Hodgkin's Lymphoma (HL)

Question 1

What is the difference between lymphoma and leukaemia?

YOU DO NOT NEED TO KNOW THE SUBTYPES OF LYMPHOMA!!!!

Answer 1

Lymphoma is a malignant proliferation of mature lymphocytes (as in CLL) but they accumulate in the lymph nodes +/- other tissue

Leukaemia arises from eh bone marrow and spreads to the lymph nodes

Question 2

What is used to differentiate between Hodgkins and non-Hodgkins lymphoma?

HODGKIN’S LYMPHOMA MAKES UP 20% OF ALL LYMPHOMAS

Answer 2

Light microscopy

HL has ‘mirror image’ binucleated Reed-Sternberg cells

Question 3

What type of cell cancer is HL?

Answer 3

B-cell cancer

Question 4

S+S:

Lymphadenopathy:

• Are the nodes painful?
• What do they feel like?
• Where are they usually found? - 3
• Why is it important to ask about alcohol consumption?
• Mediastinal lymph nodes could cause mass effect. What could this cause?
• What lung pathology can occur due to spread?

They increase and decrease spontaneously.

Answer 4

No, they are non-tender

Rubbery feeling

Inguinal
Axillary
Cervical

They often become painful with alcohol consumption

SOB due to bronchial compression
Dry cough
SVC obstruction

Pleural effusion

Question 5

S+S:

What generic symptoms could they have?

Why do they get anaemia?

Why do they get splenomegaly? - advanced disease

Why do they get hepatomegaly? - advanced disease

Answer 5

Weight loss 
Fever 
Night sweats 
Lethargy 
Pruritis 

If lymphoma cells are in the bone marrow, they take up space that is normally used to make healthy blood cells. This can lower the number of red blood cells your bone marrow makes, so you have less haemoglobin and develop anaemia.

Lymphoma cells can build up inside your spleen, making it swell. Sometimes, this might be the only sign that you have lymphoma. … If your spleen is swollen, more red blood cells and platelets than usual fit inside it and it removes red blood cells and platelets from the bloodstream more quickly than it should.

Hepatomegaly is more common in non-Hodgkin’s lymphomas and various leukaemias and usually represents neoplastic involvement of that organ.

Question 6

Risk factors - list some?

Answer 6

FH

EBV infection

Question 7

Investigations:

Baseline investigations are done!

Bloods:
- What disease may occur due to bone marrow infiltration?

Biopsy for diagnosis:
- What does this involve?

Imaging:

• Why is a CXR done?
• What imaging is done for staging?

Reed-Sternberg cells are found on biopsy. What are the sometimes compared to looking like?

Answer 7

Pancytopenia

Lymph node excision via USS or CT guidance
Bone marrow aspirate and biopsy if there is altered FBC or B (systemic) symptoms

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Mediastinal disease (widening)

Contrast CT head-neck-abdo
PET-CT

Owl’s eye appearance of entire nucleus - a finding in Reed–Sternberg cells in individuals with Hodgkin’s lymphoma.

Question 8

What is the name of the system used to stage both Hodgkins and non-Hodgkins lymphoma?

Answer 8

Ann Arbor Staging System

A: absence of B symptoms
B: fever, night sweats, weight loss

Question 9

Management:

Same as always

What can men do pre-chemo to preserve fertility?

PET:

What does it stand for?

How does it work?

Answer 9

Go to a sperm bank

Positron emission tomography

Finds increased glycolytic activity of malignant tissues