Peer tutoring for Haem cancers

Question 1

What causes the difference in presentation between acute and chronic leukaemias?

Answer 1

Acute - total block of proliferation, so you only get progenitor cells which can’t function –> pancytopaenia

Chronic - some proliferation preserved so you still get functioning cells

Question 2

Which form of leukaemia is more commonly seen in children?

Answer 2

Lymphoblastic

Question 3

Which form of leukaemia is more commonly seen in the elderly?

Answer 3

Myeloid

Question 4

Which forms of leukaemia are more common in

a) elderly
b) paediatric

patients?

Answer 4

a) Myeloid

b) Lymphoblastic

Question 5

What do blast cells look like on a blood film?

Answer 5

Large in diameter

High nuclear:cytoplasmic ratio

Question 6

What is the most common childhood cancer?

Answer 6

Acute lymphoblastic leukaemia (ALL)

Question 7

What is the presentation of pancytopaenia?

Answer 7

Anaemia

Recurrent infection

Abnormal bleeding

Question 8

What is the presentation of acute lymphoblastic leukaemia?

Answer 8

Typically a child with acute onset anaemia, infection and abnormal bleeding

Examination reveals hepato/splenomegaly

Blood film shows lymphoblasts

FBC shows raised white cell count

Question 9

How is the

a) anaemia

b) increased infection risk

c) abnormal bleeding

of pancytopaenia managed?

Answer 9

a) Blood transfusion

b) Prophylactic antibiotics

c) Platelet transfusion

Question 10

Which combination of chemotherapy and immunosuppression is used to treat ALL?

Answer 10

Vincristine

Prednisolone

wipes out the immune system, start from scratch

Question 11

What is the typical presentation of CLL?

Answer 11

Asymptomatic

Examination: non-tender lymphadenopathy, hepato/splenomegaly

Blood film: lymphocytosis, smear cells

Question 12

Smear cells are a blood film finding of which malignancy?

Answer 12

Chronic lymphoblastic leukaemia (CLL)

Question 13

What is a blood film finding specific to CLL?

Answer 13

Smear cells

Question 14

How is CLL treated?

Answer 14

Chemotherapy + radiotherapy

IV Ig injections

Question 15

What is a mnemonic for remembering the symptoms of multiple myeloma?

Answer 15

CRAB

Hypercalcaemia

Renal impairment

Anaemia

Bacterial infection / Back pain

Question 16

Where do myeloma patients often feel pain?

Answer 16

Back pain

Question 17

Why do patients with multiple myeloma develop hypercalcaemia?

Which organs does a raised serum calcium damage?

Answer 17

Bony involvement (inflammation causes osteoclast activation, raises serum calcium)

Kidneys (renal impairment, plus the paraproteins cause damage too)

Question 18

What is a blood film finding of multiple myeloma?

Answer 18

Rouleaux formation

i.e a “stack of coins” appearance, with RBCs overlapping

Question 19

What is found in the urine of patients with multiple myeloma?

Answer 19

Bence Jones proteins

Paraproteins secreted by the malignant plasma cells

Question 20

Describe the CRAB presentation of multiple myeloma.

Answer 20

Hypercalcaemia

Renal impairment

Anaemia

Bacterial infection

Question 21

Which demographic of patients tends to develop multiple myeloma?

What does this mean for management?

Answer 21

Elderly

Intensive treatment isn’t likely to be in the patient’s best interest

Question 22

What is the management of multiple myeloma in patients unfit for chemotherapy?

Answer 22

Analgesia

Bisphosphonates

Question 23

What is the management of multiple myeloma in younger, fitter patients?

Answer 23

VAD

Vincristine

Adriamycin

Dexamethasone

> Immune reset

Question 24

Which malignancy causes acute onset pancytopaenia, typically in older patients?

Answer 24

Acute myeloid leukaemia (AML)

Question 25

What is the **presentation** of **AML?**

Answer 25

**Older patient** who is **anaemic, bleeding abnormally** and **recurrently infected** **Examination** reveals **hepato/splenomegaly** **Blood film / biopsy** shows **myeloblasts** and **Auer rods**

Question 26

What are **blood film** findings specific to **AML?**

Answer 26

**Myeloblasts** **Auer rods**

Question 27

**AML** typically affects older patients, who are subsequently treated with **replacement** and **chemotherapy.** How can it be treated in **young patients?**

Answer 27

**Bone marrow transplant**

Question 28

**Chemotherapy** can lead to which **inflammatory arthropathy?** ## Footnote **Why?**

Answer 28

**Gout** **Uric acid released when cells are killed off by chemotherapy**

Question 29

**CML**, like the other leukaemias, causes a ___ on FBC.

Answer 29

**pancytopaenia**

Question 30

What is the **specific cause** of **CML?**

Answer 30

**TRANSLOCATION OF BCR-ABL GENE (9:22)** **ON PHILADELPHIA CHROMOSOME**

Question 31

Which specific drug is used to treat **CML?**

Answer 31

**Imatinib** Targets BCR-ABL tyrosine kinase affected by the 9:22 translocation on the Philadelphia chromosome

Question 32

What are **three named lymphomas** you need to know about?

Answer 32

**Hodgkins lymphoma** **Non-Hodgkins lymphoma** **Burkitt's lymphoma**

Question 33

What is the difference between **Hodgkins** and **Non-Hodgkins lymphoma?**

Answer 33

**Hodgkins lymphoma** shows **Reed-Sternberg cells** on blood film **Non-Hodgkins** does not This is the important difference

Question 34

What does a **Reed-Sternberg cell** look like? Which malignancy is it a feature of?

Answer 34

**B lymphocyte with a DOUBLE NUCLEUS** **Hodgkins lymphoma**

Question 35

What is the **presentation** of **Hodgkins lymphoma?**

Answer 35

**Young patient** with **non-tender lymphadenopathy** **B symptoms** - fever, weight loss, night sweats **Pain on drinking alcohol** **Rash without itch**

Question 36

Are **B symptoms** (fever, weight loss, night sweats) specific to **Hodgkins or Non-Hodgkins lymphoma?**

Answer 36

**B symptoms seen in both**

Question 37

**Hodgkins lymphoma** is more common in patients who have undergone which procedure?

Answer 37

**Transplant**

Question 38

How is **lymphoma** investigated?

Answer 38

**Lymph node biopsy**

Question 39

Following **lymph node** biopsy, which staging system is used for **lymphoma?**

Answer 39

**Ann Arbor staging**

Question 40

Describe the **Ann-Arbor system** for staging **Hodgkins/NH lymphomas.**

Answer 40

**A: no systemic symptoms** **B: systemic symptoms** ***I:*** ***one lymph node affected*** ***II: two nodes affected, both on same side of the diaphragm*** ***III: nodes affected on both sides of diaphragm*** ***IV: spread beyond lymph nodes*** so AI, BIV etc.

Question 41

What are the **mnemonics** used to remember the treatment regimes for a) **multiple myeloma** b) **Hodgkins lymphoma** c) **Non-Hodgkins lymphoma?**

Answer 41

a) **VAD** b) **ABVD** c) **R-CHOP-21**

Question 42

What is the **ABVD** management plan for **Hodgkins lymphoma?**

Answer 42

**Adriamycin** **Bleomycin** **Vincristine** **Dexamethasone**

Question 43

What is the **R-CHOP-21** management plan for **Non-Hodgkins lymphoma?**

Answer 43

**R-CHOP-21** Rituximab Cyclophosphamide Doxorubicin Vincristine Prednisolone 21 day course of this The letters don't match up with the generic drug names which sort of defeats the point of a mnemonic