Lymphoma (brief)

Question 1

What causes it?

Answer 1

The lymphomas are neoplastic transformations or normal B or T cells which reside predominantly in lymphoid tissues. They are commoner than the leukaemia’s and are increasing in incidence for reasons that are unclear. The disease is classified based on histological appearance into Hodgkin and non-Hodgkin lymphomas.

Question 2

Signs on examination?

Answer 2

Hodgkin’s lymphoma: Painless lymph node enlargement (often cervical) is the most common presentation. These lymph nodes have a rubbery consistency on examination. There may be hepatosplenomegaly. Systemic symptoms are fever, night sweats and weight loss (>10% in previous 6 months). Other constitutional symptoms such as puritis, fatigue, anorexia and alcohol induced pain at the site of enlarged lymph nodes also occurs.

Non-Hodgkin lymphoma: Presentation is rare before 40. Most present with painless peripheral lymph node enlargement. Systemic symptoms as in Hodgkin’s lymphoma may occur. Extranodal involvement is more common that in Hodgkin’s lymphoma and almost any organ in the body can be involved. Bone marrow infiltration leads to anaemia, recurrent infections and bleeding.

Question 3

Investigations?

Answer 3

FBC
ESR
LFTs

Question 4

Treatment

Answer 4

Hodgkin’s lymphoma:

• Early stage: treated with brief chemo (ABVD, doxorubicin, bleomycin, vinblastine, dacarbazine) followed by involved field irradiation
• Late stage: Cyclidal combination of chemo, (8 cycles of ABVD) with irradiation at sites of bulk disease. PET/CT is used to detect disease activity after treatment.

Non-Hodgkin lymphoma:

• Depends on the subtype and stage
• The most common, diffuse large B cell lymphoma and first line treatment is cyclidal combination chemo-immunotherapy with field irradiation for those with bulky disease. Between 60-70% will be cured with this regime.