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Haematology > Lymphoma > Flashcards

Lymphoma Flashcards

1
Q

What are the two main types of lymphoma?

A

Hodgkin’s lymphoma

Non-Hodgkin’s lymphoma

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2
Q

Non-hodgkin’s lymphoma is more common in women. T/F?

A

False - it is more common in women

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3
Q

What is the peak age of incidence of Hodgkin’s lymphoma?

A

20-24 years old

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4
Q

What is the usual presentation of lymphoma?

A

Lymphadenopathy
Splenomegaly
Anaemia
B symptoms

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5
Q

What are the B symptoms of lymphoma?

A

Night sweats
Weight loss
Unexplained fever

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6
Q

Itch is a B symptom. T/F?

A

False

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7
Q

Rarely there is alcohol induced pain in Hogdkin’s lymphoma. T/F?

A

True

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8
Q

What are the usual presentations of lymphadenopathy?

A

Painless

Rubbery

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9
Q

Describe the Ann-Arbor classification system for lymphoma.

A

Stage I - single lymph node group
Stage II - more than one lymph node group SAME side of the diaphragm
Stage III - lymph node groups on both sides of the diaphragm
Stage IV - extra nodal involvement e.g. liver, bone marrow
A or B added to signify absence or presence of B symptoms

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10
Q

How is possible lymphoma investigated?

A

Lymph nodes and splenomegaly
Blood tests include FBCs, U&Es, LFTs, Ca, ESR and LDH
Imaging tests include CT scans and PET scans

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11
Q

Which antigen is expressed on B -lymphoctes?

A

CD-20

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12
Q

What monoclonal antibody can be used to treat lymphoma?

A

Ritixumab

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13
Q

Give an example of an indolent B cell lymphoma.

A

Follicular lymphoma

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14
Q

Follicular lymphoma is characterised by translocations involving which gene?

A

BCL2 gene

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15
Q

What is the median age of diagnosis of follicular lymphoma?

A

65 years

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16
Q

B symptoms are common in follicular lymphoma. T/F?

A

False

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17
Q

Not all patients require treatment at diagnosis for follicular lymphoma. T/F?

A

True

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18
Q

How are early stage follicular lymphomas treated?

A

Radiotherapy

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19
Q

How are advanced stage follicular lymphoma which are asymptomatic, with no bulk and no end organ comrpomise treated?

A

Watchful waiting

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20
Q

How are advanced stage follicular lymphomas which are symptomatic and/or show organ compromise treated?

A

Immunochemotherapy with rituximab and chemotherapy followed by maintenance of rituximab every 2 months for 2 years.

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21
Q

Follicular lymphoma is very responsive to treatment but has a tendency to relapse. T/F?

A

True

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22
Q

With newer therapies, what is the average survival of follicular lymphoma?

A

> 15 years

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23
Q

What is the most common subtype of non-hodgkin’s lymphoma?

A

Diffuse large B cell lymphoma

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24
Q

Diffuse large B cell lymphoma mostly occurs in adults. T/F?

A

True

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25
Q

Where can extra-nodal presentations occur in diffuse large B cell lymphoma?

A

Waldeyers ring, Gi tract, skin, bone and CNS

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26
Q

What B symptoms can occur in diffuse large B cell lymphoma?

A

Pyrexia of unknown origin
Night sweats
Weight loss

27
Q

Diffuse large B cell lymphoma is aggressive but curable. T/F?

A

True

28
Q

Early stage diffuse large B cell lymphoma is treated with…?

A

Three rounds of R-CHOP chemotherapy and radiotherapy

29
Q

Late stage diffuse large B cell lymphoma is treated with…?

A

Six rounds fo R-CHOP and radiotherapy

30
Q

Elderly and unfit patients need assessment of general frailty and co-morbidities before treatment for diffuse large B-cell lymphoma. T/F?

A

False

31
Q

What drugs are used in R-CHOP chemotherapy?

A 
Rituximab
Cyclophosphamide
Adriamycin
Vincristine
Prednisolone
32
Q

R-CHOP chemotherapy is given on day one on a cycle of how many days?

A

21 day cycle

33
Q

Translocations of which gene are associated with Burkitt lymphoma?

A

MYC gene

34
Q

There is a very high rate of proliferation and cell death in Burkitt lymphoma. T/F?

