Leukaemia and Lymphoma Flashcards
(101 cards)
1
Q
what are the 2 cell types
A
> myeloid stem cell
> lymphoid stem cell
2
Q
what are the 3 types of lymphoid stem cells
A
> pre-B stem cell
= B cells
> thymocyte
= T cells
> NK cells
(these are lymphocytes)
3
Q
what are the 3 types of of myeloid stem cells
A
> BFU-E
> CFU-Meg
> CFU-GM
4
Q
what do BFU-E cells divide into
A
CFU-E then become red cells (erythrocytes)
5
Q
what do CFU-Meg cells become
A
> megakaryoblast
> platelets (megakaryocytes)
6
Q
what are the different cells CFU-GM divides into
A
> neutrophils
> basophils
> eosinophils
> monocytes
7
Q
what does over production of the end cell types develop into
A
malignancies
8
Q
when can haematological cells turn neoplastic
A
at a number of stages
the earlier in the cell line it occurs the more potentially aggressive the malignancy
9
Q
how do haematological malginancy occur
A
> DNA mutation (usually translocation - part of DNA strand gets artificially added on to the wrong part of the DNA chain when replicating and it ends up in wrong place)
> switches off a tumour suppressor gene or switches on an oncogene
> clonal proliferation
(one cell changes and this one become immortalised, tends to be more than one cell type in a tumour, ones which are hard to kill comes back)
10
Q
what are characteristics of cancer cells
A
> uncontrolled proliferaton
loss of apoptosis
loss of normal function / products
11
Q
what are the 2 classes of leukaemia and lymphoma
A
acute
chronic
12
Q
give an example of acute lymphoid leukaemia
A
acute lymphoblastic leukaemia
13
Q
give an example of acute myeloid leukaemia
A
acute myeloid leukaemia
14
Q
name chronic lymphoid leukaemia / lymphomas
A
> chronic lymphocytic leukaemia
hodgkin lymphoma
non-hodgkin lymphoma
multiple myeloma
15
Q
name chronic myeloid leukaemia / lymphoma
A
> chronic myeloid leukaemia
> myeloproliferative disorders
16
Q
how is chronic lymphocytic leukaemia found
A
by accident
usually through a blood test but testing for something else
find lots of white blood cells present but no symptoms
changes to acute in a period of months = problem
17
Q
what is hodgkin lymphoma
A
lots of white cells in lymph node
18
Q
what is multiple myeloma
A
malignancy of basal cells
tendency to dissolve away bones (bones become hallowed out and break)
19
Q
what do lymphocytic, lymphoblastic and myeloid describe
A
describe the point in the cell lines or cell type at fault
20
Q
what do leukemic cells look like
A
they still look like the cells they are meant to be before malginancy
21
Q
what do lymphoblastic cells look like
A
cant tell what type of cell it is meant to be
22
Q
what does blast mean
A
immature cell
23
Q
what is leukaemia
A
describes a group of cancer of the bone marrow which prevent normal manufacture of the blood and therefore result in
> anaemia
> infection (neutropenia)
> bleeding (thrombocytopenia)
24
Q
what is the pathogenesis of leukaemia
A
> clonal proliferation
replacement of marrow
increasing marginalisation of productive normal marrow leading to marrow failure and organ infiltration
25
how do patients with leukaemia present
tiredness
| spontaneous bleeding
26
what are the clinical presentations of leukaemia
> anaemia
problems carrying oxygen
> neutropenia
problems with infection
> thrombocytopenia
problems with bleeding
```
> lymphadenopathy
extra number of wbc
occupies bone marrow and spreads outside
whole cell lumps in lymph nodes and soft tissues
may not be palpable
```
> splenomegaly / hepatomegaly
swollen abdomen
> bone pain (children)
bone marrow trying to expand within the bone cavity itself
27
what are the symptoms of anaemia in a clinical presentation
```
progressive
> breathlessness
> tiredness
> easily fatigued
> chest pain / angina
```
28
what are the signs of anaemia in a clinical presentation
```
> pallor
> signs of cardiac failure
- ankle swelling
- breathlessness
> nail changes
- brittle nails
- koilonychia
```
29
how does neutropenia appear clinically
```
> infections associated with portals of entry
- mouth
- throat
§ tonsillitis
§ pharyngitis
- chest
§ bronchitis
§ pneumonia
- skin
§ impetigo
§ cellulitis
- perianal
§ thrush
§ abscesses
```
> reactivation of latent infections
(infection returns when immune system is suppressed)
> increased severity, frequency and can rapidly lead to systemic infection
(immune response reduces)
30
what is a major problem with tuberculosis
you never really get rid of the infection
whether treated or not
it remains in the body waiting for an opportunity to arise again
if immune system is suppressed the infection will return
31
what are the symptoms of a neutropenia infection
> recurrent infection
| > unusual severity of infection
32
what are the signs of a neutropenia infection
```
> unusual patterns of infection and rapid spread
> will respond to treatment but recur
> signs of systemic involvement
- fever
- rigors
- chills
> investigations
- unusual pathogens (usually bacterial)
```
33
what are the symptoms of bleeding at clinical presentation
> bruises easily or spontaneously
> minor cuts fail to clot
> gingival bleeding or nose bleeds (no gingivitis)
> menorrhagia
34
what are the signs of bleeding at clinical presentation
> bruising
> petechiae
> BOP
> bleeding / bruising following procedures
35
what is A.L.L.
