Lymphoma

Question 1

What is Lymphoma?

Answer 1

Malignancy originating from lymphocytes.

Question 2

Presentation of Lymphoma?

Answer 2

Large, non-tender lymphadenopathy.
Painless to palpation, ‘rubbery’.
May present with generalized cancer red flags (25%)

Question 3

Bedside Investigations?

Answer 3

Rule out other things e.g.

FBC (infection), CRP (inflammation), Viral Screen (virus)

Question 4

Diagnosis of Lymphoma?

Answer 4

1) Tissue diagnosis: excision biopsy 1st line

2) Imaging - CT (diagnostic) + PET (staging)

Question 5

Hodgkin’s vs Non-Hodgkin’s?

Answer 5

Excision Biopsy - Reed Sternberg (multi-nucleate) cells

Present = Hodgkin’s, Absent = Non-Hodgkin’s

Question 6

Staging of Lymphoma + effect on management?

Answer 6

Ann Arbor criteria w/CT Tap.

>IIA + >3 areas affected = longer chemotherapy

Question 7

Managing Hodgkin’s?

Answer 7

1) ABVD chemotherapy : Adriamycin, Bleomycin, Vinblastine + Dacarbazine
2) Radiotherapy
3) Autologous stem cell transplant (relapsing disease)

Question 8

Managing Non-Hodgkin’s (low + high grades)?

Answer 8

1)Low Grade: Conservative (incurable) - Radiotherapy if localized.
2)High Grade: Curative (hard to treat) -
R-CHOP chemotherapy

Question 9

Associated disease?

Answer 9

Epstein-Barr Virus, AIDs (Both)
Immunodeficiency/Autoimmune (Non-H)
H-Pylori = MALT lymphoma (Non-H)