Lymphoma, Non-Hodgkin's

Question 1

Define

Answer 1

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

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

It can range from stable, indolent disease to aggressive disease

Question 2

Causes

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

• Radiotherapy
• Immunosuppressive agents
• Chemotherapy
• HIV, HBV, HCV
• 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

Symptoms

Answer 5

Painless enlarging mass (in neck, axilla or groin)

Systemic Symptoms (occurs less frequently than in Hodkin’s):

• Fever
• Night sweats
• Weight loss > 10% body weight
• Symptoms of hypercalcaemia
• Symptoms related to organ involvement

Extranodal disease is MORE COMMON in NHL than in Hodgkin’s lymphoma

• Skin rashes
• Headache
• Sore throat
• Abdominal discomfort
• Testicular swelling

Question 6

Signs

Answer 6

Painless firm rubbery lymphadenopathy

Skin rashes

• Mycosis fungoides - looks like a fungal infection but is in fact a cutaneous T-cell lymphoma)

Abdominal mass

Hepatosplenomegaly

Signs of bone marrow involvement:

• Anaemia
• Infections
• Purpura

Question 7

Investigations

Answer 7

Bloods

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

Blood Film

• Lymphoma cells may be visible in some patients

Bone Marrow Aspiration and Biopsy

Imaging - CXR, CT, PET

Lymph Node Biopsy - allows histopathological evaluation, immunophenotyping and cytogenetics

Staging - Ann-Arbor