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Haematology > Lymphoma > Flashcards

Lymphoma Flashcards

1
Q

What is lymphoma?

A

Cancer affecting lymphocytes inside the lymphatic system

Cancerous cells proliferate inside lymph nodes, causing lymph nodes to become abnormally large (lymphadenopathy)

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2
Q

What are the two categories of lymphoma?

A

Hodgkin’s lymphoma

Non-Hodgkin’s lymphoma

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3
Q

What are the different peaks for Hodgkin’s lymphoma?

A

20-25 years old
80 years old

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4
Q

What are the risk factors for Hodgkin’s lymphoma?

A

HIV
EBV
Autoimmune conditions e.g. RA and sarcoidosis
Family history

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5
Q

What are main types of Non-Hodgkin’s lymphoma?

A

Diffuse large B cell lymphoma - rapidly growing painless mass in older patients
Burkitt lymphoma - associated with EBV and HIV
MALT lymphoma - affects mucosa associated lymphoid tissue, around stomach

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6
Q

What are the risk factors for non-Hodgkin’s lymphoma?

A

HIV
EBV
Helicobacter pylori (associated with MALT lymphoma)
Hepatitis B or C
Pesticide exposure
Trichloroethylene exposure
Family history

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7
Q

How does lymphoma present?

A

Lymphadenopathy
Enlarged lymph node or nodes in neck, axilla or inguinal area

Non-tender, firm or rubbery

May experience lymph node pain after alcohol

B symptoms

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8
Q

What are B symptoms?

A

Systemic symptoms of lymphoma
- Fever
- Weight loss
- Night sweats

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9
Q

What are the non-specific symptoms of lymphoma?

A

Fatigue
Pruritis
Cough
SOB
Abdominal pain
Recurrent infections

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10
Q

What investigations are used for lymphoma?

A

Excisional lymph node biopsy
Critical diagnostic investigation

CT,MRI and PET can be used to help diagnose and stage

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11
Q

Why is FNAB not used for lymphoma?

A

May miss the cancer and not show the morphology of cancerous cells

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12
Q

What characteristic finding is present in lymph node biopsy in Hodgkin’s lymphoma?

A

Reed-Sternberg cells

Large cancerous B lymphocytes
- Two nuclei and prominent nucleoli
- Looks like an owl
- CD15 and CD30 positive

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13
Q

What causes formation of Reed Sternberg cells in HL?

A

Centroblasts are responsible for B cell formation

In HL centroblasts don’t undergo apoptosis so they continue to replicate

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14
Q

What causes the classical B symptoms in HL?

A

Reed Sternberg cells release cytokines which act on the hypothalamus

This causes an increased body temperature

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15
Q

What are some highly specific features of HL?

A

Pel Ebstein Fever
- Cyclical fevers

Alcohol induced lymph node pain

Eosinophilia

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16
Q

What are the different subtypes of Hodgkin’s lymphoma?

A

Common subtypes
Nodular sclerosing HL (most common)
Mixed cellularity HL

Rare subtypes
Lymphocyte-depleted HL (worst prognosis)
Lymphocyte-rich HL (best prognosis)

17
Q

How can HL be differentiated from NHL?

A

NHL
- Extranodal involvement
- Non-continuous
- No RS cells

18
Q

What classification is used for lymphoma?

A

Lugano classification

Stage 1
Confined to one node or group of nodes

Stage 2
More than one group of nodes, but same side of diaphragm (above or below)

Stage 3
Affects lymph nodes above and below diaphragm

Stage 4
Widespread involvement, including non-lymphatic organs e.g. liver or lungs

19
Q

How is lymphoma managed?

A

Chemotherapy and radiotherapy

Treatment aims to cure disease, usually successful, risk of relapse and side effects from treatment

20
Q

What the key lymph nodes affected in HL?

A

Cervical
Supraclavicular
Axillary
Mediastinal

21
Q

What can chemotherapy lead to?

A

Infections
Cognitive impairment
Secondary cancers
Infertility

22
Q

What can radiotherapy lead to?

A

Risk of tissue fibrosis
Secondary cancers
Infertility

23
Q

What does management of non-Hodgkin’s lymphoma involve?

A

Depends on type and stage

  • Watchful waiting
  • Chemotherapy
  • Monoclonal antibodies (rituximab, targets B cells)
  • Radiotherapy
  • Stem cell transplantation
24
Q

What is Burkitt lymphoma?

A

High-grade aggressive NHL

Presents with more widespread disease and B symtpoms

25
Q

What is the characteristic lymph node biopsy of Burkitt lymphoma?

A

Starry sky appearance

26
Q

What is Burkitt lymphoma heavily associated with?

A

Previous EBV infection

27
Q

What gene translocation is associated with Burkitt lymphoma?

A

MYC gene
T(8:14)

28
Q

What gene translocation is associated with follicular lymphoma?

A

T(14:18)

29
Q

How does folliclular lymphoma present?

A

Painless lymphadenopathy

No classical featurse of HL e.g. night sweats and alcohol-induced tenderness

Haematology (18 decks)

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