acute lymphoblastic leukaemia
36
what cells does acute lymphoblastic leukaemia occur in
b cells / t cells
| high up the differentiation process
37
what is the peak age group for acute lymphoblastic leukaemia to occur
around the age of 4
largely seen in children
can occur in adults too
38
when does acute lymphoblastic leukaemia develop over
days or weeks
39
what is the catabolic state of acute lymphoblastic leukaemia
> fever
> sweats
> malaise
40
what is common in acute lymphoblastic leukaemia
lymphadenopathy common
| tissue infiltration common
41
who is the prognosis best for in acute lymphoblastic leukaemia
younger female patients
| girls 2-12 do best
42
how successful is treatment for acute lymphoblastic leukaemia in children
over 80% cured, almost 90%
| very successful
43
what is A.M.L
acute myeloid leukaemia
44
when is acute myeloid leukaemia most common
most common in elderly
can occur at any age
not common in children
45
what is the clinical presentation of acute myeloid leukaemia
similar to A.L.L.
46
what is the prognosis for acute myeloid leukaemia
30-40% of over 60 y/os cured
| 10% cure for over 70 y/os (this is improving)
47
what is C.L.L.
chronic lymphocytic (lymphoid) leukaemia
48
what sort of disease is chronic lymphocytic leukaemia
b cell clonal lymphoproliferative disease
49
what age is chronic lymphocytic leukaemia likely
older adults
| peak age is over 70s
50
how does chronic lymphocytic leukaemia occur / be discovered
occurs gradually over many years, slow progression
found by accident
no symptoms (asymptomatic)
patient unaware
usually discovered in routine blood tests
51
which gender is more affect by chronic lymphocytic leukaemia
males : females
| 2:1
52
is treatment needed for chronic lymphocytic leukaemia
may not need treatment
an aggressive form like occasional blast transformation may need treatment
treatment = monoclonal antibodies can take out specific cells and be removed from the blood
53
what is chronic myeloid leukaemia
increase in neutrophils and their precursors
54
what chromosome do patients have with chronic myeloid leukaemia and why
95% of patients have philadelphia chromosome
cell replication gone wrong
chromosome been moved into another chromosome and changes the transcription
55
what is the peak age for chronic myeloid leukaemia
50-70s
| can occur any age
56
are males or females more likely to get chronic myeloid leukaemia
slight male preponderance
57
what are the clinical presentations of chronic myeloid leukaemia
```
fatigue
weight loss
sweating
anaemia
bleeding
splenomegaly
```
58
what is lymphoma
generally solid lumps
normal number of white blood cells
abnormal collection of cells usually in lymph nodes
solid tumour but some cells in blood
59
what are the 2 types of lymphoma
> hodgkin lymphoma
| > non-hodgkin lymphoma
60
which is more common hodgkin lymphoma or non hodgkin lymphoma
non hodgkin lymphoma is more common than hodgkin lymphoma (6:1)
61
what does staging require
requires imaging
> CT
> PET / CT
> MRI
62
what are the different categories of staging
> number of nodes involved and site
> extra nodal involvement
> systemic symptoms
63
what is staging important in
predicting prognosis and deciding treatment
64
define stage I
single lymph node region
65
define stage II
two or more sites, same side of diaphragm
66
define stage III
two or more sites on both sides of diaphragm
67
define stage IV
diffuse involvement of extralymphatic site and / or nodal disease
68
when is the peak incidence of hodgkin lymphoma
age 15-40 years
69
are males or females more likely to develop hodgkin lymphoma
males > females
| 2:1
70
name clinical presentations of hodgkins lymphoma
```
> painless lymphadenopathy
- typically cervical
- fluctuate in size
- pain with alcohol notable
> fever
> night sweats
> weight loss
> itching
> infection
```
71
what is the cure prognosis for stage I and II of hodgkins lymphoma
over 90%
72
what is the cure prognosis for stage III and IV in hodgkins lymphoma
50-70%
| older people do less well
73
what are the types of non-hodgkin lymphoma
b cell type = 85%
| t cell type = 15%
74
what age is likely to develop non-hodgkin lymphoma
any age
| more indolent in elderly
75
what is the aetiology of non-hodgkin lymphoma
> microbial factors strongly implicated
- EBC
- HTLV-1
- H.pylori
> autoimmune disease
- sjogren's syndrome
- rheumatoid arthritis
> immunosuppression
- AIDS
