Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Y4 Cancer Care > Haematological Cancers > Flashcards

Haematological Cancers Flashcards

(82 cards)

Start Studying
1
Q

Leukaemia is cancer of a particular line of stem cells in the bone marrow, causing unregulated production of a specific type of blood cell.

The types of leukaemia can be classified depending on how rapidly they progress (chronic is slow and acute is fast) and the cell line that is affected (myeloid or lymphoid) to make four main types:

A

Acute myeloid leukaemia (rapidly progressing cancer of the myeloid cell line)

Acute lymphoblastic leukaemia (rapidly progressing cancer of the lymphoid cell line)

Chronic myeloid leukaemia (slowly progressing cancer of the myeloid cell line)

Chronic lymphocytic leukaemia (slowly progressing cancer of the lymphoid cell line)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What patient group is most affected by leukaemia?

A

Most types of leukaemia occur in patients over 60-70. The exception is acute lymphoblastic leukaemia, which most commonly affects children under five years.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

the most common leukaemia in children and is associated with Down syndrome =

A

ALL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

leukaemia associated with warm haemolytic anaemia, Richter’s transformation and smudge cells =

A

CLL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

leukaemia with three phases, including a long chronic phase, and is associated with the Philadelphia chromosome =

A

CML

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

leukaemia that may result in a transformation from a myeloproliferative disorder and is associated with Auer rods =

A

AML

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the pathophysiology of leukaemia?

A

A genetic mutation in one of the precursor cells in the bone marrow leads to excessive production of a single type of abnormal white blood cell.

The excessive production of a single type of cell can suppress the other cell lines, causing the underproduction of different cell types. This can result in pancytopenia, which is a combination of low red blood cells (anaemia), white blood cells (leukopenia) and platelets (thrombocytopenia).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How may leukaemia present?

A

Fatigue
Fever
Lymphadenopathy
Hepatosplenomegaly
Pallor due to anaemia
Petechiae or bruising due to thrombocytopenia
Abnormal bleeding
Failure to thrive (children)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

One key presenting feature of leukaemia is bleeding under the skin due to thrombocytopenia. Bleeding under the skin causes non-blanching lesions.

These lesions are called different things based on the size of the lesions:

A

Petechiae are less than 3mm and caused by burst capillaries
Purpura are 3 – 10mm
Ecchymosis is larger than 1cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

The top differentials for a non-blanching rash caused by bleeding under the skin are:

A

Leukaemia
Meningococcal septicaemia
Vasculitis
Henoch-Schönlein purpura (HSP)
Immune thrombocytopenic purpura (ITP)
Thrombotic thrombocytopenic purpura (TTP)
Traumatic or mechanical (e.g., severe vomiting)
Non-accidental injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How can leukaemia be diagnosed?

A

FBC within 48 hours

Lactate dehydrogenase (often raised in leukaemia but is a very non-specific marker)

A blood film
Bone marrow biopsy
CT and PET scans for staging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Outline the options for obtaining a bone marrow biopsy

A

usually taken from the iliac crest
involves a local anaesthetic and a specialist needle

The options are aspiration or trephine:
Bone marrow aspiration = taking a liquid sample of cells from within the bone marrow

Bone marrow trephine = solid core sample of the bone marrow, provides a better assessment of the cells and structure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the pathophysiology of ALL?

A

Acute lymphoblastic leukaemia (ALL) affects one of the lymphocyte precursor cells, causing acute proliferation of a single type of lymphocyte, usually B-lymphocytes. Excessive accumulation of these cells replaces the other cell types in the bone marrow, leading to pancytopenia.

ALL most often affects children under five but can also affect older adults. It is more common with Down’s syndrome.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the pathophysiology of CLL? How does it present?

A

Chronic lymphocytic leukaemia is where there is slow proliferation of a single type of well-differentiated lymphocyte, usually B-lymphocytes.

It usually affects adults over 60 years of age.

It is often asymptomatic but can present with infections, anaemia, bleeding and weight loss.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How can CLL be investigated?

