Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Haematology - Path > Lymphoma 1: MDT > Flashcards

Lymphoma 1: MDT Flashcards

1
Q

Define lymphoma

A

Lymphoma means neoplastic (malignant) tumour of lymphoid cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where are lymphomas most commonly found?

A
  • Lymph nodes, bone marrow and/or blood (the lymphatic system)
  • Lymphoid organs: spleen or the gut-associated lymphoid tissue
  • Skin (often T cell disease)
  • Rarely “anywhere” (CNS, occular, testes, breasts etc)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the incidence of lymphoma?

A

200 new cases per year for every million of the population

  • Non-Hodgkin’s lymphoma = 80%
  • Hodgkin Lymphoma = 20%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How many types of lymphoma are there?

A

>60 types of lymphoma exist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the downside of an adaptive immune system that increases lymphoma risk?

A
  • DNA molecules are
  1. cut and rejoined plus
  2. undergo deliberate point mutation, which allows for the generation of immunoglobulin and T cell receptor diversity
  • Dependent on apoptosis (90% of normal lymphocytes die in the germinal center)
    • Ensures antibody specificitty - preventing autoimmune disease
    • Apoptosis is switched off in germinal center (cancer)
    • Acquired DNA mutation in pro-apoptotic genes (cancer)
  • Rapid cell proliferation in the germinal center
    • Cell division = risk of DNA replication error
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe lymphoma recombination associated translocations

A
  • Involve the Ig locus
  • Ig promoter highly active in B cells
  • Bring intact oncogenese close to the Ig promoter
  • Oncogenes may be anti-apototic, proliferative
    • bcl2
    • bcl6
    • Myc
    • cyclin D1
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the known risk factors for lymphoma?

A
  • Constant antigenic stimulation
  • Infection (direct viral infection of lymphoyctes)
  • Loss of T cell function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe lymphoma and chronic antigenic stimulation, and what conditions could be a risk

A
  • Initially antigen dependent, eventually become autonomous (malignant)

Conditions:

  • H.pylori: Gastric MALT area affected
  • Sjorgen syndrome: marginal zone NHL of parotid lymphoma
  • Coeliac disease: small bowel T cell lymphoma (enteropathy associated T cell Non-Hodgkin Lymphoma (EATL))
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe viral infection and the risk of lymphoma:

  1. Direct Viral integration
  2. EBC infection and immunosuppression
A
  1. Direct viral integration
    • HTLV1 infects T cells by vertical transmission
    • Caribbean and Japan carriers
    • May develop Adult T cell leukemia (2.5% at 70 years)
  2. EBV infection and immunosuppression
  • EBV infects B lymphocytes
  • Healthy carrier state maintained by cytotoxic T cells kill EBV antigen expressing B cells
  • Loss of T cells function give risk of EBV driven lymphomas

HIV - 60 fold increase in lymphoma (high grade B-Non-Hodgkin’s lymphoma)

Post transplant lymphoproliferative disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe what is involved in the diagnosis and staging of lymphoma

A
  • Histological diagnosis
  • Anatomical stage - using CT PET, BM biopsy etc
  • Prognostic factors
    • LDH
    • Beta2 microglobulin
    • Albumin
    • Kidney/BM function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
  1. What do Reed Sternberg cells signify?
A
  1. Classical Hodgkin Lymphoma

15% of all lymphoma/leukemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

15% of lymphoma is classical hodgkin lymphoma, describe what makes up the other 85%

A

Other 85% of lymphoma is Non-Hodgkin lymphoma

B cell

  • Precursor B lymphoblastic leukemia (B-ALL) or lymphoma
  • Mature B cell neoplasm - DLBCL, Follicular NHL, CLL etc

T or NK cell

  • Precursor T lymphoblastic leukemia or lymphoma (T-ALL)
  • Mature T and NK neoplasm - PTCL, Anaplastic, cutaneous
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q
  1. Describe the epidemiology of Hodgkin Lymphoma
  2. What are the signs and symptoms of Hodgkin lymphoma
A
  1. Hodgkin lymphoma
  • 1% of all cancer, 3:100,000 population
  • HL is more common in males than females
  • Bimodal age incidence
    • Most common age 20-29, young women NS subtype
    • Second smaller peak affecting elderly >60 years old
  1. Signs and Symptoms:
  • Painless enlargement of lymph node/nodes which may cause obstructive symptoms/signs
  • Constitutional symptoms:
    • Fever
    • Night sweats
    • Weight loss (the B symptoms)
    • Pruritis
    • RARE: Alcohol induced pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe the sub-types of Classical Hodgkin Lymphoma

