Oncology Flashcards by M G

Pathophysiology of leukaemia?

Acquired malignant transformation in the stem cells of the haemopoietic system

_{Acute lymphoblastic leukaemia and lymphoblastic lymphoma are the same entities.}

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Usual age range for ALL?

2-10 years

second peak about 40

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Median age of presentation for AML?

55-60

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Diagnostic triad for ALL?

Malaise, pallor and bone pain

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Diagnostic triad for AML?

Malaise, Pallor, oral problems (eg gingival hypertrophy)

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Symptoms of leukaemia?

General constitutional

symptoms of anaemia - _{Low RBC}

susceptiblity to infection - mouth ulcers, chest infections, sore throat - _{low Wcc}

easy bruising and bleeding - _{low platelets}

BONE PAIN - esp in children with ALL

joint pain

Symptoms due to infiltration of tissues with blast cells (eg gingival hypertrophy in AML)

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Signs of leukaemia?

Pallor of aneamia

Bruising

Gum hypertrophy, stomatitis, gingivitis

Signs of infection

Variable ENLARGEMENT of spleen, liver and lymphnodes

Bony tenderness - especially sternum

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Investigations in leukaemia?

FBE and film: normochromic/normocytic anaemia

Increased white cells

Pancytopenia with circulatory BLAST cells

platelets usually reduced

Bone marrow examination

PCR studies

Cytogenetics

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Treatment of acute leukaemia?

Chemotherapy

Immunotherapy

Stem Cell transplantation (Bone marrow)

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What happens if acute leukaemia relapses?

Usually fatal unless bone marrow transplant is successful

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Diagnostic triad of CML?

Fatigue, fever/night sweats and abdominal fullness (SPLENOMEGALY)

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Diagnostic triad of CLL

Fatigue,

Fever/Nightsweats

and LYMPHADENOPATHY and WEIGHT LOSS

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What age group is affected by CML?

Middle age 40-60 years

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What age group is affected by CLL?

Elderly

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Clinical features and Investigation findings in CML?

Insidious onset

Can have very large splenomegaly - ABDO fullness or discomfort

Fever, nightsweats, weight loss,

Symptoms of anaemia

Can get priapism and gout

MARKEDLY ELEVATED WCC (GRANULOCYTOSIS)*
marked LEFT shift in myeloid series*
Philadelphia Chromosome positive*

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CLinical features of CLL

Insidious onset

malaise, weight loss, fever, night sweats

LYMPHADENOPATHY (large rubbery nodes) - neck, axilla, groin (80%)

moderately enlarged liver and spleen (50%)

mild anaemia

Lymphocytosis > 15 x 10⁹

Mature appearance of lymphocytes

CONSIDER cytogenetics

Usually - indolent progression. No specific treatment

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What is Pel-Ebstein fever

Its a cyclical fever - typically high for 7-10 days and then normal/low for 7-10 days. Its associated with HODGKINS LYMPHOMA

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Is pruritis more common in Hodgkins or Non Hodgkins lymphoma?

HODGKINS

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How is hodgkins and non hodgkins diagnosed?

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Lymph node biopsy and histological confirmation

Enlarged lymph nodes with pain induced by alcohol?

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HODGKINS lymphoma

Diagnostic triad of hodgkins lymphoma?

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Fever/night sweats, malaise and PRURITIS

also can get PEL-ebstein fevers

alcohol induced pain in enlarged lymph nodes

Diagnostic triad of non hodgkins lymphoma

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malaise, fever/nightsweats, lymphadenopathy

can also get extranodal sites of disease - GIT/Skin/CNS/Bone

Can get mycosis fungoides

can get hepatosplenomegaly

What are B symptoms

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TRIAD of

FEVER

Unexplained weight loss

Night sweats

Can get in either of the two lymphomas

Treatments of lymphoma

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Chemo, radio, immuno Rx

Investigations in Lymphoma?

