Week 4 Cancers Flashcards Preview

IHO > Week 4 Cancers > Flashcards

Flashcards in Week 4 Cancers Deck (55):
1

Acute Myelogenous Leukemia

20%(WHO) of bone marrow is bone marrow myelobasts

2

M0

Undifferentiated myeloid leukemia

3

M1

Acute myeloid leukemia w/o differentiation

4

M2

Acute myeloid leukemia with differentiation

5

M3

Acute promyelocytic leukemia which can be readily cured t(15;17) commonly see auer rods

6

M4

acute myelomonocytic leukemia

7

M5

acute monocytic leukemia

8

M6

Acute erythroleukemia

9

M7

acute megakaryocytic leukemia

10

Favorable cytogenetics

t(8;21) t(16;16) t(15;17) and auer rods

11

Remission

less than 5% blasts after 14 days

12

Chronic Lymphocytic Leukemia

Disorder of B cells but CD5+(t cell antigen), CD20+ and TdT(lymphoblasts) negative "CD23+" , tx with patience. treat sx. infection is problem Adults only

13

Hairy Cell leukemia

Hairy cells, splenomegaly, no lymphadenopathy, pancytopenia. Is a chronic B cell proliferative disorder. often >40 Male. Chicken wire bone marrow. TRAP+ CD20+ CD5- Tx. chemo, good prognosis Adults only

14

Prolymphocytic Leukemia

prolymphocytes, splenomegaly w/o lymphadenopathy, rare and aggressive. very high wBC, Low Hgb and platelets. dark dense chromatin Adults only

15

Large granulated Lymphocyte leukemia

Large granulated lymphocytes. "T cell" leukemia. Neutropenia- suceptible to infections. Long survival. Adults only

16

Chronic Myeloid Leukemia

neutrophilic leukocytosis. basophillia, phildelphia chromosome t(9;22) bcr-abl tyrosine kinase, three phases. Slow onset, fever, fatigue, full abdomen, night sweats
tx. imatinib

17

CML Chronic phase

stable counts, easily controlled, half go on to accelerated phase, half go onto blast crisis.

18

CML Accelerated phase

unstable counts, blast crisis within 6-12 months

19

CML Blast crisis

-becomes acute leukemia, migh mortality, blasts over 20%. can get a lymphoid problem as well

20

Chronic myeloproliferative disorders

Chronic myeloid leukemia, Polycthemia vera, Essential thrombocytopenia, Myelofibrosis occur only in adults. Long clinical course, increased WBC with left shift, may evolve into acute leukemia

21

Polycythemia vera

High RBC (sludgy blood) can get infarcts downstream diferent from secondary polycythemia, thrombosis and hemorrhage, Jak-2 kinase mutation in mostly all. Dx. high red cell mass, normal O2 sats. can have splenomegaly, thrombocytosis, increased WBC, Leukocyte alkaline phosphatase, increased B12. Marrow full of eryth. precursors. tx. phlembotomy, myelosuppressive drugs. Death from thromb. or hemmor.

22

JAK-STAT pathway

Signal binds cytokine receptor which has JAK bound. JAK Phos. receptor, STAT binds P. JAK phosphorylates STAT, STATS dimerize and become transcription factors.

23

Essential Thrombocytopenia

form of Chronic myeloproliferative disorder. Very high platelet count. Young women. Thrombosis and hemorrhage. Dx. platelets> 600,000. Hgb<13 or RBC normal. No marrow fibrosis, no other reason for thrombocytosis.
Experience bleeding and clotting.
Sx. pupura(red dots in skin from hem.), bruising, pallor, tachycardia, big spleen. tx. platelet pheresis, asprin

24

Chronic Myelofibrosis

form of Chronic myeloproliferative disorder Marrow full of myeloid cells, extramedulllary hematopoiesis- huge spleen. "teardrop red cells" from fibrotic marrow. Sx. LUQ fullness, weakness, fatigue. tx. supprotive. 3-5 year survival.

25

Imatinib

BCR-ABL tyrosine kinase inhibitor which causes apoptosis. Hugely effective. Not effective against blast phase disease. Taken for life. Treats CML with t(9,22)

26

Lymphoma

Malignancy of hematopoietic cells, starts in lymph nodes, can spread to blood or nodes. Mostly B and T cells. present with lymphadenopathy. Lymphoma lymph node- said to have fish flesh texture

27

Benign Follicular hyperplasia

large irregular follicles, mixture of cells in germinal centers, tingible body macrophages, B cell response to some immune stimulus.

28

Benign interFollicular hyperplasia

Expanded areas between follicles, mixture of cells, partial effacement, T-cell response to some immune stimulus, invade fat in the node.

29

Non-Hodgkin Lymphoma

Malignant proliferation of lymphoid cells. (blasts or mature) skips throughout body in unpredictable pattern. many subtypes, most are B cell. Sx. -painless, firm lymphadenopathy, extranodal manifestations, B sx. weight loss, night sweats, fever B=bad.