A

FBC:
* lymphocytosis
* anaemia: due to bone marrow replacement or autoimmune hemolytic anaemia (AIHA)
* thrombocytopenia: either due to bone marrow replacement or ITP

blood film: smudge cells

immunophenotyping is the key investigation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Give 4 complications of CLL

A

anaemia

hypogammaglobulinaemia leading to recurrent infections

warm autoimmune haemolytic anaemia in 10-15% of patients

transformation to high-grade lymphoma (Richter’s transformation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is Richter’s transformation?

A

when leukaemia cells enter the lymph node and change into a high-grade, fast-growing non-Hodgkin’s lymphoma. Patients often become unwell very suddenly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does Richter’s transformation present?

A

lymph node swelling
fever without infection
weight loss
night sweats
nausea
abdominal pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are smear or smudge cells on blood film?

A

ruptured white blood cells that occur while preparing the blood film when the cells are aged or fragile. They are particularly associated with chronic lymphocytic leukaemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the 3 phases of CML?

A

Chronic phase
Accelerated phase
Blast phase

The chronic phase is often asymptomatic, and patients are diagnosed after an incidental finding of a raised WCC - can last several years before progressing.

The accelerated phase occurs when the abnormal blast cells take up a high proportion (10-20%) of the bone marrow and blood cells. In the accelerated phase, patients are more symptomatic and develop anaemia, thrombocytopenia and immunodeficiency.

The blast phase follows the accelerated phase and involves an even higher proportion (over 20%) of blast cells in the blood. The blast phase has severe symptoms and pancytopenia and is often fatal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How may CML present?

A

Presentation (60-70 years)
anaemia: lethargy
weight loss and sweating are common
splenomegaly → abdo discomfort

On investigation:
an increase in granulocytes at different stages of maturation +/- thrombocytosis
decreased leukocyte alkaline phosphatase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How may CML be managed?

A

imatinib is now considered first-line treatment
- inhibitor of the tyrosine kinase associated with the BCR-ABL defect, very high response rate in chronic phase CML

hydroxyurea

interferon-alpha

allogenic bone marrow transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When does AML commonly present?

A

It can present at any age but normally presents from middle age onwards.

It can be the result of a transformation from a myeloproliferative disorder, such as polycythaemia rubra vera or myelofibrosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What may be found on blood film and bone marrow biopsy in AML?