A
  • Nodular sclerosing (80%) - good prognosis
  • Mixed cellularity (17%) Good prognosis
  • Lymphocyte rich (rare) Good prognosis
  • Lymphocyte depleted (rare) Poor prognosis

Nodular lymphocyte predominant HL 5% - More a disorder of the elderly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q
  1. How is Hodgkin Lymphoma staged?
  2. What is the staging system?
A

1.

  • Pathological diagnosis of a lymph node biopsy
  • FDG-PET/CT scan
  • Consider biospy of other site if possiblly infiltrated
  1. Stages
  • I = one group of nodes
  • II = >1 group of nodes same side of the body
  • III = nodes above and below the diaphragm
  • IV = extra-nodal spread
  • Suffix A if none of the below, B if any of the below:
    • Fever
    • Unexplained weight loss >10% in 6 months
    • Night sweats
      ​
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the outline of therapy for lymphoma?

A
  • Chemotherapy - if often given as a combination of drugs which affect the malignant cells in different ways
  • Radiotherapy - HL is highly responsive to radiotherapy, can be given at the end of chemo as an involved field is a small area only targeting diseased nodes (less toxicity to normal tissue)
  • Combined modality - uses both chemo and radiotherapy
17
Q
  • What is ABVD and the treatment of HL?
  • What are the risks and benefits of ABVD?
A

ABVD are the drugs used for chemotherapy in HL, given at 4 weekly intervals

  • Adriamycin
  • Bleomycin
  • Vinblastine
  • DTIC

Benefits:

  • Effective treatment
  • Preserves fertility (unlike MOPP the original chemo)

Risks:

  • Can cause long term
    • pulmonary fibrosis
    • cardiomyopathy
18
Q

Describe the pros and cons for the use of radiotherapy for HL

A

Pros:

  • Modern practice and only targets the involved field, so less toxicity to healthy tissue
  • Low/negligible risk of relapse within field

Cons:

  • Risk of damage to normal tissue
    • Breast cancer - 1:4 risk after 25 years
    • Leukaemia/MDS - 3% at 10 years
    • Lung or skin cancer
  • Combined modality gives greatest risk of secondary malignancy (as gives two mechanisms of DNA damage)
19
Q
  1. Describe the treatment for HL
  2. What is the prognosis?
A
  • Chemotherapy required for all cases (ABVD)
    • ABVD 2-6 cycles (depending on stage)
    • +/- radiotherapy
    • PET CT
      • Interim post 2 cycles, response assessment
      • End of treatment: guides further treatment
  • Relapse
    • High dose salvage chemotherapy Autologous PB stem cell transplant as salvage
  1. Prognosis:
  • Depends on stage
  • Cure rates range from 50-90% - better prognosis for people who have stage 1 or 2 disease.
  • Only 50% of people with stage 4 disease are cured
20
Q

What does cure mean in HL?

  • 80% of patients with stage 1 or 2 HL are cured
  • only 50% of patients with stage 4 disease get cured
A

Cure means

  • Overall 80% are long term survivors can we improve
  • 10% die from relapse of HL (first 10 years)
  • 10% die from long term treatment complications (after 10 years)
  • Eradicating HL in a 25 year old patient with highly toxic lymphoma therapy does not guarantee long term survival
21
Q

Describe the treatment dilemmas with treating HL

A
  • HL is a curable disease overall approx 80%
  • More intense therapy cures more but has a risk of causing more secondary cancers
  • Reduce therapy cures less but less secondary cancer

Reduce therapy:

  • Chemotherapy only
  • Reduce risk of secondary malignancy
  • Increased HL relapse
  • 10% die of HL

Intensify therapy:

  • Chemo/+radiotherapy
  • Decrease HL relapse
  • Increase secondary malignancy of breast skin, BM
  • 10% die of therapy complication

Haematology - Path (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions