Lymphoma Flashcards
Lymphoma risk factors
Constant antigenic stimulation (e.g. Coeliac disease in EATL)
Infection (e.g. EBV in Burkitts, HTLV1 in ATLL)
Loss of T cell function (normally controls B cell proliferation - e.g. in HIV)
Is Hodgkin’s or non-Hodgkin’s more common?
Non-Hodgkin’s (80%)
Hodgkin’s (20%)
Hodgkin’s vs. non-Hodgkin’s
Single site vs. multiple sites
Pain after alcohol vs. no pain after alcohol
Reed-Sternberg cells, Pal Ebstein fever (Hodgkin’s)
B cells vs. B and T cells
Contiguous spread between nodes vs. random spread between nodes
Classical / non-classical vs. B cell / T cell
Hodgkin’s sub-types
Classical: Nodular sclerosing (80%), mixed cellularity, lymphocyte rich, lymphocyte depleted
Non-classical: Nodular lymphocyte predominant
Most common Hodgkin’s
Nodular sclerosing
Pain in nodes after alcohol
Hodgkin’s
Owl eyed cells
CD15 and CD30 positive
Reed Sternberg cells
Cyclical fever lasting 1-2w
Hodgkin’s lymphoma
Pal Ebstein fever
Hodgkin’s bad prognosis
Lymphocyte depleted
Single site painless lymphadenopathy Pain after alcohol Contiguous spread between LN Reed-Sternberg cells Pal Ebstein fever B cells only
Hodgkin’s
Multiple sites painless lymphadenopathy
Random spread between LNs
B and T cells
Non-Hodgkin’s
B symptoms
Fever >38
Night sweats
Weight loss >10% in 6m
EBV in lymphoma
Hodgkins lymphoma
Non-Hodgkins Burkitts
Ann Arbor lymphoma staging
1 = 1 LN region 2 = 2 LN regions same side of diaphragm 3 = 2 LN regions opposite sides of diaphragm 4 = Extranodal spread (e.g. Liver, BM)
A = No B symptoms B = B symptoms
Causes of death lymphoma
<5y
>5y
<5y relapse
>5y secondary malignancy
Hodgkins lymphoma treatment
- Combination chemo ABVD given to all
- Radio if small targetable area but radiation can = secondary malignancy
- Intensive chemo, autologous SCT if resistant
Balance risk of relapse (give chemo and radio) vs risk of secondary malignancy (give chemo only)
ABVD
Hodgkin’s chemo
Adriamycin, bleomycin, vinblastine, dacarbazine
Are B cell or T cell non-Hodgkin’s lymphomas more common?
B cell
Non-Hodgkins lymphoma sub-types
B / T cell
B cell then divided into: Very aggressive, aggressive, indolent
Very aggressive NHL
Burkitt’s
2-5w survival without treatment
Curable
Aggressive NHL
DLBC, mantle cell
3-12m survival without treatment
Less curable
Indolent NHL
Follicular, CLL/SLL, MALTs
10-15y survival
Mostly incurable
5 main B cell NHL
Burkitts, DLBC, Mantle, Follicular, MALTs
What happens to curability and survival without Tx as aggression decreases?
Curability decreases
Survival increases
