Hodgkin's Lymphoma Flashcards
What is Hodgkin’s Lymphoma?
- This is a cancer of the lymphatic cancer
What are the lymph organs?
- Adenoids
- Tonsils
- Thymus
- Spleen
What is the function of the spleen?
- The spleen acts as a blood filter, it removes the red blood cells and plays a role in the immune response
What is the function of the Thymus?
- The Thymus is responsible for development and maturation of T lymphocyte cells
What is the physiology of lymph nodes?
- Lymph nodes are kidney shaped
- They play an important role in the immune response to infection
- Each node contains T lymphocytes, B lymphocyte
- Lymph nodes enter the node through the afferent lymphatic channels and leaves through the efferent lymphatic channels
- They are able to mount an immune response if they detect the presence of a pathogen
- This is why lymph nodes are typically found to be palpable
What are the lymph vessels?
- The lymphatic vessels transport lymph fluid around the body
- Superficial vessels - arise in the subcutaneous tissue, follow venous flow and drain into the deep vessels
- Deep vessels - drain the deeper structures of the body, follow the deep arteries
- drainage of lymph begins in lymph channels to lymph nodes and then lymphatic trunks which are your right lymphatic duct and thoracic duct
What does the right lymphatic duct drain?
- The right upper quadrant part of the body
What does the Thoracic duct drain?
- The remaining part of the body
What is Lymph Fluid?
- Lymph is a transudative fluid (transparent and yellow), it is formed when fluid leaves the capillary bed due to hydrostatic pressure
How much lymphatic fluid does an average adult produce?
- 3/4Litres
What is the composition of lymph?
- Water, proteins, lipids, carbs, ions and lymphocytes
What is Chyle?
- Chyle is lymph that is produced in the GI system
What are the groups of lymph nodes called?
- Neck (cervical)
- Groin (inguinal)
- Armpits (axillary)
- Internal abdominal lymph nodes (Mesenteric/ Retroperitoneal)
- Chest cavity (mediastinal)
- Lower Abdomen (pelvic)
What cells are seen under the microscope with Hodgkin’s Lymphoma?
- Reed Sternberg cells
What are Reed Sternberg cells
- These are a type of B lymphocytes which have become cancerous.
What are the different types of Hodgkin’s Lymphoma?
- Classical Hodgkin Lymphoma
- Nodular lymphocyte predominant Hodgkin Lymphoma
What is the difference between Classical HL and Nodular Lymphocyte predominant HL?
- NLPHL is not very common
- In NLPHL there are very few Reed- Sternberg cells
- In NLPHL there are abnormal cells known as Popcorn cells
What is the Classical HL?
- Nodular Sclerosing (most common type of HL, most common type in young adults, usually found at an early stage)
- Mixed Cellularity (affects a few groups of lymph nodes, contain lymphocytes and other blood cells)
- Lymphocyte rich (lymphocytes look small)
- Lymphocyte depleted
What is the classification system for Lymphoma?
- Lugano classification
- Ann Arbor Staging
What are B symptoms?
- High temperatures that come and go, often at night
- heavy sweating at night
- unexplained weight loss
What is Bulky disease?
- A lymph node that is 10cm or more
- Lymphoma in the mediastinum which is at least a third of the width of your chest
What is Stage 1?
- Lymphoma in a single lymph node, or one group of lymph nodes or an organ of the lymphatic system
- Lymphoma in an extranodal site
What is Stage 2?
- Lymphoma in two or more groups of lymph nodes
- Lymphoma in an extranodal site and one/ more groups of lymph nodes
- Both side of the diaphragm
What is Stage 3?
- Lymphoma is in lymph nodes on both sides of the diaphragm
- Lymphoma is in lymph nodes above diaphragm/ Lymphoma in an organ of the lymphatic system
What is Stage 4?
- Lymphoma is in an extranodal site and lymph nodes are affected
- Lymphoma is in more than one extranodal site (liver, bones or lungs
What are extranodal sites of the lymphatic system?
- Lungs, Liver, Blood, Bone Marrow, Kidneys, Brain and Spinal Cord
What is the treatment for Stage 1 HL?
- 2/4 cycles of chemotherapy with/without radiotherapy
What is the treatment for Stage 2 HL?
- 2/4 cycles of chemotherapy with/ without radiotherapy
What is the treatment for Stage 3 HL?
- 6/8 cycles of chemotherapy
- Steroids possibly included
- with/ without radiotherapy
What is the treatment for Stage 4 HL?
- 6/8 cycles of chemotherapy
- Steroids are apart of this
- with/ without radiotherapy
What are the symptoms of HL?
- Painless swelling in the lymph node
- Heavy sweating
- High temperatures
- Weight Loss
- Itching of the skin worse after alcohol
- Cough/ SOB
- Abdominal Pain/ Vomiting after drinking alcohol
- Nerve pain
- Swelling in the arms due to blockage of the lymphatic fluid
- Jaundice of the skin due to blocking of the bile
What are the symptoms of HL in the bone marrow?
- SOB/ tiredness = anaemia due to low red blood cell count
- Increased infections because of low WCC
- Low platelet count = nosebleeds, very heavy periods, rashes under the skin
What are the risks of developing HL?
- Male
- Age (20-40 and abover 75)
- Lowered immunity (HIV, SLE, RA)
- EBV
- Family History
- Being Overweight
- Smoking
What investigations are done for Lymphoma?
- Excision biopsy of the lymph node
What bloods are done?
- FBC
- U+E
- LFTS
- LDH
- Uric Acid
- ESR
- HIC, Hep B and C
What imaging is done for Lymphoma?
- Chest X-ray
- PET CT (staging)
- CT neck, chest, abdomen and pelvis
- MRI
What is additional investigations are there?
- LP and CSF analysis
- ECHO
- PFTs
- Bone Marrow Biopsy
What is the Chemotherapy Regime for HL?
- ABVD
- Doxorubicin (A)
- Bleomycin (B)
- Vinblastine (V)
- Dacarbazine (D)
What is important to note about blood transfusions for patients with HL?
- The blood must be irradiated
What are the long term side effects of Chemotherapy?
- Loss of fertility
- Menopause
- Second Cancers (Risk of getting another type of cancer)
- Heart or Lung Problems (Bleomycin = pulmonary fibrosis)
What is the mainstay of treatment for HL?
- Chemotherapy and Radiotherapy
- Stem cell transplants ( allogenous)
What is a targeted treatment for HL that has come back after treatment?
- Brentuximab
What is a targeted treatment for advanced NLPHL?
- Rituximab
What is a targeted treatment for HL which has come back after treatment or is not responding to treatment?
- Pembrolizumab