- post-transplant
76
what does H.pylori cause
stomach ulcers
strong connection between this and gastric lymphoma
infected element that is keeping the immune process going is causing the tumour
take away the infected element and the tumour shrinks
77
why is a post-transplant patient at risk of non-hodgkins lymphoma
more vulnerable
prognosis is worse
more potential for treatment
78
how does non-hodgkins lymphoma present
> lymphadenopathy
- often widely disseminated
- may be invisible
> extra-nodal disease more common
- oropharyngeal involvement
(waldeyer's ring - noisy breathing and sore throat)
> symptoms of marrow failure
> constitutional symptoms less common
79
what is the prognosis of non-hodgkins lymphoma
over 50% will relapse after treatment
aggressive disease, poor prognosis untreated but notably often responds better to treatmetn
indolent disease
hard to cure
80
what is multiple myeloma
malignant proliferation of plasma cells
> plasma cells make lots of antibodies
> based on light chain and heavy chain combinations
81
what are the features of multiple myeloma
> monoclonal paraprotein in blood and urine
> lytic bone lesions - bone and fracture
> excess plasma cells in bone marrow - marrow failure
82
what is the mean age of diagnosis and which gender is more commonly affected by multiple myeloma
70 years
| Males > females
83
what is associated with multiple myeloma
```
> infection
> bone pain
> renal failure
> amyloidosis
containable not treatable
can stop the effects it has on the body
```
84
what are the treatments of haematological malignancies
> chemotherapy
>radiotherapy
> monoclonal antibodies
> haemopoietic stem cell transplantation
85
what sort of problem arises with bone marrow transplant
inflammatory problem
| graft v host disease
86
what is a safer way to have a bone marrow transplant
use patient's own stem cells and clean them to remove the bad cells and place the good cells back in the patient again
this is less risky
wont reject own bone
87
what concepts are associated with the treatment of haematological malignancies
> induction
= intense chemo, blast the bad cells out
> remission
= no cancer cells remaining
> maintenance and consolidation
= tries to ensure the cancer doesnt come back
> relapse
= not all cancer cells are removed, can only be removed if the cells can be accessed
these are predictable phases
88
what is included in supportive therapy
> nutrition
> psychological and social support
> prevention and treatment of infection
> managing symptoms of therapy side effects
> correcting marked blood component deficits
> pain control
89
what does chemotherapy target
cells with high turnover rate
90
what is the problem with chemotherapy
kill cells in other tissues that you need
responsible for many unwanted effects in normal high turnover tissues
causes ulcers cause no new cells come through to replace the old cells when they are killed
91
what are the side effects of chemotherapy
```
hair loss
nausea
vomiting
tiredness
these are improving
```
92
what is a long term risk of chemotherapy in surviving patients
oncogenesis
93
what does radiotherapy do
cytotoxic effect of ionising radiation
> beam directed from outside the body
> adjacent healthy tissue also irradiated
> effect of this minimised using complex spatial positioning, targeting and doing technique
94
what risk does radiotherapy treatment carry
> risk of inducing late cancers
| > damage to stem cell DNA
95
What are monoclonal antibodies specific to
specific cancer cell antigens
96
what do monoclonal antibody drug names end in
-mab
| eg inflixmab
97
where does the cells for a haemopoietic stem cell transplant come from
```
a relative (sibling / close genetic match)
a stranger who has been matched
```
98
what does allogenic transplant mean
stem cells are collected from a matching donor and transplanted into the patient to suppress the disease and restore the patient's immune system
99
what do autologous transplant mean
cells come from the patient
100
what does haemopoietic stem cell transplant require
total body irradiation
eradicate malignant cells and host marrow = clean sheet
get rid of patents bone marrow
cant make any cells = chance of death is very high
101
what are the risks associated with haemopoietic stem cell transplant
> life threatening infection
> graft versus host disease
> graft failure and total marrow failure
> bone marrow failure = mortality
