Hemeonc 14 Flashcards
what is Cancer of the lymph nodes?
lymphoma
What classifications of lymphoma should you know?
Hodgkin’s/Non
Mature B cell neoplasms (common, easier to tx)
over 70 types
When you do a physical exam of the lymph nodes, what findings would raise a red flag for lymphoma?
enlarged, non tender rubbery lymph node(s). Nodes that are “fixed” in location.
In addition to your physical exam, what symptoms might raise a red flag for lymphoma
persistant “idiopathic” cough, severe night sweats, pruritus (after showering)
What cells express CD15 and CD30(hallmark of Hodgkin’s)?
Reed-Sternberg cells (owl eyes)
How is a definitive dx of lymphoma made?
EXCISIONAL bx (to see specific cell markers that cannot be seen with aspiration bx)
In Ann Arbor staging of lymphoma, describe the 4 stages (called “cotswold’s staging” in handout)
I–single lymph node region
II–2+ lymph node regions on the SAME side of the diaphragm
III–lymph node regions on BOTH sides of the diaphragm
IV–diffuse involvement of an organ or tissue (other than lymph)
what are “B symptoms”
constitutional: fever, night sweats, wt loss
what is the preferred treatment of early stage Hodgkin’s lymphoma (stage I-II)
Favorable:
2-4 cycles of ABVD chemo + radiation OR
6 cycles of ABVD chemo
Unfavorable:
ABVD chemo until max tumor response + 2 cycles and radiation
what is the preferred tx of advanced stage Hodgkin’s lymphoma (stage III-IV)
ABVD chemo x 6 +/- radiation (radiation not supported by research, but many clinicians will use)
What time frame constitutes and early relapse vs a late relapse?
Early 12 months
What is a new, well tolerated second line chemo that we were asked to remember?
Brentuximab
If you had a patient with an early relapse of Hodgkin’s lymphoma, what would you recommend? Late relapse
Early = chemo + autologous transplant Late = chemo +/- radiation
Allogenic transplant is last resort in rare cases
(NOTE: autologous transplant is not an option for aggressive lymphomas)
What is a risk factor for non-HL
h/o immunosuppression/auto immune dz
On lab tests for lymphomas, what would you expect LDH to do?
elevation (due to high cell turnover rates)
What is significant about Burkett’s lymphoma? What would the PBS look like?
Burkett’s is very aggressive. PBS looks like a “starry sky”
Should you be really sad, if you find a very aggressive non-HL?
Not necessarily, more aggressive = more treatable
When staging non-HL, what might you want to perform?
BMbx (always, presence of CA will be stage IV)
PET scan, eval for B symptoms
LP/brain MRI (if CNS involvement suspected)
what drug is an anti B cell treatment?
Rituximab
Autologous and Allogenic transplants are options after relapse of what lymphoma?
Large B cell (and early relapse Hodgkin’s)
t-cell and natural killer cell lymphomas have a poor prognosis, true or false?
true
When should you consider transplant for lymphomas?
only in a relapse setting
