Hodgkin's lymphoma & Non-Hodgkin's Lymphoma

Question 1

What is the most important prognostic factor for Hodgkins Lymphoma?

Answer 1

Stage
The later the stage, the worst the prognosis
Youth is a positive prognostic factor

Question 2

What is the most important prognostic factor for NHL?

Answer 2

Grade
Pts usually present with large bulk disease
Diaphragm plays no role in NHL

Question 3

How does HD spread?

Answer 3

In a predictable manner

Question 4

What two peak incidence age does HD present at?

Answer 4

11 - 30

75 - 80

Question 5

What are B symptoms?

Answer 5

Disease below the diaphragm.

Question 6

What is the function of the lymph nodes?

Answer 6

The production of lymphocytes and the filtration of foreign particles and cellular debris from the lymph before it returns to the circulatory system.

Question 7

What are the major lymph nodes?

Answer 7

Waldeyer's ring and cervical, pre auricular, and occipital lymph nodes.
Sclav and infraclav lymph nodes
Axillary lymph nodes
Thorax (Hilar and mediastinum nodes)
Abdominal cavity (including paraaortics)
Pelvic cavity (including iliac nodes)
Inguinal and femoral lymph nodes

Question 8

Where does majority of patients have disease?

Answer 8

Above the diagram

Question 9

What is Stage I AJCC staging?

Answer 9

Involvement of a single lymph node region

Or localized involvement of a single extra lymphatic organ or site (IE)

Question 10

What is Stage II AJCC staging?

Answer 10

Involvement of 2 or more lymph nodes on the same side of the diaphragm.

Or localized involvement of a single associated extra lymphatic organ or site and its regional lymph node(s) with or without the involvement of other lymph node regions on the same side of the diaphragm (IIE)

Question 11

What is Stage III AJCC staging?

Answer 11

Involvement of lymph node regions on BOTH sides of the diagram (III) which may be accompanied by localized involvement of an associated extra lymphatic organ or site (IIIE), by involvement of the spleen (IIIS), or both III (E + S)

Question 12

What is Stage IV AJCC staging?

Answer 12

Disseminated (multifocal) involvement of one or more extra lymphatic organs, with or without associated lymph node involvement, or isolated extra lymphatic organ involvement with distant (nonregional) nodal involvement.

Question 13

What is surgery used for?

Answer 13

Only used to grade the stage of the disease or to debulk large tumor masses.

Question 14

What lymph nodes does the Mantle Field cover?

Answer 14

The nodes above the diaphragm.

Question 15

What are the anatomical landmarks for the mantle field?

Answer 15

Sup: at the lower jaw
Inf: at the diaphragm
Lat: cover humeral heads

Question 16

Mantle field blocks are used for:

Answer 16

• Lungs, excluding 1 cm margins for xrt borders
• Lower jaw and teeth
• Both humeral heads and synovial joins
• Spinal cord block after 35 Gy
• AP larynx block after 25 Gy
  Cardiac silhouette block after 15 Gy

Question 17

What XRT doses do we use for HD?

Answer 17

Total dose of 3500 cGy - 4400 cGy using 150 - 200 cGy per day per fx.

Question 18

What is the median age for NHL?

Answer 18

Occurs in older persons with median age of 50 yrs.

Question 19

How does NHL spread?

Answer 19

Randomly

Question 20

Etiology for NHL

Answer 20

Unknown but more common in patients with immune deficiency syndromes and AIDS

Question 21

What types of cells in the lymph system?

Answer 21

B cells - Makes antibodies
T cells- REgulates the immune system)
Majority of lymphomas in the U.S. are of B cell origin.

Question 22

How are lymphomas histopathologically classified?

Answer 22

Nodular and Diffuse

Question 23

What cell origin are nodular lymphomas?

Answer 23

B cell origin

They tend to run an indolent course with prolonged survival

Question 24

What cell origin are diffuse lymphomas?

Answer 24

B or T cell origin

They have a more aggressive course

Question 25

What state and type of lymphoma have excellent survival rates with XRT?

Answer 25

Stage I and II

Nodular lymphomas