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3: Surgery Y3 - Cancer Care [1] (check ILOs) > [10] Hodgkin's Lymphoma > Flashcards

[10] Hodgkin's Lymphoma Flashcards

1
Q

What is Hodgkin’s lymphoma?

A

A malignant tumour of the lymphatic system

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2
Q

What is Hodgkin’s lymphoma histologically characterised by?

A

The presence of multi-nucleated giant cells and associated abnormal smaller mononuclear cells

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3
Q

What are the multi-nucleated giant cells seen in Hodgkin’s lymphoma known as?

A

Reed-Sternberg cells

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4
Q

Where do the smaller mononucleated cells in Hodgkin’s lymphoma originate from?

A

B lymphocytes in the germinal centres of lymphoid tissue

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5
Q

What helps to determine the most favourable treatment and prognosis for Hodgkin’s lymphoma?

A

Accurate classification of the type and staging of the disease

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6
Q

How many distinct classifications of Hodgkin’s lymphoma are there?

A

2

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7
Q

What are the 2 classifications of Hodgkin’s lymphoma?

A
  • Classical Hodgkin’s lymphoma

- Nodular lymphocyte-predominant Hodgkin’s lymphoma (NLPHL)

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8
Q

What % of cases of Hodgkin’s lymphoma are classical?

A

95%

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9
Q

What are the subtypes of classical Hodgkin’s lymphoma?

A
  • Nodular sclerosis
  • Mixed cellularity
  • Lymphocyte rich
  • Lymphocyte-depleted
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10
Q

Are the subtypes of classical Hodgkin’s lymphoma important for prognosis and management?

A

No

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11
Q

How is NLPHL different from classical Hodgkin’s lymphoma?

A

Histologically distinct with absence of Reed-Sternberg cells

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12
Q

What is the risk of NLPHL?

A

High risk of transforming to high-grade non-Hodgkin’s lymphoma

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13
Q

What is the relevance of the distinction between classical Hodgkin’s lymphoma and NLPHL?

A

Managed differently

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14
Q

What are the risk factors for Hodgkin’s lymphoma?

A
  • EBV
  • Previous mononucleosis infection
  • Immunosuppression
  • Cigarette smoking
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15
Q

What % of patients with Hodgkin’s lymphoma have EBV within their Reed-Sternberg cells?

A

50%

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16
Q

How do most patients present with Hodgkin’s lymphoma?

A
  • Enlarged lymph node, typically in the lower neck or supraclavicular region
  • Otherwise asymptomatic
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17
Q

What are some other ways Hodgkin’s lymphoma presents?

A
  • Mediastinal mass on routine CXR

- Chest discomfort with cough or dyspnoea

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18
Q

What term is given for systemic symptoms caused by Hodgkin’s lymphoma?

A

B-symptoms

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19
Q

What % of patients with Hodgkin’s lymphoma present with B-symptoms?

A

25%

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20
Q

What are some B-symptoms of Hodgkin’s lymphoma?

A
  • Drenching night sweats
  • Unexplained fever >38
  • Weight loss >10% over 6 months
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21
Q

What are the examination findings in Hodgkin’s lymphoma?

A
  • Lymphadenopathy
  • Hepatomegaly
  • Splenomegaly
  • Superior vena cava syndrome
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22
Q

What are the differentials for Hodgkin’s lymphoma?

A
  • Infectious mononucleosis
  • AIDS
  • Non-Hodgkin’s lymphoma
  • TB
  • Leukaemia
  • Sarcoidosis
  • Myeloma
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23
Q

What investigations are useful in Hodgkin’s lymphoma?

A
  • FBC
  • ESR
  • Tests for possible differentials
  • HIV testing
  • Lymph node biopsy
  • CXR
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24
Q

What can an FBC exclude as differentials for Hodgkin’s lymphoma?

A
  • Leukaemia
  • Mononucleosis
  • Other causes of lymphadenopathy
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25
Q

Why can FBC be useful in suspected Hodgkin’s lymphoma?

A
  • Exclusion of differentials

- Indicating prognosis

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26
Q

What are some prognostic indicators for Hodgkin’s lymphoma seen on FBC?

A
  • Anaemia
  • Leukocytosis
  • Lymphopenia
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27
Q

Why can ESR be useful in Hodgkin’s lymphoma?

A

Determining prognosis

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28
Q

What ESR indicates a poor prognosis for Hodgkin’s lymphoma?

A

ESR >70

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29
Q

What can CXR be used for in suspected Hodgkin’s lymphoma?

A

Assessing any intrathoracic lymphadenopathy and mediastinal expansion

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30
Q

How is Hodgkin’s lymphoma pathologically diagnosed?

A

Lymph node biopsy

31
Q

How should a lymph node biopsy be used to diagnose Hodgkin’s lymphoma?

A

From a sufficiently large specimen from fine needle or core biopsy or excisional biopsy

32
Q

What type of biopsy is better for diagnosing Hodgkin’s lymphoma?

A

Excisional biopsy

33
Q

Why is excisions biopsy best for diagnosing Hodgkin’s lymphoma?

A

Allows diagnosis based on morphology of the lymph node

34
Q

What investigations are used for staging and assessing risk in Hodgkin’s lymphoma?

A
  • FBC
  • CRP
  • ESR
  • TSH
  • Pre-treatment BBV evaluation
  • Contrast-enhanced CT of neck, CAP
  • PET scan
35
Q

What BBV’s are looked for in the pre-treatment evaluation for Hodgkin’s lymphoma?

A
  • Hep B and C

- HIV

36
Q

What should patients with early stage Hodgkin’s lymphoma be classified into?

A

Favourable and non-favourable prognosis

37
Q

What does the prognosis of early stage Hodgkin’s lymphoma depend on?

A
  • Presence or absence of mediastinal adenopathy
  • Presence of symptoms
  • Level of ESR
  • Number of lymph node sites involved
38
Q

What staging system is used for Hodgkin’s lymphoma?

A

Ann Arbor system

39
Q

What are the stages for Hodgkin’s lymphoma?

A
  • Stage I -IV
40
Q

What is Stage I Hodgkin’s lymphoma?

A

Involvement of one lymph-node region or lymphoid structure

41
Q

What is Stage II Hodgkin’s lymphoma?

A

Involvement of two or more lymph-node regions on the same side of the diaphragm

42
Q

What is Stage III Hodgkin’s lymphoma?

A

Involvement of lymph nodes both sides of the diaphragm

43
Q

What nodes are involved in Stage III 1 Hodgkin’s lymphoma?

A
  • Splenic
  • Hilar
  • Coeliac
  • Portal
44
Q

What nodes are involved in Stage III 2 Hodgkin’s lymphoma?

A
  • Para-aortic
  • Iliac
  • Mesenteric
45
Q

What is Stage IV Hodgkin’s lymphoma?

A

Involvement of extra nodal site(s)

46
Q

How can the progression of Hodgkin’s lymphoma be further classified?

A
  • Limited
  • Intermediate
  • Advanced
47
Q

What is limited disease in Hodgkin’s lymphoma?

A

Up to IIB with no risk factors

48
Q

What is Intermediate disease in Hodgkin’s lymphoma?

A

Up to IIB with at least 3 involved lymph node areas or high ESR

49
Q

What is advanced disease in Hodgkin’s lymphoma?

A
  • Stage IIB with large mediastinal mass or extra nodal disease
  • Any Stage III or above
50
Q

What management options are available in Hodgkin’s lymphoma?

A
  • Chemotherapy
  • Radiotherapy
  • Combination therapy
51
Q

What should happen to patients before Hodgkin’s lymphoma management?

A

Assessment for risk of acute and/or long term complications

52
Q

What pre-treatment precautions are taken in Hodgkin’s lymphoma?

A
  • Cardiac and pulmonary tests
  • Vaccinations given
  • Reproductive counselling and consideration of fertility preservation techniques
53
Q

What is the risk of chemotherapy in Hodgkin’s lymphoma?

A
  • Increased risk of leukaemia

- Neutropenic sepsis

54
Q

Who has a higher risk of leukaemia following chemotherapy for Hodgkin’s lymphoma?

A
  • Those undergone splenectomy

- Advanced disease

55
Q

What can be given tor educe the risk of neutropenic sepsis in chemotherapy for Hodgkin’s lymphoma?

A

G-CSF

56
Q

How can G-CSF reduce the risk of neutropenic sepsis when using chemotherapy for Hodgkin’s lymphoma?

A

Stimulates the production of neutrophils

57
Q

How is radiotherapy classical administered in Hodgkin’s lymphoma?

A

Extended field of radiotherapy involving all nodal areas above the diaphragm

58
Q

What additional radiation is given in Stage I and II Hodgkin’s lymphoma?

A

Prophylactic abdominal irradiation

59
Q

What is the advantage of more extensive radiation in Hodgkin’s lymphoma?

A

Reduces the risk of relapse

60
Q

What is the disadvantage of more extensive radiation in Hodgkin’s lymphoma?

A

Increases the risk of mortality from other causes

61
Q

For how long are patients treated for Hodgkin’s lymphoma followed up for?

A

2-5 years

62
Q

What are pattens treated for Hodgkin’s lymphoma at increased risk of?

A
  • Secondary neoplasm

- Cardiovascular disease

63
Q

What should patients treated for Hodgkin’s lymphoma be offered to reduce the risk of complications?

A
  • Avoid smoking
  • Manage hypertension
  • Manage DM
  • Manage hyperlipidaemia
64
Q

What should patients who have had neck radiotherapy for Hodgkin’s lymphoma receive regularly?

A

TFT’s

65
Q

What is an important blood transfusion related part of post-Hodgkin’s lymphoma management?

A

Patient should now only receive irradiated blood products

66
Q

What do the complications of Hodgkin’s lymphoma mostly relate to?

A

Treatment

67
Q

What are the potential complications of chemotherapy for Hodgkin’s lymphoma?

A
  • Leukaemia

- Infertility

68
Q

What type of leukaemia are patients treated for Hodgkin’s lymphoma with chemotherapy at particular risk of?

A

Acute myeloid leukaemia

69
Q

What are the potential complications of radiotherapy for Hodgkin’s lymphoma?

A
  • Secondary solid tumours
  • Hypothyroidism
  • Cardiovascular disease
70
Q

What secondary solid tumours are patients treated for Hodgkin’s lymphoma with radiotherapy at particular risk of?

A
  • Colon
  • Lung
  • Breast
  • Thyroid
71
Q

What is the 5 year survival rate of Hodgkin’s lymphoma?

A

81%

72
Q

How does the survival differ between local and advanced Hodgkin’s lymphoma?

A

Both can be cured in most patients

73
Q

What do long-term survivors of Hodgkin’s lymphoma have despite high cure rates?

A

Increased mortality

3: Surgery Y3 - Cancer Care [1] (check ILOs) (47 decks)

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