Lymphoma

Question 1

How can you distinguish between Hodgkin’s and Non-Hodgkin’s lymphoma?

Answer 1

There are Reed-Sternberg cells in Hodgkin’s lymphoma. These have 2 nuclei.
(OHCM, medsoc mock)

Question 2

What does stage 1A mean in the Ann Arbor classification?

Answer 2

Hodgkin’s lymphoma is confined to a signed lymph node region (1) and there is an Absence of systemic symptoms other than pruritus (A)

Question 3

What does stage 2B mean in the Ann Arbor classification?

Answer 3

Hodgkin’s lymphoma affects two or more nodal areas on the same side of the diaphragm (2) and there are B symptoms of weight loss, fever, or severe night sweats.

Question 4

What does stage 3B mean in the Ann Arbor classification?

Answer 4

There is involvement of nodes either side of the diaphragm and there are B symptoms of fever, weight loss or night sweats.
(OHCM, medsoc mock)

Question 5

Give 3 potential side-effects of chemotherapy.

Answer 5

Nausea and vomiting
Hair loss/ alopecia
Loss of appetite
Fatigue
Increased infections
Neutropaenic sepsis

Question 6

Describe the management of Non-Hodgkin’s lymphoma.

Answer 6

H. Pylori eradication for gastric MALT
Indolent: Watch and wait (avoid side-effects of treatment), alkylating agents
Aggressive: Chemotherapy, radiotherapy and antibody therapy if advanced (rituximab).
R-CHOP: Rituximab, cyclophosphamide, hydroxydaunorubicin, oncovin (=vincristine), prednisolone.

Question 7

Give 3 causes of lymphoma.

Answer 7

Immunodeficiency (HIV)
Infection: EBV (Impaired immunosurveillance of EBV infected cells, infected B cells escape and proliferate autonomously.)
Autoimmune disorders

Question 8

Describe the pathophysiology of NHL.

Answer 8

There is a genetic mutation affecting B cells and T cells, which proliferate to form a neoplasm predominantly in the lymph nodes.

Question 9

What parts of the body does lymphoma affect?

Answer 9

Mostly lymph nodes but also blood, bone marrow, spleen, MALT (extranodal).

Question 10

What can occur when lymphoma spreads through the blood?

Answer 10

Gastric: bowel obstruction
Bone marrow: crowds normal cells causing decreased RBCs, WBCs and platelets
Spinal cord compression

Question 11

What are the 3 grades of B cell NHL? Give an example of each.

Answer 11

Indolent (slow-growing) eg follicular
Aggressive, eg diffuse large B cell lymphoma (most common)
Highly aggressive, eg Burkitt lymphma.
(osmosis)

Question 12

Describe the pathophysiology of Burkitt’s lymphoma. What might a Burkitt’s patient from the UK present with?

Answer 12

Burkitt’s lymphoma results from a chromosomal translocation. The MYC gene is overexpressed so there is increased cell division. Outside of Africa, this causes extranodal involvement of the abdomen.

Question 13

Describe the histopathology of Burkitt’s lymphoma

Answer 13

‘Starry sky’ appearance.

Question 14

Define lymphoma.

Answer 14

Malignancy of mature lymphocytes that arises in the lymphatic system. (PTS)

Question 15

Describe the epidemiology and risk factors of Hodgkin’s lymphoma.

Answer 15

Bimodal age distribution: young adults and elderly.
Risk factors: EBV, SLE, post-transplantation, obesity.
(PTS)

Question 16

Describe the management of Hodgkin’s lymphoma.

Answer 16

Stage 1-2A: Radiotherapy
Stage 2B-4: Combination chemotherapy (4 drugs)
(lecture)

Question 17

Describe the main clinical features of Hodgkin’s lymphoma

Answer 17

Painless, non-tender, rubbery lymph node enlargement, particularly cervical. Pain may be induced by alcohol
Fever, weight loss, night sweats, lethargy, pruritus
Hepatosplenomegaly

Question 18

How is relapse of Hodgkin’s lymphoma treated?

Answer 18

Responds well to autologous bone marrow transplanation.

Question 19

Describe the prognosis of Hodgkin’s lymphoma and the impact of this.

Answer 19

Prognosis is good, which means a lot of emphasis is on decreasing side-effects of treatment especially long-term. Chemotherapy can cause infertility, heart/lung/nerve damage which become more problematic than the original cancer.

Question 20

Give some differences between HL and NHL.

Answer 20

NHL has more varied presentation, types, treatments, and prognosis (usually worse with higher relapse rate).

Question 21

How does rituximab work and what is the major side-effect?

Answer 21

Targeted against CD20 which is on B lymphocyte surfaces. Kills B lymphocytes. Chimeric protein: half human, half-mouse so causes immune reaction: fever, hypotension, rash. Prevented using steroids. There are minimal other side-effects.

Question 22

Give 3 risk factors for NHL.

Answer 22

H. Pylori (causes gastric MALT)

HIV, toxins.

Question 23

Describe the clinical features of NHL.

Answer 23

Same as Hodgkin’s: painless lymphadenopathy etc
Night sweats, weight loss
Gastric: obstruction
Bone marrow: fatigue
Spinal cord compression: leg weakness
Small bowel involvement: abdo pain, vomiting, diarrhoea
T cell lymphomas: skin involvement