A

high proportion of blast cells

Auer rods in the cytoplasm of blast cells are a characteristic finding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Give some poor prognostic features in AML
> 60 years > 20% blasts after first course of chemo cytogenetics: deletions of chromosome 5 or 7
26
What targeted therapies can be used to treat leukaemia?
Tyrosine kinase inhibitors (e.g., imantinib) Monoclonal antibodies (e.g., rituximab, which targets B-cells)
27
Give some complications of chemotherapy
Failure to treat cancer Stunted growth and development in children Infections due to immunosuppression Neurotoxicity Cardiotoxicity Infertility Secondary malignancy Tumour lysis syndrome
28
Lymphoma is a type of cancer affecting the lymphocytes inside the lymphatic system. Cancerous cells proliferate inside the lymph nodes, causing the lymph nodes to become abnormally large (lymphadenopathy). What are the 2 main types?
Hodgkin’s lymphoma (a specific disease) Non-Hodgkin’s lymphoma (which includes all other types)
29
Hodgkin’s lymphoma is the most common specific type of lymphoma. It has a bimodal age distribution with peaks around 20-25 and 80 years. Risk factors for Hodgkin’s lymphoma include:
HIV Epstein-Barr virus Autoimmune conditions, such as rheumatoid arthritis and sarcoidosis Family history
30
Non-Hodgkin’s lymphoma includes many types. A few notable ones are:
Diffuse large B cell lymphoma typically presents as a rapidly growing painless mass in older patients Burkitt lymphoma is particularly associated with Epstein-Barr virus and HIV MALT lymphoma affects the mucosa-associated lymphoid tissue, usually around the stomach
31
Risk factors for non-Hodgkin’s lymphoma include:
HIV Epstein-Barr virus Helicobacter pylori (H. pylori) infection is associated with MALT lymphoma Hepatitis B or C infection Exposure to pesticides Exposure to trichloroethylene (a chemical with a variety of industrial uses) Family history
32
How may lymphoma present?
Lymphadenopathy The enlarged lymph nodes might be in the neck, axilla or inguinal region. They are characteristically non-tender and feel firm or rubbery. Patients with Hodgkin’s lymphoma may experience lymph node pain after drinking alcohol B symptoms refer to systemic symptoms of lymphoma: Fever Weight loss Night sweats
33
What clinical findings may help to differentiate Hodgkins and non-Hodgkins lymphoma?
Lymphadenopathy in Hodgkin's lymphoma can experience alcohol-induced pain in the node 'B' symptoms typically occur earlier in Hodgkin's lymphoma and later in non-Hodgkin's lymphoma Extra-nodal disease is much more common in non-Hodgkin's lymphoma than in Hodgkin's lymphoma
34
What extranodal disease may be present in Non-Hodgkin's lymphoma?
gastric (dyspepsia, dysphagia, weight loss, abdominal pain), bone marrow (pancytopenia, bone pain), lungs, skin, central nervous system (nerve palsies)
35
How may lymphoma be investigated?
Excisional lymph node biopsy is diagnostic HIV test (often performed as this is a risk factor for non-Hodgkin's lymphoma) FBC and blood film ESR (useful as a prognostic indicator) LDH CT, MRI, and PET scans may be used to help diagnose and stage the disease
36
What is the characteristic finding from a biopsy of Hodgkin’s lymphoma?
Reed-Sternberg cells They are large cancerous B lymphocytes with two nuclei and prominent nucleoli, giving them a cartoonish appearance of an owl face with large eyes.
37
Investigation findings for Hodgkin's lymphoma?
normocytic anaemia may be multifactorial e.g. hypersplenism, bone marrow replacement by HL eosinophilia caused by the production of cytokines e.g. IL-5 LDH raised lymph node biopsy Reed-Sternberg cells are diagnostic
38
What features suggest a poor prognosis of Hodgkin's lymphoma?
B symptoms: weight loss > 10% in last 6 months, fever, night sweats male age > 45 years stage IV disease haemoglobin < 10.5 g/dl lymphocyte count < 600/µl or < 8% albumin < 40 g/l white blood count > 15,000/µl
39
The Lugano classification system is used for Hodgkin’s and non-Hodgkin’s lymphoma (replacing the older Ann Arbor system). It emphasises whether the affected nodes are above or below the diaphragm. A simplified version is:
Stage 1: Confined to one node or group of nodes Stage 2: In more than one group of nodes but on the same side of the diaphragm (either above or below) Stage 3: Affects lymph nodes both above and below the diaphragm Stage 4: Widespread involvement, including non-lymphatic organs, such as the lungs or liver
40
How can Hodgkin's lymphoma be managed?
chemotherapy and radiotherapy Chemotherapy may result in infections, cognitive impairment, secondary cancers (e.g., leukaemia) and infertility. Radiotherapy creates a risk of tissue fibrosis, secondary cancers and infertility.
41
What chemotherapy regimes may be used in Hodgkin's lymphoma?
ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine): considered the standard regime BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone): alternative regime with better remission rates but higher toxicity
42
What is the main risk to patients with treated Hodgkin's lymphoma?
