Lymphoma (non-Hodgkin's)

Question 1

Definition

Answer 1

· Lymphomas are malignancies of lymphoid cells originating in lymph nodes or other lymphoid tissues. Non-Hodgkin’s lymphomas are a diverse group consisting of:

o 85% B cell
o 15% T cell and NK cell forms

· It can range from stable, indolent disease to aggressive disease

Question 2

Aetiology

Answer 2

· Complex process involving the accumulation of multiple genetic lesions

· The changes in the genome in certain lymphoma subtypes have been associated with the introduction of foreign genes via oncogenic viruses (e.g. EBV and Burkitt’s lymphoma)

Question 3

Risk factors

Answer 3

o Radiotherapy
o Immunosuppressive agents
o Chemotherapy
o HIV, HBV, HCV
o Connective tissue disease (e.g. SLE)

Question 4

Epidemiology

Answer 4

· Incidence increases with age
· More common in MALES
· More common in the WESTERN WORLD

Question 5

Presenting symptoms (systemic)

Answer 5

· Painless enlarging mass (in neck, axilla or groin)

· Systemic Symptoms (occurs less frequently than in Hodkin's):
o Fever
o Night sweats
o Weight loss > 10% body weight
o Symptoms of hypercalcaemia

Question 6

Presenting symptoms (relating to organ involvement)

Answer 6

o Extranodal disease is MORE COMMON in NHL than in Hodgkin's lymphoma
o Skin rashes
o Headache
o Sore throat
o Abdominal discomfort
o Testicular swelling

Question 7

Signs on physical examination

Answer 7

· Painless firm rubbery lymphadenopathy

· Skin rashes
o Mycosis fungoides - looks like a fungal infection but is in fact a cutaneous T-cell lymphoma)

· Abdominal mass

· Hepatosplenomegaly

Question 8

Signs on physical examination (bone marrow involvement)

Answer 8

Anaemia
Infections
Purpura

Question 9

Investigations (blood)

Answer 9

· Bloods
o FBC
· Anaemia
· Neutropaenia
· Thrombocytopaenia
o High ESR and CRP
o Calcium may be raised
o HIV, HBV and HCV serology

· Blood Film
o Lymphoma cells may be visible in some patients

Question 10

Investigations (other)

Answer 10

· Bone Marrow Aspiration and Biopsy

· Imaging - CXR, CT, PET

· Lymph Node Biopsy - allows histopathological evaluation, immunophenotyping and cytogenetics

· Staging - Ann-Arbor