HL & NHL Flashcards
S&S HL
Enlarged painless mass-usually in the neck and s/c region
33% of patients will have B symptoms
–.unexplained fevers & wt loss, drenching night sweats,
S&S of NHL
Enlarged lymph nodes in the cervical region (70%)
-groin and axilla
B-Symptoms 10-15%
Most commonly involved with NHL S&S
GI tract (MC)--> epigastric discomfort Waldeyer's ring--> sore throat
Epi/Eti HL
usually diagnosed before 40
1st peak–>25-30
2nd peak–>75-80
Rare in children <10yrs
No defined risk factors
Epi/Eti NHL
1.5:1 male
occurs in older people 80-84
immunosuppressed
Pathology HL
Always arises in lymph nodes, typically derived from B cells
predictable due to the presence of Reed-Sternberg cells
2 groups
- Nodular lymphocyte predominant HL (not classical) most favourable
- Classical HL 4 subtypes
a) Nodular Sclerosing (most common)
b) Mixed Cellularity
c) Lymphocyte Rich (Favourable of all CHL)
d) Lymphocyte depleted
Pathology NHL
1) diffuse 60%
- B or T cell
- more aggressive
- increase involvement in bone marrow and waldeyer’s ring
- Follicular 40%
- B Cell origin
- Low grade and slow growing
- usually appear below diaphragm
Acute side effects
Radiation pneumonitis–> 6-12 weeks after mantle
radiation pericarditis
shingles
Secondary Malignancy for HL & NHL
Breast, lung, GI
Disease Management HL
Staging sx–>Laparotomy
sx is used for biopsy and debulk
chemo: standard tx! ABVD w/ or w/out RT
Stage I&II: chemo ABVD alone or w/ chemo
Stage III&IV: ABVD and RT for recurrence
Dose HL
2000-3000 for non-bulky
2000-3600 for bulky
Disease Management NHL
Stage I&II Diffuse lg B cell: R-CHOP followed by RT
-30-35/150-200
Stage III&IV: RCHOP only
Stage I&II low grade follicular (indolent)
-20-30/10-20fx
Stage II&IV:
- Stage III–> observation until symptoms (no cure)
- chemo and immunotherapy
- 35-45–> TBI + BMT
NHL is radiosensitve but has limited success due to high probability of spread to other LN or organs
Classic Mantle Field (HL)
Supradiaphragmatic LN
Sup: mandible Inf: T10
Shielded–> Head of humorous, lungs, larynx, occipital regions, spinal cord and heart
Classic inverted Y field (HL)
Sub-diaphragmatic (disease inferior to diaphragm)
treating the Pelvic, common iliac, inguinal and PA nodes
Classic total nodal radiation (HL)
All lymphatics treated
Mantle + inverted Y
APPA 6-15MV