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Practice topics Exam 1 > Leukemias, Lymphomas, and Misc. > Flashcards

Leukemias, Lymphomas, and Misc. Flashcards

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1
Q

Leukocytosis

A

increases leukocyte count

often a normal protective response

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2
Q

Leukopenia

A

Decrease in leukocyte count

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3
Q

Below ____ = risk of infection

A

1000/mm 3

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4
Q

Below ____ = life threatening

A

500/mm 3

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5
Q

Hematologic Neoplasias

A

Cancer which originates in hematologic tissues of the body - specifically from changes in the stem cells
Metastasis to bone marrow

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6
Q

Ex of hematologic neoplasia

A

Multiple myeloma
Leukemia
Polycythemia vera

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7
Q

How common is leukemia

A

9th most common cancer in US

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8
Q

Avg age of diagnosis for leukemia

A

66

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9
Q

Leukemias (Weissus Blut) is what

A

primary neoplasm is within the bone marrow

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10
Q

Lympho =

A

involving lymphoid tissue

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11
Q

Myelo =

A

involving hematopoietic stem cells

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12
Q

-blastic =

A

acute

immature cells

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13
Q

-cytic =

A

chronic

mature cells

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14
Q

Acute leukemias

A

accumulation of immature (blast) cells
Overcrowding of bone marrow
Anemia might be first s/s
Onset is abrupt

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15
Q

Common clinical findings with acute leukemia

A 
Anemia
Coagulopathy
DIC
Infection
Weight loss
Bone pain
Inc uric acid excretion
Liver, spleen, lymph node enlargement
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16
Q

Acute lymphoblastic leukemia (ALL) defined as

A

more than 30% lymphoblasts

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17
Q

Acute lymphoblastic leukemia (ALL) epidemiology

A

Accounts for 20% of all leukemias
Most common (57%) in those under 20 yrs
Median age diagnosis is 15

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18
Q

Acute lymphoblastic leukemia (ALL) 5 yr survival

A

68%
Children 95% attain remission, 80% long term survivial
Adults 40% long term

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19
Q

Acute Myelogenous Leukemia (AML)

A

Most common (35%)
Variety of subtypes
Peak diagnosis btw 60-70 yrs
Rare to occur in less than 40 yrs

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20
Q

Acute Myelogenous Leukemia (AML) - survivial (5 yr)

A

27%

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21
Q

Acute Myelogenous Leukemia (AML) - s/s

A

Typical manifestations
About 2% have neuro s/s including disorientation and HA
Might see CN problems

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22
Q

Acute Myelogenous Leukemia (AML) - treatment

A

Significantly high WBC count which can cause vascular damage secondary to occlusion
Chemotherapy - phased with the goal of achieving remission

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23
Q

Acute Myelogenous Leukemia (AML) - chemotherapy phased treatment

A

1 = Induction therapy - eradication of neoplastic cells
2 = Post Remission - delivery of additional drugs to inc eradication effects
3 = Consolidation therapy - stem cell or bone marrow replacement
Maintenance and supportive therapy

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24
Q

Chronic leukemias

A

slow onset with vague s/s
cells are well differentiated
some functional WBCs are being produced at the same time

