Lymphoma and myeloma

Question 1

what are the age incidences of Hogkins lymphoma?

Answer 1

Bimodal

15-30 and elderly

Question 2

what are the S&S of HL?

Answer 2

lymphadenopathy - typically cervical

alcohol induced lymph node pain

fever, weight loss, night sweats pruritis, lethargy

mass effects of LN’s - bronchial or SVCO

Question 3

what Inv are done in HL?

Answer 3

FBC with differential
- decreased Hb and platelets in BM involvement

ESR
- elevated

CXR
- mediastinal mass or large lymphadenopathy

PET-CT
- shows affected LNs

Lymph node biopsy
- Reed sternberg and popcorn cells

Question 4

On LN biopsy, what cells are distinctive of HL?

Answer 4

Reed Sternberg

Question 5

what is the staging system for Lymphoma? outline it

Answer 5

Ann Arbor system

1 = confined to single LN region 
2= Involvement of >2 nodal areas on same side of diaphragm 
3= involvement on both sides of diaphragm 
4 = extra nodal involvement

Question 6

what are the non-hodgkins lymphomas?

Answer 6

follicular
DLBCL
Burkitts

Question 7

how does follicular lymphoma present?

Answer 7

lymphadenopathy

B-symptoms less common

Question 8

where might the extranodal symptoms of DLBCL arise?

Answer 8

Waldeyers ring
GI tract
Skin and bone
CNS

Question 9

where might the extra nodal symptoms of Burkitts lymphoma arise?

Answer 9

Jaw and facial bones 
ileocaecal 
Ovaries 
Kidneys 
Breast

Question 10

what is the pathology behind myeloma?

Answer 10

cancerous plasma cells infiltrate the bone marrow and crowd out normal cells

Question 11

the clinical features of myeloma are remembered by the acronym CRAB. What does it stand for?

Answer 11

hyperCalcaemia due to increased osteoclast activity from myeloma cell signalling. leads to N&V, constipation, headaches

Renal impairment due to light chain deposition

Anaemia, neutropenia and thrombocytopenia due to marrow invasion

Bone lesion and pain

Question 12

what investigations are preformed in a myeloma screen?

Answer 12

Serum/urine electrophoresis

• monoclonal protein
• paraprotein
• immunoglobulin light chains

Skeletal survey

Serum free light chain assay - BJP

BM aspirate and biopsy
- >10% plasma cells in BM

blood tests

• anaemia
• hypercalcaemia
• renal impairment

Question 13

what are the treatment for multiple myeloma?

Answer 13

analgesia 
Bisphosphonates 
Transfusion and EPO 
fluids or dialysis 
chemo 
SCT

Question 14

what are the complications of MM?

Answer 14

bone fracture
SCC
hyperviscosity of blood
acute renal injury