Lymphoma Flashcards
What age group is most affected by Hodgkin lymphoma?
Bimodal age distribution with with peaks at age 20 and 75
What is the definition of lymphoma?
Group of cancers that affect the lymphocytes inside the lymphatic system by proliferating within the lymph nodes and causing them to become enlarged.
What are some risk factors for Hodgkin lymphoma?
Immunosuppression (HIV)
Autoimmune disorders
EBV
Family history
What are some risk factors for non-Hodgkin lymphoma?
Infections (HIV, EBV, malaria)
Hepatitis B or C infection
Exposure to pesticides and the chemical trichloroethylene
Family history
What are some types of non-Hodgkin lymphoma?
Burkitt lymphoma - associated with EBV, malaria and HIV
MALT lymphoma - usually around stomach, associated with H.pylori infection
Diffuse large B cell lymphoma - rapidly growing painless mass in patients >65
What are some clinical features of lymphoma?
Lymphadenopathy (non-tender and rubbery, painful when drinking alcohol in Hodgkin lymphoma)
B symptoms (fever, night sweats, weight loss)
Itch without rash
Symptoms relating to involvement of other organs (eg breathlessness and cough if lungs involved)
What are some investigations for lymphoma?
Bloods
- LDH often raised in HL but not specific
- ESR elevation and Hb fall associated with poor prognosis in HL
Lymph node biopsy (KEY DIAGNOSTIC TEST)
- Reed-Sternberg cell in HL (abnormally large B cells with multiple nuclei)
CT, MRI, PET scans
- Used for diagnosis and staging
- Lugano staging used (based off old Ann-Arbor system)
What is the management of Hodgkin lymphoma?
Multi-agent chemotherapy +/- radiotherapy
- ABVD (adriamycin, bleomycin, vinblastine, decarbazine)
Immunotherapy/stem cell transplant for patients not responding to chemo
What is the management of non-Hodgkin lymphoma?
Multi-agent chemotherapy +/- radiotherapy
- R-CHOP (rituximab, cyclophosphamide, hydroxydaunorubicin, oncovin, prednisolone)
Monoclonal antibody therapy + chemotherapy
High dose therapy with autologous stem cell rescue or CART for patients with failing chemo
Why should steroids not be started in lymphoma patients before biopsy?
Can cause cell necrosis and distort cellular architecture to confuse the diagnosis as lymphomas are very sensitive to steroids
What are some complications of lymphoma treatment?
Bleomycin and pneumonitis
Secondary cancers
Cardiovascular disease
Cardiotoxicity
Infertility
Neutropenia
Which type of NHL is curable?
High grade NHL is potentially curable
Low grade is incurable but many patients don’t need treatment immediately