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25
Chronic myelogenous leukemia - epidemiology
15% of all leukemias | Almost exclusively an adult onset (2% in children)
26
Chronic myelogenous leukemia - diagnosis
Philadelphia chromosome is diagnostic marker
27
Chronic myelogenous leukemia - survival
overall 5 yr survival is 67% | dramatic inc since 2001 with new drug
28
Chronic myelogenous leukemia - phases
1 chronic phase - lasts 2-3 yrs with mild symptoms (most are diagnosed in this phase) 2 accelerated phase - inc number of problems and severity of symptoms (4 yrs) 3 Blast phase - resembles the acute leukemia
29
Chronic myelogenous leukemia - treatment
stem cell transplantation is curative but not everyone is a candidate (secondary to multisystem issues) Biological therapies like interferon can induce remission or supress progression
30
Chronic myelogenous leukemia - new drug
``` imatinib mesylate (gleevac) Hugely expensive ```
31
Chronic lymphocytic leukemia - epi
2nd most common type (28%) Adults over 50 85% survivial rate
32
Chronic lymphocytic leukemia - primary cell involved is
B cell therefore see side effects as suppression of humeral immunity
33
Chronic lymphocytic leukemia - what is it
accumulation of mature but incompentent cells Fatigue, lymphadenopathy Opportunistic infections are often a hallmark of disease (75%)
34
Chronic lymphocytic leukemia - treatment
hugely resistent to drugs Treatment is more palliative in nature Younger have more success with bone marow transplants
35
Lymphoma
Cancers that develop in immune system 2 types - Hodgkins disease - Non-Hodgkins disease
36
Hodgkins disease characterized by presence of what
Reed Sternberg cell (owl eyes)
37
Hodgkins disease - epi
8% of all lymphomas peak age 20-35 most common in young adult males
38
Hodkins disease is considered an
immunodeficient disease | can metastasize to non lymph tissue but does so infrequently!
39
Hodgkins disease - stages - stage 1
signle node region or a single extra lymphatic site | survivial is 90%
40
Hodgkins disease - stages - stage 2
Two or more nodes on one side of the diaphragm
41
Hodgkins disease - stages - stage 3
involved tissue both sides of diaphragm
42
Hodkins disease - stages - stage 4
Multifocal involvement including extra lymphatic involvement
43
Hodskins disease - lymphadenopathy =
firm, rubbery, usually not tender or painful | more than 1cm in diameter
44
Hodgkins disease s/s
``` Night sweats - severe Intermittent fever Weight loss of more than 10% in 6 months Pruritis Pain and/or neuro s/s in extremities CNS s/s and symtpoms are NOT common ```
45
Hodgkins prognosis
Highly curable 5 yr survival is 85% (avg) stages 1 and 2 have 93% Age is a factor
46
Hodgkins treatment
Stage 1 and 2 radiation with supplemental chemo Satge 3 aggressive chemo Stage 4 Multiagent drug regimen
47
Non hodgkins lymphoma is what
hetergenous group of lymphoproliferative malignancies 7th most common cancer in US significant inc since 1970 - secondary to increase in HIV
48
Non hodgkins lymphoma - epi
95% occur after age 45 M more than F Typically diagnosed 65-74 yrs Survival rate 71%
49
Non hdgkins lymphoma - course
Bx and spread not as predicitive as hodgkins tends to spread to extranodal sites (spleen, GI, bone) Clinical course varies depending on subtype
50
Subtypes of Nonhodgkins lymphoma
``` Low grade (follicular) lymphoma AKA indolent Intermediate grade (indolent) High grade (aggresive) ```
51
Non hodgkins lymphoma - s/s
``` painless lymphadenopathy fever fatigue, night sweats spread to extranodal areas visceral and structural obstruction or impingement s/s ```
52
Non hodgkins lymphoma - tx
``` Chemo Biological/immunotherapy - hormonal, interferon Radiation Plasmapheresis Stem cell transplant ```
53
Disseminated Intravascular Coagulation (DIC) is what? and what is it commonly seen with?
Hyper or over activation of the coagulation system Acquired platelet malfunction Sepsis, trauma, ob/gyn complication, leukemia complication
54
Disseminated Intravascular Coagulation (DIC) - pathology
Coagulation leads to thrombosis formation Deposits of fibrin due to activation of fibrolytic system Fibrinolysis impaired Because there is clotting widespread, clotting factors within both intrinsic and extrinsic pathways are used up Hemorrhage occurs Thrombi develop as clotting factors are depleted
55
Disseminated Intravascular Coagulation (DIC) - clinical features
``` Unexpected bleeding from all body openings Hematomas, petechieae Swelling Mottled/cold hands and feet Resp distress Neuro issues Hypotension, tachycardia Renal issues ```
56
Disseminated Intravascular Coagulation (DIC) - diagnosis
clinical diagnosis confirmed with lab tests
57
Disseminated Intravascular Coagulation (DIC) - treatment
directed at the cause Heparin may be used to get rid of clots Blood product replacement therapy can be used (transufion) Can be fatal! Monito lab test frequently with PT - generally seen bedisde
58
Hematopoietic stem cell transplant
blood (or bone marrow) source Umbiical cord Allogenic vs. Autologous
59
Hematopoietic stem cell transplant - who
Pt about to undergo aggressive chemo or high dose radiation | Certain hematological neoplasias
60
Hematopoietic stem cell transplant - s/s
``` Severe immunosuppression weakness fatigue cardiac and liver toxicity (from the drugs) hemorrhage myopathy and osteoporosis risk for integumentary breakdown ```
61
Hematopoietic stem cell transplant - beforehand
Pre-transplant assessment and education is recommended
62
Hematopoietic stem cell transplant - PT
``` Typically they will be deconditioned (we wont see them until long time after transplantation) pulmonary sys dec Energy conservation Pt education on safety Regular and close monitor of labs Infection control procedures ```

Practice topics Exam 1 (15 decks)

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