Lymphoma

Question 1

what are the lymphomas?

Answer 1

neoplastic transformations of normal B or T cells which reside predominantly in lymphoid tissues

classified histologically into Hodgkins and non-Hodgkins

Question 2

What is thought to play a role in the pathogenesis of Hodgkin’s lymphoma?

Answer 2

previous infection with Epstein-Barr virus (EBV)

Question 3

Epidemiology HL

Answer 3

unusually in late teens
20 yr old female

also spike at age 60

Question 4

Clinical features HL

Answer 4

painless cervical lymph node enlargement. rubbery (like CLL)

? hepatosplenomegaly

systemic B symptoms: fever, wt loss, night sweats

Question 5

Blood count and ESR for HL

Answer 5

blood count: may be normal or show a normochromic, normocytic anaemia

ESR is usually raised

Question 6

An adverse prognostic marker for HL

Answer 6

serum lactate dehydrogenase (LDH), if raised

Question 7

What may CXR show in HL?

Answer 7

mediastinal widening from enlarged nodes

Question 8

how to diagnose HL?

Answer 8

lymph node biopsy and histological Ex showing

REED-STERNBERG CELLS
binucleate or multinucleate malignant B lymphocytes

Question 9

how to stage HL?

Answer 9

CT
PET

1. Lymhpoma in one place
2. Lymphoma in more than 1 place, same side of diaphragm
3. Lymphoma in more than 1 place, both sides of diaphragm
4. Spread to liver/bone

Each stage has a and b. B for b symptoms being present

Question 10

What does Tx (which is given with curative intent) of HL depend on?

Answer 10

stage
involved sites
‘bulk’ of lymph nodes involved
presence of ‘B’ symptoms

Question 11

Tx early stage disease HL

Answer 11

brief chemo (ABVD) followed by involved field irradiation

Question 12

Tx advanced disease HL

Answer 12

cyclical combination chemotherapy (8 cycles of ABVD) with irradiation at sites of bulk disease

then PET/CT to assess success

Question 13

Emergency presentation of HL

Answer 13

infection
SVC obstruction (JVP increase)
dyspnea
blackouts
facial oedema

Question 14

How many of Non-Hodgkin’s lymphoma are B cell origin, how many T cell

Answer 14

70% are B cell origin

30% T cell

Question 15

Aetiology NHL

Answer 15

mainly unknown

some are associated with a specific infection e.g. Helicobacter pylori and gastric mucosa-associated lymphoid tissue (MALT) lymphoma- this one doesn’t involve lymph nodes!

Question 16

Clinical presentation NHL

Answer 16

rare before the age of 40

painless peripheral lymph node enlargement

systemic symptoms as in HL may occur

Extra-nodal involvement is more common than in HL, and almost any organ in the body can be involved

Question 17

In NHL, what does T cell lymphoma present with?

Answer 17

mycosis fungiodes and Sezary syndrome

Question 18

Blood count NHL

Answer 18

may show anaemia

elevated white cell count or thrombocytopenia suggests bone marrow involvement

ESR may be raised

Question 19

prognostic indicators for NHL

Answer 19

serum lactate dehydrogenase

and B2-microglobulin

Question 20

what is lymph node biopsy required for (NHL)?

Answer 20

for definitive Dx and sub typing

Question 21

NHL: low-grade lymphomas

Answer 21

~incurable: follicular lymphoma, marginal zone lymphoma/MALT, lymphocytic lymphoma

Question 22

NHL: high grade lymphomas

Answer 22

more aggressive but curable:

Burrkitt’s lymphoma + lymphoblastic lymphomas

Question 23

Tx of low-grade lymphomas (NHL)

Answer 23

RT for localised disease, chlorambucil for diffuse disease

Question 24

Tx of high-grade lymphomas (NHL)

Answer 24

RCHOP chemo regime

monoclonal antibodies for B cell lymphomas

Question 25

What is RCHOP/ CHOP + R

Answer 25

``` cyclophosphamide hydroxydaunorubicin vincristine prednisolone + rituximab ```

Question 26

what s the most common type of NHL? and its Tx?

Answer 26

diffuse large B cell lymphoma Tx is with CHOP + R with field irradiation for those with bulky disease. 65% cure rate with this regimen

Question 27

Tx for primary gastric lymphoma (NHL)

Answer 27

usually associated with H. pylori infection so eradicating this is usually enough

Question 28

Burkitt's lymphoma (NHL) and Tx

Answer 28

occurs mainly in african children associated with EBV infection jaw lymphadenopathy, usually with GI involvment Tx: cyclical combination chemotherapy

Question 29

How is Burkitt's lymphoma thought to be associated with malaria infection?

Answer 29

Its thought that malaria reduces the resistance to EBV allowing the virus to take hold

Question 30

ABVD

Answer 30

A – doxorubicin (Adriamycin ®) B – bleomycin V – vinblastine (Velbe ®) D – dacarbazine (DTIC).