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🏠3.2 Hematologic Cancers

Week 3, Lecture 2: Wiley Edited

Question Bank

1
What are hematological cancers
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malignancies affecting blood, bone marrow, or the lymphatic system, often caused by the rapid, uncontrolled growth of abnormal white blood cells

2
What percentage of newly diagnosed cancers are hematologic cancers?
Show answer
7%

3
What percentage of all diagnosed cancers are leukemias?
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2.5%

4
How many Americans are diagnosed with lymphoma each year?
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80,000

5
Main categories of hematologic cancers
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Lymphomas, Leukemias, Multiple Myeloma

6
Types of lymphomas?
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Hodgkin's Lymphoma Non-Hodgkin's Lymphoma

7
Subtypes of Non-Hodgkin's lymphoma?
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• Burkitt's Lymphoma • Diffuse Large B-Cell Lymphoma (DLBCL) • Follicular Lymphoma

8
Types of Leukemias
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• Acute lymphocytic leukemia • acute myeloid leukemia • chronic lymphocytic leukemia

9
What is the primary function of a myeloid stem cell?
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To differentiate into red blood cells, platelets, and granulocytes

10
Main types of granulocytes produced from myeloid stem cells?
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Eosinophils, Neutrophils, Basophils

11
What do lymphoblasts differentiate into?
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B lymphocytes, T lymphocytes, and natural killer cells

12
3 types of Hodgkin's Lymphoma
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• Classic- 4 subtypes • Nodular lymphocyte predominant • HL, not otherwise classifiable

13
What is the most common type of lymphoma in young adults?
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Hodgkin’s Lymphoma

14
Which virus is associated with Hodgkin’s Lymphoma?
Show answer
Epstein-Barr Virus

15
What is the key histologic feature of Hodgkin’s Lymphoma?
Show answer
Reed-Steinberg Cell ‘owl-eyed’

16
What are the typical enlarged lymph nodes affected in Hodgkin's Lymphoma?
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Neck, mediastinum, axillary, and groin region

17
Which B symptoms are associated with Hodgkin's Lymphoma?
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Low-grade fever, weight loss, and night sweats

18
What does the 'A' or 'B' designation denote in the staging of Hodgkin’s Lymphoma?
Show answer
The absence or presence of B symptoms

19
What is a rare oral manifestation of Hodgkin's Lymphoma?
Show answer
Enlargement of the tonsillar tissue in Waldeyer’s ring and paleness of the oral mucosa

20
What is the Waldeyer ring?
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A ring of lymphoid tissues in the throat

21
Stage I Hodgkin’s Lymphoma characterized by?
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Involvement of a single lymph node region or a single extralymphatic site

22
Parts of the Waldeyer ring?
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• Pharyngeal tonsils • tubal tonsils • palatine tonsils • lingual tonsils

23
Stage II Hodgkin’s Lymphoma characterized by?
Show answer
involvement of 2+ lymph node regions on same side of diaphragm

24
Stage III Hodgkin’s Lymphoma characterized by?
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Involvement of lymph node regions on both sides of the diaphragm

25
What does Stage IV Hodgkin’s Lymphoma involve?
Show answer
Diffuse extralymphatic disease (e.g., in liver, bone marrow, lung, skin)

26
What percentage of diagnosed lymphomas fall into the category of Non-Hodgkin’s Lymphoma?
Show answer
85%

27
Which age group is most commonly affected by Non-Hodgkin’s Lymphoma?
Show answer
Adults, but can be seen in children

28
Physical presentations of Non-Hodgkin’s Lymphoma?
Show answer
– Enlarged lymph nodes and other lymphoid organs – B-symptoms – Extranodal presentation

29
Oral presentation of Non-Hodgkin’s Lymphoma?
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– Swelling of the soft tissue of the oral mucosa – Enlargement of the minor or minor salivary glands – Osteolytic (radiolucent) lesion in the jaw bones

30
Lesion in the jaw bones related to Non-Hodgkin’s Lymphoma?
Show answer
Osteolytic (radiolucent) lesion

31
Pathophysiology of Chronic Lymphocytic Leukemia
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Slow lymphocytic infiltrate of the bone marrow

32
What type of lymphoma is Burkitt's lymphoma?
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Aggressive type of Non-Hodgkin’s, B-cell lymphoma

33
What is the molecular abnormality associated with Burkitt's lymphoma?
Show answer
t(8;14)(q24;q32)

34
Types of Burkitt's lymphoma?
Show answer
– Endemic: children of central african descent – Sporadic: older children and adults in Western countries – Immunodeficiency associated

35
Oral presentation of CLL
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• Pallor throughout the oral cavity • Infection of the oral soft tissue

36
Clinical presentation of endemic Burkitt's Lymphoma
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• Rapidly growing tumor (abdominal organs) • Abdominal tumors accompanied by pain/vomiting

