Lymphoma

Question 1

What are some symptoms of lymphoma?

Answer 1

Lymphadenopathy
Fatigue
Itching
Feeling ill when drinking alcohol
Fevers
Weight loss

Question 2

What is lymphoma?

Answer 2

Cancer of the lymphatic system (lymph nodes, spleen, thymus, and bone marrow)

Categorised into
- Hodgkin lymphoma
- Non-Hodgkin lymphoma (NHL)

Question 3

What test is done to work out if the cause of renal failure in pre-renal, renal, or post-renal?

Answer 3

Ultrasound of the kidney

Question 4

What medication can be given to treat hypercalcaemia?

Answer 4

Bisphosphonates beside rehydration

Question 5

What is the first line chemotherapy drug for lymphoma?

Answer 5

Retuximab

Question 6

After a lymphoma tumour has been treated, how will it leave the body?

Answer 6

Through the kidneys
The proteins will break down from amino acids into uric acid

Question 7

What is tumour lysis syndrome?

Answer 7

When the break down products of cancer cause electrolyte imbalances that lead to
- Acute kidney injury
- Cardiac arrhythmias
- Nausea and vomiting
- Seizures

Question 8

How is tumour lysis syndrome treated?

Answer 8

Intense hydration and Allopurinol

(To break down the uric acid)

Question 9

Which infections can cause lymphoma?

Answer 9

• HTLV-1 (Human T-lymphotropic virus 1)
• EBV
• Helicobacter Pylori

Question 10

How are lymphomas staged?

Answer 10

Using the Ann Abor system

Stage I- Single Site
Stage II- 2 Sites, Same side
Stage III - Both sides
Stage IV - Diffuse

Question 11

What are some histological subtypes of lymphoma?

Answer 11

-Lymphocyte Predominant (9%)
-Nodular Sclerosis (63.6%)
-Mixed cellularity (22.7%)
-Lymphocyte depleted (4.5%)

Question 12

What are the risks for developing lymphoma?

Answer 12

• 40% of cases are linked to EBV
• Immunodeficiency (HIV)

Question 13

What is R-CVP?

Answer 13

The combination of cancer drugs used to treat low grade non-Hodgkin lymphoma

R – rituximab
C – cyclophosphamide
V – vincristine

Question 14

What is pancytopenia?

Answer 14

Low levels of all 3 types of red blood cell:

Red blood cell
White blood cell
Platelet

Question 15

What is thrombocytopaenia?

Answer 15

Low platelet count

Question 16

What is the difference between Hodgkin’s and Non-Hodgkin’s lymphoma?

Answer 16

Hodgkin’s lymphoma presents with Reed-Sternberg cells, Non-Hodgkin’s doesn’t

Question 17

What is R-CHOP chemo therapy?

Answer 17

A type of chemoimmunotherapy used to treat non-Hodgkin’s Lymphoma

Combines (rituximab [Rituxan®], cyclophosphamide [Cytoxan®], doxorubicin [hydroxydoxorubicin], Oncovin® [vincristine] and prednisone)

Question 18

What is stereotactic radiotherapy?

Answer 18

Therapy given from lots of different directions to avoid damaging healthy tissue and reduce side effects

Question 19

What are the uses of Denosumab?

Answer 19

It’s used to treat osteoporosis and it helps prevent bone metastases in cancer

Great drug because it reduces cancer progression and reduces risk of pathological fractures and osteoporosis caused by treatment

Question 20

What are B and E symptoms?

Answer 20

E = Extranodal site / Extension

B = Constitutional symptoms (Weight Loss, Night Sweats, Fever)

Included in staging of lymphoma

Question 21

What is the difference between leukaemia and lymphoma?

Answer 21

Leukaemia is malignancy of the bone marrow, lymphoma is outside the bone marrow

Question 22

What is the clinical presentation of lymphoma?

Answer 22

• B symptoms (fatigue, night sweats, fever, weight loss)
• Dyspnoea, cough, chest pain (due to mediastinal involvement
• Bruises and anaemia
• Jaundice and itchy skin (due to abdominal involvement)

Question 23

How does alcohol affect lymphoma?

Answer 23

Causes pain at nodal signs

• Classic presentation that is not often seen

Question 24

What are the differentials for lymphoma?

Answer 24

• TB
• Leukaemia
• HIV (AIDS)
• Infectious mononucleosis
• Toxoplasmosis
• Myeloma
• Other viral infection

Question 25

What is the difference in management of Hodgkin’s and non-Hodgkin’s lymphoma?

Answer 25

Hodgkin’s:
- Radiotherapy and chemotherapy

non-Hodgkin’s:
- Chemotherapy
- Biologics, radiotherapy, bone marrow transplant

Question 26

What are the different types of Hodgkin’s lymphoma?

Answer 26

Most common:
- Nodular sclerosis

Other:
- Mixed cellularity
- Lymphocyte-rich
- Lymphocyte-depleted (aggressive)

Question 27

What are the 2 categories of Hodgkin’s lymphoma?

Answer 27

• Classical Hodgkin’s lymphoma (95%)
• Nodular lymphocyte-predominant Hodgkin’s lymphoma

Question 28

What are the 2 categories of non-Hodgkin’s lymphoma?

Answer 28

• T-cell
• B-cell

Question 29

What are the types of B-cell non-Hodgkin’s lymphoma?

Answer 29

Most common:
- Diffuse large B-cell lymphoma (DLBCL)
- Follicular lymphoma

Other:
- Mantle cell lymphoma
- Burkitt’s lymphoma
- Primary CNS lymphoma
- Marginal cell lymphoma
- Precursor B-lymphoblastic lymphoma

Question 30

What are the types of T-cell lymphoma?

Answer 30

• Anaplastic large-cell lymphoma
• Peripheral T-cell lymphoma
• Mycosis fungoid
• Cutaneous T-cell lymphoma
• Precursor T-lymphoblastic lymphoma

Question 31

How common is T-cell lymphoma compared to B-cell lymphoma?

Answer 31

15%

Question 32

What are primary extra nodal lymphomas (pENL)?

Answer 32

Lymphomas that begin outside of the lymph nodes, most commonly the stomach and small bowel

Eg. diffuse large B-cell lymphoma, and extra nodal marginal B-cell lymphoma

Question 33

How does lymphoma begin?

Answer 33

An uncontrolled proliferation of B or T cells

Caused by genetic factors, infections, and environment

Question 34

What are the complications of lymphoma?

Answer 34

Disease related:
- Obstruction (Eg. superior vena cava, bowel)
- Pain
- Pericardial effusion or pleural effusion

Treatment related:
- Neutropenic sepsis
- Diarrhoea and vomiting
- Anorexia and weight loss
- Tumour lysis syndrome
- Infertility
- Toxicity and impairment of organs
- Secondary cancers