Lymphoma Flashcards
What is lymphoma?
cancer of lymphatic system, where lymphocytes proliferate quickly
How does lymphoma generally present?
firm, tender, swollen lymph nodes in the neck, groin and axillary areas
- generally B symptoms seen
compare Hodgkins and non-hodgkins?
Hodgkins - contiguous manner spread to nearby lymph nodes, rarely extra nodal, better prognosis, Reed-Sternberg cells, younger pt, alcohol induced pain
non - can sometimes spread non-contiguously, involving extra nodal sites, older age
What is the characteristic feature of Hodgkin’s?
B cells derived from germinal centres of lymphoid tissues mutate and lead to presence of large, multi-nucelated giant cells called ‘Reed-Sternberg’ cells
*B cells stop expressing surface immunoglobulins and transform into reed-sternberg cells - hence resistant to apoptosis
What are some risk factors of developing Hodgkin’s?
- previous EBV infections
- increasing age
- immunosuppression
- previous cancer - NHL
- family history
- smoking
What are some clinical features of Hodgkin’s?
- enlarged lymph nodes - rubbery, commonly in cervical supraclavicular and neck
- hepatosplenomegaly
- generalised pruritus seen (rare with non-hodgkin’s)
- B symptoms seen in 1/3
- cough
- SOB
- Weight loss
- alcohol induced lymph node pain
What are some differentials to consider in lymphoma?
- sarcoidosis
- lymphocytic lymphoma
- miliary tuberculosis
- infectious mononucleosis
- thoracic aortic aneurysm
- thymoma
- chronic lymphocytic leukaemia
How might you investigate suspected Hodgkins?
- FBC - normocytic anaemia due to bone marrow infiltration, hypersplenism // eosinophilia due to cytokine production
- LDH raised - bad prognostic factor
- CXR - mediastinal widening
- CT scan +/- PET
- lymph node biopsy - Reed-Sternberg cells diagnostic
- “multinucleated or have a bilobed nucleus with prominent eosinophilic inclusion” - owl’s eye
How is Hodgkins staged and graded?
*Ann arbour staging - localised, 2+ LN regions, above and below diaphragm and mets
*A or B depending on systemic involvement
How might Hodgkin’s be treated?
- chemo with AVBD, BEACOPP
- combined chemo and radio
- antibody meds
- autologous stem cell post myeloblasia
What are some side effects of lymphoma chemo?
hair loss, N+V, myelosuppression, allergy, neuropathy or delayed infertility, pulmonary/ cardiac toxicity
What is the significance of types of non-hodgkin’s ?
- divided into low and high grade
- low grade - good prognosis, incurable eg: follicular, marginal zone
- high grade - worse but cure potential eg: diffuse B cell, burkitt
What are some risk factors associated with NHL?
- Elderly
- Caucasians
- History of viral infection (specifically Epstein-Barr virus)
- EBV link - Burkitt’s
- T cell lymphotropic virus
- Family history
- Certain chemical agents (pesticides, solvents)
- History of chemotherapy or radiotherapy
- Immunodeficiency
- Autoimmune disease
What is the clinical presentation of NHL?
- superficial lymphadenopathy - painless
- effects of BM infiltration - anaemia, thrombocytopenia, neutropenia
- constitutional symptoms - lethargy, fatigue, anorexia
- B symptoms - fevers, night sweats, weight loss
- extranodal - GI tract, testes, brain, thyroid, hepatosplenomegaly
What are the investigations done for NHL?
- excision node biopsy
- CP CAP for staging
- HIV test
- FBC
- LDH
- LFT
- LP
- PET CT
- BM aspiration
