lymphoma

Question 1

What is lymphoma? how can it be classified?

Answer 1

• an over proliferation of lymphocytes - aggregate in lymph nodes causing lymphadenopathy
• Hodgkin’s and non-Hodgkin’s

Question 2

What are some causes of lymphoma?

Answer 2

• unknown
• infection - EBV, H.pylori
• primary immunodeficiency - ataxia telangiectasia
• secondary immunodeficiency - HIV, transplant pts
• autoimmune disorders

Question 3

Hodgkin’s and non differ. How do they differ in terms of histology and in terms of symptoms and in terms of incidence?

Answer 3

• histology - Reed-sternberg cells (mirror-nuclei)
• symptoms - non-hodgkin is more widespread lymphadenopathy
• Incidence - Hodg = 20s and 70s, Non= 55-60s

Question 4

What are the clinical features of lymphadenopathy?

Answer 4

• enlarged, painless, non-tender, ‘rubbery’, superficial lymphadenopathy
• nodes increase and decrease randomly
• alcohol induced lymph pain
• constitutional ‘B’ Sx - fever, night sweats, malaise, weight loss, lethargy , puritis
• 2nd and 7th decade peaks of incidence

Question 5

Signs of hodgkins lymphoma?

Answer 5

• hepatosplenomegaly
• cachexia
• normocytic anaemia, eosinophilia, raised LDH

Question 6

investigations for lymphoma?

Answer 6

• tissue biopsy - lymph node histology
• bloods
• +/- bone biopsy
• Ct for staging

-GOLD STANDARD - complete excision of a LN and detailed histology
REED-STERNBERG CELLS

Question 7

What is the staging system for lymphoma?

Answer 7

ANN ARBOR CLASSIFICATION
Stages 1-4
1 = one area of nodes effected
2 = 2 or more on one side of the diaphragm
3= lymph nodes of both sides of the diaphragm affected
4= beyond lymph node spread (liver, bones marrow)

then A or B
A= no B symptoms
B= B symptoms

Question 8

How we treating hodgkins?

Answer 8

1-2A= chemo + radio 
2B-4= just chemo 

combination chemo is ABVD:
adriomycin 
bleomycin 
vinblastine 
decarbazine 

HoDgkins = abvD (non = RCHOP)

SE = infertility, cardiomyopathy, lung damage, peripheral neuropathy, secondary cancers, psychological issues

Question 9

Tell me about some the types of non-hodgkins lymphoma?

Answer 9

• they are all lymphomas that DON’T have reed-sternberg cells
• they often have extra nodal involvement such as:
• skin nodes - cutaneous T cell lymphoma
• gastric lymphoma - MALT (mucosa associated lymphoid tissue) - non-MALT gastirc (bad)
• small bowel lymphoma

Question 10

What’s the classic Non-hodkins treatment?

Answer 10

R-CHOP (becuase it’s nOn-hodgkins)

• Rituximab
• Cyclophosphomide
• hydroxydaunorubicin
• oncovin
• prednisolone

Question 11

What are some acute presentations of lymphoma?

Answer 11

• infection
• SVC obstruction leading to facial swelling
• ‘fullness of the head’
• dyspnoea
• blackouts