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Haematology > Lymphoma > Flashcards

Lymphoma Flashcards

1
Q

What are lymphomas?

A

Malignant proliferation of lymphocytes

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2
Q

What is lymphadenopathy?

A

Disease of the lymph nodes in which they are abnormal in size or consistency

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3
Q

What are the different types of lymphomas?

A

=> Lymphomas:

  • Hodgkins lymphoma
  • Non-Hodgkins lymphoma

=> Non-Hodgkins Lymphoma:

  • B cell Non-Hodgkins
  • T cell Non-Hodgkins

=> B cell Non-Hodgkins:

  • High grade
  • Low grade
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4
Q

What histologically defines Hodgkins Lymphomas?

A

Reed-Sternberg cells - mirror image nuclei

Sometimes referred to as large multinucleate cells with prominent eosinophilic nucleoli

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5
Q

What are the causes of Lymphoma?

A
  • EBV
  • Immune dysregulation
  • Familial association
  • Chromosomal translocation
  • Gene rearrangements
  • Pro-proliferative
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6
Q

What are the clinical features of Lymphomas?

A
  • B symptoms (fevers, night sweats, weight loss)
  • Malaise
  • Painless lymphadenopathy
  • Hepatosplenomegaly
  • Mass
  • Mass effects
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7
Q

What are the different causes of lymphadenopathy?

A

=> Mnemonic HILLS START

H - HIV
I - infective
L - Lymphoma
L - Leukemia
S - Sarcoidosis
S - Syphilis
T - Tuberculosis
A - All disseminated malignancies 
R - Rheumatoid Arthritis 
T - Toxicity
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8
Q

What are the main infective causes of lymphadenopathy?

A
  • Infectious mononucleosis
  • CMV
  • Toxoplasmosis
  • Pyrogeic infections
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9
Q

Why are B cell Lymphomas more common than T cell Lymphomas?

A

As B cells undergo more hyperosmotic mutation than T cells so there is a greater likelihood of mistakes

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10
Q

What is the staging system used for Lymphomas?

A

=> Ann Arbor Staging

STAGE I - Single lymph node region
STAGE II - 2 or more regions on the same side of diaphragm
STAGE III - Involvement of lymph nodes on both sides
STAGE IV - Involvement of extra-nodal sites

Each stage is given an A or B
A - Absence of B symptoms
B - B symptoms present

Stages through CT of chest, abdomen and pelvis

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11
Q

What is the general approach to lymphoma treatment?

A
  • Chemotherapy
  • Immunotherapy
  • Small molecule inhibitors
  • Radiotherapy
  • Stem cell transplant
  • Supportive care
  • Palliative care
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12
Q

What are the risk factors of Hodgkin’s Lymphoma?

A
  • Male
  • Affected sibling
  • EBV
  • SLE
  • Post transplantation
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13
Q

What are the clinical features of Hodgkins Lymphoma?

A
  • Painless lymphadenopathy
  • Splenomegaly
  • B symptoms
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14
Q

What are the investigations in suspected Hodgkins Lymphoma?

A

=> Tissue diagnosis
Lymph node excision biopsy and histological evaluation. Reed Sternberg cells

=> Bloods - ESR
- Increased ESR

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15
Q

What is the management of Hodgkin’s Lymphoma?

A
  • Radiotherapy and short courses of chemotherapy for stages IA to IIA
=> Chemotherapy:
A - Adriamycin
B - Bliomycin
V - Vinblastine
D - Dacarbazine

=> Longer courses of chemo for:

  • stage IIA with 3 or more lymph nodes affected
  • stage IIB

=> In cases of relapse, stem cell transplant considered

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16
Q

What are low grade lymphomas?

A
  • Follicular lymphoma
  • SLL/CLL
  • Lymphoplasmacytoid lymphomas
  • Marginal zone lymphomas

=> Not considered curable unless disease is localised

17
Q

What are the indications to start treatment on low grade lymphomas?

A
  • Systemic symptoms
  • Bulky lymphadenoapthy
  • Progressive Nodal Enlargement
  • Compromise of vital organ function
18
Q

What are high grade lymphomas?

A
  • Diffuse large B cell lymphomas

- Burkitt’s lymphoma

19
Q

What is the management of high grade lymphomas and low grade lymphomas (Non-Hodgkins)?

A

=> Low grade lymphoma management:

  • Typically incurable
  • If symptomless, treatment not needed
  • Radiotherapy in localised disease
  • Interferon alpha or Rituximab to induce remission
=> High grade lymphoma management - R CHOP:
R - Rituximab
C - Cyclophosphamide 
H - Hydroxydaunorubicin 
O - Oncovin (chemically Vincristine)
P - Prednisolone
20
Q

What are the signs and symptoms for Non-Hodgkin’s lymphoma?

A
  • Superficial lymphadenopathy
  • Extra-nodal disease (gut, skin, oropharynx)
  • B symptoms (not as common as in Hodgkin’s lymphoma)
  • Pancytopenia from marrow involvement

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