Lymphoma Flashcards
What is lymphoma?
Cancer affecting lymphocytes inside the lymphatic system
Cancerous cells proliferate inside lymph nodes, causing lymph nodes to become abnormally large (lymphadenopathy)
What are the two categories of lymphoma?
Hodgkin’s lymphoma
Non-Hodgkin’s lymphoma
What are the different peaks for Hodgkin’s lymphoma?
20-25 years old
80 years old
What are the risk factors for Hodgkin’s lymphoma?
HIV
EBV
Autoimmune conditions e.g. RA and sarcoidosis
Family history
What are main types of Non-Hodgkin’s lymphoma?
Diffuse large B cell lymphoma - rapidly growing painless mass in older patients
Follicular lymphoma
Burkitt lymphoma - associated with EBV and HIV
MALT lymphoma - affects mucosa associated lymphoid tissue, around stomach
What are the risk factors for non-Hodgkin’s lymphoma?
HIV
EBV
Helicobacter pylori (associated with MALT lymphoma)
Hepatitis B or C
Pesticide exposure
Trichloroethylene exposure
Family history
How does lymphoma present?
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
What are B symptoms?
Systemic symptoms of lymphoma
- Fever
- Weight loss
- Night sweats
What are the non-specific symptoms of lymphoma?
Fatigue
Pruritis
Cough
SOB
Abdominal pain
Recurrent infections
What investigations are used for lymphoma?
Excisional lymph node biopsy
Critical diagnostic investigation
CT,MRI and PET can be used to help diagnose and stage
Why is FNAB not used for lymphoma?
May miss the cancer and not show the morphology of cancerous cells
What characteristic finding is present in lymph node biopsy in Hodgkin’s lymphoma?
Reed-Sternberg cells
Large cancerous B lymphocytes
- Two nuclei and prominent nucleoli
- Looks like an owl
- CD15 and CD30 positive
What causes formation of Reed Sternberg cells in HL?
Centroblasts are responsible for B cell formation
In HL centroblasts don’t undergo apoptosis so they continue to replicate
What causes the classical B symptoms in HL?
Reed Sternberg cells release cytokines which act on the hypothalamus
This causes an increased body temperature
What are some highly specific features of HL?
Pel Ebstein Fever
- Cyclical fevers
Alcohol induced lymph node pain
Eosinophilia
What are the different subtypes of Hodgkin’s lymphoma?
Common subtypes
Nodular sclerosing HL (most common)
Mixed cellularity HL
Rare subtypes
Lymphocyte-depleted HL (worst prognosis)
Lymphocyte-rich HL (best prognosis)
How can HL be differentiated from NHL?
NHL
- Extranodal involvement
- Non-continuous
- No RS cells
What classification is used for lymphoma?
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
How is lymphoma managed?
Chemotherapy and radiotherapy
Treatment aims to cure disease, usually successful, risk of relapse and side effects from treatment
What the key lymph nodes affected in HL?
Cervical
Supraclavicular
Axillary
Mediastinal
What can chemotherapy lead to?
Infections
Cognitive impairment
Secondary cancers
Infertility
What can radiotherapy lead to?
Risk of tissue fibrosis
Secondary cancers
Infertility
What does management of non-Hodgkin’s lymphoma involve?
Depends on type and stage
- Watchful waiting
- Chemotherapy
- Monoclonal antibodies (rituximab, targets B cells)
- Radiotherapy
- Stem cell transplantation
What is Burkitt lymphoma?
High-grade aggressive NHL
Presents with more widespread disease and B symtpoms
What is the characteristic lymph node biopsy of Burkitt lymphoma?
Starry sky appearance
What is Burkitt lymphoma heavily associated with?
Previous EBV infection
What gene translocation is associated with Burkitt lymphoma?
MYC gene
T(8:14)
What gene translocation is associated with follicular lymphoma?
T(14:18)
How does folliclular lymphoma present?
Painless lymphadenopathy
No classical featurse of HL e.g. night sweats and alcohol-induced tenderness
