Haematological Malignancy

Question 1

haematological malignancies account for what percent of all human cancers?

Answer 1

10%

Question 2

do blood cancers occur more often in men or women?

Answer 2

adult males

Question 3

what is the most common cancer among children aged 0-14?

Answer 3

leukaemia

Question 4

leukaemia makes up what percent of all childhood cancers?

Answer 4

30%

Question 5

what is the most common form of leukaemia in children?

Answer 5

acute lymphocytic leukaemia

Question 6

myeloid malignancies arise from what cells?

Answer 6

RBC
Platelets
Neutrophils
Eosinophils
Basophils
Monocytes

Question 7

lymphoid malignancies arise from what cells?

Answer 7

B-cell

T-cell

Question 8

using a diagram describe leukaemia vs lymphoma

Answer 8

see notes

Question 9

name the major groups of haematological malignancies

Answer 9

acute leukaemia's
chronic leukaemia's
malignancy lymphomas
multiple myeloma
myelodysplastic syndromes (MDS)
chronic myeloproliferative disease (biologically malignant)

Question 10

name acute leukaemia’s

Answer 10

acute lymphoblastic leukaemia (ALL)

acute myeloid leukaemia (AML)

Question 11

name chronic leukaemia’s

Answer 11

chronic myeloid leukaemia (CML)
chronic lymphocytic (CLL)

Question 12

name the malignancy lymphomas

Answer 12

Non-Hodgkin lymphomas (NHL)
Hodgkin lymphoma (HL)

Question 13

describe the features of acute leukaemia

Answer 13

leukaemic cells do not differentiation
bone marrow failure
rapidly fatal if untreated
potentially curable

Question 14

describe the features of chronic leukaemia

Answer 14

leukaemic cells retain the ability to differentiate
proliferation without bone marrow failure
survival for a few years
not presently curable without BMT

Question 15

clinical features of acute leukaemia

Answer 15

bone marrow failure
anaemia
thrombocytopenic bleeding
infection because of neutropenia

Question 16

what is the most likely cause of infection acute leukaemia?

Answer 16

bacterial and fungal

Question 17

essential investigations in acute leukaemia

Answer 17

• Blood count and blood film
• Bone marrow aspirate/trephine
• Cytogenetics of leukemic blasts
• Immunophenotyping of leukemic blasts
• CSF examination if symptoms

Question 18

treatment of AML

Answer 18

• Supportive care
• Anti-leukemic chemotherapy
• Stem cell transplantation – allogenic
• All trans retinoic acid in APL

Question 19

clinical features of chronic myeloid leukaemia

Answer 19

•	Anaemia
•	Splenomegaly, often massive
•	Weight loss
•	Hyperleukocytosis – fundal haemorrhage and venous congestion, altered consciousness, respiratory failure
Gout

Question 20

laboratory features of CML

Answer 20

• High WCC (can be very high)
• High platelet count
• Anaemia
• Blood film shows all stages of white cell differentiation with increased basophils
• Bone marrow is hypercellular
• Bone marrow and blood cells contain the Philadelphia chromosome t(9,22)

Question 21

treatment of CML

Answer 21

• Tyrosine Kinase Inhibitors
o Imatinib (Gilvec), Dasatinib (Sprycel), Nilotinib (Tasigna), Busitinib, Ponatinib
• Direct inhibitors of BCR-ABL is first line
• Allogenic transplantation – only in TKI failures

Question 22

what are myelodysplastic syndromes?

Answer 22

acquired clonal disorders of the bone marrow

Question 23

who gets myelodysplastic syndromes?

Answer 23

often old age

Question 24

what do myelodysplastic syndromes present as?

Answer 24

macrocytic anaemia

pancytopenia

Question 25

wht are myelodysplastic syndromes fatal?

Answer 25

result of progression to bone marrow failure of AML

Question 26

treatment of myelodysplastic syndromes

Answer 26

supportive or stem cell transplantation for the few young patients

Question 27

give 3 examples of myeloproliferative diseases

Answer 27

* Polycythaemia vera * Essential thrombocythemia * Idiopathic myelofibrosis

Question 28

where are B cells found in lymph nodes?

Answer 28

follicles

Question 29

where are T cells found in lymph nodes?

Answer 29

paracortex

Question 30

where are plasma cells found in lymph nodes?

Answer 30

medulla

Question 31

where in the lymph node do cells undergo expansion and selection?

Answer 31

germinal centre

Question 32

where in the lymph node are naive cells found?

Answer 32

mantle zone

Question 33

presentation of the lymphomas

Answer 33

• Nodal disease – lymphadenopathy o >90% HL o ~60% present purely with nodal disease • Extranodal disease o ~40% NHL present with an extranodal component • Systemic symptoms o Fever, drenching sweats, loss of weight, pruritis, fatigue

Question 34

causes of lymphadenopathy: localised and painful

Answer 34

bacterial infection in drainng site

Question 35

causes of lymphadenopathy: localised and painless

Answer 35

rare infections, catch scratch fever, TB metastatic carcinoma from draining site - hard lymphoma - rubbery reactive, no cause identified

Question 36

causes of lymphadenopathy: generalised and painful/tender

Answer 36

viral infections: EBV, CMV, hepatitis, HIV

Question 37

causes of lymphadenopathy: generalised and painless

Answer 37

``` lymphoma leukaemia connective tissue diseases, sarcoidosis reactive, no cause identified drugs ```