Lymphoma -Hodgkin's lymphoma

Question 1

What is lymphoma?

Answer 1

Refers to cancer that affects the lymphocytes inside the lymphatic system.

Cancerous cells proliferate inside thelymph nodes, causing lymphadenopathy).

Question 2

Types of lymphoma?

Answer 2

Hodgkin’s lymphoma
Non-Hodgkin’s lymphoma

Question 3

What is Hodgkin’s lymphoma? When is the peak incidence?

Answer 3

Refers to malignant lymphoma characterised by the presence of Reed–Sternberg cells.

Peak: third decade of life

Question 4

Risk factors for Hodgkin’s lymphoma?

Answer 4

Epstein–Barr virus
HIV
Immunosuppression
Cigarette smoking

Question 5

Presentation of Hodgkin’s lymphoma?

Answer 5

Non-tender lymphadenopathy (cervical or supraclavicular)
Alcohol-induced painful lymphadenopathy (can lead to SOB, abdo pain)
Pruritus
Hepatomegaly
Splenomegaly

B symptoms:
- fever
- night sweats
- wt loss

Question 6

Investigations for Hodgkin’s lymphoma?

Answer 6

FBC (cytopenia; low Hb)
U&Es, raised LDH (tumour burden, tumour lysis syndrome)
LFTs (tumour burden)
Urate (tumour lysis syndrome)
Raised ESR

Virology

CT or PET (staging)

Biopsy (identify lymphoma type, level of marrow infiltration)
- lymph node (Reed–Sternberg cells)
- solid mass
- bone marrow

Question 7

Management of Hodgkin’s lymphoma?

Answer 7

Supportive care:
- treat cytopenias
- infection risk
- irradiated blood products

Chemotherapy
- curative
- aims to reduce toxicity/increasing fertility
- stage of disease determines type and duration of chemotherapy

Question 8

What is non-Hodgkin’s lymphoma?

Answer 8

a variety of malignancies that impact the lymphoid system.

ABSENCE OF REED-STERNBERG CELLS.

Question 9

Causes of non-Hodgkin’s lymphoma?

Answer 9

H.pylori
EBV
Hep C
human T-cell lymphotropic virus type 1 (HTLV1)
immunodeficiency states (HIV/AIDS, post-organ transplant)
autoimmune disorders (Sjögren’s disease and coeliac disease)
inherited disorders affecting DNA repair

Question 10

Presentation of non-Hodgkin’s lymphoma?

Answer 10

Painless lymphadenopathy (symmetrical, multiple sites)
- non-tender, firm lymphadenopathy affecting the cervical, axillary and/or inguinal lymph nodes

B symptoms (more common in non-Hodgkin than in Hodgkin lymphoma)

splenomegaly and hepatomegaly

Oropharyngeal involvement

Question 11

IVx of non-Hodgkin’s lymphoma?

Answer 11

Blood test
- elevated LDH (poor prognostic marker)
- normocytic/haemolytic anaemic

Blood film
- nucleated red cells and left shift
- circulating lymphoma cells (ie. abnormal lymphocytes)

Biopsy

Bone marrow biopsy

Staging scans

Cytogenics (t(11;14) can aid in diagnosing mantle cell lymphoma)

Question 12

Management of non-Hodgkin’s lymphoma?

Answer 12

Low-grade:
- watch and wait until there is evidence of symptoms/organ failure
- stage 1 local radiotherapy
- rituximab in combination with chemotherapy or obinutuzumab with chemotherapy.

High-grade:
- R-CHOP chemotherapy (cyclophosphamide, doxorubicin, vincristine and prednisolone) plus the anti-CD20 monoclonal antibody rituximab

Question 13

Complications of non-hodgkin lymphoma?

Answer 13

infections
neurological complications
bleeding and coagulopathy
secondary malignancies