haematological

Question 1

lymphoma:

• two types?
• risk factors? 2
• typical presentation?
• investigation findings?
• treatment?

Answer 1

Hodgkins
= presence of Reed-Sternberg cells
- young adults (esp men, also elderly peak)
- PMH infection w EBV
= most present with painless, rubbery, superficial lymph nodes (often cervical or axillary)
= 25% have B symptoms (also lymph nodes may become painful w alcohol)
+ raised ESR
+ lymph node biopsy (shows Reed-Sternberg cells)
+ LFTs may be deranged
+ CXR may show mediastinal widening
- chemo & radiation

nb use Ann Arbor system of grading Hodgkins!
- “people are always analysing specifics of women’s bodies (like Ann) so looking at exactly how many lymph nodes are involved in what part of body, above/below diaphragm etc”

Non-Hodgkins 
= without Reed-Sternberg cells, lots of diff types (high grade, low grade etc)
- normally elderly, but depends on type
= most present with painless, rubbery, superficial lymph nodes (often cervical or axillary)
= 25% have extra nodal disease, incl bone marrow involvement
\+ lymph node biopsy
\+ FBC 
\+ LFTs
\+ CT/PET for staging
\+ bone marrow aspiration
- depends on subtype + stage
- chemo/imuno/radiotherapy

nb high grade are more aggressive but respond more to treatment than low grade