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Y4 Cancer Care > Myeloma > Flashcards

Myeloma Flashcards

1
Q

What is Myeloma?

A

Cancer of plasma cells

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2
Q

What are Plasma cells?

A

Type of B lymphocyte that produces antibodies

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3
Q

Why are B cells called that?

A

They are found in Bone marrow

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4
Q

What happens in Myeloma?

A

Specific type of plasma cell affected –> specific antibody produced in large quantities

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5
Q

What is Multiple Myeloma?

A

Myeloma affects multiple parts of body

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6
Q

What are the main types of Antibodies? (5 things)

A
  1. A
  2. G
  3. M
  4. D
  5. E
    (In Myeloma, one of these will be super high)
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7
Q

What antibody type is most commonly raised in Myeloma?

A

IgG (more than 50%)

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8
Q

How does Myeloma affect the blood? (3 steps)

A
  1. Cancerous plasma cells invade bone marrow (Bone marrow infiltration)
  2. Suppression of blood cell dev
  3. Anaemia (low RBC) + Neutropenia (low neuts) + Thrombocytopaenia (low plat)
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9
Q

What are some specific diseases that Myeloma causes? (2 things)

A
  1. Myeloma bone disease
  2. Myeloma renal disease
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10
Q

What it the Pathophysiology of Myeloma bone disease? (2 steps)

A
  1. Cytokines released from Plasma cells + Stromal cells
  2. Increased osteoclast activity + Suppressed osteoblast activity
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11
Q

What are the most common places for Myeloma bone disease to happen? (4 things)

A
  1. Skull
  2. Spine
  3. Long bones
  4. Ribs
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12
Q

What can happen in the weak parts of Myeloma bone disease bones?

A

Pathological #s

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13
Q

What does the increases Osteoclast activity in Myeloma bone disease lead to?

A

Beh calcium reabsorbed from bone –> Hypercalcaemia

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14
Q

What is the Pathophysiology of Myeloma Renal Disease? (3 things)

A
  1. High levels of antibodies –> block flow thru tubules
  2. Hypercalcaemia –> impaires renal function
  3. Dehydration
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15
Q

What are the CF of Myeloma? (4 things)

A
  1. Calcium raised
  2. Renal failure
  3. Anaemia
  4. Bone lesions / pain
    CRAB
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16
Q

What types of Anaemia can you get in Myeloma? (2 things)

A
  1. Normocytic
  2. Normochromic
17
Q

What are the RF of Myeloma? (5 things)

A
  1. Age
  2. Male
  3. Black African ethnicity
  4. FHx
  5. Obesity
18
Q

When does NICE recommend you sus Myeloma? (2 things)

A

Over 60 with:
1. Persistent bone pain (esp back pain) // OR
2. Unexplained #s

19
Q

What initial investigations should you do in sus Myeloma? (4 things)

A
  1. FBC
  2. Calcium
  3. ESR
  4. Plasma viscosity
20
Q

What will the FBC show in Myeloma?

A

Low WBC

21
Q

What will the Calcium test show in Myeloma?

A

Raised calcium

22
Q

What will the ESR test show in Myeloma?

A

Raised ESR

23
Q

What will the Plasma viscosity test show in Myeloma?

A

Raised plasma viscosity

24
Q

What urgent investigations should you do if initial investigations are positive (or you still sus Myeloma)? (2 things)

A
  1. Bence-Jones protein
  2. Light chain assay (serum-free)
  3. Immunoglobulins (serum)
  4. Protein electrophoresis (serum)
    BLIP
25
Q

What investigation should you do to confirm Myeloma Dx?

A

Bone marrow biopsy

26
Q

What investigations should you do to assess for bone lesions? (3 things)

A
  1. MRI
  2. CT
  3. Skeletal survey (XR of full skeleton)
    Only need 1 of them
27
Q

What will you see on a XR of Myeloma? (2 things)

A
  1. Lytic (punched out) lesions
  2. “Raindrop skull” (bc many lytic lesions)
28
Q

What is the FIRST line Mx option for Myeloma? (4 things)

A

Combination of Chemo with:
1. Bortezomid
2. Thalidomide
3. Dexamethasone

29
Q

What is a CLINICAL TRIAL Mx option of Myeloma?

A

Stem cell transplantation
(only done when pt are suitable)

30
Q

What is a CLINICAL TRIAL Mx option of Myeloma?

A

Stem cell transplantation
(only done when pt are suitable)

31
Q

What do you need to add when giving certain chemo regimes (e.g Thialidomide)?

A

Aspirin (bc high risk of VTE)

32
Q

What are the Mx options for Myeloma one disease? (4 things)

A
  1. Bisphosphonates
  2. Radiotherapy
  3. Orthopaedic surgery
  4. Cement augmentation
33
Q

How do Bisphosphonates work in Myeloma bone disease Mx?

A

Suppress osteoclast activity

34
Q

How does Radiotherapy work in Myeloma bone disease Mx?

A

Improve bone pain

35
Q

How does Orthopaedic surgery work in Myeloma bone disease Mx? (2 things)

A
  1. Stabilise bone
  2. Treat #s
36
Q

What is Cement augmentation?

A

Injecting cement into vertebral #s / lesions

37
Q

How does Cement augmentation work in Myeloma bone disease Mx? (2 things)

A
  1. Improves spine stability
  2. Relieves pain
38
Q

What are the complications of Myeloma / its Tx? (8 things)

A
  1. Inf
  2. Pain
  3. Renal failure
  4. Anaemia
  5. Hypercalcaemia
  6. Peripheral neuropathy
  7. Spinal cord compression
  8. Hyperviscosity

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