Lymphoma

Question 1

What are lymphomas?

Answer 1

A group of cancers that effect the lymphocytes inside the lymphatic system

Question 2

What does lymphoma do directly to the lymph nodes?

Answer 2

Causes them to become abnormally large due to the proliferation of the lymphocytes within them = lymphadenopathy

Question 3

What are the two main categories of lymphoma?

Answer 3

Hodgkins lymphoma and non-hodgkins lymphoma

Question 4

How many lymphomas tend to be Hodgkins lymphomas?

Answer 4

1 in 5

Question 5

What is the age distribution of Hodgkins lymphoma?

Answer 5

Bimodal. Peaks around 20 and 75 years

Question 6

What are the risk factors for Hodgkins lymphoma?

Answer 6

HIV, EBV, autoimmune e.g RA and sarcoidosis

Question 7

How does Hodgkins lymphoma present?

Answer 7

• Lymphadenopathy - non tender and rubbery
• Pain in the lymph nodes when they drink alcohol
• B symptoms - systemic e.g fever, weight loss and night sweats.

Question 8

What investigations can be done in Hodgkins lymphoma?

Answer 8

• LDH - none specific
• Lymph node biopsy - key diagnostic test - presence of Reid stern-berg cells - which are abnormally large B cells which have multiple nuclei
• CT
• MRI

Question 9

What is the staging system used for lymphoma?

Answer 9

The Ann Arbor staging system
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: Widespread involvement including non-lymphatic organs such as the lungs or liver.

Question 10

What are the key managements for lymphoma?

Answer 10

Chemo and radiotherapy

Question 11

What is non-hodgkins lymphoma?

Answer 11

A group of malignancies that can be either B cell or T cell in origin.

Question 12

What are two examples of a B cells neoplasm in non-hodgkins lymphoma?

Answer 12

Berkitts lymphoma - associated with EBV

Diffuse large cell lymphoma

Question 13

What are the risk factors for non-hodgkins lymphoma?

Answer 13

• HIV
• Epstein-Barr Virus
• H. pylori (MALT lymphoma)
• Hepatitis B or C infection
• Exposure to pesticides and a specific chemical called trichloroethylene used in several industrial processes
• Family history

Question 14

What is the presentation of non-hodgkins lymphoma?

Answer 14

Very similar to hodgkins lymphoma and can often only be differentiated when a biopsy is done

Question 15

What treatment is used in non-hodgkins lymphoma?

Answer 15

• Watchful waiting
• Chemotherapy
• Radiotherapy
• R-CHOP pharmacology: Rituximab, cyclophosphamide, hydroxydaunomycin, vincristine, prednisolone