Haematology malignancy workbook Flashcards
What questions should you ask when someone presents with lymphadenopathy?
- How long has it been there?
- Has it gotten bigger? If so by how much?
- Is it painful?
- B symptoms
- Recurrent infection
- <4 weeks= less likely to be a reactive lymph node
- Pancytopenia= fever, bruising, chest pain, fatigue
Differentials for unilateral lymphadenopathy in the neck?
- Lymphoma
- ALL
- Infection- EBV/IM
- Chest- TB
- SLE/Bechet’s
What clinical features would you specifically look for on examination of lymphpadenopathy?
- SVCO- collaterals/pancoast tumor
- Cachexia
- Pancytopenia- petechiae, bruising, anaemia
- Lymphoreticular- craggy/irregular= metastatic. Rubbery= lymphoma/leukaemia
You have found a 2x3cm hard lymph node in the left cervical chain.
What diagnostic test does he need?
Core biopsy of the lymph node
Excisional biopsy if you can’t get a core biopsy
Do you use FNAC for lymphoma?
No
Not as good diagnostically- don’t get the architecture
Who do you refer to when you find unilateral lymphadenopathy?
ENT
Investigations ENT will do if suspecting a laryngeal mass?
Flexible nasal endoscopy
After finding a raised lymph node and suspecting lymphoma- what other tests may be useful at this stage and why?
Staging CT CAP- to look for possible metastatic source
FBC- signs of pancytopenia
Blood film
Bone marrow biopsy
TFTs- midline lump
What is the most common low grade sub-type of NHL?
Follicular
What is the most common high grade sub-type of NHL?
Diffuse large B-cell lymphoma
What is the new staging system used for lymphoma?
Murgano staging
Management of stage 2 lymphoma?
Watchful waiting- B symptoms
What is the LDH level of low grade lymphomas?
Low or normal
What is the LDH level of high grade lymphomas?
High
What are concerns before you start chemotherapy?
Low neutrophil count- neutropenic sepsis
Tumor lysis syndrome
