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Case 20 Lymphoma > Lymphoma > Flashcards

Lymphoma Flashcards

1
Q

What are signs and symptoms of lymphoma?

A

Cough, fever, fatigue, night sweats, weight loss, lymphadenopathy, discomfort after drinking alcohol

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2
Q

What are the signs of hilar lymphadenopathy?

A

Chest pain, peri-hilar shadows on CXR

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3
Q

What are the features of a malignant node?

A

hard, painless and adherent to the surrounding tissues and hence they do not move freely

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4
Q

What causes Tuberculous Lymphadenopathy?

A

result of infection of the lymph nodes by the TB bacillus. Most commonly observed in immunocompromised.

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5
Q

What are the clinical features of Tuberculous Lymphadenopathy?

A

chronic, painless mass in neck. Mass may become adherent to skin and form a chronic discharging sinus.

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6
Q

What causes cervical lymphadenopathy?

A

Inflammatory

Malignant

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7
Q

What are the signs of an inflammatory lymph node?

A

Preceding infection, node gets bigger and small over time, can be painful

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8
Q

What are the signs of a malignant node?

A

Continued progressive growth. Often have associated head and neck symptoms. Glands often painless. Fixed and irregular.

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9
Q

What are the features of lymph nodes in lymphoma?

A

presents with multiple often smooth and firm rather than hard irregular

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10
Q

How do you investigate cervical lymphadenopathy?

A

Full head and neck exam - fibreoptic endoscopy in ENT neck lump clinic

Imaging - USS, CT, MRI, PET

Biopsy - fine-needle aspiration

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11
Q

What are features of mucosal squamous cancer?

A

Odynophagia with associate otalgia, hoarseness, dysphagia, neck lump

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12
Q

What are risk factors for mucosal squamous cancer?

A

Smoking, alcohol, HPV, cannabis

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13
Q

What are two types of lymphoma?

A

Hodgkin or non-hodgkin

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14
Q

What are the classifications of non-hodgkin lymphoma

A

High-Grade or low-grade

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15
Q

What is a high-grade tumour?

A

tumours divide rapidly, are typically present for a matter of weeks before diagnosis, may be life-threatening. Potentially curable.

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16
Q

What is a low-grade tumour?

A

divide slowly, may be present for many months before diagnosis, and typically behave in an indolent fashion. Non-curable by conventional therapy.

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17
Q

What is a lymphoma?

A

A malignancy that involves the lymphocytes and present as solid tumours involving the lymph nodes

18
Q

What increases risk of NHL?

A

autoimmune disease, HIV/AIDs, eating a large amount of meat and fat

19
Q

What increases risk of HL?

A

infection with Epstein Barr Virus

20
Q

What is the histological hallmark of HL?

A

Reed-Sternberg cells. They have an owl’s eye appearance.

21
Q

What are the clinical features of HL?

A

painless, rubbery lymphadenopathy which may fluctuate in size

hepatosplenomegaly

22
Q

What type of HL is more common in young patients and woman?

A

nodular sclerosing type

23
Q

How is HL staged?

A

Stage 1 : One group of lymph nodes is affected.
Stage 2: Two or more groups of nodes are affected, but the lymphoma is restricted to one side of the diaphragm only
Stage 3: Lymphadenopathy is evident on both sides (above and below) of the diaphragm.
Stage 4: The lymphoma has spread beyond the lymph nodes to other organs such as the spleen, bone marrow, liver or lungs.

As well as giving each stage a number, a letter code – A or B, is added to each of the above stages to indicate whether or not the patient has systemic symptoms (such as weight loss, fevers or night sweats).

24
Q

What investigations would you carry out in suspected HL?

A

FBC, ESR, Renal function test, Liver function test, LDH measurements, CXR, CT TAP, PET, lymph node biopsy

25
Q

What are poor prognostic factors in HL?

A

Normochromic, normocytic anaemia or lymphopenia; raised LDH

26
Q

How is HL managed?

A

Stage 1A/2A - radiotherapy

or

Chemo + radiotherapy

27
Q

What chemotherapy is used in HL?

A

ABVD regimen (doxorubicin, vinblastine, bleomycin and dacarbazine)

28
Q

What is NHL?

A

represents a monoclonal proliferation of lymphoid cells of B cell (70%) or T cell (30%) origin

29
Q

What are clinical features of NHL?

A

Often widely disseminated at presentation, including in extranodal sites

Lymph node enlargement with weight loss, sweats, fever and itching

Compression Syndromes

Most likely to be stage III/IV at presentation

30
Q

What investigations are carried out in NHL?

A

Same for HL +:

  • Bone marrow aspiration and trephine
  • Immunophenotyping - T cell or B cell
  • Immunoglobulin determination
  • HIV testing
  • Uric acid levels
  • Cytogenic analysis to detect chromosomal translocation
31
Q

How is low grade NHL managed?

A
  • Radiotherapy - stage 1
  • Chemo - Rituximab (R) in combination with cyclophosphamide, vincristine and prednisolone (R-CVP)
  • Bone marrow transplant
32
Q

How is high grade NHL managed?

A

R-CHOP is currently recommended as first-line therapy for those with stage II or greater diffuse large B-cell lymphoma.

R-CHOP - rituximab + cyclophosphamide, doxorubicin, vincristine and prednisolone

Radiotherapy - stage 1 w/o bulky disease

Haemopoetic stem cell transplant

33
Q

What is histological hallmark of NHL?

A

Characterised by diffuse or nodular abnormal lymphocytes.

34
Q

What is role of the MDT?

A

discuss a patient’s case, to agree an individual treatment plan, and to coordinate and support the patient through their treatment.

35
Q

How does PET-CT help in diagnosis of malignancy?

A
  • PETCT helps shows the difference between a reactive node and a malignant node
  • The radioactive sugar is taken up by metabolically active cells and so shows how widespread a cancer or lymphoma is
36
Q

What are the main side effects with chemo?

A

Reduced WCC so increased risk of infection

Hair loss

37
Q

What is most common type of NHL?

A

Diffuse large B cell lymphoma

38
Q

What is Follicular non-hodgkins lymphoma

A

Malignant proliferation of B lymphocytes but architecture of the B cell preserved

39
Q

What is the most common indolent B cell lymphoma?

A

Follicular non-hodgkins lymphoma

40
Q

Which is the most common type of Hodgkin’s lymphoma?

A

Nodular Sclerosing

41
Q

Which type of Hodgkin’s lymphoma carries the worst prognosis?

A

Lymphocyte depleted

42
Q

A 34-year-old man who is HIV positive is starting treatment for Burkitt’s lymphoma. His chemotherapy regime includes cyclophosphamide, vincristine, methotrexate and prednisolone. Around 24 hours after starting chemotherapy he becomes confused and complains of muscle cramps in his legs. What is most likely to have occurred?

A

Tumour Lysis Syndrome

Case 20 Lymphoma (3 decks)

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