37
What is a key oral presentation of endemic Burkitt's Lymphoma?
Show answer
• Large tumor of maxilla or mandible w/ pain or paresthesia • Displacement of teeth; involves oral soft tissues • poorly-defined osteolytic lesions

38
What is the common age group affected by Acute Lymphocytic Leukemia (ALL)?
Show answer
young children

39
Physical presentation of Acute Lymphocytic Leukemia (ALL)?
Show answer
– Enlargement of lymphoid organs – Pallor, fever, fatigue, bone pain – Excessive bleeding and anemia

40
Oral presentation of Acute Lymphocytic Leukemia (ALL)?
Show answer
Oral ulceration, infections, and paresthesia

41
What is the form of leukemia typically seen in adult patients?
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Acute Myeloid Leukemia (AML)

42
Which type of cells is involved in the proliferation seen in AML?
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myeloblast

43
Physical presentation with AML?
Show answer
• Pallor, bone pain, and flu-like symptoms • Anemia, petechiae and bruising of the skin • Enlargement of lymph nodes, tonsillar tissue and spleen • Poor wound healing and recurrent infections

44
Oral presentations of Acute Myeloid Leukemia?
Show answer
• Submucosal hemorrhage, mucosal ulceration, severe periodontitis • Gingival hyperplasia • Oral microbial infections • Paresthesia

45
What type of lymphocytes form the tumor in Chronic Lymphocytic Leukemia (CLL)?
Show answer
partially mature clonal B lymphocytes

46
What is the most common form of leukemia in adults?
Show answer
Chronic Lymphocytic Leukemia (CLL)

47
Physical presentations of CLL?
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– B-symptoms – Lymphadenopathy – Bleeding tendency, anemia, and slow wound healing

48
What type of cells are affected in Chronic Myeloid Leukemia?
Show answer
Neoplasm of partially mature myeloid cells

49
Which chromosome abnormality is associated with Chronic Myeloid Leukemia?
Show answer
t(9;22) Philadelphia Chromosome

50
Physical symptoms of Chronic Myeloid Leukemia?
Show answer
• B-symptoms, fatigue, excessive bleeding, and infection • Enlarged abdomen (splenomegaly) • Bleeding, anemia, and infection

51
What is another focus of pts in remission
Show answer
Side effects of post cancer treatment therapy 1. Graft vs Host Disease 2. Radiation-Induced ORN 3. MRONJ

52
What type of cells is primarily affected in Multiple Myeloma?
Show answer
plasma cells

53
What protein product is secreted by abnormal cells in Multiple Myeloma?
Show answer
M-protein ( Bence Jones proteins)

54
What is the primary age group affected by Multiple Myeloma?
Show answer
adults over the age of 40

55
Physical presentations of multiple myeloma?
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– Hypercalcemia, renal failure, anemia, amyloidosis, and lytic bone lesions – Back pain, headaches, and fever – Increase risk of excessive bleeding and infection

56
Oral manifestations of multiple myeloma?
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– Enlargement of the soft tissue – Lytic lesions of the jaws bone – Tooth loss

57
What condition is depicted in the clinical image?
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Amyloid deposition with Multiple Myeloma

58
What condition is depicted in the images?
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Lytic bone lesions involving the mandible and skull “punched-out” radiolucencies (multiple myeloma)

59
What is the primary visual symptom shown in the images?
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Oral Amyloid Deposition

60
What type of medical imaging is shown in the image?
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Lateral Cephalogram (multiple myeloma)

61
What condition is indicated by the arrows in the image?
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Multiple Myeloma

62
Diagnostic modalities
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– Physical examination – Medical history – CBC with Differential – Diagnostic imaging – Blood and urine analysis – Peripheral Blood smear – Biopsy – Immunophenotyping – Cytogenetic testing

63
Dental considerations prior to cancer therapy - Pretreatment
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1. Risk of infection 2. Exposure to infectious diseases 3. Bleeding tendency/anemia 4. Eradication of oral disease prior to cancer therapy 5. Patient education

64
Dental considerations prior to cancer therapy - During Treatment
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6. Side effects associated with cancer therapy 7. Coordinating dental treatment with cancer therapy

65
What is the importance of addressing oral disease before cancer therapy?
Show answer
Eradication of oral disease prior to cancer therapy

66
What is the importance of coordinating dental treatment with cancer therapy?
Show answer
To minimize complications and optimize patient outcomes

67
Management for hematologic cancers?
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• Chemotherapy • Radiation • Stem cell transplantation • Surgery • Prednisone – often used in combination with other type of therapy • Biologic therapy (Immunotherapy + Targeted therapy) • Bisphosphonates

68
Oral side effects of cancer therapy
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1. radiation induced caries 2. oral mucositis 3. fungal infection/candidiasis/oral thrush

69
What is the primary focus of dental considerations during remission?
Show answer
Permanent changes to the oral cavity and overall health after cancer treatment • trismus • growth/dev changes in children