secondary malignancies are a risk, in particular solid tumours: breast and lung
43
How can non-Hodgkin's lymphoma be managed?
depends on the type and stage. It may involve: Watchful waiting Chemotherapy Monoclonal antibodies (e.g., rituximab, which targets B cells) Radiotherapy Stem cell transplantation
44
Give some complications of Non-Hodgkin's lymphoma
Metastasis Bone marrow infiltration causing anaemia, neutropenia or thrombocytopenia Superior vena cava obstruction Spinal cord compression Complications related to treatment e.g. Side effects of chemotherapy
45
What is the prognosis like for non-Hodgkin's lymphoma?
Low-grade non-Hodgkin's lymphoma has a better prognosis High-grade non-Hodgkin's lymphoma has a worse prognosis but a higher cure rate
46
Burkitt's lymphoma is a high-grade B-cell neoplasm. There are two major forms:
endemic (African) form: typically involves maxilla or mandible sporadic form: abdominal (e.g. ileo-caecal) tumours are the most common form. More common in patients with HIV
47
What are the microscopic findings of Burkitt's lymphoma?
'starry sky' appearance: lymphocyte sheets interspersed with macrophages containing dead apoptotic tumour cells
48
How can Burkitt's lymphoma be managed?
Management is with chemotherapy. This tends to produce a rapid response which may cause 'tumour lysis syndrome'. Rasburicase is often given before the chemotherapy to reduce the risk of this occurring
49
What is myeloma?
a type of cancer affecting the plasma cells in the bone marrow. Plasma cells are B lymphocytes that produce antibodies. Cancer in a specific type of plasma cell results in the production of large quantities of a specific paraprotein (or M protein), which is an abnormal antibody.
50
What is multiple myeloma?
where the myeloma affects multiple bone marrow areas in the body
51
The CRAB mnemonic can be used to remember the four key features of myeloma:
C – Calcium (elevated) R – Renal failure A – Anaemia B – Bone lesions and bone pain
52
Anaemia is the most common complication of myeloma. Why does this occur?
Bone marrow infiltration by myeloma suppresses the other blood cell lines, leading to anaemia (low haemoglobin), leukopenia (low white blood cells) and thrombocytopenia (low platelets). Anaemia in myeloma is normocytic and normochromic.
53
What causes Myeloma bone disease?
cytokines released from abnormal plasma cells = increased osteoclast activity and suppressed osteoblast activity. Osteoclasts absorb bone, and osteoblasts deposit bone. The metabolism of bone becomes imbalanced, with more bone being reabsorbed than constructed.
54
Give some common sites of myeloma bone disease
skull, spine, long bones and ribs
55
What are Plasmacytomas?
individual tumours formed by cancerous plasma cells. They can occur in the bones, replacing normal bone tissue, or in the soft tissues.
56
Patients with myeloma often develop renal impairment, which can have various causes:
Paraproteins deposited in the kidneys Hypercalcaemia affecting kidney function Dehydration Glomerulonephritis (inflammation around the glomerulus and nephron) Medications used to treat the condition
57
Plasma viscosity increases when more proteins are in the blood, such as the paraproteins found in myeloma. Hyperviscosity syndrome is considered an emergency. It can cause many issues:
Bleeding (e.g., nosebleeds and bleeding gums) Visual symptoms and eye changes (e.g., retinal haemorrhages) Neurological complications (e.g., stroke) Heart failure
58
Give some risk factors for developing myeloma
Older age Male Black ethnic origin Family history Obesity
59
The presenting features that should raise suspicion of myeloma include:
Persistent bone pain (e.g., spinal pain) Pathological fractures Hypercalcaemia Anaemia Renal impairment Unexplained fatigue, weight loss, fever
60
Other features of myeloma include:
amyloidosis e.g. macroglossia carpal tunnel syndrome neuropathy
61
What lab investigations are indicated for myeloma?
FBC (anaemia or leukopenia in myeloma) U&E (for renal impairment) Calcium (raised in myeloma) ESR (increased in myeloma) Plasma viscosity (increased in myeloma) Serum protein electrophoresis (to detect paraproteinaemia) Serum-free light-chain assay (to detect abnormally abundant light chains) Urine protein electrophoresis (to detect the Bence-Jones protein)
62
What further investigations are indicated for myeloma?
Bone marrow biopsy is required to confirm the diagnosis and perform cytogenetic testing. Imaging is used to assess for bone lesions. The order of preference is: Whole-body MRI Whole-body low-dose CT Skeletal survey (x-ray images of the entire skeleton)
63
Typical x-ray changes seen in patients with myeloma include:
Well-defined lytic lesions (described as looking “punched-out”) Diffuse osteopenia Abnormal fractures Raindrop skull (sometimes called pepper pot skull) refers to multiple lytic lesions seen in the skull on an x-ray.
64
How can myeloma be managed?
Treatment usually involves a combination of chemotherapy, which may include: Bortezomib (a proteasome inhibitor) Thalidomide Dexamethasone
