Lymphoma Flashcards
What is lymphoma?
a malignant growth of white blood cells predominantly in the lymph nodes
(but can also occur in the blood, bone marrow, liver, spleen and anywhere where there are lymphocytes)
What are the causes of lymphoma?
primary immunodeficiency secondary immunodeficiency (HIV< transplant recipient) infection (EBV, H. pylori, HTLV-1) autoimmune disorders eg RA
At what age is Hodgkin’s lymphoma most common?
15-34 is the predominant peak and there is another peak at 65 yrs old
What is the pathophysiology of lymphoma?
80% are B cell in origin - B cells escape regulation and proliferate autonomously
How is lymphoma classified?
split into Hodgkins and Non-hodgkins
Non- hodgkins are further classified according to growth rate: low grade and high grade
What is the name of the characteristic histological cell type seen in Hodgkin’s lymphoma?
Reed-Sternberg cell = lacunar histiocyte
they are a type of not fully developed B cell
What are the signs and symptoms of lymphoma?
nodal disease = lymphadenopathy: painless, rubbery, non-tender lymph nodes
hepatosplenomegaly chest symptoms or SVCO
spinal cord compression
B symptoms: fever, night sweats, weight loss, loss os appetite
bone marrow failure: anaemia, thrombocytopenia, leucopenia
other organ involvement: eg GI and MALT ie extranodal disease
How is lymphoma diagnosed?
- lymph nodes biopsy + histology
- bone marrow biopsy 3. immunohistochemistry of biopsy samples eg for CD20+
- FBC - to see if bone marrow failure
- Blood film
- cytogenetics: FISH and karyotype analysis, done for classification
- molecular techniques: PCR
What can be used to stage lymphoma?
PET scan
CT scan
blood tests
bone marrow biopsy
What is done after the pt has been diagnosed with lymphoma?
staging
find out how fit the pt is for treatment
make a plan for treatment in MDT meeting
How is the pt assessed to see how fit they are for treatment?
history and examination bloods: FBC, U+Es, LFTs, Viral serology for HIV, Hep B, hep C CXR ECHO PFTs WHO Performance status
What are the stages of the WHO performance status
0 - asymptomatic, activities without restriction
1 - symptomatic but completely ambulatory (restricted strenuous activity, but can do light work)
2 - symptomatic, <50% of time in bed during the day (ambulatory and capable of all self care, but unable to carry out any work activities)
3- symptomatic and more than 50% of the time in bed, limited self-care
4- bedbound - cannot carry out any self care
5 -death
which WHO statuses are fit for chemo?
0-2
Name a low grade non-Hodgkin’s lymphoma
Follicular lymphoma
Name a high grade lymphoma
Diffuse large B cell lymphoma
Name a very high grade lymphoma
Burkitt’s
What are the four stages of Hodgkin’s lymphoma?
Stage 1 - single lymph node region or single extralymphatic site
stage 2 - two or more lymph node regions on the same side of the diaphragm (or one lymph nodes region and one extralyphatic region)
stage 3 - involvement of lymph regions on both sides of the diaphragm
stage 4- disseminated involvement of one or more extralymphatic organs with or without node involvement
Which stages of HL cannot be treated with radiotherapy?
stage 3 and 4
What is the treatment for HL?
stage 1-2A: combination chemo and radiotherapy
stage 2B-4: combination chemo (as widespread disease so radiotherapy doesn’t work)
What is the prognosis for HL and what is the implication of this for treatment?
HL has a good prognosis - >80% can be cured
this means that young people who are cured have a high risk of developing complications due to the effect of treatment, so de-escalation of treatment is being done for those who are likely to respond better to treatment
Give examples of long term side effects from chemo treatment used in HL
infertility cardiomyopathy lung damage peripheral neuropathy second cancers
What is the disadvantage of having a slow growing NHL like follicular lymphoma?
usually advanced at presentation
incurable
What treatment may be offered to those with indolent ie slow growing NHL?
do nothing alkylating agents combination chemo monoclonal antibodies radio-immunocongugates radiotherapy bone marrow transplant
What is the disease progression of indolent NHL?
all pts with follicular lymphoma treated with chemo will relapse and some may transform into diffuse large B cell lymphoma
