Lymphoma

Question 1

Features of Hodgkin lymphoma

Answer 1

ASYMMETRICAL painless lymphadenopathy - Adjacent spread - 70% cervical; Also Cervical
B-Symptoms
Itch
Hepato or splenomegaly

Question 2

Investigations of HL

Answer 2

FBC, ESR, LFT, LDH, (increased ESR and decreased Hb = worse prognosis

LN biopsy/FNA - Reed-Sternberg Cells
if B symptoms are present BM Bx
Staging with CT/MRI

Question 3

Management of HL

Answer 3

Combination Therapy
ABVD regimen

BMT for prolapse

Question 4

What is lymphoma

Answer 4

Rapid proliferation of Lymphocytes throughout the Lymphatic tissues (mainly Nodes)
Found in peripheral blood and lymphoid organs

Split into Hodgkin and non-Hodgkin lymphoma

Question 5

Staging process for Hodgkin lymphoma

Answer 5

Ann-Arbour Staging

I - Single LN region
II - 2 or more LN site on same side of diaphragm
III - Nodes present on both sides of the diaphragm
IV - Spread Beyond LNs - Liver/BM etc.

Question 6

Non-Hodgkin Lymphoma

Answer 6

All Lymphomas without Reed-sternberg cells

Most derived from B-Cell lines

Question 7

Features of NHL

Answer 7

SYMMETRICAL painless lymphadenopathy
Multiple sites with discontinuous spread

Extranodal - Skin - in T-cell lymphomas; CNS, Oesophagus, GIT, Splenomegaly

B-Symptoms
Pancytopaenia, hyperviscocity

Question 8

Ix of NHL

Answer 8

Film: normal Circulating lymphoma cells (NON reed-sternberg) +/- pancytopaenia

FBC, U+E, LFT, LDH (increased LDH = worse prognosis)

Question 9

Classification of NHL

Answer 9

LN and BM Bx

Based on B or T cell lineage (B cell commonest)

LOW GRADE: usually indolent but often incurable
Follicular, small-cell lymphocytes
will respond to chemo but incurable

HIGH GRADE: Aggressive but may be curable
Diffuse Large B-Cell
Burkitt’s Lymphoma

Question 10

Treatment of NHL

Answer 10

R-CHOP regime (rituximab)

Treat Low Grade if clinically indicated