65
High-dose chemotherapy followed by a stem cell transplant is an option for fitter patients with myeloma and may achieve a more extended period of remission. Stem cell transplantation can be:
Autologous (using the person’s own stem cells) Allogeneic (using stem cells from a healthy donor)
66
Management of myeloma bone disease may involve:
Bisphosphonates to suppress osteoclast activity Radiotherapy for bone lesions can improve bone pain Orthopaedic surgery to stabilise bones (e.g., by inserting a prophylactic intramedullary rod) or treat fractures Cement augmentation (injecting cement into vertebral fractures or lesions) to improve spine stability and pain
67
There are many complications of myeloma and its treatment, including:
Infection Bone pain Fractures Renal failure Anaemia Hypercalcaemia Peripheral neuropathy Spinal cord compression Hyperviscosity syndrome Venous thromboembolism
68
Myeloproliferative disorders involve the uncontrolled proliferation of a single type of stem cell. They are considered a form of cancer occurring in the bone marrow, although they tend to develop and progress slowly. They have the potential to transform into acute myeloid leukaemia. What are the 3 main disorders?
Primary myelofibrosis - haemopoetic stem cells Polycythaemia vera - erythroid cells Essential thrombocythaemia - megakaryocytes
69
What gene mutation might be involved in myeloproliferative disorders?
JAK2. Treatment might involve JAK2 inhibitors, such as ruxolitinib.
70
What is Myelofibrosis?
where the proliferation of a single cell line leads to bone marrow fibrosis, where bone marrow is replaced by scar tissue. This is in response to cytokines released from the proliferating cells e.g. fibroblast growth factor. When the bone marrow is replaced with scar tissue, we see extramedullary haematopoiesis = hepatomegaly, splenomegaly, and portal hypertension.
71
A blood film in myelofibrosis can show:
Teardrop-shaped red blood cells Anisocytosis (varying sizes of red blood cells) Blasts (immature red and white cells)
72
How may myeloproliferative disorders present?
Initially, myeloproliferative disorders may be asymptomatic. They can present with non-specific symptoms: Fatigue Weight loss Night sweats Fever
73
Thrombosis is a common complication of polycythaemia and thrombocythaemia, leading to MI, stroke or VTE Clinical signs of polycythaemia include:
Ruddy complexion (red face) Conjunctival plethora (the opposite of conjunctival pallor) Splenomegaly Hypertension
74
How can myeloproliferative disorders be diagnosed?
Bone marrow biopsy is required to confirm the diagnosis. Bone marrow aspiration may be “dry” with myelofibrosis, as the bone marrow has turned to scar tissue. Testing for the JAK2, MPL and CALR genes can help with diagnosis and management.
75
Management of primary myelofibrosis may involve:
No active treatment for mild disease with minimal symptoms Supportive management of complications, such as anaemia, splenomegaly and portal hypertension Chemotherapy (e.g., hydroxycarbamide) to help control the disease Targeted therapies, such as JAK2 inhibitors (ruxolitinib) Allogeneic stem cell transplantation (risky but potentially curative)
76
Management of polycythaemia vera may involve:
Venesection to keep the haemoglobin in the normal range Aspirin to reduce the risk of thrombus formation Chemotherapy (typically hydroxycarbamide) to help control the disease
77
Management of essential thrombocythaemia may involve:
Aspirin to reduce the risk of thrombus formation Chemotherapy (typically hydroxycarbamide) to help control the disease Anagrelide is a specialist platelet-lowering agent
78
What is Myelodysplastic syndrome?
is a form of cancer caused by a mutation in the myeloid cells in the bone marrow, resulting in ineffective haematopoiesis It has the potential to transform into acute myeloid leukaemia.
79
How may Myelodysplastic syndrome present?
Patients may be asymptomatic. It may be diagnosed after incidental findings on a full blood count. They may present with symptoms of: Anaemia (fatigue, pallor or shortness of breath) Neutropenia (frequent or severe infections) Thrombocytopenia (bleeding and purpura)
80
How may Myelodysplastic syndrome be investigated?
Full blood count will be abnormal. There may be blasts on the blood film. Bone marrow biopsy is required to confirm the diagnosis.
81
How may Myelodysplastic syndrome be managed?
Depending on the symptoms, risk of progression and overall prognosis, the treatment options are: Watchful waiting Supportive treatment (e.g., blood or platelet transfusions) Erythropoietin (stimulates red blood cell production) Granulocyte colony-stimulating factor (stimulates neutrophil production) Chemotherapy and targeted therapies (e.g., lenalidomide) Allogenic stem cell transplantation (risky but potentially curative)
82
Myeloma without metastasis is characterised by what biochemical pattern?
high calcium, normal/high phosphate and normal alkaline phosphate

Y4 Cancer Care (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions