Hematological Malignancies and Blood Cancer Types
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Questions and Answers

What is the primary characteristic of cancer?

  • Controlled cell growth with loss of apoptosis
  • Uncontrolled cell growth with loss of apoptosis (correct)
  • Uncontrolled cell growth with increased apoptosis
  • Controlled cell growth with increased apoptosis

    • Which type of blood cell cancer is associated with plasma cells?

  • Myeloma (correct)
  • Lymphoma
  • Myelodysplastic Syndrome
  • Leukemia

    • What is the normal maturation process of a Neutrophil?

  • Myeloblast → Myelocyte → Metamyelocyte → Band → Neutrophil
  • Myeloblast → Promyelocyte → Myelocyte → Metamyelocyte → Band
  • Myeloblast → Promyelocyte → Myelocyte → Metamyelocyte → Band → Neutrophil (correct)
  • Myeloblast → Promyelocyte → Myelocyte → Metamyelocyte → Neutrophil

    • Which of the following genetic disorders is associated with an increased risk of acute leukemias?

    <p>All of the above</p> Signup and view all the answers

    What is the only known risk factor for chronic leukemias?

    <p>Exposure to ionizing radiation</p> Signup and view all the answers

    Which of the following is a risk factor for lymphomas?

    <p>All of the above</p> Signup and view all the answers

    What is the term for a pre-malignancy of the bone marrow?

    <p>Myelodysplastic Syndrome</p> Signup and view all the answers

    Which of the following is associated with an increased risk of multiple myeloma?

    <p>All of the above</p> Signup and view all the answers

    What is the primary site of origin for Lymphoma?

    <p>Lymphoid tissue</p> Signup and view all the answers

    Which type of leukemia is associated with an eosinophilic disorder?

    <p>Hypereosinophilic Syndrome</p> Signup and view all the answers

    What is the term for the process by which a cell undergoes programmed cell death?

    <p>Apoptosis</p> Signup and view all the answers

    Which of the following is a risk factor for developing Acute Leukemias?

    <p>Down Syndrome</p> Signup and view all the answers

    What is the name of the genetic translocation associated with Chronic Myeloid Leukemia?

    <p>t(9;22)</p> Signup and view all the answers

    Which of the following is a risk factor for developing Multiple Myeloma?

    <p>All of the above</p> Signup and view all the answers

    What is the term for a type of leukemia that arises from the proliferation of megakaryocytes?

    <p>Acute Megakaryoblastic Leukemia</p> Signup and view all the answers

    What is the term for the process by which a cell becomes abnormal and grows uncontrollably?

    <p>Neoplasia</p> Signup and view all the answers

    What percentage of hospice care is provided under Medicare Part A or Medicaid?

    <p>98%</p> Signup and view all the answers

    What is the primary goal of Palliative Care?

    <p>Relieving suffering associated with serious illness</p> Signup and view all the answers

    What is a requirement for a patient to be eligible for hospice care?

    <p>A terminal illness with a life expectancy of six months or less</p> Signup and view all the answers

    What is the purpose of Respite care?

    <p>To allow caregivers to rest and take a break</p> Signup and view all the answers

    What is the focus of the Hospice team?

    <p>Offering expertise and compassion to dying persons</p> Signup and view all the answers

    What type of care provides general inpatient/hospital level care?

    <p>IPU: In-Patient Unit</p> Signup and view all the answers

    Who can initiate the hospice process?

    <p>Anyone, including the patient, family member, or medical provider</p> Signup and view all the answers

    What is the purpose of Bereavement Counseling?

    <p>To provide grief support to the bereaved</p> Signup and view all the answers

    What is the focus of the Hospice team's plan of care?

    <p>Providing comfort and supporting loved ones</p> Signup and view all the answers

    What is the term for comfort care that may be provided at any time, regardless of diagnosis or prognosis?

