HL & NHL Flashcards

1
Q

S&S HL

A

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,

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2
Q

S&S of NHL

A

Enlarged lymph nodes in the cervical region (70%)
-groin and axilla

B-Symptoms 10-15%

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3
Q

Most commonly involved with NHL S&S

A
GI tract (MC)--> epigastric discomfort
Waldeyer's ring--> sore throat
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4
Q

Epi/Eti HL

A

usually diagnosed before 40
1st peak–>25-30
2nd peak–>75-80

Rare in children <10yrs

No defined risk factors

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5
Q

Epi/Eti NHL

A

1.5:1 male
occurs in older people 80-84

immunosuppressed

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6
Q

Pathology HL

A

Always arises in lymph nodes, typically derived from B cells
predictable due to the presence of Reed-Sternberg cells

2 groups

  1. Nodular lymphocyte predominant HL (not classical) most favourable
  2. Classical HL 4 subtypes
    a) Nodular Sclerosing (most common)
    b) Mixed Cellularity
    c) Lymphocyte Rich (Favourable of all CHL)
    d) Lymphocyte depleted
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7
Q

Pathology NHL

A

1) diffuse 60%
- B or T cell
- more aggressive
- increase involvement in bone marrow and waldeyer’s ring

  1. Follicular 40%
    - B Cell origin
    - Low grade and slow growing
    - usually appear below diaphragm
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8
Q

Acute side effects

A

Radiation pneumonitis–> 6-12 weeks after mantle
radiation pericarditis
shingles

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9
Q

Secondary Malignancy for HL & NHL

A

Breast, lung, GI

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10
Q

Disease Management HL

A

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

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11
Q

Dose HL

A

2000-3000 for non-bulky

2000-3600 for bulky

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12
Q

Disease Management NHL

A

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

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13
Q

Classic Mantle Field (HL)

A

Supradiaphragmatic LN
Sup: mandible Inf: T10
Shielded–> Head of humorous, lungs, larynx, occipital regions, spinal cord and heart

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14
Q

Classic inverted Y field (HL)

A

Sub-diaphragmatic (disease inferior to diaphragm)

treating the Pelvic, common iliac, inguinal and PA nodes

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15
Q

Classic total nodal radiation (HL)

A

All lymphatics treated
Mantle + inverted Y
APPA 6-15MV

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16
Q

NHL Treatment technique

A

Whole abdomen RT
A) initially (in 2 weeks) APPA border: dome of diaphragm to top of iliac 1500/150

B) secondary (in 2 weeks) upper abdomen is treated using lateral fields.
Ant border: ant abd wall Post: ant to kidneys 1500/150

C) Boost (in 2 weeks) Wide PA node field. APPA 1500/150

Total dose 45/6-7 weeks