30

Low grade non-hodgkin's lymphoma

older patients, indolent (not dividing fast) small mature cells, non destructive. 4 types: small Lymphocytic lymphoma, follicular lymphoma, mycosis fungoides

31

High grade non-hodgkin's lymphoma

Children, aggressive, big ugly cells, destructive. 3 types: large cell lymphoma, lymphoblastic lymphoma, Burkitt, lymphoma

32

Small Lymphocytic Lymphoma

type of NHL Low grade. Small mature lymphocytes, same as CLL, B-cell lesion, but CD5+. long course. RIchter transformation= bad

33

Marginal zone Lymphoma (MALT)

type of NHL Low grade Mucosa associated lymphoid tissue. a bunch of lymphomas with marginal zone pattern. MALT is common type-salivary glands, lymphoid tissue Goes away with antibiotics to H. Pylori.

34

Mantle Cell Lymphoma

"CD5+, CD23-, Cyclin D1 +" type of NHL Low grade "t(11;14)" Mantle zone pattern, small angulated lymphocytes, translocation leads to cyclin D1 and IgH to be by each other, 14=H. allows passage through checkpoints to be faster. aggressive. CD20 and CD5 positive

35

Follicular Lymphoma

type of NHL Low grade. Follicular pattern. "t(14,18)" cells immortal. small cleaved cell, mixed or large cell. grade1-3. fat in lymph nodes. Butt cells=clefted nuclei of lymphocytes. Early therapy does not improve survival. Treat when forced to with rituximab

36

Mycosis fungoides

type of NHL Low grade. messed up lion face pic. skin lesions appear as excema-> mushroom growth on skin. blood involvement, T- cell immunophenotype. Sezary cells- look like little brains

37

diffuse-Large cell Lymphoma

type of NHL high grade. Large B cells, extranodal involvement, rapid growth, bad prognosis.

38

Lymphoblastic Lymphoma

type of NHL high grade. B and T types. Same as Acute Lymphoblastic leukemia. "T"-Lymphoblastic lymphoma seen in "t"een, male with mediastinal mass.

39

Burkitt Lymphoma

type of NHL high grade. Endemic(near mandible) vs Nonendemic(abdomen). typically child with fast growing mass. "starry sky pattern" "t(8,14) c-myc and IgH. can involve blood- burkitt's leukemia. Blue cytoplasam and punched out vacuoles.

40

Adult T-cell Leukemia/ Lymphoma

Japan/ carribean. HTLV-1 virus. skin lesions, hypercalcemia, aggressive. Not common, hard to treat. flowery blood cells.

41

Hodgkin Lymphoma

Younger patients, good prognosis. CD30+ Contigious sprad. 5 subtypes. "Reed-Sternberg cell" (owl's eyes). a huge multinucleated cell with big nucleoli. peaks in males 20-30, and later in life. Spreads node to node. different subtypes

42

Nodular lymphocyte Hodgkin Lymphoma

asymptomatic young male, good prognosis, B cell origin, popcorn cells, most common subtype, lacunar cells. CD20+

43

Mixed cellularity Hodgkin Lymphoma

Worse prognosis, usually disseminated at presentation. Classic reed sternberg cells.

44

Lymphocyte rich Hodgkin Lymphoma

Uncommon, usually localized, popcorn cells.

45

Lymphocyte depletion Hodgkin Lymphoma

Rare, often disseminated, classic reed sternberg cells. , collagen or reticulin background.

46

Chronic Lymphocytic Leukemia Staging

•Rai system
•Rai 0: lymphocytosis –can just monitor
•Rai 1: lymphadenopathy
•Rai 2: splenomegaly
•Rai 3: HgB < 11 g/dL
•Rai 4: platelets < 100K

47

CLL curative modality

Mostly just watch them, but best way to cure is allogenic transplant

48

Staging of Lymphomas

Stage1: localized disease, single node or organ
Stage 2: two or more node regions on same side of diaphragm
Stage3: two or more lymph node regions above and below diaphragm
Stage 4: widespread disease, multiple organs, with or without lymph node involvement.

49

Lymphoma staging scan

PET. Lymphomas love me sum shugga

50

ECOG SCORE

1 point for each max=5= worst
age>60
PS2-4?
Stage 3-4
LDH elevated
Extra nodal (stage 4)

51

NHL treatment

CHOP!, R-CHOP for B cell lymphomas- R=rituxumab

52

Indolent B cell Lymphomas

Follicular, CLL/SLL, Marginal zone, MALT, LPL or wldenstrom

53

Aggressive B cell lymphomas

DLBCL, Mantle cell

54

Highly aggressive B cell lymphomas

Burkett.=EBV

55

CHOP

Treats CD20+ (bcell lymphomas) do not treat T cell lymphomas, No CD 20