clinical lymphoma Flashcards
how many tumour cels in classical hodgkin lymphoma
Very few tumour cells and lots of reactive cells
presentation of lymphoma
painless progressive lymphadenopathy
* palpable node
* extrinsic compression - Ureter, Bile duct, large blood vessel, bowel, trachea, oesophagus, mediastinum
malignant lymphocytes infiltate or impair organ system - skin rash, ocular&CNS, liver failure
Recurrent infections – because clonal cells cant fight the infection
Constitutional symptoms – fever/sweats
Coincidental e.g. FBC, Imaging
where is the lymphoma here
mesenteric and axillary
axillary and cervical
splenomegaly
ix for dx and staging of lymphoma
histological dx - biopsy
anatomical stage:
* CT, or PET scans – look for LN
* BM biopsy
* +/-Lumbar puncture CNS should not have lymphocytes – but if concern that there is meningeal involvement – need to look In CSF
Blood tests
LDH - intracellular enzyme - any dying cells
Albumen,
kidney/BM function - will affect ability to treat
HIV & Hep B serology If carrier of hep B – if wipe away B cells may get fatal reactivation of Hep B
+/- HTLV1
Extensive stage, CNS involved, impaired high LDH and impaired function all = poor Px
what ar the lymphoid malignancies
epidemiology of HL
1% all cancer
>male
bimodal - 20-29yrs young women NS (nodular sclerosis subtype) subtype
Second smaller peak affecting elderly >60 years old
sx of HL
enlargement of nodes - can -> obstructive sx
B sx - fever, night sweats, wht loss (10% in 6mo)
Pruritis and rarely alcohol induced pain – at the time of drinking alcohol
classification and px of HL
Classical HL
* Nodular sclerosing (thick band fibrous tissue around nodules) 80% Good prognosis (causes the peak incidence in young women)
* Mixed cellularity 17% Good prognosis
* Lymphocyte rich (rare) Good prognosis
* Lymphocyte depleted (rare) Poor Prognosis
Nodular Lymphocyte predominant HL 5% (disorder of the elderly multiple recurrences)
how does HL spread
contiguously
means spread through lymphatics - so presents with more limited/early stage disease compared to NHL
staging for HL
after dx wih biopsy - do FDG-PET/CT and consider biopsying another site eg liver
Stage
* I; one group of nodes
* II; >1 group of nodes same side of the diaphragm
* III; nodes nodes above and below the diaphragm (note - spleen counts as a node and not stage 4)
* IV; extra nodal spread – liver/bone marrow mainly
Suffix A if none of below, B if any of below
* Fever
* Unexplained Weight loss >10% in 6 months
* Night sweats
want to see improvement in stage after 2 chemo
nodular sclerosing HL
Young women(>men) 20-29 years
Neck nodes and mediastinal mass(may be massive and compress SVC or trachea – cause obstructive sx)
May have B symptoms
Needs a Tissue diagnosis
chemo for HL
ABVD
* Adriamycin
* Bleomycin
* Vinblastine
* DTIC
given at 4-weekly intervals, 2-6cycles (depending on stage and response)
* PET CT at 2 cycles - assess response
* PET CT end of treatment - see if need radio
* +- radio
curative
preserves fertility
can cause pul fibrosis and cardiomyopathy long term
if relapse - high dose chemo + autologous PB stem cell transplant
radiotherapy for HL
Very good at sterilizing area where HL is - doesn’t work as sole modality of Rx
Reduce chance of relapse by adding radio to chemo - but dealing with young pts and a disease that may have been Rx with chemo – so radio increases chance of developing a secondary Ca
px of HL
older = worse
lymphocyte depleted histology = poor px
cure rate from 50-90%
overall:
* 80% are loing term survivors,
* 10% die from relapse,
* 10% die from treatment complications
* therefore curing cHL doesnt = long term survival
summarise NHL
def - neoplastic proliferation of lymphoid cells
incidence increasing
clinical course depends on subtype:
* fastest proliferating malignancy (Burkitt Lymphoma)
* indolent diseases (eg Follicular NHL with a possible 25 year survival)
* Antibiotic responsive disease such as Gastric MALT
subtypes of NHL
different types of NHL and their clinical course
PX of NHL
summarise follicular lymphoma
indolent
t(14,18) -> over expression of bcl-2 - anti-apoptosis protein
FLIPI score
incurable - survival 12-15yrs
may need 2-3 different chemo schedules - each remission shorter until succumb
