Cancer

Question 1

What is Lymphoma?

Answer 1

• Group of blood cancers which develop from lymphocytes and tumours are mainly found in the lymph nodes
• Hodgkins (20%)
• Non-Hodgkins (80%)
  • Diffuse B cell
  • Burkitts
  • Mantle cell
  • Follicular

Question 2

Epidemiology of Hodgkins

Answer 2

• Bimodal age distribution : between 20-30 and >60
• M>F
• Associated with Epstein Barr Virus

Question 3

H&E of Hodgkins

Answer 3

• Asymmetrical lymphadenopathy
  
  • Painful after alcohol
  • Commonly mediastinal and cervical
  • Firm and rubbery
• FLAWS
• Splenomegaly +/- Hepatomegaly

Question 4

Investigations for Hodgkins

Answer 4

• Lymph node biopsy : Reed-Sternberg cells (bi-nucleated ‘owl eyes’)

Question 5

Management of Hodgkins

Answer 5

• Chemotherapy
• Radiotherapy
• Stem cell transplant

Excellent prognosis especially in younger patients

Question 6

Epidemiology of Non-Hodgkins

Answer 6

• More common than Hodgkins
• 85% are B-cell, 15% T-cell or NK cell
• Associated with Epstein Barr Virus, HIV, SLE and Sjogren’s
• Incidence increase with age

Question 7

H&E of Non-Hodgkins

Answer 7

• Painless enlarging mass in neck, axilla or groin
• FLAWS (less common than Hodgkins)
• Organ involvement
  • skin rashes
  • Headache
  • Hepatosplenomegaly (more common than Hodgkins)

Question 8

Investigations for Non-Hodgkins

Answer 8

• Lymph node biopsy : NO Reed-Sternberg cells

Question 9

Management of Non-Hodgkins

Answer 9

• Chemotherapy
• Radiotherapy
• Stem cell transplant

Excellent prognosis especially in younger patients

Question 10

Burkitt’s Lymphoma

Answer 10

• Strong association with EBV
• Translocation between chromosomes 8 and 14 = over expression of c-myc oncogene
• Rapidly enlarging lymph node in jaw
• Starry sky appearance under microscopy

Question 11

Investigations for Metastatic Disease for all patients

Answer 11

NICE recommends the following investigations:

• FBC, U&E, LFT, Calcium, Urinanalysis, LDH
• CXR
• CT CAP
• AFP and hCG

Question 12

Investigations for Metastatic Disease for specific patients

Answer 12

• Myeloma screen (if lytic bone lesions)
• Endoscopy (directed towards symptoms)
• PSA (men)
• CA 125 (women with peritoneal malignancy or ascites)
• Testicular US (men with germ cell tumours)
• Mammography (women with clinical or pathological features compatible with breast cancer)

Question 13

Management of Metastatic Disease

Answer 13

Involves a combination of:

Systemic therapies (chemo, targeted or immunotherapy)

Local treatments (surgery or radiation therapy)

Supportive care (pain management or palliative)