Lymphoma

Question 1

Lymphoma is ___?

Answer 1

malignant proliferation of lymphocytes which accumulate in lymph nodes but may also be found in peripheral organs

Hodgkins and Non Hodgkins

Question 2

Hodgkins versus Non

Answer 2

Hodgkins

• characterised by Ree-sternberg cells
• 2 peak incidence - young adults and elderly
• Rx: family Hx, EBV, SLE, obese
• Types: nodular sclerosing 70%, mixed cellularity, lymphocyte rich, lymphocyte deplete (worse prognosis)

Non-Hodgkins

• all other lymphomas
• Very diverse category
• Rx: HIV, immunodeficiency, EBV, toxins, congenital
• B cells (most common) and T cell lines
• Low grade = indolent, wide spread, incurable
• High grade = aggressive, rapidly enlarging lymphadenopathy

Question 3

Symptoms for lymphoma?

Answer 3

Nodes = superficial, rubbers, painless, fluctuating size, typically cervical
Constitutional upset = fevers, weight loss, night sweats, lethargy, fatigue
Mediastinal involvement = bronchial or SVC obstruction, pleural effusion
Extranodal disease = oropharynx, bone, gut, cns, lung
Infection + bleeding = from pamncytopenia

Question 4

Past Hx. Ix and treatment

Answer 4

PMHx:

• Infection
• predisposing condition (HIV, AI, I suppressive drugs)

Ix:

• node biopsy
• CT or MRI
• bone marrow aspirate

Tx:

• Chemotherapy +/- radiation
• Peripheral stem cell transplants

Question 5

Examination

Answer 5

Cachexia, Anaemia
Lymph node enlargement
Spleno/hepatomegaly
Extra nodal involvement

Question 6

Differential for cervical lymph node enlargement

Answer 6

Infection: acute pyogenic, mono, CMV, TB, HIV 
Autoimmune: RA 
Drugs: Phenytoin 
Primary lymph node malignancies 
secondary malignancies

Question 7

Ix for lymphoma

Answer 7

Blood: CBC, ESR differential count, film, UEC, eGFR, LFTs, Ca, LDH
Imaging: CXR (mediastinal widening?) CT/PET CAP
Bone marrow biopsy
Excision biopsy
Cytology of effusion
Cytology of CSF if CNS signs

Question 8

Staging for Lymphoma

Answer 8

Ann Arbor Staging: 
I - confined to single node 
II - more than 2 nodal areas same side of diaphragm 
III - More than 2, both sides 
IV - spread beyond nodes

in addition: 
A - no systemic symptoms other than pruritis 
B - B symptoms 
E - extranodal 
S - spleen involvement

Question 9

Management of Hodgkins and Non- H Lymphoma

Answer 9

HODGKINS = 80% 5 year survival - depending on staging
Radiotherapy and chemotherapy with high dose chemo and peripheral stem cell transplantation for relapsed disease

NON-H = 40% 5 year survival
low-grade = radiotherapy + chemo + alpha-interferon or rituximab for maintenance remission
high grade = R’CHOP
- Rituximab, cyclophosphamide, hydroxydaunorubicin, oncovin, perdnisolone. (+ GCSF helps with neutropemnia)

Question 10

SE of treatment

Answer 10

Radiotherapy: inc risk of second malignancy, IHD, hypothyroidism, lung fibrosis
Chemotherapy: myelosuppression, nausea, alopecia, infection, AML, NH lymphoma, infertility