20. Lymphoma Flashcards
What are the differentials if. someone presents with acute SOB and a new non-tender mass in the neck (lymphadenopathy)
Glandular Fever Sarcoid Lymphoma TB Disseminated malignancies (ie think of secondary tumours)
Describe a malignant node
tend to be hard, painless and adherent to the surrounding tissues and so don’t move freely
Name the primary sites of malignancy that may metastasise to cervical nodes
breast Stomach Lung Pancreas Thyroid
what is the normal function of lymph nodes
filters our blood
the neck is split into anterior and posterior triangles however how do surgeons like to label the neck
divide it into 5/6 levels which includes the space behind the SCM and also the thyroid cartilage
what is the shape of a normal lymph node compared to malignant
and also what size do they have to be to be clinically relevant
rugby ball shape is quite normal but round balls are more worrying
above 1cm, in paeds it is above 2cm
What are the main causes of lymphadenopathy
inflammation
malignant
Name some bacterial causes of lymphadenopathy
o Streptococcus group A o Staph aureus o Strep pneumoniae o Anaerobes eg fusobacterium (teeth) o Bartonella (cat scratch disease) o Note toxoplasmosis ( parasite not bacteria)
name some viral causes of lymphadenopathy
o Adenovirus
o Rhinovirus
o Coxsackie virus A and B
o EBV – can cause glandular fever and patients can become quite unwell
What is the typical presentation of TB (scrofula) and what is the atypical bacteria that is found in cases in children
typical presentation ie in the chest
atypical- mycobacterium avium
Describe the character of a lymphoma
multiple nodes that are often smooth and firm rather than hard
Name the main primary cancers if there is metastatic node in the supraclavicular fossa
lung or GI tract
Name some of the causes of metastatic nodes in the neck
o Mucosal squamous carcinoma
o Thyroid cancer
o Salivary gland cancer
o Skin cancer (squamous, melanoma)
name some investigations for someone presenting with neck lymphadenopathy
Full head and neck exam including fiberoptic endoscopy
US for thyroid and characterising benign nodes
CT good for primary disease below the hyoid
MRI good for primary above hyoid
Biopsy FNA core
What do the terms odynophagia and otalgia mean
pain on swallowing
pain in ear
Name some risk factors for lymphoma
smoking
alcohol
HPV
cannabis
Hodgkin’s lymphoma is characterised by the presence of what kind of cells
Reid Sternberg cells (RS) - owl appearance
Non-Hodgkin’s lymphoma is characterised by the presence of what kind of cells
diffuse or nodular abnormal lymphocytes
In non-Hodgkin’s lymphoma there are a number of subtypes but they are either graded into high grade or indolent lymphomas based on histology
- what does indolent mean
- tumours grow slowly and may not require treatment for long periods
- this means it responds well to chemo but rarely cured
give an example of a low-grade (indolent) non-Hodgkin’s lymphoma
Follicular lymphomas
Give an example of high grade non-Hodgkin’s lymphoma
Diffuse large B-cell lymphomas and Burkitt lymphomas
Lymphomas and other forms of haematological malignancies can commonly involve other components/organs that are part of the reticulo-endothelial system such as ?
the spleen, liver and bone marrow
Grading of lymphomas: 1-4 aka Ann Arbor staging
what is stage 1
one group of Lymph nodes is affected
Grading of lymphomas: 1-4 aka Ann Arbor staging
what is stage 2
two or more groups of nodes are affected, by the lymphoma is restricted to one side of the diaphragm only
Grading of lymphomas: 1-4 aka Ann Arbor staging
what is stage 3
Lymphadenopathy is evident on both sides (above and below) the diaphragm
Grading of lymphomas: 1-4 aka Ann Arbor staging
what is stage 4
the lymphoma has spread beyond the lymph nodes to other organs such as the spleen, bone marrow, liver or lungs
swell as staging lymphomas 1-4 they are also given a letter code A or B. What does that mean
indicates whether or not hte patient has systemic ‘B’ symptoms such as weight loss, fevers or night sweats
Where do lymphoid leukaemia originate and hence why it is involves circulating lymphocytes
bone marrow
Define lymphoma
a group of cancers that affect the lymphocytes inside the lymphatic system
what fraction of lymphomas are Hodgkin’s lymphoma and what is the usual age of presentation
1 in 5
bimodal age with peaks around 20 and 75
what are the risk factors for Hodgkin’s lymphoma
• HIV
• Epstein-Barr Virus (EPV)
• Autoimmune conditions such as rheumatoid arthritis and sarcoidosis
• Family history
Any condition what causes reduced immunity
what is the presentation of Hodgkin’s lymphoma
Lymphadenopathy in the neck, axilla or inguinal region
characteristically non-tender and rubbery
pain experience pain in the lymph node when they drink alcohol
what are the B symptoms
- Fever
- Weight loss (more than 10% of body weight in last 6 months)
- Night sweats
apart from B symptoms, how else can someone with Hodgkin’s lymphoma present
- Fatigue
- Itching
- Cough
- Shortness of breath
- Abdominal pain
- Recurrent infections
what investigations are carried out in suspected Hodgkin’s lymphoma
- Lactate dehydrogenase (LDH) is a blood test that is often raised in Hodgkin’s lymphoma but is not specific and can be raised in other cancers and many non-cancerous diseases.
- Lymph node biopsy is the key diagnostic test.
- Reed Sternberg cells (abnormally large B cells)
What is the risk of chemotherapy
leukaemia and infertility
what is the risk of radiotherapy
cancer, damage to tissues and hypothyroidism
give some examples of non-Hodgkin’s lymphoma
- Burkitt lymphoma is associated with Epstein-Barr virus, malaria and HIV.
- MALT lymphoma affects the mucosa-associated lymphoid tissue, usually around the stomach. It is associated with H. pylori infection.
- Diffuse large B cell lymphoma often presents as a rapidly growing painless mass in patients over 65 years.
give some risk factors for non-Hodgkin’s lymphoma
- HIV
- Epstein-Barr Virus
- H. pylori (MALT lymphoma)
- Hepatitis B or C infection
- Exposure to pesticides and a specific chemical called trichloroethylene used in several industrial processes
- Family history
Why is a PETCT useful
shows the difference between a reactive node and a malignant node
what is the most important thing with chemotherapy
the effect on the bone marrow
reduces the amount of white blood cells and neutropenia and make them more susceptible to infection
most non-Hodgkin’s lymphomas involve what kind of cells and what are the 1st and 2nd most common
B cell
most common type is diffuse large B cell lymphoma
2nd is follicular
(note that there are some rare ones that do involve T cells but they are predominantly in the skin)
why should patients with Hodgkin’s lymphoma stop smoking
o Lung cancer is increased in patients with Hodgkin’s Lymphoma who were treated with chemotherapy and radiotherapy.
o This risk is increased by 20x in smokers
o Smoking will also increase her risk of future cardiac problems.
in people who need extensive chemotherapy what can they be offered
men can be offered sperm banking before chemo and also women can have their eggs frozen
