Lymphoma

Question 1

what is lymphoma?

Answer 1

cancer of lymphocytes

Question 2

how is lymphoma different to lymphocytic leukaemia?

Answer 2

lymphocytic leukaemia = cancer of developing lymphocytes in the blood and bone marrow?
lymphoma = cancer of lymphocytes in lymphatic system and lymph nodes

Question 3

2 main types of lymphoma?

Answer 3

hodgkins (has reed sternberg cells)

non-hodgkins (no reed sternberg cells)

Question 4

how does hodgkins spread?

Answer 4

continuously to nearby lymph nodes (rarely extra-nodal)

Question 5

how does non-hodgknis spread?

Answer 5

non-continuously

more extra-nodal involvement than hodgkins

Question 6

which has better prognosis - hodgkins or non-hodgkins and why?

Answer 6

hodgkins (continuous spread to nearby lymph nodes allows direct targeted treatment)

Question 7

what causes lymphoma>

Answer 7

genetic mutation in lymphocytes

possible link to viruses (eg HIV, EBV)

Question 8

possible complications of lymphoma?

Answer 8

metastasis to spinal cord causing compression of cord and sensory/motor deficits
metastasis to bone marrow causing overcrowding of marrow which results in decrease in progenitor cells (erythrocytes/leukocytes/platelets)

Question 9

how is lymphoma diagnosed?

Answer 9

lymph node biopsy

Question 10

how is lymphoma staged?

Answer 10

CT scan

Question 11

how is lymphoma managed?

Answer 11

depends on stage, extent of disease, age, health etc
chemo
stem cell transplant
radiation

Question 12

who gets hodgkins?

Answer 12

bi-modal - young adults and over 55s

Question 13

who gets non-hodgkins?

Answer 13

children and adults

Question 14

cellular characteristics of hodgkins?

Answer 14

B cells

reed sternberg cells

Question 15

cellular characteristics of non-hodgkins?

Answer 15

B cells
T cells
NK cells

Question 16

how does hodgkins present?

Answer 16

painless localized lymphadenopathy

B symptoms

Question 17

how does non-hodgkins present?

Answer 17

painless localized lymphadenopathy
B symptoms
and/or symptoms of extra-nodal spread

Question 18

which type of lymphoma is more associated with EBV?

Answer 18

hodgkins

or endemic burkitt lymphoma - type of non hodgkins - is closely associated

Question 19

Which is more common hodgkins or non-hodgkins?

Answer 19

non hodgkins

Question 20

risk factors for non-hodgkins?

Answer 20

elderly
caucasian
EBV
fam history
history of chemo or radiotherapy
immunodeficiency 
autoimmune disease

Question 21

symptoms of non-hodgkins?

Answer 21

painless lymphadenopathy
constitutional/B symptoms (fever, weight loss, night sweats, lethargy)
extra-nodal disease
can have palpable abdo mass or testicular mass

Question 22

describe lymph nodes in non-hodgkins?

Answer 22

non-tender
rubbery
asymmetrical

Question 23

types of extra-nodal disease in non-hodgkins?

Answer 23

gastric - dyspepsia, dysphagia, weight loss, abdo pain
bone marrow failure
lungs
skin
CNS - nerve palsies

Question 24

how is hodgkins differentiated from non-hodgkins?

Answer 24

biopsy
also have clues in clinical presentation
- extra-nodal disease more common in non-hodgkins
- alcohol induced lymph node pain in hodgkins
- B symptoms occur earlier in hodgkins and later in non-hodgkins

Question 25

investigations in non-hodgkins?

Answer 25

excisional node biopsy = diagnostic CT chest, abdo, pelvis = staging FBC and blood film (rule out leukaemia) LDH (marker of cell turnover, prognostic indicator) other tests depending on clinical picture (LFTs if liver mets suspected, PET or bone marrow biopsy if bone involvement suspected, LP if neuro symptoms)

Question 26

how is lymphoma staged?

Answer 26

ann arbour: - 1 = one node affected - 2 = more than one node on same side of diaphragm - 3 = nodes affected on both sides of diaphragm - 4 = extra-nodal involvement (eg spleen, bone marrow etc)

Question 27

general management of non-hodgkins?

Answer 27

depends on sub-type can be watchful waiting, chemo or radiotherapy everyone gets flu/pneumococcal vaccine patients with neutropenia may require antibiotic prophylaxis

Question 28

complications of non-hodgkins?

Answer 28

bone marrow infiltration causing anaemia, neutropaenia or thrombocytopenia SVC obstruction metastasis spinal cord compression complications related to treatment (eg chemo side effects)

Question 29

blood test features of hodgkins?

Answer 29

normocytic anaemia eosinophilia raised LDH