Lymphoma Flashcards
In non-Hodgkin’s lymphoma, most are _ cell and express ______
B cell, express CD20
T/f: Non-hodgkin’s increases in incidence with age?
True
Epidemiology of NHL?
- Unknown
- Linked to viral/bacterial (EBV, H.pylori, Hep C, HTLV)
- Environmental/occupation
- Autoimmune disease
Epidemiology of NHL
- Decreased immune system (Immunosuppressive drugs, prior chemo, HIV/AIDS)
- Hereditary
- Dietary
2 most common subtypes of NHL
- Diffuse large B cell
- Follicular
Symptoms of NHL
- PAINLESS swelling of lymph node
- B Symptoms: fevers, night sweats, wt. loss
- Lack of energy/fatigue
- Itching/rash
- Alcohol induced pain
- Cough, SOB, ab pain, early satiety
- Asymptomatic
What labs would you do with every patient with NHL? How would you identify the subtype?
How would you stage?
- Labs: CBC, diff, LDH, CMP
- ID subtype with Lymph node biopsy.
- Staging with CT scan: neck, chest, abdomen, and pelvis.
Staging of lymphoma
Stage 1= single lymph node region
Stage 2= 2 or more node regions, same side of diaphragm
Stage 3= Node regions both sides of diaphragm.
Stage 4= Diffuse extra-lymphatic involvement.
A= no symptoms B= Wt. loss >10% over 6 months, fever, night sweats E= Involvement of a single extranodal site contiguous or proximal to known nodal site.
A painless, slow growing, peripheral lymph node enlargement which may have waxed or waned/ +/- splenomegaly or cytopenia. It is felt to be incurable and median survival is said to be 10 years. What is it?
Low grade NHL (indolent). Most common type is Follicular B-cell lymphoma
Follicular lymphoma international prognostic index: “NoLASH”
No=Nodes (>4?) L=LDH (>normal) A=Age (>60?) S=Stage (III or IV) H-Hemoglobin (<12 g/dL?)
International Prognostic Index for Lymphomas:
APLES A=Age >60 P=Performance status L= LDH >1x normal E= Extranodal sites >1 S= Stage II or IV
This accounts for about 6% of lymphomas and affects men 3x more tha women, Usually over 60 y/o and the bone marrow is usually involved along with GI tract sometimes. What is it and what should be done at initial diagnostic work-up?
Mantle Cell- do a colonoscopy
Patient presents with enlarged lymph nodes, necrotic nasal/facial lesions, systemic illness or pulmonary symptoms. What do you suspect?
Peripheral T-cell lymphoma
WHAT DOES SURGERY DO WITH LYMPHOMA?
Primary role in diagnosis, assist in staging, but not effective in treatment of lymphoma.
When would you use the watch and wait approach with lymphoma?
- Asymptomatic low grade
- Regular routine physician visits every 2-3 months with lab and/or CT scan
- Symptomatic or the disease progressing then other treatment measures need considered
- Consider pts feelings and emotions
