Lymphoma Flashcards
what is lymphoma
malignant disease of MATURE lymphocytes, which divide uncontrollably and dont die
where does it accumulate
in the LN and the extranodal tissue/organs
can arise anywhere in the body/brain/lung/skin/ GI tract
can spontaneously wax and wane [grow and shrink without trt]
how do people present
swollen lymph glands
pain
can deteriorate quickly:
- dehydration
- anaemia
- hypercalcemia: release of osteoclasts
- infection
- critical organ damage
how are they diagnosed
FBC: WBC
chest x-ray: involvement in the mediastinum accumulation in the thymus could lead to an SVCO
BM aspiration: ONLY NHL
biopsy
PET/CT: lymphatic involvement/spread NOT for NHL
why is a biopsy needed
to find out if it is a HL or NHL due to its presence of reed-steinberg cells
risks of HL
EPV
smoking
HIV
incidence has risen 37% since 1990s
links with deprivation
presentation of HL
enlarged neck nodes: 60%
axilla: 20%
groin: 15%
enlarged spleen: 10%
what do HL have
reed-sternerg cells
what is a variant of RS cell in HL
nodular predominant HL
what is stage 1 of a HL
1 LN region or 1 extranodal site or organ
what is stage 2 of a HL
2 or more LN regions on the same side of diaphragm alone or with involvement limited contiguous
what is stage 3 of a HL
LN on both sides of the diaphragm including one organ or area near the LN or spleen
what is stage 4 of a HL
dissemination to one or more extra lymphatic organs or tissues with/without involvement of nearby LN
what is an A for modifying features
assymptomatic
what is a B for modifying features
unexplained fever (>38), night sweats, loss of more than 10% of body weight in 6 mths
what is a E for modifying features
involvement of a single, contiguous or proximal extranodal site
what is an X for modifying features
bulky disease (mass > 10cm)
what is INRT
involved node RT = CTV (node only) + no margin
what is ISRT
involved site RT = CTV (node + margin) + only involved nodes included
what is IFRT
involved field RT = CTV (entire nodal region)
what is EFRT
extended field RT = no longer seen
what used to be the RT technique
extended field: mantel + inverted Y + chemo
why was the old technique for HL stopped
patients were developing AML, secondary cancer. cardiac issues, greater risk of death than relapse in survivors
what is RT based on now
age, site, size of RT field
what chemo is given
low dose for children
ABVD [doxorubicin, bleomycin, vinblastine, dacarbazine]
what is the trt for stage IA/IIA
2-4 cycles of ABVD + RT
what is the trt for the other stages
6-8 cycles of ABVD +/- RT
what are the hodgkin RT sites
whole brain (meninges involvement: field extends to C2/3)
breast
bone (A/P) to cover whole bone
thyroid: cervical lymphatics (also in trt field)
orbit: single applied or angled parallel to avoid contralateral eye
early HL trt
favourable: 2 cycles of ABVD + 20Gy in 10 over 2 weeks
unfavourable: 4 cycles of ABVD + 30Gy in 15 over 3 weeks
advanced HL trt
RT for residual disease is indicated after partial response chemo
30-36Gy in 15-20 over 3-4 weeks
what is given if relapse for HL occurs
high dose chemo is given
single site relapse not previously irradiated has 30-34Gy
after chemo 30Gy in 15 over 3 weeks
persistent disease after chemo is 36-40Gy in 18-20 fractions over 3-4 weeks
what is given to younger pt who have HL relapse
SCT
what indicates high chance of relapse after SC transplant
high PET uptake
what are the palliative recommendations for HL
no definitive ones however
30Gy in 10
20Gy in 5
8Gy in 1
stats for NHL
6th most common in the UK
lower in asian and black ethnic groups
1/39 males
1/51 females
what are the risks of NHL
age
HEP C [26%]
occupational exposure
- 40% organochlorine
- 22% organophosphate
- 26% field crop
autoimmune conditions
- coeliac
- rheumatoid arthritis
how are NHL categorised
how fast they grow
what type they originate from (T or B cell)
what are NHL classified as
low or high grade
what is the most common NHL
diffuse large B cell
what is treatment for NHL dependent on
fitness, age, disease subtype
what chemo is given for NHL
R-CHOP [rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone]
intrathecal: methotrexate and cytarabine
what treatment can be given for NHL
chemo
RT
immunotherapy
why is RT given
if the disease is bulky or aggressive
pt not responding/tolerating chemo
RT for NHL, early DLBCL
early DLBCL: 30Gy in 15
RT for NHL, CMR
CMR patients receiving consolidation RT: 30Gy in 15
RT for NHL with incomplete response to chemo
36-40Gy in 18-20 fractions in 3-4 weeks
what is the RT for bridging over for CAR-T therapy for NHL
30Gy in 10-15 over 2-3 wks
20Gy in 5
what is common in pregnancy
HL
RT in the first trimester is avoided
pt in 2nd or 3rd can be avoided
how long should pt wait to not get pregnant for after trt
2 years to avoid relapse
information on HL
more often localised to single axial group of nodes (cervical, media, para-aortic)
orderly spread by contiguity
mesenteric nodes + waldeyers ring rarely involved
extranodal involvement uncommon
information on NHL
more frequent involvement of multiple peripheral nodes
non contiguous spread
mesenteric nodes + waldeyers ring commonly involved
extranodal involvement is common
mycosis fungoides
T cell lymphoma - skin invasion
superficial or electrons
10Gy in 5
sometimes TBE: 8Gy in 2 or 12Gy in 3
what does CNS lymphoma RT impact
cognitive function therefore 40-45Gy in 20-25 is given
how is RT controversial for
paediatrics