    <p>Palliative care</p> Signup and view all the answers

    What is the typical age range for Acute Lymphoid Leukemia (ALL)?

    <p>Children and young adults</p> Signup and view all the answers

    What is the characteristic feature of Reed-Sternberg cells in Hodgkin's lymphoma?

    <p>Owl eyes</p> Signup and view all the answers

    What is the primary goal of hospice care?

    <p>To provide palliative care and support</p> Signup and view all the answers

    What is the term for a pre-malignant disorder of the bone marrow?

    <p>Myelodysplasia</p> Signup and view all the answers

    What is the typical presentation of Multiple Myeloma?

    <p>Mild back pain in the mid-thoracic region</p> Signup and view all the answers

    What is the cultural shift in perspectives on dying that has impacted hospice and palliative care?

    <p>A recognition that dying is a natural process</p> Signup and view all the answers

    What is the characteristic chromosomal abnormality in Chronic Myeloid Leukemia (CML)?

    <p>Philadelphia chromosome</p> Signup and view all the answers

    What is the primary focus of hospice care?

    <p>Creating a holding space for dying persons and their loved ones</p> Signup and view all the answers

    What is the primary method of reducing cancer risk?

    <p>Quitting tobacco use</p> Signup and view all the answers

    What is the TNM staging system used for?

    <p>Staging the location and spread of cancer</p> Signup and view all the answers

    What is the primary goal of debulking surgery in cancer treatment?

    <p>Reducing the size of the tumor</p> Signup and view all the answers

    What is the term for the spread of cancer to distant sites in the body?

    <p>Metastasis</p> Signup and view all the answers

    What is the primary role of medical oncologists and medical oncology PAs in cancer treatment?

    <p>Providing systemic chemotherapy</p> Signup and view all the answers

    What is the purpose of stereotactic radiation therapy?

    <p>Treating tumors in the brain and neck</p> Signup and view all the answers

    What is the primary risk factor for esophageal cancer?

    <p>Tobacco use</p> Signup and view all the answers

    What is the primary goal of brachytherapy in cancer treatment?

    <p>Delivering radiation directly into the body</p> Signup and view all the answers

    What is the classification of cancer staging based on the results of surgery?

    <p>Pathologic staging</p> Signup and view all the answers

    What is the primary risk factor for pancreatic cancer?

    <p>Tobacco use</p> Signup and view all the answers

    What is the primary goal of the GUIDE Model in relation to dementia care?

    <p>All of the above</p> Signup and view all the answers

    What is the most common cause of cancer deaths in the US?

    <p>Lung and bronchus</p> Signup and view all the answers

    What is the main reason for the decline in cancer deaths in the US?

    <p>All of the above</p> Signup and view all the answers

    What is the percentage of US cancer deaths related to tobacco use?

    <p>30%</p> Signup and view all the answers

    What is the term for abnormal tissue that grows more rapidly than normal and continues to grow and proliferate in the absence of the originating growth signal?

    <p>Neoplasm</p> Signup and view all the answers

    What is the main difference between solid tumors and liquid/hematologic malignancies?

    <p>Solid tumors are typically epithelial or squamous cell tumors, while liquid/hematologic malignancies are diseases of the bone marrow</p> Signup and view all the answers

    What is the primary reason for the increasing number of cancer survivors in the US?

    <p>All of the above</p> Signup and view all the answers

    What is the most common cancer diagnosis in women in the US?

    <p>Female breast cancer</p> Signup and view all the answers

    What is the main factor that contributes to health care disparities and increased risk of cancer?

    <p>Lack of access to healthcare</p> Signup and view all the answers

    What is the term for a comprehensive package of care coordination and management, caregiver support and education, and respite services?

    <p>The GUIDE Model</p> Signup and view all the answers

    What is the primary goal of neoadjuvant treatment in cancer?

    <p>To shrink a tumor before the main treatment</p> Signup and view all the answers

    What is the term for a syndrome that is caused by the body's response to cancer, rather than the cancer itself?

    <p>Paraneoplastic syndrome</p> Signup and view all the answers

    What is the primary role of a radiation oncologist in the interdisciplinary oncology team?

    <p>To provide radiation therapy to the patient</p> Signup and view all the answers

    What is the term for the treatment given after the primary treatment to lower the risk of cancer recurrence?

    <p>Adjuvant treatment</p> Signup and view all the answers

    What is the classification of oncologic emergencies that are caused by the tumor's physical presence?

    <p>Mechanical or obstructive</p> Signup and view all the answers

    What is the term for the condition in which the cancer treatment causes the tumor to break down rapidly, leading to metabolic problems?

    <p>Tumor lysis syndrome</p> Signup and view all the answers

    What is the role of a nurse educator in the oncology care team?

    <p>To educate the patient and their family on cancer care</p> Signup and view all the answers

    What is the term for the care provided to cancer patients after they have completed treatment?

    <p>Survivorship care</p> Signup and view all the answers

    What is the primary goal of emergency management in treating hypercalcemia?

    <p>To ensure rehydration with brisk urinary output</p> Signup and view all the answers

    Why is calcium level not a reliable indicator in patients with cancer?

    <p>Because patients with cancer often have low albumin levels due to malnutrition or liver damage</p> Signup and view all the answers

    What is the treatment approach for hypercalcemia in patients with a good chance of effective tumor therapy?

    <p>Vigorous treatment of hypercalcemia while awaiting definitive tumor therapy</p> Signup and view all the answers

    What is the typical complication of myelosuppression in patients receiving cytotoxic chemotherapeutic agents?

    <p>Febrile neutropenia</p> Signup and view all the answers

    How do bisphosphonates help in treating hypercalcemia?

    <p>By inhibiting osteoclastic bone resorption</p> Signup and view all the answers

    In what stage of a tumor is treatment of hypercalcemia typically judicious?

    <p>Late stages of a tumor that is resistant to antitumor therapy</p> Signup and view all the answers

    What is the primary mechanism of hypercalcemia in patients with cancer?

    <p>All of the above</p> Signup and view all the answers

    What is the most common site of malignant spinal cord compression?

    <p>Thoracic spine</p> Signup and view all the answers

    What is the primary treatment for superior vena cava syndrome caused by non-small-cell lung cancer?

    <p>Radiation therapy</p> Signup and view all the answers

    What is the term for features of a cancer that are considered to be due to its remote effects?

    <p>Paraneoplastic syndrome</p> Signup and view all the answers

    What is the most common symptom of malignant spinal cord compression?

    <p>Localized back pain</p> Signup and view all the answers

    What is the term for compression of the spinal cord and/or cauda equina by an extradural tumor mass?

    <p>Malignant spinal cord compression</p> Signup and view all the answers

    What is the primary goal of treatment for malignant spinal cord compression?

    <p>All of the above</p> Signup and view all the answers

    What is the most common type of cancer associated with paraneoplastic syndromes?

    <p>Small cell lung cancer</p> Signup and view all the answers

    What is the term for the clinical manifestation of superior vena cava obstruction?

    <p>Superior vena cava syndrome</p> Signup and view all the answers

    What is the primary reason for ordering a chest radiograph in a patient with suspected superior vena cava syndrome?

    <p>To assess the mediastinal anatomy</p> Signup and view all the answers

    Study Notes

    Hematological Malignancies

    • Cancer is uncontrolled cell growth with loss of apoptosis (programmed cell death), occurring in any cell in the body.

    Types of Hematological Malignancies

    • Leukemia: originates from myeloid or lymphoid cells.
    • Lymphoma: originates from lymphoid tissue (in bone marrow or peripheral).
    • Myeloma: originates from plasma cells (a type of B cell).

    Review of Marrow Components

    • Neutrophils: can develop into Acute Myeloid Leukemia.
    • Lymphocytes: can develop into Acute Lymphocytic Leukemia.
    • Monocytes: can develop into Acute Myeloid Leukemia.
    • Eosinophils: can develop into Hypereosinophilic Syndrome.
    • Basophils: can develop into AML, seen in CML, and also in HD.
    • RBC's: can develop into Acute Erythroid Leukemia (rare).
    • Platelets: can develop into Acute Megakaryoblastic Leukemia (rare).

    Normal Maturation of a Neutrophil

    • Myeloblast → Promyelocyte → Myelocyte → Metamyelocyte → Band →Neutrophil.

    Epidemiology of Acute Leukemias

    • Generally affects older people, non-Hispanic whites.
    • Risk factors include genetic disorders (e.g., Down Syndrome, Ataxia telangiectasia, Fanconi Anemia, Li Fraumeni), radiation exposure, and chemical exposure.

    Epidemiology of Chronic Leukemias

    • Only known risk factor is exposure to ionizing radiation.
    • CML was the first disorder proven to be caused by a genetic translocation [t(9;22)].

    Epidemiology of Lymphomas

    • Relatives of probands have a 3.5x higher chance of developing lymphoma.
    • Higher incidence in patients with autoimmune diseases (e.g., RA, hemolytic anemia, psoriasis, SLE, Systemic sclerosis, Polyarteritis nodosa, sarcoidosis), immunosuppression, and viral infections (HIV, HTLV, EBV).

    Epidemiology of Multiple Myeloma

    • Affects multiple parts of the body, hence the name.
    • Higher incidence in African Americans and those with a higher body mass index.
    • Risk increases with exposure to agent orange (especially those with MGUS).
    • Higher incidence in families (3.5x higher with 1st-degree relative).

    Myelodysplastic Syndrome (MDS)

    • Not a malignancy, but a pre-malignancy of the bone marrow.
    • Defined as a disorder in which the bone marrow does not produce enough healthy blood cells.

    Hematological Malignancies

    • Cancer is uncontrolled cell growth with loss of apoptosis (programmed cell death), occurring in any cell in the body.

    Types of Hematological Malignancies

    • Leukemia: originates from myeloid or lymphoid cells.
    • Lymphoma: originates from lymphoid tissue (in bone marrow or peripheral).
    • Myeloma: originates from plasma cells (a type of B cell).

    Review of Marrow Components

    • Neutrophils: can develop into Acute Myeloid Leukemia.
    • Lymphocytes: can develop into Acute Lymphocytic Leukemia.
    • Monocytes: can develop into Acute Myeloid Leukemia.
    • Eosinophils: can develop into Hypereosinophilic Syndrome.
    • Basophils: can develop into AML, seen in CML, and also in HD.
    • RBC's: can develop into Acute Erythroid Leukemia (rare).
    • Platelets: can develop into Acute Megakaryoblastic Leukemia (rare).

    Normal Maturation of a Neutrophil

    • Myeloblast → Promyelocyte → Myelocyte → Metamyelocyte → Band →Neutrophil.

    Epidemiology of Acute Leukemias

    • Generally affects older people, non-Hispanic whites.
    • Risk factors include genetic disorders (e.g., Down Syndrome, Ataxia telangiectasia, Fanconi Anemia, Li Fraumeni), radiation exposure, and chemical exposure.

    Epidemiology of Chronic Leukemias

    • Only known risk factor is exposure to ionizing radiation.
    • CML was the first disorder proven to be caused by a genetic translocation [t(9;22)].

    Epidemiology of Lymphomas

    • Relatives of probands have a 3.5x higher chance of developing lymphoma.
    • Higher incidence in patients with autoimmune diseases (e.g., RA, hemolytic anemia, psoriasis, SLE, Systemic sclerosis, Polyarteritis nodosa, sarcoidosis), immunosuppression, and viral infections (HIV, HTLV, EBV).

    Epidemiology of Multiple Myeloma

    • Affects multiple parts of the body, hence the name.
    • Higher incidence in African Americans and those with a higher body mass index.
    • Risk increases with exposure to agent orange (especially those with MGUS).
    • Higher incidence in families (3.5x higher with 1st-degree relative).

    Myelodysplastic Syndrome (MDS)

    • Not a malignancy, but a pre-malignancy of the bone marrow.
    • Defined as a disorder in which the bone marrow does not produce enough healthy blood cells.

    Heme Malignancies

    • Leukemias:
      • Myeloid:
        • Acute: AML (sudden, >20% blasts, severe)
        • Chronic: CML (Philadelphia chromosome)
      • Lymphoid:
        • Acute: ALL (kids)
        • Chronic: CLL (older, smudge cells)
    • Lymphomas:
      • Hodgkin's:
        • Peak at young age
        • Peak at old age
        • "Owl eyes"
        • Reed-Sternberg cells
      • Non-Hodgkin's:
        • All ages and races
        • Splenomegaly
        • Implants
        • H. pylori
    • Multiple Myeloma:
      • Mild back pain
      • Mid-thoracic back pain
      • Not alleviated when lying down
      • Middle age
      • Pain when in supine position
      • Can cause cord suppression
    • MDS (Myelodysplastic syndrome):
      • Pre-cancer but will be cancer if left untreated
      • Premalignant disorder

    Hospice and Palliative Care

    • Origins:
      • Cultural shift in perspectives on dying (Kubler-Ross)
      • Technological and medical advances
      • Dying is not simply a medical event
      • It is a process, an experience, that is physical, social, mental, emotional, and spiritual
    • CORE Promises:
      • Your story is unique
      • Your voice matters
      • Your story will be honored
      • Stories unfold and evolve
      • Understanding comes from knowing
    • Hospice:
      • Provides a philosophy of care and tools
      • Supports loved ones after death
      • 1/3 of patients die within 7 days of being in hospice
      • Challenges a death-denying culture
      • Changes the medical mindset from "nothing more we can do" to "there is much to be done"
    • The hospice team:
      • A circle of care offering expertise and compassion
      • Plan of care is established and constantly updated
      • Provides medical equipment, supplies, medications, and 24-hour on-call
      • Offers bereavement care, physical therapy, nutritionist, and more

    Advanced Illness Care Continuum

    • Palliative Care:
      • Focuses on quality of life for anyone dealing with serious illness
      • May be just one consultation or comprehensive care
      • Focuses on establishing goals of care, relieving suffering, and navigating complex medical decisions
    • Eligibility:
      • Any diagnosis
      • Any age
      • Any time in the course of disease
      • Any patient with uncontrolled symptoms
    • Not all palliative care is the same:
      • Program variations
      • Team make-up
      • Services provided
      • Location of services provided

    Oncology

    • Definition of Cancer:
      • Unregulated cell growth
      • Abnormal tissue that grows more rapidly than normal
      • Can be solid or liquid (hematologic)
    • Common Cancers:
      • Top 10 cancers by rates of new cases
      • Top 10 cancers by rates of cancer death
      • Increased death in men compared to women
      • Health care disparities and lack of access = increased risk of cancer
    • Risk Factors:
      • Non-modifiable: genetic predisposition, sex, age
      • Modifiable: tobacco, nutrition, physical activity, radiation
      • Vaping and electronic cigarette aerosol
      • Tobacco cessation is the most important treatment for preventing cancer
    • Staging:
      • Refers to where a cancer is located and if it has spread
      • Determines treatment options and prognosis
      • TNM system:
        • T: tumor location, size, and level of invasion
        • N: absence or presence and extent of nodal metastases
        • M: absence or presence of systemic metastases
    • Treatment:
      • Surgery
      • Chemotherapy
      • Radiation Therapy
      • Oncology care:
        • Physicians/Surgeons/Radiologists
        • PAs/NPs
        • Nurse Educators
        • Chemotherapy Nurses
        • Pharmacists
        • Social Workers
        • Counselors/Psychologists
        • Financial Support Experts
      • Survivorship

