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Clinical lectures: Yr2 > Lymphoma: High/low grade, Hodgkin/Non-Hodgkin > Flashcards

Lymphoma: High/low grade, Hodgkin/Non-Hodgkin Flashcards

1
Q

Define lymphoma?

A

Group of haematological malignancies of lymphocytes, which originates from the lymphatic system

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2
Q

What is the main difference between lymphoma and lymphocytic leukaemia?

A

Lymphoma and lymphocytic leukaemia both are cancers of lymphocytes

But lymphoma originates from lymphatic system and leukaemia originates from bone marrow

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3
Q

What is the usual initial clinical presentation of lymphoma?

A

Painless swelling of lymph node

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4
Q

What 3 B symptoms can present in lymphoma, and are also red flags of other haematological malignancies?

A

Drenching night sweats

Unexplained fever

Weight loss over 6 months, that was unintentional and over 10% baseline weight

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5
Q

Give the 2 main ways in which lymphoma can affect other organs, in terms of clinical presentation?

A

Splenomegaly

Presentation of symptoms due to lumps compressing other structures eg. shortness of breath due to lesion in lung, bowel movement changes

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6
Q

Give examples of signs of BMF or anaemia commonly present in clinical presentation of lymphomas, and the underlying lab finding that causes these?

A

Cytopenias

Which cause eg. TATT, frequent infections, bleeding or bruising easily, pallor

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7
Q

If a patient presents with pruritus, what can this signify when classifying the lymphoma?

A

Pruritus (widespread itching) is a common feature of Hodgkin lymphoma instead of Non-hodgkin lymphoma

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8
Q

Describe the location of the lump that characteristically presents in Hodgkin’s lymphoma, and what is the anatomical term?

A

Lump in chest

Mediastinal mass

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9
Q

Give one characteristic feature of Hodgkin’s lymphoma that presents when drinking?

A

Lymph node pain when drinking alcohol

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10
Q

Which 2 age groups are most commonly affected by Hodgkin’s lymphoma?

A

Young adults

Over 60 yrs old

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11
Q

Is Hodgkin’s lymphoma equally common in males and females?

A

More common in males

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12
Q

What virus is Hodgkin’s lymphoma associated with, and is this a causative agent?

A

EBV

Not causative agent

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13
Q

What lab investigation confirms the diagnosis of lymphomas, and why?

A

Lump biopsy (core biopsy or whole node excision)

Provides info about HL/NHL and grade

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14
Q

Why is FNA of a lymph node not used to confirm lymphoma diagnosis?

A

FNA can give info about cellular tissue of lymph node but not about grade or HL/NHL

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15
Q

Compare the history and onset of high grade (aggressive) and low grade (indolent) lymphomas?

A

High grade: Short history (symptomatic with rapid onset)

Low grade: Longer or no history (asymptomatic with insidious onset)

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16
Q

Compare the general treatment of high grade (aggressive) and low grade (indolent) lymphomas?

A

High grade: Treated immediately with intensive chemotherapy

Low grade: Treated by watch and wait, until low intensity chemotherapy is needed

17
Q

Compare the prognosis of high grade (aggressive) and low grade (indolent) lymphomas?

A

High grade: Potentially curable with 1-2 chances (After relapse, second-line drug is used which can be successful)

Low grade: Lifelong illness that is treated with multiple chances, to relieve symptoms

18
Q

Why are low grade lymphomas rarely cured, and instead stay as lifelong illnesses?

A

Rarely cured because they often present at advanced stage

19
Q

Describe the classification of Burkitt lymphoma, its characteristic pathophysiology, onset and lab finding?

A

Very rapidly progressive subtype of high grade Non-Hodgkin lymphomas

Starry sky appearance: Characterised by large vacuolated cells

Caused by chromosome translocation (8;14): On chromosome 8 , C-MYC gene is a regulator of the cell cycle and plays a major role in the control of cell growth, differentiation, apoptosis and neoplastic transformation

20
Q

Describe the lab finding that confirms the diagnosis of Hodgkin lymphoma and Non-Hodgkin lymphoma?

A

Hodgkin lymphoma diagnosis: Microscopic imaging of biopsy shows presence of Reed-Sternberg cells

Non-Hodgkin lymphoma diagnosis: Microscopic imaging of biopsy shows absence of Reed-Sternberg cells

21
Q

Describe the appearance of Reed-Sternberg cells, and what cancer is this a hallmark of?

A

Large, abnormal lymphocyte with binucleated nucleus that resembles owl eyes

Hallmark of Hodgkin lymphoma

22
Q

What staging system is used to classify lymphomas, and how many stages are there?

A

Ann Arbor Staging

Stages 1 to 4

23
Q

How does lymphoma treatment change as the stage increases?

A

From stages 1 to 4, radiotherapy alone becomes less effective and chemotherapy is needed

24
Q

What do each of the stages of the Ann Arbor Staging system indicate about the spread of the lymphoma?

A
  1. Localised disease
  2. Disease in more than 1 lymph node, on the same side of diaphragm
  3. Disease above and below diaphragm
  4. Extranodal disease (outside lymph nodes and spleen)
25
Q

What is the meaning of the A/B suffixes also added to the numeral staging of lymphomas?

A

A: Absence of B symptoms

B: Presence of B symptoms

26
Q

What mode of radiological investigation is used to for lymphoma staging?

A

PET scan

Radio-tracer uptake (dark areas) show metabolically active areas (due to active malignancy) or normal physiological uptake (this is would be during remission)

27
Q

What is another characteristic finding of a Hodgkin lymphoma biopsy, apart from Reed-Sternberg cells?

A

Also shows many reactive myeloid cells eg. eosinophilia (causes pruritus)

28
Q

What type of Burkitt lymphoma is found in the UK?

A

Sporadic Burkitt lymphoma

29
Q

What type of Burkitt lymphoma is found in some parts of Africa?

A

Endemic Burkitt lymphoma

30
Q

What are the 5 types of Hodgkin’s lymphoma?

A

Classical lymphocyte predominant: Best prognosis
Nodular lymphocyte predominant
Nodular sclerosing
Lymphocyte depleted
Mixed cellularity

31
Q

What is the standard chemotherapy regime to treat lymphomas?

A

ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine)

32
Q

What chemotherapy regime is used to treat lymphoma if ABVD can’t be used?

A

BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone)

Better remission rates, worse toxicity

Clinical lectures: Yr2 (41 decks)

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