Lymphoma Flashcards
What are the two classifications of lymphoma and their features?
Hodgkin’s - More common, bimodial age distribution. Risk factors: HIV, EBV, autoimmune and family history.
Non-hodgkins eg, DLBL, Burkitt, MALT. Risk factors: HIV, EBV, H.pylori, Hepatitis, pesticides, trichloroethyelene
What are the symptoms of lymphoma?
Painless lymphadenopathy (Hodgkins - pain induced by alcohol and pruritis)
B symptoms (fever, weight loss, night sweats, lethargy),
Extranodal disease - GI effects, pancytopenia, nerve palsies. More common in non-hodgkins
What are some factors of the clinical presentation which can help differentiate between hodgkins and non hodgkins?
In Hodgkins you can get alcohol induced pain in lymph node.
B symptoms occur earlier in hodgkins,
Extra-nodal disease is much more common in non-Hodgkins
What are the signs of lymphoma?
Weight loss,
Lymphadenopathy,
Palpable abdominal masses (hepatomegaly, splenomegaly),
Testicular mass,
Fever
What are the investigations for Non-Hodgkin’s lymphoma?
Excisional node biopsy - diagnostic test.
CT CAP/PET - staging,
HIV test,
Bloods - baseline and blood film to rule out leukaemia,
ESR and LDH (prognostic marker)
What is the Lugano (ann Arbor staging) system?
Stage 1 - One node/group of nodes affected
Stage 2 - More than one node/group of nodes affected on same side of diaphragm,
Stage 3 - Nodes affected on both sides of diaphragm,
Stage 4 - Extra-nodal involvement (spleen, bone marrow or CNS)
Each combined with letter A or B to indicated presence of B symptoms
Describe features of Burkitt’s lymphoma
High grade B cell lymphoma (rapid onset) associated with c-myc gene translocation. Often extranodal disease (jaw/facial bone tumorus), endemic in africa.
Microscopy shows starry sky.
Treatment is chemotherapy but high risk of tumour lysis syndrome
Describe features of follicular lymphoma
Low grade so often late stage when found. Translocation of BCL2 gene.
Treatment normall symptom control. If end organ damage then can give rituximab and chemo
What antigen is on the surface of B-lymphocytes and how is this targeted in treatment?
CD20 antigen. It is targeted with the monoclonal antibody - Rituximab
What are some features of diffuse large B cell lymphoma
Resembles activated B cells, It is very aggressive but often curable.
If stage 1A then 3 rounds of R-CHOP + radiotherapy.
1A+ - 6 rounds of R-CHOP.
High dose methotrexate for CNS prophylaxis.
What is the management of non-hodgkins lymphoma?
Typically watch and wait, chemotherapy (R-CHOP - don’t use rituximab in T cell lymphomas) or radiotherapy.
Refractory/relapse - CAR T
What are the complications of non-hodgkins lymphoma?
Bone marrow infiltration causing pancytopenia,
SVC obstruction,
Metastasis,
Spinal cord compression
What is found on the lymph node biopsy for Hodgkin’s lymphoma?
Reed-Sternberg cells (diagnostic of Hodgkins)
What are the different types of Hodgkin’s lymphoma?
Nodular sclerosing,
Mixed cellularity,
Lymphocyte predominant,
Lymphocyte depleted
What are factors which indicate a poor prognosis in lymphoma?
Age > 45,
Stabe IV disease,
Hb < 10.5,
Low lymphocyte count,
Male,
Albumin < 40,
WCC > 15
