4 - Lymphomas

Question 1

What is lymphoma?

Answer 1

T, B, NK cells (MC’ly B-cells)

“Cancer of the lymph nodes”

Question 2

Reed-Sternberg cells, think:

Answer 2

Hodgkins lymphoma

Binucleated cells (owl)

Question 3

MC lymphoma is which type?

Answer 3

Non-Hodgkin

Most are B-cell in origin

Question 4

Age for NHL?

Answer 4

Affects any age (more frequent in the elderly)

Question 5

Follicular lymphoma

Answer 5

Indolent / low grade

Question 6

Diffuse large B-cell lymphoma

Answer 6

Aggressive, high grade

Question 7

Etiology of NHL

Answer 7

Chronic inflammation

Chronic infection

Exposures

Question 8

2 main presentations of NHL

Answer 8

Aggressive or indolent

Question 9

Indolent NHL presentation?

Answer 9

Peripheral lymphadenopathy

Slow-growing

B type sxs UNCOMMON

Hepatosplenomegaly

Question 10

Aggressive NHL presentation

Answer 10

B sxs COMMON

Rapidly progressive painless lymphadenopathy

Can be either lymph or extranodal dz (i.e. GI, skin, kidneys)

Question 11

Abdominal pain/mass, think:

Answer 11

Burkitt lymphoma

Question 12

Labs for NHL

Answer 12

CBC (anemia)
Chem
LFTs
LDH (elevated)
Consider HIV/HBV

Question 13

Definitive dx of NHL

Answer 13

Excisional bx

Question 14

Ann Arbor staging

Answer 14

For NHL and HL

A - no B sxs
B - presence of B sxs

1- single node or group
2 - two or more sites, same side of diaphragm
3 - both sides of diaphragm
4 - widespread

Question 15

Txt for NHL

Answer 15

Chemo + Rituximab

R-CHOP or R-CVP

Radiation added to chemo for limited stage dz (I and II)

Surgery (rarely used alone)

Question 16

Follicular lymphoma txt?

Answer 16

Asymptomatic pts can be left alone until they develop sxs

Question 17

Prognosis for NHL

Answer 17

Generally, indolent (low-grade) NHL is not curable

Aggressive — generally curable

Question 18

International prognostic index

Answer 18

Factors leading to poor outcomes

Old
Ann Arbor III or IV
LDH elevated
2+ extranodal sites

Question 19

HL ages?

Answer 19

1st peak - young adults, mid-twenties

2nd peak - adults > 55

Question 20

Sxs HL

Answer 20

Painless, SINGLE lymph node (versus chain for NHL)

Spreads in orderly fashion to contiguous nodes

B sxs in 1/3 of patients

Pruritis / excoriations

Pain in lymph node on ETOH ingestion

Question 21

DDx for HL

Answer 21

Mono
Cat-scratch dz
Drug reactions
NHL
Mets

Question 22

Dx of HL

Answer 22

Excisional biopsy

Reed-Sternberg cells (owl)

Once dx’d, send to heme-onc

Question 23

Txt of HL

Answer 23

Based on staging

I and II - short course chemo and rads

III and IV - full-course chemo (probably 12+ weeks)

ABVD = MC chemo used for HL

Question 24

If relapse of HL after chemo+rads:

Answer 24

Stem cell transplant (if good candidate)

Question 25

Prognosis for HL?

Answer 25

Stage 1/2 - 90% 10-yr survival

Stage 3/4 - 50% 10-yr survival

Question 26

Today i will live in the moment

Answer 26

Unless the moment is unpleasant, then i will eat a cookie