FBE and film, CXR Lymph node biopsy is diagnostic CT - staging May need bone marrow biopsy and functional isotopic scanning

Diagnostic triad in myeloma?

Unexplained Back pain, susceptibility to infection and weakness

Myeloma - Triad In an older person

anaemia, back pain, elevated esr

What is myleoma?

neoplastic proliferation of plasma cells Look for CRAB - hypercalcaemia, renal impairment, anaemia, Bony changes (osteolytic lesions)

**Screening investigation** for myeloma in a suspected case?

1. Serum protein electrophoresis with immunofixation 2. Serum free light chain assay (FLC)

Intial investigations in myeloma

**1. Serum protein electrophoresis with immunofixation** **2. Serum free light chain assay (FLC)** **THEN** FBE - anaemia, leukopenia, thrombyctopenia UEC - renal impariment **Skeletal survey - osteolytic lesions** **Urine electrophoresis -Bence Jones Proteins** Calcium - hypercalcaemia with normal PTH and Vit D ESR elevated B2 Microglobulin **Diagnostic triad** - paraprotein on serum electrophoresis Bence jones on urine electrophoresis Osteolytic lesions on skeletal survey ONCE DIAGNOSIS has been made - _24 hour urine electrophoresis_ They will go on to have a bone marrow biopsy with their haematologist

Which proteins are increased in MM?

The globulins Specifically - GAMMA globulins which function as Immunoglobulins _{In a standard LFT - Total protein could be UP with normal Albumin - indicating increase in globulins.}

Whats the differential for a gammopathy/gammaglobinopathy?

MM and MGUS Monoclonal gammopathy of undetermined significance

How do you differentiate MGUS from MM?

- absence of end organ damage - eg lytic lesions, renal probs, hypercalcaemia, anaemia, - Clonal bone marrow plasma cells LESS Than 10 percent (in MM its more than 10) Serum M protein less than 3 g/dL MGUS - MM -- 1% risk each year of transformation

What is the differential for multiple lucent/lytic lesions?

F - fibrous dysplasia E- eosinophilic granuloma E - endochondroma M - metastatic disease - myeloma H - hyperparathyroidism I - Infection **FEEMHI**

Which Cancers does AFP test for?

Testicular Cancer (non seminoma) ``` HCC GIT cancers (With and without mets) ```

Which cancers does CA-125 test for ?

Ovarian and breast

Which cancers does Ca -15-3 test for?

Breast

Which cancers does Ca 19-9 test for?

Pancreas, colon, ovarian

Which cancers does CEA test for?

Colorectal Ca Pancreatic, breast, lung, small intestine, stomach, ovaries

Which cancers does HCG test for?

Choriocarcinoma hydadtiform mole trophoblastic diseases

Which cancers does alphamicroglobulin test for?

multiple myeloma, some lymphomas

What is the differential for a paediatric neck lump

Thyroglossal duct cyst - _midline,_ congenital, **rises with extrusion of the tongue (benign) - conservative mx or surg** Branchial cleft abnormality - **Lateral,** congenital, can present as a cyst, sinus or fistula that becomes infected - conservative mx or surg Reactive lymphadenopathy - secondary to inflammation - **expectant management for 6 weeks is appropriate** Lymphoma - Rare in kids under age of 5, **Hodgkins lymphoma presents with cervical lymphadenopathy** more than non hodgkins - chemo/radio Rhabdomyosarcoma - chemo/surg/radiotx

When looking at wounds what factors help healing?

Infection? Pressure - remove Arterial - revascularisation Venous - elevation and compression bandage Local environment - Moist and protected Dressings - if lots of exudate - alginate best, next would be a hydrocolloid if wound is dry, scaly and needs moisture - do a hydrogel if granulating - foam dressing like allevyn

Causes of a solitary thyroid nodule

Hypertrophy of thyroid tissue inflammation of thyroid gland iodine def neoplastic cystic

Oncology Flashcards

(45 cards)