Lymphoma

Question 1

What is it?

Answer 1

group of cancers that affect the lymphocytes inside the lymphatic system

these cancerous cells proliferate within the lymph node

Question 2

Types

Answer 2

Hodgkin’s

Non-hodgkin’s

Question 3

Investigations

Answer 3

Bloods:

• normocytic anaemia
• eosinophilia
• LDH raised

Lymph node biopsy is the key diagnostic test:
- Reed-Sternberg cell is the key finding in Hodgkin’s lymphoma: abnormally large B cells with multiple nuclei that have nucleoli inside them (face of an owl with large eyes)

CT, MRI and PET scans can be used for diagnosing and staging lymphoma and other tumours

Question 4

Clinical Features

Answer 4

Non-tender, rubbery, immobile lymphadenopathy

B symptoms are the systemic symptoms of lymphoma:

• Fever
• Weight loss
• Night sweats

Question 5

Hodgkin’s Lymphoma Clinical Features

Answer 5

Pel-Ebstein - cyclical fevers

Alcohol pain

Question 6

Ann-Arbour Staging

Answer 6

The Ann Arbor staging system is used for both Hodgkins and non-Hodgkins lymphoma. The system puts importance on whether the affected nodes are above or below the diaphragm. A simplified version is:

Stage 1: Confined to one region of lymph nodes.
Stage 2: In more than one region but on the same side of the diaphragm (either above or below).
Stage 3: Affects lymph nodes both above and below the diaphragm.
Stage 4: Metastatic involvement including non-lymphatic organs such as the lungs or liver.

Question 7

Types of Hodgkin’s Lymphoma

Associated risk factor for one of them

Answer 7

Nodular sclerosing Hodgkin lymphoma (NSHL)

Mixed-cellularity Hodgkin lymphoma (MCHL) - associated with EBV

Lymphocyte-depleted Hodgkin lymphoma (LDHL)

Lymphocyte-rich classical Hodgkin lymphoma (LRHL)

Question 8

Types of Non-hodgkin’s lymphoma and associations

Answer 8

Burkitt lymphoma is associated with Epstein-Barr virus, malaria and HIV: starry night blood film

MALT lymphoma (type of diffuse large B cell lymphoma) affects the mucosa-associated lymphoid tissue, usually around the stomach. It is associated with H. pylori infection and Coeliac. Management is H pylori eradication

Diffuse large B cell lymphoma often presents as a rapidly growing painless mass in patients over 65 years.

Question 9

Management

Answer 9

The key treatments are chemotherapy and radiotherapy. The aim of treatment is to cure the condition. This is usually successful however there is a risk of relapse, other haematological cancers and side effects of medications.

Chemotherapy:

• creates a risk of leukaemia and infertility
• R-CHOP in non-hodgkin’s lymphoma

Radiotherapy creates a risk of cancer, damage to tissues and hypothyroidism.