Lymphoma Flashcards
Incidence
Incidence is rising
More in males
15-24yrs old
Age dependent incidence -> varies with type
What is lymphoma
Malignancy that arises from LNs
Can occur anywhere lymphoid tissue is present
2 major classifications
Hodgkins and non-hodgkins
Most common sites
Most common in auxiliary nodes, mediastinal
May also be para-aortic or inguinal
RT chases “lymph chains”’
Hodgkins characterisitcs
Reed-stern berg cells
Two age groups: 15-40; 55+
Upper body—> contiguous nodes
Rarely extra nodal
Distinct type
Arise from b cells
Micro enlarged (more than one nucleus)
Non hodgkins characteristics
Risk increases with age (60+)
No site predominance
Widely disseminated node groups (non-contiguous)
Common extra nodal involvement (90% stage 3 or 4)
>30 types
Aetiology of hodgkins
Familial
Higher socioeconomic
HIV, glandular fever
Aetiology of non Hodgkins
Viral infection- HIV
Immunodeficiency
Environment - pesticide exposure
Classification of hodgkins
Lymphocyte predominant, modular sceloris, mixed cellularity, lymphocyte depleted
Classification of non-hodgkins
B cell and T cell
B cell: low grade- follicular, high grade: burkitts lymphoma
T cell: low grade: my cos is fungicides, high grade: large cell
Signs and symptoms of hodgkins
Lymphadenopathy- mediastinal, splenomagely, abdominal mass, alcohol induced pain
Systemic-, pruritus, fatigue, bone pain
B symptoms - fever, weight loss, night sweats
Advanced - liver involvement, bone marrow, bone involvement, lung involvement
Local - chest pain, cough, SVCO, Bronchial obstruction
Signs and symptoms of non-hodgkins
Lymphadenopathy in neck, more widespread, compression
Diagnosis of hodgkins and non-hodgkins
Biopsy, physical exam, full medical history, CT, FBC, bone marrow biopsy
Staging
Using Lugano system
Stage 1 - one node or a group of adjacent nodes
Stage 2 - 2 or ore nodal groups on same side of diaphragm
Stage 2 “bulky” - bulky disease
Stage 3 - nodes on both sides of diaphragm
Stage 4 - additional non-continuous extralymphatic involvement
Early Clinical management of hodgkins
Combined modality: rt+- chemo
2 months of chemo
4 weeks of finishing chemo - RT starts
If PET is negative following chemo - no RT
Early Clinical management of non-hodgkins
RT is only prescribed if
- Patient did not receive 4 cycles of CHOP
- Patients who received 4 doses of R-CHOP with tumours greater than 5cm
- Patients who received 6 cycles of RCHOP with lucky disease, inadequate chemo response and high risk of relapse
Late Clinical management for hodgkins
6 cycles of chemo then PET
PET negative = 30Gy in 1.8Gy per #
PET positive = 30Gy in 1.5Gy pe r#
Late Clinical management for non-hodgkins
Pet negative - 30Gy in 1.8Gy per #
Pet positive after chemo -SIB
30Gy in 1.8-2Gy per #
Residual pet positive site - 34.4Gy 2.3Gy per #
Radiation treatment technique hodgkins
Involved field - 3dcrt
Mantle or inverted Y
Total nodal radiation
Tomotherapy - total nodal
Static fif IMRT
VMAT - DIBH
Radiation treatment technique non-hodgkins
Treats mycosis fungoides
TSET 10-20Gy in small fraction sizes
Patients may require report courses of radiation with chronic relapse
Positioning for hodgkins
H+N: arms by side or on chest, chin extended, s frmae
Thorax: arms above head or by sides, wing board, vacbag
Pelvis: arms on chest, knee support, ankle stocks.
Positioning for non-hodgkins
Standing, total body electrons
Acute side effects of treatment
Depends on size and location- reduced blood count, fatigue, vomiting, diarrhoea, slope is, erythema
Late side effects
Secondary cancer, cardiac sequels, thyroid dysfunction, pneumonitis, gonadal effects, skeletal effects, sterility