A

True

35
Q

There is a good prognosis for Burkitt lymphoma treated with intensive chemotherapy. T/F?

A

True

36
Q

What are the common extra-nodal sites of Burkitt lymphoma?

A

Jaws and facial bone
Ileocaecal region of GIT
Ovaries, kidneys, breast, lymph nodes, bone marrow, CNS

37
Q

Burkitt lymphoma is a low grade lymphoma. T/F?

A

False - it is high grade

38
Q

Classic Hodgkin Lymphoma is associated with which virus?

A

Epstein Barr Virus

39
Q

Classic Hodgkin Lymphoma is characterised by strong expression of which antigen?

A

CD30

40
Q

What is the peak age of incidence of Hodgkin Lymphoma?

A

20-30 years

later peak >50 years

41
Q

Describe the presentation of Hodgkin Lymphoma

A

Pains
Lymphadenopathy
B symptoms
Itch

42
Q

How is early stage Hodgkin’s lymphoma treated?

A

ABVD Chemotherapy and radiotherapy

43
Q

How is advanced stage Hodgkin’s lymphoma treated?

A

ABVD chemotherapy

44
Q

What are the late effects of Hodgkin’s lymphoma?

A 
Malignancy
Cardiac
Pulmonary
Fertility
Endocrine
45
Q

ABVD chemotherapy is used in the treatment of Hodgkin Lymphoma. Which drugs are used in this type of chemotherapy?

A

Adriamycin
Bleomycin
Vinblastine
Dacarbazine

46
Q

On what days of a 28 day cycle are ABVD chemotherapy agents given?

A

days 1 and 15

47
Q

How long is a cycle of ABVD chemotherapy in the treatment of Hodgkin’s lymphoma?

A

28 days

48
Q

Myeloma is a cancer of which cells?

A

Mature plasma cells

49
Q

What is the median age of onset of myeloma?

A

71 years

50
Q

What plasma cell markers are often shown in myeloma?

A

CD138
CD56
Cyclin D1

51
Q

What are the presenting features of myeloma?

A 
Backache or rib pain
Fatigue
Symptoms of hypercalcaemia
Recurrent infections
Renal Impairment
52
Q

What term is used to describe the abnormal monoclonal protein which is found in most myeloma patients?

A

Paraprotein

53
Q

IgE paraprotein is very rare in myeloma. T/F?

A

True

54
Q

IgM paraprotein is rare in myeloma. This is associated with…?

A

Waldenstroms macroglobulinaemia

55
Q

What classic triad of signs characterises myeloma?

A

Increased plasm cells in bone marrow
Paraproteins
Lytic bone lesions

56
Q

Urine tests can be used in the diagnosis of myeloma. What would these urine tests be looking for?

A

The presence of kappa light chains in the urine (Bence jones protein)

57
Q

What blood tests are used in the diagnosis of myeloma?

A 
FBC
ESR
U&Es
Ca
Serum protein electrophoresis
58
Q

In addition to blood and urine tests, how would possible myeloma be investigated?

A

Bone marrow aspirate

MRI imaging

59
Q

Asymptomatic myeloma is treated with aggressive chemotherapy. T/F?

A

False - this undergoes watchful waiting

60
Q

How is symptomatic myeloma treated?

A

Autologous SCT
Chemotherapy including a steroid and thalidomide
Radiotherapy
Supportive therapies

61
Q

Why would bisphosphonates be used in the treatment of myeloma?

A

To reduce pain, pathological fractures, hypercalcaemia and the need for radiotherapy

62
Q

What supportive therapies can be used in the treatment of myeloma?

A

Bisphosphonates
Blood transfusion / EPO
Surgery
Interventional radiology

63
Q

Explain how myeloma differs from a condition called monoclonal gammopathy of unknown significance (MDUS)

A

There is >10% marrow plasma cells present, variable but high levels of serum paraportein, pence jones protein often present, immune paresis present, lytic bone lesions often present and symptoms such as anaemia, raised calcium, bone pain and renal dysfunction often present in myeloma

64
Q

Describe the appearance of the Reed Sternberg cell seen in Hodgkin’s lymphoma?

A

Large, two nuclei with smaller nuclei inside give an ‘owl eye appearance’

Haematology (6 decks)

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