Lymphoma Flashcards
What is lymphoma?
Lymphoma is a cancer of lymphocytes in the lymphatic system, causing lymph node enlargement due to abnormal cell proliferation
What are the key features of Hodgkin lymphoma?
- Reed-Sternberg cells
- bimodal age distribution
(peaks at 20 and 75 years) - Painful lymphadenopathy after alochol consumption. Uusally painless
- Systemic symptoms - B (fever, night sweats, weight loss)
- Good prognosis
- accounts for 1/5 of lymphomas
Name risk factors for Hodgkin lymphoma
(1) Immunosuppression (e.g., HIV)
(2) Autoimmune diseases (e.g., rheumatoid arthritis)
(3) EBV infection, and family history
(4) Male sex
What is Burkitt lymphoma associated with?
Epstein-Barr virus
Malaria
HIV
t(8;14) translocation.
What infection is commonly associated with MALT lymphoma?
H. pylori infection
Name risk factors for non-Hodgkin lymphoma
(1) Infections (HIV, EBV, H. pylori)
(2) Hepatitis B/C - BBBB bitch
(3) Exposure to pesticides, and trichloroethylene.
What is the hallmark symptom of lymphoma?
Lymphadenopathy
= enlarged, non-tender, rubbery lymph nodes.
What are “B symptoms” in lymphoma?
Fever, night sweats, and weight loss.
How does lymphadenopathy differ between Hodgkin and non-Hodgkin lymphoma?
Hodgkin lymphoma usually presents with localised lymphadenopathy that is painless and has a continuous spread, whilst non-Hodgkin lymphoma typically has generalised lymphadenopathy that is painless and does not have a continuous spread
What unusual symptoms might some Hodgkin lymphoma patients experience?
Pain in the lymph nodes after drinking alcohol
What is the key diagnostic test for lymphoma?
Lymph node biopsy
What is the characteristic finding on lymph node biopsy in Hodgkin lymphoma?
Reed-Sternberg cells – large B cells with bilobed nuclei and an “owl’s eye” appearance
What imaging is used to stage lymphoma?
CT, MRI, and PET scans
Describe the Ann-Arbor staging system for lymphoma
I: Single lymph node region.
II: Multiple regions, same side of the diaphragm
III: Both sides of the diaphragm
IV: Spread beyond lymph nodes (e.g., liver, bone marrow)
A = No systemic symptoms
B = Systemic symptoms
(weight loss, fever, night sweats)
What is the main treatment regimen for Hodgkin lymphoma?
ABVD – adriamycin, bleomycin, vinblastine, and dacarbazine
What side effect is associated with bleomycin in ABVD treatment?
Pneumonitis
What are the long-term risks of Hodgkin lymphoma treatment?
Secondary cancers, cardiovascular disease, and infertility (with intensive treatment)
What is the main treatment regimen for non-Hodgkin lymphoma?
R-CHOP
R - rituximab
C - cyclophosphamide
H - hydroxydaunorubicin (doxorubicin)
O - Oncovin®
P - Prednisolone
How is MALT lymphoma treated?
Triple therapy with a PPI
(omeprazole)
and two antibiotics
(e.g., amoxicillin and clarithromycin)
What is Richter transformation in lymphoma?
Transformation of a low-grade lymphoma (eg, CLL) into a high-grade lymphoma (eg, DLBCL)
Why should steroids be used cautiously before a biopsy in suspected lymphoma?
They can cause cell necrosis and distort tissue architecture, complicating the diagnosis
What is the significance of lactate dehydrogenase (LDH) in lymphoma?
Elevated LDH is often seen in Hodgkin lymphoma but is non-specific
What is a poor prognostic factor in Hodgkin lymphoma?
Elevated ESR or decreased haemoglobin
What factors indicate a poor prognosis in Hogkin’s lymphoma?
Advanced stage > stage 4
B symptoms
Large mediastinal mass
High ESR
Older age (>45 years)
Male sex
Low albumin