Lymphoma Flashcards
what is lymphoma?
cancer of lymphocytes
how is lymphoma different to lymphocytic leukaemia?
lymphocytic leukaemia = cancer of developing lymphocytes in the blood and bone marrow?
lymphoma = cancer of lymphocytes in lymphatic system and lymph nodes
2 main types of lymphoma?
hodgkins (has reed sternberg cells)
non-hodgkins (no reed sternberg cells)
how does hodgkins spread?
continuously to nearby lymph nodes (rarely extra-nodal)
how does non-hodgknis spread?
non-continuously
more extra-nodal involvement than hodgkins
which has better prognosis - hodgkins or non-hodgkins and why?
hodgkins (continuous spread to nearby lymph nodes allows direct targeted treatment)
what causes lymphoma>
genetic mutation in lymphocytes
possible link to viruses (eg HIV, EBV)
possible complications of lymphoma?
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)
how is lymphoma diagnosed?
lymph node biopsy
how is lymphoma staged?
CT scan
how is lymphoma managed?
depends on stage, extent of disease, age, health etc
chemo
stem cell transplant
radiation
who gets hodgkins?
bi-modal - young adults and over 55s
who gets non-hodgkins?
children and adults
cellular characteristics of hodgkins?
B cells
reed sternberg cells
cellular characteristics of non-hodgkins?
B cells
T cells
NK cells
how does hodgkins present?
painless localized lymphadenopathy
B symptoms
how does non-hodgkins present?
painless localized lymphadenopathy
B symptoms
and/or symptoms of extra-nodal spread
which type of lymphoma is more associated with EBV?
hodgkins
or endemic burkitt lymphoma - type of non hodgkins - is closely associated
Which is more common hodgkins or non-hodgkins?
non hodgkins
risk factors for non-hodgkins?
elderly caucasian EBV fam history history of chemo or radiotherapy immunodeficiency autoimmune disease
symptoms of non-hodgkins?
painless lymphadenopathy
constitutional/B symptoms (fever, weight loss, night sweats, lethargy)
extra-nodal disease
can have palpable abdo mass or testicular mass
describe lymph nodes in non-hodgkins?
non-tender
rubbery
asymmetrical
types of extra-nodal disease in non-hodgkins?
gastric - dyspepsia, dysphagia, weight loss, abdo pain bone marrow failure lungs skin CNS - nerve palsies
how is hodgkins differentiated from non-hodgkins?
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
investigations in non-hodgkins?
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)
how is lymphoma staged?
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)
general management of non-hodgkins?
depends on sub-type
can be watchful waiting, chemo or radiotherapy
everyone gets flu/pneumococcal vaccine
patients with neutropenia may require antibiotic prophylaxis
complications of non-hodgkins?
bone marrow infiltration causing anaemia, neutropaenia or thrombocytopenia
SVC obstruction
metastasis
spinal cord compression
complications related to treatment (eg chemo side effects)
blood test features of hodgkins?
normocytic anaemia
eosinophilia
raised LDH
