Leukaemias and Lymphomas: Overview and Management Principles for PLAB 1
This module covers the essential overview and management principles of leukaemias and lymphomas, crucial for PLAB 1 preparation. We will explore the fundamental differences, common presentations, and general management strategies, focusing on UK guidelines where applicable.
Understanding Leukaemias and Lymphomas
Leukaemias and lymphomas are both cancers of the blood and lymphatic system, originating from lymphocytes or their precursors. The key distinction lies in their primary site of origin and behaviour.
| Feature | Leukaemia | Lymphoma |
|---|---|---|
| Origin | Bone marrow (haematopoietic stem cells) | Lymphoid tissue (lymph nodes, spleen, thymus, bone marrow) |
| Primary Presentation | Circulating in blood and bone marrow | Solid tumours in lymph nodes or other lymphoid organs |
| Cell Type | Immature white blood cells (blasts) | Mature lymphocytes |
| Spread | Disseminates early via blood and lymph | Often starts localized and spreads regionally |
Leukaemias: An Overview
Leukaemias are broadly classified based on the type of white blood cell affected (lymphoid or myeloid) and the speed of progression (acute or chronic).
Lymphomas: An Overview
Lymphomas are cancers of the lymphatic system, primarily affecting lymphocytes. They are broadly categorized into Hodgkin lymphoma and Non-Hodgkin lymphoma (NHL).
Common Presentations and Red Flags
Recognizing the signs and symptoms is vital for prompt diagnosis and management. Key red flags include:
Persistent, unexplained lymphadenopathy (especially if firm, rubbery, and painless) is a significant red flag for lymphoma.
For leukaemias, common presentations mimic other conditions and include:
Symptoms of Leukaemias: Anaemia (fatigue, pallor, dyspnoea), Infection (fever, sore throat, recurrent infections due to neutropenia), Bleeding/Bruising (petechiae, ecchymoses, epistaxis, gum bleeding due to thrombocytopenia), Bone pain, Lymphadenopathy, Splenomegaly, Hepatomegaly, Neurological symptoms (headache, vomiting, cranial nerve palsies in CNS involvement).
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For lymphomas, common presentations include:
Painless swelling of lymph nodes (neck, armpits, groin). B symptoms (fever, drenching night sweats, unintentional weight loss). Itching (pruritus). Fatigue. Cough or shortness of breath (if chest nodes are involved). Abdominal pain or swelling (if abdominal nodes or spleen are enlarged).
General Management Principles (UK Context)
Management is highly individualized and depends on the specific diagnosis, stage, patient's age, and overall health. The principles generally involve:
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Key aspects of management include:
1. Diagnosis and Staging: Accurate diagnosis through biopsy, blood tests, and imaging (CT, PET scans) is paramount. Staging helps determine the extent of the disease.
2. Treatment Modalities:
- Chemotherapy: The backbone of treatment for many leukaemias and lymphomas.
- Radiotherapy: Used for localized lymphomas and sometimes in leukaemia management.
- Targeted Therapy: Drugs that specifically target cancer cells, such as tyrosine kinase inhibitors for CML (e.g., imatinib).
- Immunotherapy: Harnessing the patient's immune system to fight cancer (e.g., monoclonal antibodies like rituximab).
- Stem Cell Transplantation (Bone Marrow Transplant): Used for relapsed or high-risk leukaemias and lymphomas.
3. Supportive Care: Essential for managing treatment side effects and complications. This includes blood product transfusions, antibiotics, antiemetics, and nutritional support.
4. Monitoring and Follow-up: Regular monitoring for disease recurrence and long-term side effects is crucial.
UK guidelines emphasize multidisciplinary team (MDT) approach for optimal patient care, involving oncologists, haematologists, pathologists, radiologists, nurses, and allied health professionals.
Reed-Sternberg cells.
Fever, drenching night sweats, unintentional weight loss.
The BCR-ABL fusion gene (Philadelphia chromosome).
Learning Resources
Provides a comprehensive overview of leukaemia, including causes, symptoms, diagnosis, and treatment options, aligned with UK healthcare standards.
An authoritative guide to lymphoma from the NHS, covering different types, symptoms, diagnostic procedures, and treatment pathways.
Offers patient-focused information on leukaemia, including types, symptoms, and treatment, from a leading UK charity.
Detailed information on lymphoma, including Hodgkin and Non-Hodgkin types, from Blood Cancer UK, a trusted source for blood cancer information.
Access to official UK National Institute for Health and Care Excellence (NICE) guidelines for the diagnosis and management of various leukaemias and lymphomas.
A detailed breakdown of different types of leukaemias and lymphomas, with clear explanations of their characteristics and classifications.
Provides practical and emotional support information for those affected by leukaemia, including explanations of treatments and living with the condition.
Offers comprehensive information on lymphoma, covering diagnosis, treatment, and support services from a leading UK cancer charity.
Specific information on Acute Myeloid Leukaemia, including causes, symptoms, diagnosis, and treatment, from a reputable cancer research organization.
Detailed information on Chronic Lymphocytic Leukaemia, covering its nature, symptoms, and management strategies.