Lymphoma

Question 1

A patients with Sjogren’s syndrome presents with asymmetrical salivary gland swelling. What is this suspicious of?

Answer 1

Lymphoma.

Question 2

What is lymphoma?

Answer 2

CLINIC PROLIFERATIOn of LYMPHOCYTES arising in a LYMPH NODE or ASSOCIATED TISSUE.

Question 3

Where is lymphoma found?

Answer 3

• a SOLID tumor, some cells in the blood.
• Found in SOMATIC TISSUES rather than in bone marrow.

Question 4

What are the types of lymphoma?

Answer 4

2 types:
- Hodgkin and Non-Hodgkin.

Question 5

Why type of lymphoma is most common?

Answer 5

Non Hodgkin, 6:1.

Question 6

What is staging?

Answer 6

Determines the EXTENT of disease.

Question 7

Why is cancer stage important?

Answer 7

It determines the PROGNOSIS and TREATMENT.

Question 8

What determines lymphoma stage? How is the stage found (what diagnostic tools used)?

Answer 8

• Whether disease is on BOTH SIDES OF THE DIAPHRAGM
• number and site of lymph nodes involved.
• extra nodal involvement.
• systemic symptoms.

Question 9

What is a typical cell seen in Hodgkin lymphoma?

Answer 9

Reed-sternberg cells are GIANT LYMPHOCYTIC CELL, seen in biopsies of affected Hodgkin tissues.

Question 10

What is the clinical presentation of Hodgkin lymphoma? (8)

Answer 10

• Lymphadenopathy - typically CERVICAL, can fluctuate in size.
• Pain on DRINKING ALCOHOL
• Fever, night sweats, weight loss, weakness, itching, infection

Question 11

What is the cure prognosis for hodgkins lymphoma?

Answer 11

Stage I and II –> more than 90%

Stage III and IV –> cure prognosis 50-70%

Question 12

When are reed-sternberg cells seen?

Answer 12

In tissues affected by HODGKINS lymphoma.

Question 13

What cells are usually involved in non Hodgkins lymphoma?

Answer 13

B cells (85%) and T cells (15%)

Question 14

What are the 3 common causes of non Hodgkins lymphoma?

Answer 14

• Microbial factors.
• Autoimmune disease (Sjogrens, peptic ulcer, rheumatoid).
• Immunosuppression

Question 15

What are the 3 mains presentations of Non-Hodgkins lymphoma?

Answer 15

• DISSIMINATED lymphadenopathy.
• Extra nodal involvent –> WELDEYERS RING, OROPHARYNHEAL INVOLVMENT
• Noisy breathing and sore throat (due to above).
• Marrow failure.
• Constitutional symptoms less common (fever, sweats etc).

Question 16

A patient presents with lymphoma and their symptoms are: lymphadenopathy, fever and sweating. Which type is it MORE LIKELY to be?

Answer 16

Hodgkins

(constitutional symptoms less common with Hodgkins).

Question 17

What is the prognosis for non hodgkins lymphoma?

Answer 17

50% will relapse - POOR PROGNOSIS.

Question 18

What cells are involved in multiple myeloma?

Answer 18

Malignant proliferation of PLASMA CELLS which produce an abundance of ANTIBODIES.

Question 19

What are plasma cells derived from?

Answer 19

B cells.

Question 20

What are 3 main features on multiple myeloma?

Answer 20

• monoclonal paraprotein in blood and urine
• lytic bone lesions (cause BONE PAIN AND FRACTURE).
• excess plasma cells in bone marrow (cause MARROW FAILURE).

Question 21

Name 4 symptoms of multiple myeloma.

Answer 21

1. infection
2. bone pain/ fracture.
3. renal failure.
4. amyloidosis.

Question 22

How is multiple myeloma treated and why is this relevant to dentistry?

Answer 22

Patient may be taking BISPHOSPHONATES

Question 23

Name 5 different modes of treatment for hematological malignancies.

Answer 23

1. chemotherapy.
2. radiotherapy.
3. monoclonal antibodies.
4. Haemopoietic stem cell transplantation.
5. supportive therapy.

Question 24

How does chemotherapy work? What are 2 drawbacks?

Answer 24

• Targets cells with HIGH TURNOVER RATE.
• Side effects: hair loss, nausea, vomiting, tiredness.
• Long-term risk of oncogenesis.

Question 25

How does radiotherapy work? What are 2 drawbacks?

Answer 25

• Uses CYTOTOXIC effect of IONIZING RADIATION on cells with high turnover.
• Adjacent tissue also irradiated yet minimizing with positioning and dosing.
• Risk of inducing late cancers.

Question 26

How do monoclonal antibodies work? What is their advantage?

Answer 26

• Monoclonal antibodies to SPECIFIC CANCER CELL ANTIGENS are produced artificially. Gives TARGETED TREATMENT.
• Use Cluster definition/ cell recognition antigens on white cells.
• Target interleukin messaging.
• Target growth factor.

Question 27

What are the 2 sources of haemopoietic stem cell transplantation?

Answer 27

• Allogenic (stranger/ family member).
• Autologus (from self).

Question 28

What are 3 risks with haemopoietic stem cell transplant? What is the mortality risk?

Answer 28

• Life threatening infection.
• Graft versus host disease.
• Graft failure and total marrow failure.

10% mortality risk.

Question 29

What are the stages to haemopoietic cancer treatment?

Answer 29

1. Induction.
2. Remission.
3. Maintenance and consolidation.
4. Relapse.