This is a concise and detailed summary of all the main types of blood cancers that students need to learn for their medical schools finals. Also, there are detailed investigations and management plans included for each cancer to have a better understanding of the topic. Always remember to follow th...
Acute:
Haematology: Cancers - Early stages: 1 or 2 ABV
Lymphoma dacarbazine
Leukaemias - Advanced: 3 or 4 AVD a
MGUS Or: BEACOPP: bleomycin,
vincristine, procarbazine,
Multiple myeloma - Asymptomatic pts:
IA, IIA: rituximab and chem
III, IV: rituximab and chem
1. Lymphoma: Hodgkin’s Chronic pts:
Mostly presents with: Painless cervical and/ or supraclavicular lymphadenopathy - See local specialist guideli
in young adults - Salvage therapy combined
B symptoms: fever (temp >38), night sweats, weight loss >10% in the last 6 - Stem cell transplantation
months - Consider brentuximab
malignant Reed-Sternberg cells harbour Epstein-Barr virus (EBV) antigens in a
significant proportion of cases (20% to 40%)
2. Non-Hodgkin's lymph
RFs:
Hx of mononucleosis is a risk factor for EBV-positive Hodgkin lymphoma
- EBV with Burkitt’s lympho
It is a B-cell malignancy
- EBV with AIDS related prim
- EBV with nasal natural kill
Other signs and symptoms:
- Hep C with splenic margin
- Dyspnoea
- Hep C with diffuse large B
- Cough
- Human herpesvirus 8 with
- Chest pain
- H.pylori with gastric MALT
- Asymmetric lymphadenopathy
- Borrelia burgdorferi with
- SVC syndrome cough, SOB, face and upper extremity oedema, dilated
- Coxiella burnetiid with B c
neck veins
- Chlamydia psittaci in MAL
- Abdominal pain
- Pruritus
Associated with:
- ** alcohol-induced pain at involved sites
- Sjogren syndrome, rheum
- Hepatosplenomegaly
- Post organ transplant and
- Tonsillar enlargement
- Ataxia telangiectasia, Kline
- Pesticides and phenoxyhe
Classification:
- Breast implants increase r
Type Frequency Prognosis Notes
Nodular sclerosing Most common: Good More in women
B-cell lymphoma:
70% Linked to lacunar
- immature B cells, mature
cells
B cells may transform to v
Mixed cellularity 20% Good Large number of
diffuse large B-cell lympho
Reed Sternberg
T- cell lymphoma:
cells
- Pluripotent haematopoieti
Lymphocyte 5% Best - and T)
predominant
- T cells migrate early into t
Lymphocyte Rare Worst - the process starts from th
depleted (TCR) alpha, forming the m
CD4+/CD8+
factors associated with a poor prognosis:
- Age >45 Classifications:
- Stage 4 disease 1. Mature B cell neoplasm:
- Hb<10.5 CLL/ small lymphocytic lym
- Lymphocyte count <600/ microL or <8% Monoclonal B cell lympho
- Male Splenic marginal zone lym
- Albumin <40 g/l B cell prolymphocytic leuk
- WBC > 15000/ microL Hairy cell leukaemia
Splenic B cell lymphoma/
Lymphoplasmacytic lymph
Staging: Ann-Arbor staging MGUS IgM: monoclonal g
1. Single lymph node Heavy chain diseases: alph
2. 2 or more lymph nodes/ regions on the same side of the diaphragm disease
3. Nodes on both sides of the diaphragm MGUS IgA/ IgG
4. Beyond lymph nodes Plasma cell myeloma
Divide each stage into A or B: Solitary plasmocytoma of
A: no systemic symptoms other than pruritus Extraosseous plasmacytom
B: having B symptoms Follicular lymphoma in
Paeds type of follicular lym
Risk factors: Large B cell lymphoma
, Mantle cell Usually, B lymphocytes
High-grade B-cell lymphoma, not otherwise specified Leading to pancytopenia
B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and Mostly in children and als
classical Hodgkin's lymphoma older adults
More common in Down
b. Aggressive T-cell lymphomas Associated with
Philadelphia chromosom
Enteropathy-type T-cell lymphoma/intestinal T-cell lymphoma Peak incidents: age <5
Peripheral T-cell lymphoma
Subcutaneous panniculitis-like RFs:
Systemic anaplastic - Hx malignancy
Angioimmunoblastic - Viral infections
- Hx of chemotherapy
c. Indolent B-cell lymphomas - Radiation exposure and sm
- Down syndrome and Kline
Follicular lymphoma telangiectasia
Marginal zone; gastric MALT type - Male
Chronic lymphocytic leukaemia/small lymphocytic lymphoma - Hispanic population
Lymphoplasmacytic lymphoma - FHx
o Waldenström's macroglobulinaemia
d. Indolent T-cell lymphomas Signs and symptoms:
- Fever
Mycosis fungoides/Sézary syndrome - Pallor
Primary cutaneous anaplastic large cell lymphoma - Fatigue and dizziness
- Lymphadenopathy
SIGNS AND SYMPTOMS: - Hepatosplenomegaly
- B symptoms - petechiae
- Fatigue - bruising and epistaxis and
- Lymphadenopathy - bone pain
- Splenomegaly - renal enlargement
- Hepatomegaly - meningismus and papilloe
- Cough - abdominal pain
- SOB - mediastinal and/or abdom
- Headache - pleural effusion
- Abdominal discomfort
- Chest pain Investigate:
- Pallor FBC
- Purpura Blood smears
- Jaundice Electrolytes Ca can be high
- Skin lesion Uric acid: high: due to rapid tu
- Neurological sign Tumour lysis syndrome:ONCO
hyperphosphatemia, hyperkal
Investigations: hyperuricemia and high LDH
- FBC thrombocytopenia, pancytopenia, lymphocytosis Renal function
- Blood smears: early WBC precursor, nucleated RBC LFT
- Bone marrow biopsy Coagulation profile
- LFT Bone marrow aspiration hyp
- Metabolic panel leukemic lymphoblasts >20% b
- LDH: determining the urgency of treatment and intensity of Tumour lysis Immunophenotyping
prophylaxis Cytogenetic analysis Philad
- Lymph node biopsy Blood group and antibody scre
- PET/CT Antibodies for infections HI
- Skin biopsy HLA typing
- Immunoglobulin gene rearrangement study CXR
- FISH and cytogenetic study Lumbar puncture
- HIV antibody Pleural tap
- Hep B and C CT/MRI brain
- Lumbar puncture low glucose and high protein and pressure CT chest
- Polymerase chain reaction for tumour marker **scrotal US
- Serum protein electrophoresis
- +/- Echocardiogram and colonoscopy Management:
- ACUTE PHASE:
Management: a. Induction th
Watchful waiting cyclophosph
Chemo daunorubicin
Monoclonal antibodies b. Supportive c
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