Lymphoma Flashcards
Lymphomas are 5th common malignancy in the western world.
What are lymphomas?
Lymphomas are caused by malignant proliferation of lymphocytes and malignancies of the lymphoid system.
Most commonly presents with peripheral lymphadenopathy and B symptoms i.e. weight loss, fever and night sweats.
What are the primary and secondary lymphoid organs?
Primary organs:
=> Bone marrow
=> Thymus
Secondary: => Spleen => Lymph nodes => Tonsils => Adenoids => Appendix => Peyer's patch in small intestine
Lymphoma can be histologically divided into Hodgkin’s and Non-Hodgkin’s lymphoma.
What is Hodgkin lymphoma?
Hodgkin’s lymphoma’s characteristic = Reed-sternberg cells (mirror image nuclei)
What is the underlying aetiology of Hodgkin lymphoma?
Link between infectious mononucleosis and Hodgkin’s lymphoma
Patient’s with Hodgkin’s lymphoma have a high titre of EBV antibodies
What are the 2 subclassification of Hodgkin’s lymphoma?
Classic Hodgkin’s lymphoma:
=> Hallmark = Reed-sternberg cells
=> 90-95% of Hodgkin’s lymphoma
Nodular lymphocyte-predominant Hodgkin’s lymphoma (NLPHL)
Who does Hodgkin’s lymphoma affect?
i. Two peaks:
=> Young adults - Hodgkin’s lymphoma is the commonest malignancy in the 15-24 years
=> Elderly
ii. Men > Women
What are the symptoms of Hodgkin’s lymphoma?
=> Enlarged, rubbery, superficial lymph node
=> Painless and non-tender
=> 70% cervical lymph nodes
=> Fever
=> Weight loss
=> Night sweats
=> Pruritus
=> Lethargy
=> Mediastinal lymph node involvement = mass effect e.g. bronchial or SVC obstruction
What are the signs of Hodgkin’s lymphoma?
=> Lymphadenopathy
=> Cachexia
=> Anaemia
=> Spleno / hepatomegaly
What are the risk factors of Hodgkin’s lymphoma?
Affected sibling
EBV (epstein-barr virus)
SLE
Post-transplant
What investigations are carried out for Hodgkin’s lymphoma?
Tissue diagnosis: => Lymph node excision biopsy => Image guided needle biopsy => Laparotomy => Mediastinoscopy
Bloods: => FBC => Blood film (reed-sternberg cells) => ESR => LFT => LDH (high LDH bc released during cell turnover) => Urate => calcium
*high ESR or low Hb = worse prognosis
Imaging:
=> CXR
=> CT/PET of thorax, abdo and pelvis
What staging system is used to determine treatment and prognosis of Hodgkin’s lymphoma?
Briefly describe the stages.
Ann Arbor system - by imaging ± bone marrow biopsy if B-symptoms or stage 3-4 disease.
Stage 1 : Confined to a single lymph node
Stage 2 : Involvement of >2 nodal areas on the same side of diaphragm
Stage 3 : Involvement of nodes on both sides of the diaphragm
Stage 4 : Spread beyond the lymph nodes e.g. liver / bone marrow
*Each stage is either
A = no systemic symptoms except pruritus
OR
B = B symptoms i.e. weight loss >10% in last 6 months, unexplained fever >38degrees or night sweats
B = worse disease
How do you treat Hodgkin’s lymphoma?
- Radiotherapy + chemotherapy
=> Short course for stages 1A & 2A
=> Long course for stages 2A - 4B
- More intensive regimen if poor prognosis or advanced disease
- High dose chemotherapy followed by stem cell transplantation if relapsed disease
What are the complications of treatment in Hodgkin’s lymphoma?
Radiotherapy side effects:
=> increased risk of 2nd malignancies i.e. lung, breast, melanoma, thyroid etc
=> increased risk of IHD, hypothyroidism, lung fibrosis
Chemotherapy side effects: => myelosuppression => nausea => alopecia => infection
General;
=> Infertility
=> AML
=> Non-Hodgkin’s lymphoma
What is the emergency presentation of Hodgkin’s lymphoma?
Infection, SVC obstruction => raised JVP, sensation of fullness in the head, dyspnoea, blackouts, facial oedema
What is Non-Hodgkin’s lymphoma?
Non-Hodgkin’s lymphoma - all lymphomas without Reed-sternberg cells:
=> 80% of B-cell origin (diffuse large B-cell lymphoma = commonest)
=> 20% of T-cell origin
