these are all symptoms which may be suggestive of lymphoma or another cause)

Weight loss Night sweats Fever Fatigue Itch Alcohol induced pain

What is lymphoma?

A malignant proliferation of lymphocytes

How does the lymphadenopathy feel in lymphoma?

Non-tender Rubbery soft and smooth

How is lymphoma classified?

Hodgkin's Non-hodgkin's; B-NHL; high grade and low grade T-NHL

Which is more likely to be curable, low or high grade NHL?

High grade is more likely to be curable as it is more sensitive to chemotherapy Low grade are slow growing but not curable

What investigations should be done for myeloma?

Immunohistochemistry Immunohistochemistry Genetic analysis Biopsy Imaging

What are the treatment options for myeloma?

Chemotherapy Radiotherapy Stem cell transplantation

What is leukaemia?

Malignancy of the marrow/ blood with maturation defects

Which type of malignancy involves an excess of blasts in either the peripheral blood or the bone marrow?

Leukaemia

What happens to haemopoietic reserve in leukaemia?

There is decreased normal haemopoiesis reserve (low platelets, neutrophils and anaemia) This is because there is an excess of blasts - too many primitive cells and not enough mature cells

Which type of acute leukaemia is more common in elderly patients?

Acute myeloid leukaemia (AML)

Which type of acute leukaemia is the most common childhood cancer?

Acute lymphoblastic leukaemia (ALL)

What investigations should be done for acute leukaemia?

Blood count and film Coagulation screen Immunophenotyping by flow cytometry (this clarifies the lineages involved)

What would be the expected blood film appearance in acute leukaemia?

Abnormal blasts high nuclear: cytoplasmic ratio

Auer Rods in the blood film is indicative of which type of leukaemia?

Acute myeloid leukaemia

How is acute lymphoblastic leukaemia managed?

Chemotherapy of varying intensity over 2-3 years

How is acute myeloid leukaemia managed?

Intensive chemotherapy - between 2-5 cycles over several months - requires prolonged hospitalisation

What are the treatment options for myeloma?

Chemotherapy Monoclonal antibody therapy Autologous haematopoietic stem cell transplant (AHSCT) Symptom control

What is AL amyloidosis?

A rare disorder involving small plasma cell clones There is a mutation in light chains

How is AL amyloidosis investigated?

Organ biopsy - congo red stain

How is AL amyloidosis managed?

Chemotherapy

What is waldenstrom's macroglobulinaemia (IgM paraprotein)?

Clonal disorder of cells intermediate between a lymphocyte and a plasma cell Involves characteristic IgM paraprotein

What are some of the clinical features of Waldenstrom's macroglobulinaemia?

Fatigue Visual disturbance Confusion Coma Bleeding Cardiac failure

How is Waldenstrom's macroglobulinaemia managed?

Chemotherapy Plasmapheresis

How does plasmapheresis work?

Removes the patient plasma and replaces it with donor plasma

Patients with acute leukaemia are more likely to suffer from sepsis due to which classification of bacteria

Gram negative

For cell cycle specific chemotherapy agents, what is more important; duration of exposure or dose?

Duration of exposure

For non-cell cycle specific chemotherapy agents, what is more important; duration of exposure or dose?

Dose

What are some of the general side effects of cytotoxic drugs?

Bone marrow suppression Gut mucosal damage Hair loss (immediate affects are on rapidly dividing organs)

What specific side effect are vinca alkaloids (cytotoxic chemotherapy agents) associated with?

Neuropathy

What specific side effect is cis-platinum (cytotoxic chemotherapy agent) associated with?

Nephrotoxicity

What specific side effect are anthracyclines (cytotoxic chemotherapy agents) associated with?

Cardiotoxicity / cardiomyopathy

Which cytotoxic chemotherapy agents are associated with infertility as a long-term side effect?

Alkylating agents

What is meant by autologous Vs allogeneic stem cell transplantation?

Autologous stem cell transplantation uses the patients own stem cells Allogeneic stem cell transplantation is from a sibling or someone unrelated

What are some of the characteristics of multiple myeloma?

Osteolytic lesions Increased infections Monoclonal IgG or IgA paraprotein bands

What would happen to calcium, phosphate and ALP levels in a patient with myeloma without metastasis?

High calcium Normal/ high phosphate Normal ALP

What is the mechanism of action of rituximab? Which condition is it used to treat?

Tyrosine kinase inhibitor that inhibits BCR-ABL-1 protein This protein is unique to chronic myeloid leukaemia

What is the mechanism of action of rituximab? Which condition is this used to treat?

Rituximab is a monoclonal antibody against CD20 which is expressed on B cells and B cell lymphomas

Cancers Flashcards

(68 cards)