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Year 2 > Clinical Management of Lymphomas > Flashcards

Clinical Management of Lymphomas Flashcards

1
Q

What is a lymphoma

A

Malignant growth of white blood cells in the lymph nodes

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2
Q

Where else can lymphomas be found

A

Liver
Spleen
Blood
Marrow

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3
Q

Causes of lymphomas

A
  1. Primary immunodeficiency
  2. Secondary Immunodeficiency (HIV)
  3. Infection (Heliicobacter pylori, EBV)
  4. Autoimmunity
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4
Q

How does EBV cause lymphoma

A

Immunosurveillance of EBV infected cells is impaired

Infected B cells escape regulation + proliferate autonomously

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5
Q

How is a lymphoma diagnosed

A

Blood film and bone marrow

Lymph Node biopsy (to confirm)

Immunoophenotyping

Cytogenetics (karyotype analysis - FISH)

PCR

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6
Q

What is HODS

A

Haemato Oncology DIagnostic Service

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7
Q

How do we build up a case for lymphomas

A
  1. Staging (how bad)
  2. Assessment of patients (How good is the patient)
  3. MDT (Have we got our facts right)
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8
Q

What investigations involve staging

A
  1. Blood tests
  2. CT Scan Chest/abdo/pelvis
  3. Bone Marrow Biopsy
  4. PET
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9
Q

How is a patient assessed for lymphomas

A 
History + Examination 
Bloods (FBC, /Es/Viral serology)
CXR
ECHO
PFTs
Performance status
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10
Q

What is the WHO performance status

A

0 - Asymptomatic
1 - Symptomatic but completely ambulatory
2 - Symptomatic (<50% in bed during the day)
3 - Symptomatic - more than 50% in bed but not bed bound
4 - Bedbound
5 - Death

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11
Q

How does a CXR help with lymphoma diagnosis

A

Mediastinal widening

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12
Q

What gender does Hodgkin’s lymphoma effect

A

Males

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13
Q

Two sub-categories of Hodgkin’s lymphoma

A
  1. Classical Hodgkin’s lymphoma (Reed-sternberg cells present)
  2. Nodular lymphocyte predominant HL (Popcorn cell present)
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14
Q

Clinical feature of Hodgkin’s lymphoma

A
  1. Painless cervical lymphadenopathy (rubbery sensation)

Coughs due to mediastinal lymphadenopathy

Sweats, weight loss

Pancpcytopenia if effecting bone marrow

Raised lactose dehydrogenase = worse prognosis as increased cell turnover

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15
Q

How is Hodgkin’s lymphoma treated

A
  1. Close surveillance
  2. Moderate chemotherapy (ABVD)
  3. Irradiation
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16
Q

How many stages of Hodgkin’s lymphoma are there

A 
4 
1 - Neck
2 - Neck and mediastinum
3- Neck, axilla, spine
4 - Neck, axilla, spine, pelvis
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17
Q

How is stage 1-2A Hodgkin’s treated

A

Chemotherapy followed by radiotherapy

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18
Q

How is stage 2B-4 Hodgkin’s treated

A

Combination chemotherapy

19
Q

What drugs are used in chemotherapy

A
  1. Adriamycin
  2. Bleomycin
  3. Vinblastine
  4. Dacarbazine
20
Q

What is the future of Hodgkin’s treatment

A

PET scanning to identify (and reduce amount of treatment given)

21
Q

How would a PET scan be implemented in treatment

A
  1. PET scan -> ABVD - > PET SCAN

If PET (+ve) - Escalated BEACON

If PET (-ve) Randomise ABVD v AVD

22
Q

Late effects of hodgkin’s lymphoma ABVD treatment

A
  1. Infertility
  2. Cardiomyopathy (from anthracyclines)
  3. Lung Damage (Bleomycin)
  4. Vinca alkaloid - peripheral neuropathy
  5. Second Cancers
23
Q

Name a low grade NHL

A

Follicular

24
Q

Name a high grade NHL

A

Large B cell lymphoma

25
Q

Name a very high grade NHL

A

Burkitt’s Lymphoma

26
Q

How fast do low grade NHLs grow

A

Slow

27
Q

Are Low grade NHL curable

A

No

28
Q

What is the median survival rate of low grade NHL

A

9-11 years

29
Q

How do we treat Indolent NHL

A 
Nothing
Alkylating Agents
Combination Chemotherapy 
Purine analogues
Monoclonal Antibodies
Oral targeted agents
Bone Marrow transplants
30
Q

Where are high grade NHLs presented

A

Nodes

31
Q

How often is extra nodal involvement in high grade NHL

A

1/3 of cases

32
Q

How is High grade NHl treated

A

Early:
Short course chemotherapy + RT (R-CHOP + IFRT)

Advanced:
Combo chemotherapy + monoclonal antibodies (R-CHOP)

33
Q

What monoclonal antibody do we give patents

A

Rituximab

34
Q

What does Rituximab target

A

CD20 expressed on B-cells

35
Q

What compound is given during radio-immunotherapy

A

Zevalin (Yttrium)

36
Q

What is T-cell engaging therapy

A

Bi-specific antibodies

Target CD19 on B cells
CD3 on T cells

Directs immune system

37
Q

Name a compound used in T cell engaging therapy

A

Blinatumomab

38
Q

What does A/B mean in staging

A

A - No systemic symptoms other than pruritus

B - Systemic symptoms: Feber, weight loss and night sweats

39
Q

Ann arbour classification of staging

A

I - confined to single lymph node
II - Involvement of two or more lymph nodes on the same side of diaphragm
III - Involvement of nodes on both sides
IV - spreads beyond lymph nodes (bone marrow)

40
Q

Side effects of CHEMOTHERAPY

A 
Myelosuppresion
Nausea
Alopecia
Infection
Infertility
41
Q

Complications of radiotherapy

A

Increased risk of secondary malignancies in lung,breast, stomach

Increased tosk of IHD, hypothyroidism and lung fibrosis

42
Q

Stage I vs Stage 2 hodgkins

A

1 is less than 3 areas involved

2 is more than 3 areas involved

43
Q

Extranodal clinical presentations

A

Skin

Gut, bowel, bone, cns and lung

44
Q

Why is biopsy done

A

To determine whether it is hodgkins or non-hodgkin’s

Year 2 (155 decks)

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