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Medicine year 3 TCD > Oncology > Flashcards

Oncology Flashcards

1
Q

Sign of asplenism/hyposplenism

A

Howell Jolly bodies on blood film
(RBCs don’t have nuclei, but when they’re developing they do). So these are the remnants of RBC nuclei that’re normally removed by the spleen.

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2
Q

What is lymphoma- basic

A

lymph system is part of immune system that contains WBCs. Cancer in lymphatic system.

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3
Q

Hodgkin’s Lymphoma blood film finding

A

Reed-Sternberg Cells
(bi lobed multinucleated lymph cells, Owl’s eye appearance)

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4
Q

How are lymphomas staged

A

Ann Arbor staging- basically are the affected nodes above or below the diaphragm

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5
Q

lymphoma complications and management

A

increased infection risk, cancer spreading

surgery
chemo and radiotherapy

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6
Q

Hodgkin’s Lymphoma symptoms

A

B symptoms: Fever, night sweats, unexplained weight loss >10% in 6 months.
Other symptoms- fatigue, itching, cough, SOB, Abdo pain, recurrent infections
Painless, gradual rubbery lump- lymphadenopathy. Pain when they drink w/ alcohol
Mediastinal mass -> dry cough or SVCO
Hepatosplenomegaly and/or pruritus

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7
Q

Risk factors for Hodgkin’s lymphoma

A

young adult and elderly
Epstein barr virus
HIV
Immunosuppression

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8
Q

Hodgkin’s lymphoma diagnosis

A

excision biopsy

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9
Q

Hodgkin’s lymphoma treatment

A

chemotherapy and radiotherapy adjunct
ABVD
Adriazamycin
Bleomycin
Vinblastine
Dacarbazine

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10
Q

Non Hodgkin’s lymphoma symptoms

A

painless lymphadenopathy
constitutional B symptoms- occur later in NHL than in HL
Weight loss
palpable abdo mass
testicular mass
fever

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11
Q

NHL risk factors

A

HIV (susceptible to EBV), immunosuppression, H pylori, coeliac disease

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12
Q

What is leukaemia

A

Cancer of cells in the bone marrow. Genetic mutation in one of the precursor cells in the bone marrow leads to excess production of a single type of abnormal WBC. Leads to suppression of the other cell lines causes underproduction of other cell types- pancytopenia.

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13
Q

Leukaemia presentation

A

Fatigue
Fever
Failure to thrive (kids)
Pallor - anaemia
Petechiae and abnormal bruising- thrombocytopenia
Abnormal bleeding
Lymphadenopathy
Hepatosplenomegaly

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14
Q

leukaemia complications

A

spread of cancer
increased risk of infections
type of anaemia where immune system attacks RBCs

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15
Q

leukaemia management

A

MDT
chemo
stem cell marrow transplant
radiotherapy

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16
Q

Acute Lymphoblastic Leukaemia (ALL)- what is it? Associated w/ what?

A

Most common childhood malignancy
Lymphoid progenitor cells (ie mostly B cells but can be T cells) that don’t mature (blast cells) and keep proliferating. Can fill up the bone marrow- blocking normal haematopoetic stem cell function -> marrow failure and infiltrate lymphoid tissues around the body. Associated w/ Down’s

17
Q

ALL symptoms

A

Fatigue- not enough RBCs
Dyspnoea
Angina
Recurrent infections- not enough WBCs
Petechiae, nose/gum bleeds (not enough platelets)
Hepatomegaly
Lymphadenopathy
Bone pain
CNS symptoms

18
Q

ALL diagnosis

A

Blood film- shows blast cells (large) and marrow aspiration w/ high blast cells
LDH is often raised leukaemia
Bone marrow biopsy

19
Q

Acute myeloid Leukaemia (AML)- what is it?

