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TCD 20 - Haematological Malignancies > Lymphoma > Flashcards

Lymphoma Flashcards

1
Q

What is lymphoma?

A

The normal lymphoid structure is replaced by a collection of malignant cells.

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2
Q

How is lymphoma divided?

A
  1. Hodgkin’s Lymphoma

2. Non-Hodgkin’s Lymphoma

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3
Q

What signifies Hodgkin’s Lymphoma?

A

Presence of Reed Sternberg cells (RS)

  • Large B-cells that are either multinucleated cells or have bilobed nuclei
  • “Owls eye” appearance
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4
Q

Is the malignant proliferation of B or T cells more common?

A

B cells

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5
Q

What is the bimodal age distribution of Hodgkin’s lymphoma?

A
  • 15-30yrs

- >50yrs

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6
Q

Which type of Hodgkin’s lymphoma is the most common in young adults in the UK?

A

Nodular Sclerosing Hodgkin Lymphoma

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7
Q

Which type of Hodgkin’s lymphoma is the most common in older adults in the UK?

A

Mixed Cellularity Hodgkin Lymphoma

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8
Q

Which out of the Hodgkin’s lymphomas has the worst prognosis?

A

Lymphocyte-depleted Hodgkin Lymphoma

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9
Q

What are the risk factors for lymphoma?

A
  • Family Hx
  • Reduced immunity (HIV)
  • EBV
  • Autoimmune conditions (Rheumatoid arthritis, Sarcoidosis, SLE)
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10
Q

What are the clinical symptoms of Hodgkin’s lymphoma?

A 
•	Painless lymphadenopathy 
o	Non-tender
o	Rubbery 
o	Pain when drinking alcohol 
•	B-symptoms (Fever, Weight loss, Night sweats)
•	Pruritis
•	Cough 
•	Fatigue
•	Dyspnoea
•	Abdominal pain
•	Recurrent infections
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11
Q

What are the clinical signs of lymphoma?

A
  • Lymphadenopathy
  • Cachexia
  • Anaemia
  • Spleno- or hepatomegaly
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12
Q

What are the emergency presentations of lymphadenopathy?

A
  • SVC obstruction (increased JVP)
  • Sensation of fullness of the head
  • Dyspnoea
  • Blackouts
  • Facial oedema
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13
Q

How do you diagnose lymphoma?

A
  • Raised LDH
  • Lymph node biopsy
  • PETCT scan of the neck, chest and abdomen
  • Bone marrow examination
  • FBC
  • High ESR
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14
Q

How do you treat Hodgkin’s Lymphoma?

A

Chemotherapy and Radiotherapy

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15
Q

What is Non-Hodgkin’s Lymphoma?

A

All other lymphomas not involving Reed Sternberg cells

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16
Q

What is the most common type of Non-Hodgkin’s Lymphoma?

A

Diffuse large B-cell lymphoma

17
Q

What is the median age of onset of Diffuse large B-cell lymphoma?

A

60yrs

18
Q

How do you diagnose Diffuse large B-cell lymphoma?

A
  • LDH
  • PETCT
  • Bone marrow biopsy
19
Q

How do you treat Diffuse large B-cell lymphoma?

A
  • Chemotherapy

- Immunotherapy

20
Q

What are the stats for curation and relapse for Diffuse large B-cell lymphoma?

A

50% of patients are cured

Relapse after 5 years is rare

21
Q

Which of the Non-Hodgkin’s lymphomas are non-curable?

A

Follicular lymphoma

22
Q

What is the median age of onset and survival for Follicular Lymphoma?

A

Age onset = 60yrs

Survival = 10yrs

23
Q

What is associated with Burkitt lymphoma?

A
  • EBV
  • Malaria
  • HIV
24
Q

What is affected by MALT lymphoma?

A

Mucosa-associated lymphoid tissue, usually around the stomach

25
Q

What is associated with MALT lymphoma?

A

H. Pylori

26
Q

What are the risk factors for Non-Hodgkin’s Lymphoma?

A
  • Immunodeficiency (HIV, transplant, DM)
  • Infection (EBV, Hep B or C)
  • H. pylori (MALT)
  • Exposure to pesticides and a specific chemical called trichloroethylene used in several industrial processes
  • Family Hx
  • Elderly
  • Autoimmune diseases (SLE, Sjogren’s, Coeliac)
27
Q

What are the symptoms of Non-Hodgkin’s lymphoma?

A
  • Painless lymphadenopathy (non-tender, rubbery, asymmetrical)
  • B-symptoms
  • Extranodal disease: gut, skin, oropharynx, bone, CNS, lung
  • Fever, night sweats, weight loss
  • Pancytopenia if bone marrow involvement
28
Q

What is an indolent Non-Hodgkin’s Lymphoma?

Give an example

A

o Tumours that grow slowly and may not require treatment for long periods
o When they do need treatment, they are likely to response well to chemotherapy, but they are very rarely cured

Follicular lymphoma

29
Q

What is an high-grade Non-Hodgkin’s Lymphoma?

Give an example

A

o Tumours that grow quickly and are frequently symptomatic
o More likely to be

Diffuse large B-cell lymphomas
Burkitt lymphomas

30
Q

What are the stages of the Ann Arbor staging system of lymph nodes?

A
  1. One group of lymph nodes is affected
  2. 2 or more groups of nodes are affected, but the lymphoma is restricted to one side of the diaphragm only
  3. Lymphadenopathy is evident on both sides (above and below) of the diaphragm
  4. The lymphoma has spread beyond the lymph nodes to other organs such as the spleen, bone marrow, liver or lungs
31
Q

What does the letter A or B after staging indicate?

A

Whether or not the patient has systemic symptoms (such as weight loss, fevers or night sweats)
- These are known as B symptoms

TCD 20 - Haematological Malignancies (5 decks)

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