Lymphoma and Myeloma Flashcards
Define lymphoma.
Cancer of lymphoid cells, commonly found in lymph nodes, but also occurring in extra-nodal sites
What are the 2 main types of lymphoma?
How common is each?
Hodgkin’s lymphoma (15%)
Non-Hodgkin’s lymphoma (85%)
What are the 2 types of Hodgkin’s lymphoma?
Nodular lymphocyte predominant (9%) Classical HL (90%)
Which virus is associated with classical Hodgkin’s lymphoma?
Epstein Barr virus
Describe the cellular features of Hodgkin’s lymphoma on a biopsy. (2)
Mononuclear Hodgkin cell
Reed-Sternberg cell
- Arise from B cells
- Large, pale cytoplasm
- Oval, lobulated nuclei
Describe the clinical features of classical Hodgkin’s lymphoma. (5)
Painless lymphadenopathy Mass on CXR B symptoms (unexplained fever, night sweats, weight loss) Generalised pruritus Alcohol induced lymph node pain
How is Hodgkin’s lymphoma diagnosed?
Core biopsy (lymph node) Excision biopsy (lymph node)
Which staging system is used for Hodgkin’s and non-Hodgkin’s lymphoma?
Describe how lymphomas are staged with this system. (6)
Ann Arbor system
Number staging:
1 - single lymph node region affected
2 - 2+ lymph node areas affected on the SAME side of diaphragm
3 - lymph node areas affected on BOTH sides of diaphragm
4 - distant metastases
Letter staging:
A - absence of B symptoms
B - presence of B symptoms
What are “B symptoms”?
Symptoms commonly caused by lymphoma involving B cells
Include:
- Unexplained fever
- Night sweats
- Weight loss
How would you treat Hodgkin’s lymphoma?
Chemotherapy
Radiotherapy
Describe the commonest chemotherapy regimen used in Hodgkin’s lymphoma. (4)
ABVD
Adriamycin (doxorubicon)
-Cytotoxic antibiotic
Bleomycin
-DNA synthesis inhibitor
Vinblastine
-Spindle formation inhibitor
Dacarbazine
-Alkylating agent
What are the 2 main types of non-Hodgkin’s lymphomas?
Give an example of each.
Low grade lymphoma, e.g.
-Follicular lymphoma
High grade lymphoma, e.g.
-Diffuse large B cell lymphoma
What is follicular lymphoma caused by?
T14;18 translocation
Describe the clinical features of follicular lymphoma. (4)
Painless lymphadenopathy
Widespread lymph node involvement
Hepatosplenomegaly
B symptoms (fever, weight loss, night sweats)
Which investigations would you do if you suspect follicular lymphoma? (3)
How would you diagnose it? (1)
Blood tests (including LDH)
CT scan
Bone marrow aspirate and trephine
Diagnosis:
-B cells in lymph node follicles staining for CD20+
How would you treat follicular lymphoma? Consider:
a) Early stage (1)
b) Late stage (2)
EARLY STAGE:
Localised radiotherapy
ADVANCED STAGE:
If asymptomatic: watch and wait
If symptomatic, with organ compromise: R-chemotherapy
What is R-chemotherapy?
Give 2 examples of R-chemotherapy regimens.
What is it used for?
Chemotherapy combined with rituximab, a monoclonal antibody against CD20 antigen on B cells
Examples:
- R-CHOP
- R-CVP
Used for:
- Follicular lymphoma (NHL)
- Diffuse large B cell lymphoma (NHL)
Describe the clinical features of diffuse large B cell lymphoma. (4)
Extranodal symptoms, e.g.
- Skin discolouration/ulceration
- Gut/kidneys
- Lungs
- CNS
- Salivary glands
- Bones
Painless lymphadenopathy
Hepatosplenomegaly
Unexplained fever
Which blood tests would you do for diffuse large B cell lymphoma? (2)
LDH - increased
Calcium - increased
Which drugs are included in the R-CHOP chemotherapy regimen?
Rituximab
-Monoclonal antibody against CD20+
Cyclophosphamide
-Alkylating agent
Hydroxyaunoycin (adramycin/doxorubicin)
-Cytotoxic antibiotic
Oncovin (vincristine)
-Microtubule inhibitor
Prednisolone
-Steroid
Define myeloma.
Cancer of the bone marrow plasma cells
Describe the clinical features of myeloma. (8)
HINT: there are 2 categories of clinical features.
Non-specific symptoms, e.g.
- Back pain
- Fatigue
- Hypercalcaemia
- Recurrent infections
- Kidney impairment
Classic myeloma triad:
- Increased plasma cells in bone marrow
- Clonal immunoglobulin (paraprotein)
- Lytic bone lesions
Describe the pathophysiology of myeloma. (4)
- Myeloma causes formation of abnormal plasma cells
- Myeloma cells produce abnormal proteins, called monoclonal proteins/paraproteins/M proteins, e.g.
- IgA
- IgD
- IgE - Sometimes the myeloma cells don’t produce the whole Ig paraprotein but instead only an abnormal light chain
a. This can cause kidney damage - Rarely, myeloma is secretory and there is NO Ig produced
Which blood tests would you do if you suspected myeloma? (6)
FBC ESR U&Es Serum calcium Serum protein electrophoresis (SPE) Serum free light chain levels (SFLC)