A

Most common acute leukaemia in adults. Myeloid progenitor cells (should become RBCs, platelets or non lymphoid WBCs) that don’t mature and proliferate

20
Q

AML features

A

Anaemia: pallor, lethargy, weakness
Neutropenia
Thrombocytopenia: bleeding
Splenomegaly
Bone pain
Infections, easy bleeds and anaemia

21
Q

AML blood film findings

A

high proportion of blast cells. These blast cells can have Auer rods (needle shaped structures in the cell body)

22
Q

Chronic Myeloid Leukaemia (CML) - what is it

A

uncontrolled proliferation of myeloid cells. Has 3 phases:
Chronic- often asymptomatic
Accelerated - when abnormal blast cells take up a high proportiopn of the cells in the bone marrow and blood. Pts become more symptomatic - develop anaemia and thrombocytopenia.
Blast - involves an even higher proportion of blast cells in the blood. Severe symptoms and pancytopenia. Often fatal

23
Q

What cytogenic phase is characteristic of CML?

A

Philadelphia chromosome, which is a translocation of genes bwt chromosomes 9 and 22.

24
Q

CML symptoms

A

Chronic and slowly developing symptoms such as fatigue, fever, sweats and weight loss
Anaemia- lethargy
Gout
Bleed easily
Splenomegaly

25
Q

CML blood film findings

A

immature and mature myeloid cells.
Also have a v high WBC w/ all cell types (except lymphocytes which’ll be low)

26
Q

CML treatment

A

Treat w/ tyrosine kinase inhibitors- eg imatinib
In final phase it’s managed like ALL w/ usually stem cell transplant

27
Q

Chronic lymphocytic leukaemia (CLL)- what is it?

A

Most common leukaemia and is the malignant proliferation of incompetent but matured B cells. Usually affects over 70s

28
Q

CLL presentation

A

often asymptomatic but may have infections, anaemia, malaise, weight loss, night sweats, hepatosplenomegaly, painless lymphadenoapthy
Death happens due to infection or transformation to Richter’s lymphoma (worse version of CLL)

29
Q

CLL blood film appearance

A

smear or smudge cells- aged/fragile ~WBCs rupture and leave a smudge on the film

30
Q

CLL treatment

A

Mostly chemo, TKIs, steroids if all else fails use allogenic stem cell transplants

31
Q

Multiple myeloma - what is it?

A

Haematological malignancy of mature plasma cells (activated B cells). It secretes excess monoclonal antibody.
2nd most common haematological malignancy

32
Q

Multiple Myeloma risk factors

A

Age
Family history
Black African
Male
Obesity

33
Q

Multiple myeloma symptoms

A

CRABBI
Calcium- elevated (due to increased osteoclast activity)
Renal failure (dysfunctional plasma cells release lots of immunoglobulin that can block flow thru the tubules
Anaemia - invade the bone marrow and prevent RBC generation
Bone lesions/pain- increased osteoclast activity caused by cytokines released from the plasma cells and the bone stromal cells when they’re in contact w/ the plasma cells. Leads to lytic lesions and can cause fractures as the bone is weak.
Bleeding- thrombocytopenia
Infection- neutropenia
Other symptoms: spinal cord compression, hyperviscosity of plasma, recurrent infections

34
Q

Multiple myeloma investigations

A

BLIP
Bence Jones monoclonal proteins (found in urine or serum via electrophoresis- remnants of antibodies produced by plasma cells)
serum free Light chain assay
serum Immunoglobulins
serum Protein electrophoresis

Bone marrow biopsy is necessary to confirm the diagnosis
Imaging for bone lesions- whole body MRI, CT, skeletal survey (xray)

35
Q

Multiple myeloma x ray signs

A

punched out lesions
lytic lesions
raindrop skull- caused by many punched out (lytic) lesions throughout the skull that give the appearance of raindrops splashing on a surface

36
Q

Multiple myeloma management

A

control disease
usually relapsing remitting
MDT
first line involves a combo of chemo w/ Bortezomid, Thalidomide, Dexamethasone
Stem cell transplants
VTE prophylaxis
Myeloma bone disease management:
Bisphopsohnates- suppress osteoclast activity
Radiotherapy to improve pain
Cement augmentation involves injecting cement into vertebral fractures or lesions and can improve spine stability and pain

37
Q

Multiple myeloma complications

A

Infection
Pain
Renal failure
Anaemia
Hypercalcaemia
Peripheral neuropathy
Spinal cord compression
Hyperviscosity

Medicine year 3 TCD (10 decks)

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