Introduction To Lymphomas And Myelomas

Question 1

What is lymphoma?

Answer 1

Cancer of the lymphocytes

Question 2

What does lymphoma affect?

Answer 2

Mature blood cells

Question 3

What are lymphomas due to?

Answer 3

Specific genetic mutations and chromosomal translocations

Question 4

What are primary lymph organs?

Answer 4

Sites where stem cells can divide and become immunocompetent

Question 5

What are secondary lymph organs?

Answer 5

Sites where most of the immune responses occur

Question 6

What is an adenopathy?

Answer 6

When lymph nodes increase in size

Question 7

What are the types of lymphoma?

Answer 7

Non-hodgkins

Hodgkins

Question 8

What are non-hodgkins lymphomas characterised by?

Answer 8

Mature B-cell, T-cell and NK neoplasms

Question 9

What is a neoplasm?

Answer 9

Abnormal tissue growth

Question 10

What are the warning signs of lymphoma?

Answer 10

Fever
Swelling of the face and neck
Lump in neck, armpits or groin
Excessive sweating at night
Unexpected weight loss
Breathlessness
Itchiness
Feeling of weakness
Loss of appetite

Question 11

How can you diagnose lymphoma?

Answer 11

Lymph node biopsy to check for lymphoma

Then flow cytometry, FISH or NGS to check the type

Question 12

What are the stages of lymphoma called?

Answer 12

I
II
III
IV

Question 13

What does stage I lymphoma look like?

Answer 13

Localised disease

Single lymph node region or organ

Question 14

What does stage II lymphoma look like?

Answer 14

Two or more lymph node regions on the same side of the diaphragm

Question 15

What does stage III lymphoma look like?

Answer 15

Two or more lymph node regions above and below the diaphragm

Question 16

What does stage IV lymphoma look like?

Answer 16

Widespread disease

Multiple organs with or without lymph node involvement

Question 17

What is the etiology of lymphoma?

Answer 17

Malfunctioning of the bodies immune system

Triggers are unknown but generally when a B cell develops a mutation in its DNA

Question 18

What is hodgkin lymphoma caused by?

Answer 18

50% epstein barr virus
Family history
HIV/AIDS

Question 19

How do you diagnose hodgkin lymphoma?

Answer 19

By finding a hodgkin cell in a lymph node biopsy

Question 20

What does a hodgkin cell look like?

Answer 20

Bilobed nucleus

So big you can see by a light microscope

Question 21

How do you treat hodgkin lymphoma?

Answer 21

Chemotherapy with/without radio

Stem cell transplant

Question 22

What is the prognosis for hodgkin lymphoma?

Answer 22

5 year survival of 50-90%

Question 23

What do non-hodgkin lymphomas present with?

Answer 23

Enlarged lymph nodes

Question 24

What are non-hogkin lymphomas caused by?

Answer 24

Chromosome translocations

Question 25

What is the normal role of the tissue specific enhancer on the immunoglobulin gene?

Answer 25

Activate the promoter of the rearranged V segment

Question 26

What are the risk factors for non-hodgkins lymphoma?

Answer 26

Viral infections and human T cell leukaemia virus in adult T cell lymphoma

Question 27

What happens to the epstein barr virus in highly immunosuppressed individuals?

Answer 27

Endogenous latent EBV transform B cells as no cytotoxic T cells

Question 28

What are the classifications of non-hodgkins lymphoma?

Answer 28

Low and high grade

Question 29

What are the features of low grade non-hodgkin lymphoma?

Answer 29

Normal tissue architecture partially preserved Slow division May be present for many months before diagnosis

Question 30

What are the features of high grade lymphoma?

Answer 30

Loss of noraml tissue architecture Divide rapidly Present for a matter of weeks before diagnosis Life threatening

Question 31

How can you diagnose non-hodgkin lymphoma?

Answer 31

Immunophenotyping Cylogenics-FISH Light chain restriction PCR

Question 32

How can you treat non-hodgkins lymphoma?

Answer 32

Chemo Radio Stem cell transplant Monoclonal antibody therapy

Question 33

How does the monoclonal antibody therapy work?

Answer 33

Binds NK cells to B cells and enhances cell death

Question 34

What is the prognosis for non-hodgkin lymphoma?

Answer 34

Overall 5 year survival rate = 70%

Question 35

What is a multiple myeloma?

Answer 35

Tumour of the bone marrow that involves plasma cells

Question 36

What does multiple myeloma present as?

Answer 36

Bone pain bleeding Frequent infections Anaemia

Question 37

When does multiple myeloma present?

Answer 37

Much later

Question 38

What are the risk factors for multiple myeloma?

Answer 38

Obesity Radiation exposure Family history Certain chemicals

Question 39

What are the three aspects associated with multiple myeloma?

Answer 39

Suppression of normal bone marrow, blood cell and immune cell function Bone resorption and release of calcium Pathological effects of the paraprotein

Question 40

What is a paraprotein?

Answer 40

Single monoclonal immunoglobulin in the serum

Question 41

What does high levels of paraprotein mean?

Answer 41

Malignancy

Question 42

What does supression of noraml bone marrow, blood cell and immune function cause?

Answer 42

Anaemia Bleeding Recurrent infections

Question 43

Why do multiple myelomas cause bone resorption and release of calcium?

Answer 43

Myeloma cells produce cytokines - > bone marrow stromal cells releasing RANKL - > osteoclast activation

Question 44

What symptoms are caused by calcium release from the bone?

Answer 44

Mental disturbance

Question 45

What are the effects of high paraprotein?

Answer 45

Precipitates in kidney tubules causing renal failure Deposited as amyloid in tissues Hyperviscosity syndrome (rare)

Question 46

What is hyperviscosity syndrome?

Answer 46

Increased viscosity of blood leading to stroke and heart failure

Question 47

How can you diagnose multiple myeloma?

Answer 47

``` Serum electrophoresis for paraprotein Urine electrophoresis Bone marrow biopsy for increased levels of plasma cells Erythrocyte sedimentation rate Flow cytometry and cytogenesis Radiological investigation ```

Question 48

Why is the erythrocyte sedimentation rate high in multiple myeloma?

Answer 48

Stalking of the RBC

Question 49

How do you treat multiple myeloma?

Answer 49

Radio/chemo combination Targeted therapies Immunotherapy Haematopoetic stem cell transplantation in young patients

Question 50

What is the prognosis for multiple myeloma?

Answer 50

35% survival for 5 yrs