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Malignant haematology > Hodgkins lymphoma > Flashcards

Hodgkins lymphoma Flashcards

1
Q

History of lymphadenopathy

A

Duration
pAInful
changing
B symptoms
Immunosupression
Risk - HIV.TB
Cat contacts - cat scratch fever
Travel history

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2
Q

What is hodgkins lymphoma

A

Proliferation of B lymphocytes -> lymphadenopathy
Spleen and/or bone marrow can be effected

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3
Q

Physcial exam of nodes

A

Size, shape, surface, mobility, consistency
Exam of other lymph node areas
Check skin for brusing
Neuro exam if indicated eg headahces

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4
Q

Do you see changes in FBC w lymphoma

A

No - normally doesnt infiltrate bon marrow unless advanced disease

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5
Q

Referral criteria for lymphoma

A

Any patient >1cm for 6 weeks or more
Generalised lymphadenopathy eg two or more contigious areas
Supraclavicular nodes concerning

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6
Q

Initial investigation hodgkins lymphoma

A

FBC, U+Es, LFTs, ESR, LDH
Immunoglobulins (paraprotein ass)
Viral screen - HIV, hep B, EBV -

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7
Q

Why do viral screen

A

increased risk of developing lymphoma and also reactivation in chemo

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8
Q

LDH why can signla cancer

A

(non specific if high cell turnover)

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9
Q

Why do CXR in lymphoma

A

Widened mediastinum need other scans

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10
Q

What is diagnostic investigation of lymphoma

A

Biopsy of lymph node
Core biopsies via US or CT often adequate
If cant above then surgical excision biopsy

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11
Q

What cell is classical feature of hodgkins lympomha

A

Reed steinberg cell - owl eyes on film

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12
Q

What stain use in lymphoma

A

CD20 - marks B cells

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13
Q

Imaging for Staging of lymphoma

A

CT neck, chest, abdo and pelvis
PET required for some subtypes
MRI brain and spine for CNS lymphoma

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14
Q

What does PET scan show

A

Increased glycolytic acitivity of malignant tissues

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15
Q

How stage lymphoma

A

Ann arbor staing - above or below diaphragm

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16
Q

Stages of lymphoma

A

A - no B cell symtpoms, B = present
I - 1 nodal site one side of diaphragem
II - 2 nodal sites same side of diaphragm
III - if disease crosses diaphragm in nodal sites
IV - extranodal

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17
Q

What is high grade vs low grade lymphomas

A

Treat high grade
Watch and wait low grade

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18
Q

What type of lymphoma is hodgkins

A

High grade - needs treatment

19
Q

Age distribution in hodgkins lymphoma

A

Bimodal - teenagers and young adults and then old adults

20
Q

How often do bloods in tumour lysis syndrome

A

Twice daily bloods

21
Q

Prognosis w hodgkins lymphoma

A

V good - 5 year survival 80-90% if early
40-80% if later stages

22
Q

Peak incidence hodgkins lymphoma

A

20-30 years
BIMODAL DISTRIBUTION tho

23
Q

Multifactorial causes of hodgkins lymphoma

A

EBV infection
Immunosupression - organ transplant, immunosupression, HIV
AI conditions - RA, SLE, sarcoidosis
Familial- same sex siblings 10 x more likely develop

24
Q

What are reed steinberg cells

A

Histological feature hodgkins lymphoma - post germinal B lymphocytes transfomation intended for apoptosis but escape and unchecked proliferation
EBV prevents cytotoxic T cell detection
EBNA1 nad LMP1 proteins contribute
Cytokines and chemokines from inflam cells inhibit Th1 response -> immunosupress and prolif B lymphocytes by IL13
HLA class I ihibtis CD8 antigen presnetation

25
Q

Hodgkin lymphoma types

A

Classical
Nodular lymphocyte predominant HL

26
Q

Features of nodular lymphocyte-predominant hodgkins lymphoma

A

More common in males
Not ass w EBV
absence of RS cells - characterised by LP popcorn cells
Peripheral adenopathy presents
Affects mesenteric lymph nodes

27
Q

Subtypes of classical HL

A

Nodular sclerosing
Mixed cellularity - EBV
Lymphocyte-rich - older age group
Lymphocyte -depeleted - EBV

28
Q

Subtype w worst prognosis

A

Lymphocyte depleted
more common w HIV/EBV

29
Q

Lymhpadenopathy in HL

A

Painless
ASymmetrical
Cervical nodes or mediastinal involvement
Usually upper body
Spreads continuously
Spleen, axillary, abdominal, hilar, inguino-femoral
Alxohol induced pain?

30
Q

Classical features of hodgkins lymphoma

A

B-symtpoms 30% - fever night sweats, weight loss
Pruritis
Abdo pain if lymphadenopathy
Rare:
Clinical hepatosplenomegaly
Bone marrow involvement
Pel-ebstein fever

31
Q

2 week wait vs urgent referral for HL

A

2 week wait in adults w unexplained lymphadenopathy considering ass symptoms
CHILDREN - URGENT 48 HRS REFERRAL

32
Q

Significance of A/B, E, S and X staging HL

A

A/B = presence B cell symptoms or not
E = extranodal
S = spleen
X = bulky disease/large tumour mass

33
Q

When is a mediastinal mass bulky and in need of radiotherapy

A

> 1/3 mediastinal mass ratio

34
Q

When can do regular monitoring in HL

A

Stage III/IV nodular lymphocyte predominant hodgkins lymphoma
Unless rpaid progression or symptomatic then RCHOP

35
Q

Treatment for stageI/II calssical HL

A

Chemo then radiotherapy
Chemo - ABVD (BEACOPP if unfavourable)

36
Q

When is chemo alone used in HL

A

NOn bulky HL <1/3 mediastinal mass ration
Stage III/IV classical

37
Q

When is radiotherapy alone used HL

A

Stage I/II nodular lymphcyte predom HL

38
Q

ABVD chemotherapy drugs

A

Doxorubicin, bleomycin, vinblastine, dacrabazine

39
Q

BEACOPP chrmo drugs and risk

A

Bleomycin, etoposie, doxorubicin, cyclophosphamide, vincristine, procabazine, prednisolone
Risk of secondary leukaemia higher

40
Q

Treatment for relapsed or refractory HL

A

Chemo then autologous Stem cell transplant
Immunotherapeutic agents eg brentixumab vedotin, nivolumab
Pembrolizumab

41
Q

Treatment related complications HL

A

Myelosupression -> infection, bleeding
Cardiotoxicity (anthracycline)
Secondary malignancies esp AML, NHL, solid tumours eg breast and lung cancer

42
Q

Complications disease progression HL

A

Hyperviscosity syndrome
SVC syndrome
Lymph node compression of organs or structures eg trachea, oesophagus
Liver failure, bone marrow failure = end stage

43
Q

Prognositc factors HL stage I/II

A

B symptoms
Extra nodal
High ESR

44
Q

Prognositc factors HL stage III/IV

A

Male
>45 yrs
Lymphopenia
Low Hb
Low albumin, high ESR

Malignant haematology (16 decks)

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