    Oncologic Emergencies

    • Definition: common oncologic emergency condition
    • Classifications:
      • Mechanical/Obstructive
      • Metabolic or Hormonal
      • Treatment-Related
    • Examples:
      • Superior Vena Cava (SVC) Syndrome
      • Spinal Cord Compression
      • Hypercalcemia
      • Febrile Neutropenia
      • Tumor Lysis Syndrome
      • Anemia
      • Pulmonary Embolism
      • Thrombocytopenia
      • Urinary Obstruction
      • SIADH
      • Bleeding Disorders
      • Malignant Effusions
      • Clotting disorders### Paraneoplastic Syndromes
    • Paraneoplastic syndromes refer to features of a cancer that cannot be attributed to its direct invasive or metastatic properties
    • Symptoms are due to aberrant tumor production of hormones, peptides, or cytokines or to the body's immune attack on normal tissues due to shared antigens with tumor tissues
    • Small cell lung cancer (SCLC) is the one type of cancer most likely to be associated with paraneoplastic syndromes

    Superior Vena Cava Syndrome

    • Superior vena cava syndrome (SVCS) is the clinical manifestation of superior vena cava (SVC) obstruction
    • SVC obstruction results in severe reduction in venous return from the head, neck, and upper extremities
    • Malignant tumors (lung cancer, lymphoma, metastatic tumors) are responsible for the majority of SVCS cases
    • Symptoms include neck and facial swelling, dyspnea, and cough
    • Characteristic physical findings are dilated neck veins, an increased number of collateral veins covering the anterior chest wall, cyanosis, and edema of the face, arms, and chest

    Diagnosis and Treatment of Superior Vena Cava Syndrome

    • Diagnosis of SVCS is a clinical one
    • First step is to order a chest radiograph (CXR)
    • CXR finding: widening of the superior mediastinum, most commonly on the right side
    • CT provides the most reliable view of the mediastinal anatomy
    • Radiation therapy is the primary treatment for SVCS caused by non-small-cell lung cancer and other metastatic solid tumors
    • Chemotherapy is effective when the underlying cancer is small-cell carcinoma of the lung, lymphoma, or germ cell tumor

    Spinal Cord Compression

    • Malignant spinal cord compression (MSCC) is defined as compression of the spinal cord and/or cauda equina by an extradural tumor mass
    • Thoracic spine is the most common site (70%), lumbosacral spine (20%), cervical spine (10%)
    • Lung cancer is the most common cause
    • Symptoms: localized back pain and tenderness, radicular pain, Lhermitte's sign
    • Treatment: radiation therapy plus glucocorticoids, neurosurgery in some cases

    Hypercalcemia

    • Hypercalcemia: elevated levels of calcium in the blood (>10.5 mg/dL)
    • Affects 20–30% of patients with cancer at some point during their illness
    • Most common cancers causing hypercalcemia are myeloma, breast carcinoma, and NSCLC
    • Symptoms: anorexia, nausea, fatigue, constipation, and polyuria
    • Diagnostic workup: calcium level corrected for albumin, ionized calcium level
    • Treatment: IV 0.9% saline for rehydration, bisphosphonate for moderate or severe hypercalcemia, control of tumor mass

    Febrile Neutropenia

    • Febrile neutropenia refers to the clinical presentation of fever and
    • Cytotoxic chemotherapeutic agents affect bone marrow function
    • Complications of myelosuppression result from the predictable sequelae of the missing cells' function

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    Description

    This quiz covers the basics of hematological malignancies, including types of cancer originating from blood cells, such as leukemia, lymphoma, and myeloma. It also reviews components of bone marrow and their relation to cancer development.

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