Lymphoma

Question 1

What are lymphomas?

Answer 1

Cancers affecting lymphocytes inside the lymphatic system

-leads to proliferation of cancerous cells within LN i.e. leads to lymphadenopathy

Question 2

What type of symptoms is someone with lymphoma likely to present with?

Answer 2

B symptoms:

• night sweats
• intense pruritis (itching)
• unexplained fever
• unintentional weight loss
• fatigue
• generalised weakness

Question 3

What are the 2 categories of lymphoma?

Answer 3

Hodgkins
-specific disease

Non-hodgkins
-encompases all other types of lymphoma

Question 4

What happens in Hodgkin Lymphoma?

How is most at risk of developing?

Answer 4

Proliferation of lymphocytes
People in 20s and around 75 yo-> bimodal age distribution

Risk factors:

• HIV
• EBV
• AI= RA + sarcoidosis
• FH

Question 5

How might someone with Hodgkins lymphoma present?

What would you expect a persons LN to feel like in HL?

Answer 5

Lymphadenopathy
Enlarged LN i.e. cervical, axilla, inguinal
Pain in lymph nodes when drinking alcohol (in some patients)
B symptoms (fever/ night sweats/weight loss/SOB/pruritis/abdo pain/ recurrent infections)
Enlarged spleen= might be able to palpate spleen tip

Non-tender and rubbery

Question 6

What investigations are done if HL suspected?
What method should be used to biopsy LN in HL and why?
What is the characteristic finding of biopsy?

Answer 6

LDH
-raised but not specific

Lymph node biopsy

CT MRI PET for staging

Need core biopsy NOT FNA due to FNA not preserving the architecture of the LN which is essential for diagnosis of HL

Reed-Sternberg cells (owl eyes)

Question 7

What are Reed-Sternberg cells?

Answer 7

Abnormally large B cells with multiple nuclei with nucleoli inside them which gives the characteristic owl eye appearance

Question 8

What is form of staging is used for Hodgkins lymphoma?

Answer 8

Ann Arbor

• 4 stages
• puts importance on whether the involved nodes are above or below the diaphragm

Question 9

How is HL managed?

Answer 9

Chemo therapy and radiotherapy with the aim to CURE

MAb

Immune check point therapy (PD-1)

Autologous SCT

Question 10

What is the characteristic spread of HL?

Answer 10

LN
Spleen
Liver
BM

Question 11

What are the possible side effects of treatment?

Answer 11

Chemo:
Risk of leukamia and infertilty

Radiotherapy

• risk of cancer
• can damage tissue
• hypothyroidism (if in cervical region)

Question 12

What are examples of lymphomas classified as non-Hodgkin lymphoma?

Answer 12

Burkitt Lymphoma
-associated with EBV/malaria/HIV

MALT lymphoma

• usaully affects MALT around the stomach
• can be associated with H pylori

Diffuse large B cell lymphoma

• rapidly growing painless mass in patients >65
• most common type of NHL

Question 13

How might someone with diffuse large B cell lymphoma present?
What is the main forms of treatment for this form of NHL:

Answer 13

B symptoms
Bulky lymphadenopathy
Hepatosplenomegaly

Tx:
Chemo + anti-CD20 MAb (Rituximab) 
CART
-have cytotoxic effect on lymphoma cells via CD19 
Autologous stem cell transplantation

Question 14

What are the risk factors for developing non-Hodgkins lymphoma?

Answer 14

HIV
EBV
H pylori (MALT lymphoma)
Hep B or C
Exposure to pesticides i.e. trichloroethylene 
FH

Question 15

How can you differentiate between non-Hodkings and Hodgkins lymphoma?

Answer 15

Present very similarly sp need to LN biopsy in order to differentiate

Question 16

What are the possible management options for lymphoma?

Answer 16

(Dependent of type and stage)

Watchful waiting
Chemo 
MAb i.e. rituximab 
Radiotherapy 
SCT