Lymphoma: High/low grade, Hodgkin/Non-Hodgkin Flashcards
Define lymphoma?
Group of haematological malignancies of lymphocytes, which originates from the lymphatic system
What is the main difference between lymphoma and lymphocytic leukaemia?
Lymphoma and lymphocytic leukaemia both are cancers of lymphocytes
But lymphoma originates from lymphatic system and leukaemia originates from bone marrow
What is the usual initial clinical presentation of lymphoma?
Painless swelling of lymph node
What 3 B symptoms can present in lymphoma, and are also red flags of other haematological malignancies?
Drenching night sweats
Unexplained fever
Weight loss over 6 months, that was unintentional and over 10% baseline weight
Give the 2 main ways in which lymphoma can affect other organs, in terms of clinical presentation?
Splenomegaly
Presentation of symptoms due to lumps compressing other structures eg. shortness of breath due to lesion in lung, bowel movement changes
Give examples of signs of BMF or anaemia commonly present in clinical presentation of lymphomas, and the underlying lab finding that causes these?
Cytopenias
Which cause eg. TATT, frequent infections, bleeding or bruising easily, pallor
If a patient presents with pruritus, what can this signify when classifying the lymphoma?
Pruritus (widespread itching) is a common feature of Hodgkin lymphoma instead of Non-hodgkin lymphoma
Describe the location of the lump that characteristically presents in Hodgkin’s lymphoma, and what is the anatomical term?
Lump in chest
Mediastinal mass
Give one characteristic feature of Hodgkin’s lymphoma that presents when drinking?
Lymph node pain when drinking alcohol
Which 2 age groups are most commonly affected by Hodgkin’s lymphoma?
Young adults
Over 60 yrs old
Is Hodgkin’s lymphoma equally common in males and females?
More common in males
What virus is Hodgkin’s lymphoma associated with, and is this a causative agent?
EBV
Not causative agent
What lab investigation confirms the diagnosis of lymphomas, and why?
Lump biopsy (core biopsy or whole node excision)
Provides info about HL/NHL and grade
Why is FNA of a lymph node not used to confirm lymphoma diagnosis?
FNA can give info about cellular tissue of lymph node but not about grade or HL/NHL
Compare the history and onset of high grade (aggressive) and low grade (indolent) lymphomas?
High grade: Short history (symptomatic with rapid onset)
Low grade: Longer or no history (asymptomatic with insidious onset)
Compare the general treatment of high grade (aggressive) and low grade (indolent) lymphomas?
High grade: Treated immediately with intensive chemotherapy
Low grade: Treated by watch and wait, until low intensity chemotherapy is needed
Compare the prognosis of high grade (aggressive) and low grade (indolent) lymphomas?
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
Why are low grade lymphomas rarely cured, and instead stay as lifelong illnesses?
Rarely cured because they often present at advanced stage
Describe the classification of Burkitt lymphoma, its characteristic pathophysiology, onset and lab finding?
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
Describe the lab finding that confirms the diagnosis of Hodgkin lymphoma and Non-Hodgkin lymphoma?
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
Describe the appearance of Reed-Sternberg cells, and what cancer is this a hallmark of?
Large, abnormal lymphocyte with binucleated nucleus that resembles owl eyes
Hallmark of Hodgkin lymphoma
What staging system is used to classify lymphomas, and how many stages are there?
Ann Arbor Staging
Stages 1 to 4
How does lymphoma treatment change as the stage increases?
From stages 1 to 4, radiotherapy alone becomes less effective and chemotherapy is needed
What do each of the stages of the Ann Arbor Staging system indicate about the spread of the lymphoma?
- Localised disease
- Disease in more than 1 lymph node, on the same side of diaphragm
- Disease above and below diaphragm
- Extranodal disease (outside lymph nodes and spleen)
