Lymphoma Flashcards
Two types of lymphoma
Non-hodgins
Hodgkins
Definition of lymphoma
malignant proliferation of lymphocytes
Hodgkins Rfs
Immunodeficiency
Presentation of non hodgkins
75% nodal disease (localised or generalised)
25% extra-nodal disease (ropharyngeal, skin, gut, CNS
Systemic - B symptoms
Marrow involvement - pancytopenia
Types of non-hodgkins lymphoma
Low grade- Follicular lymphoma
- widely disseminated presentation
- indolent course
- incurable
High grade- Diffuse large B cell
- more loaclised
- rapid growth
- > 50% curable
Investigations of non-hodgkins
Lymph node
- Biopsy + immunohistochemistry for CD20
- Staging
a. Vloods same as hodgkins (LHD)
b. CT scan (abdo =/- pelvis - Bone marrow
a. aspirate
b. trephine
Treatment of non-hodgkins
Treatment depends on disease subtype
Low grade- watch and wait
RCHOP! Rituximab - mab (CD20 on B-lymphocytes is target) Cyclophosphamide - chemo Hydroxdaunorubicin -chemo Oncovine (vincristine) - chemo Prednisolone - steroid
Hodgkins presentation
2 peaks of incidence (young, elderly)
Lymphadenopathy accumulate in lymph nodes causing lymphadenopathy - enlarged -painless & non tender -rubbery - alcohol induced LN pain - usually contangious
B symptoms
- Night sweats
- Fever >38o
- Weight loss >10%
hepatomeagaly, splenomegaly, pruritis
Blood film special feature
Reed-stern berg cells (bi-nuclear)
Investigations in hodgkins lymphoma
Tissue diagnosis
Lymph node exicision
Biopsy
CT scan (neck, chest, abdo, pevis)
BM
- aspirate
- trephine
Blood tests
- FBC
- ESR
- U and es
- LFTS
- LDH (raised as increased during cell turnover
Staging of hodkins lymphoma
Ann Arbour system
- Single LN region
- 2 or > nodal areas on same side of diaphragm
- nodes on both sides of the diaphragm
- spread beyond lymph nodes
A- no symptomatic symptoms (except pruritis)
B- B symptoms
Treatment of hodgkins
Relapse
- peripheral stem cell transplant
Radiotherapy
- dependent on age + stage
ABVD A- adriamycin B- bleomycin V- vincristine D- Dacarbazine
High cure rates (>80%)
