Lymphoma

Question 1

What is lymphoma?

Answer 1

Haem malignancies caused by malignant proliferation of lymphocytes which accumulate in lymph nodes and other organs

Question 2

What are types of lymphoma?

Answer 2

Hodgkins

Non-Hodgkins: either indolent (follicular) or aggressive (e.g. Burkitts, DLBCL). These are all b cell neoplasms, can also get T

Question 3

What are symptoms of lymphoma?

Answer 3

Lymphadenopathy, painless and rubbery
Splenomegaly
Abdominal/mediastinal lymphadenopathy 
B symptoms (night sweats, fever, weight loss)
Anaemia

Question 4

What Ix in lymphoma?

Answer 4

FBC: low Hb and platelets. WCC low or high.

Lymph node biopsy

Bone marrow biopsy if > stage 3 disease.

imaging: PET Ct looking for lymphadenopathy, extranodal disease, to allow staging

Also need additional tests e.g. PFTS, echo, renal to see how patients will cope with chemo which can be toxic,

TFTs if they might receive neck radiotherapy

Question 5

How is lymphoma staged?

Answer 5

Ann Arbor:

1  = single lymph node
2 = >1 lymph node, same side of diaphragm
3 = >1 lymph node, above and below diaphrahm
4 = widespread, extranodal, with or without lymph nodes 

A or B if B symptoms

Question 6

What are specific features of Hodgkins lymphoma

Answer 6

Alcohol induced pain in lymph nodes
EBV infection is risk factor
bimodal incidence
REED STERNBERG cells in lymph node biopsy

Question 7

How is Hodgkins treated?

Answer 7

Radio (can be local if early stage)

Chemo e.g. ABVD or RCHOP

Question 8

What are specific features of follicular lymphoma?

Answer 8

Indolent, so grows slowly and presents as late stage disease

B symptoms less common

usually incurable

Can transform to DLBCL

Rituximab can be given

Question 9

What are specific features of DLBCL?

Answer 9

most common NHL

increasing incidence with age
rapidly enlarging mass
extranodal e.g. waldeyer’s ring, GIT, skin
rapid proliferation so is usually earlier stage

chemo intention to cure RCHOP

Question 10

What are specific features of burkitt’s lymphoma?

Answer 10

Can present w extranodal disease e.g. jaw
MYC translocation means rapid proliferation, which can lead to tumour lysis syndrome
chemo with intention to cure

Question 11

What are complications of lymphoma/

Answer 11

Bone marrow infiltration (anaemia, thrombocytopenia, neutropenia)
SVC obstruction due to mass
SCC
s/e of chemo or radio