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Radiation Therapy > Lymphoma powerpoint (slides 1-33) > Flashcards

Lymphoma powerpoint (slides 1-33) Flashcards

1
Q

Where does leukemia originate?

A

bone marrow or blood

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2
Q

Where do lymphomas originate?

A

in the lymphatic system (lymphoreticular system)

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3
Q

What kind of treatment is used for leukemias and lymphomas?

A

systemic treatment

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4
Q

What are the two types of lymphoma?

A

Hodgkin’s and non-Hodkin’s

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5
Q

What is the lymphatic system?

A

the group of tissues and organs that
produce and store white blood cells that fight infection

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6
Q

What system does the lymphatic system work with and to what purpose?

A

circulatory system

The systems work together to transport nutrients and to
remove wastes and are intertwined throughout the bod

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7
Q

What does the lymphatic system include?

A

bone marrow, spleen, thymus,
lymph nodes, and lymphatic vessels

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8
Q

What organ is the largest lymphatic organ that recycles red blood cells and houses lymphocytes that help contest certain types of bacteria?

A

The spleen

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9
Q

____________ cells are eliminated by the lymphatic system and portions of the
__________ help produce lymph.

A

red blood

blood

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10
Q

Lymph fluid carries ________, _________, and ___________ throughout the
body and provides protection while filtering harmful particles that may give
rise to infection and disease

A

Antibodies

Nutrients

Lymphocytes

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11
Q

Lymph nodes become swollen when _________ are present and when the body
produces more lymphocytes to fight infection.

A

bacteria

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12
Q

Lymphocytes that grow abnormally are the origin of __________________ and compromise the body’s ability to fight infection

A

Hodgkin’s and Non-
Hodgkin’s lymphomas

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13
Q

What category of lymphoma is marked by the presence of a type of cell called the Reed- Sternberg cell?

A

Hodgkin’s lymphoma

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14
Q

Which category of lymphoma includes a large diverse group of cancers of immune system cells?

A

Non-Hodgkin’s Lymphoma

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15
Q

What are “natural killer cells”

A

T cells (lymphocytes)

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16
Q

_____________is the result of abnormal growth of __________ and ___________, which develop in the bone marrow and mature in the lymphatic organs.

A

Hodgkin’s lymphoma

T-cells

B-lymphocytes

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17
Q

Where do lymphocytes develop and mature?

A

Develop in bone marrow

Mature in the lymphatic organs

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18
Q

What are Reed-Sternberg cells?

A

Large lymphoid cells that contain multiple nuclei. B lymphocytes that failed to undergo apoptosis

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19
Q

HL spreads in a systematic manner from one lymph node group to the next in a
______________ _______________.

A

predictable pattern

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20
Q

HL is more prevalent in:

A

males, regardless of race

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21
Q

What is the age epidemiology of HL?

A

greatest in 20-34 years

rare occurrence in age below 5

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22
Q

What is a sign of HL?

A

A painless mass is most often discovered in lymph node
areas above the diaphragm

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23
Q

What are the virus risk factors to HL?

A

Epstein Barr Virus (EBV)

HIV

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24
Q

What are risk factors to HL?

A

Viruses

Weakened immune system

Age
-15-24 years old
-55+

Family History
-family members, especially siblings of HL patients have increased risk for developing HL

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25
Q

What are the signs/symptoms of HL?

A

painless swollen lymph nodes
(most common symptom)

Coughing

Chest pain

Fatigue

Splenomegaly
(enlarged spleen, in the case of advanced disease)

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26
Q

What are the B-symptoms of HL?

A

Weight loss – 10% of body weight in 6 months prior to diagnosis

Fevers – higher than 100.4 Fahrenheit

Night sweats

Itchy skin – generalized pruritus

Pain with alcohol ingestion

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27
Q

What imaging is used in detection and diagnosis of HL?

A

Chest x-rays
(swollen lymph nodes in chest)

CT

MRI

PET

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28
Q

How is HL detected in a history/ physical exam?

A

a physician checks for swollen lymph nodes in the neck,
underarms, and groin and checks for a swollen spleen or liver

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29
Q

What lab test is done for HL?

A

CBC to check the number of white blood cells

(platelet count, liver, and renal function tests)

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30
Q

Anemia, leukopenia, thrombocytosis, and lymphopenia can indicate _____________.

A

bone marrow involvement

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31
Q

1) Low blood albumin below___.

2) high erythrocyte ____________ rate

3) high white blood cells
count about _________.

4) low red blood cell count with hemoglobin level below ________.

5) low blood lymphocyte count below ______.

may indicate HL.

A

4

sedimentation

15,000

10.5

600

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32
Q

Bone marrow biopsies for HL are reserved for those with _________-stage disease and _______________
disease.

A

later

subdiaphragmatic

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33
Q

A ________ biopsy should be done if splenic involvement is found.

A

liver

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34
Q

What are the subcategories of HL and the percentage of incidence of each?

A

Classic Hodgkin Lymphoma
(95%)

Nodular Lymphocyte Predominant Hodgkin Lymphoma
(5%)

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35
Q

What are the subcategories of Classic Hodgkin Lymphoma (CHL)?

A

Nodular sclerosing HL

Mixed cellularity HL

Lymphocyte Rich HL

Lymphocytic Depleted HL

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36
Q

Which CHL is most common, usually involves nodes in the chest and neck, has greatest incidence in ages 20s-30s, and is typically diagnosed at an early stage?

A

Nodular Sclerosing CHL

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37
Q

Which CHL has an age diagnosis average of 38 years old and tends to be seen in those affected by HIV?

A

Mixed Cellularity CHL

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38
Q

Which CHL is found only in 5% of CHL cases, usually occurs in the upper body, and typically doesn’t occur in more than a few lymph nodes?

A

Lymphocytic Rich CHL

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39
Q

Which CHL is the rarest and usually presents with more advanced disease, therefore has the worst prognosis, and usually affects people in their 30s with HIV?

A

Lymphocytic Depleted CHL

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40
Q

In HL, the ___________ of spread is predictable, but not ____________ of spread.

A

pattern/route

rate

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41
Q

What is the typical spread pattern of HL?

A

Lymphatic drainage then spreading to other organs

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42
Q

What is considered local invasion in HL?

A

spread to surrounding viscera after spreading to adjacent lymph region

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43
Q

What is the most common site of metastasis in HL?

A

adjacent lymph nodes

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44
Q

What is the most common visceral involvement?

A

spleen, liver, and bone marrow

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45
Q

For HL, metastasis can also occur in the _______ and _________ system in late stages.

A

lungs

skeletal

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46
Q

What is the HL staging system?

A

The Ann Arbor Staging System

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47
Q

Explain ABES in the Ann Arbor Staging System

A

A: the patient does not have B symptoms

B: The patient has B symptoms

E: Extranodal disease is present

S- Disease is found in the spleen

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48
Q

What stage of HL is

involvement of two or more lymph node regions on the same side of the diaphragm or of one lymph node region and a extra-lymphatic site.

A

Stage II

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49
Q

What stage of HL is

involvement of a single lymph node region or single extra-lymphatic site

A

Stage I

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50
Q

What stage of HL is

involves disseminated disease of one or more extra-lymphatic organ.

A

Stage IV

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51
Q

What stage of HL is

involvement of lymph node regions on both sides of the diaphragm, which may include the spleen or an extra-lymphatic organ

A

Stage III

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52
Q

What can be said if patients have
clinical stage I or II disease without the
presence of B symptoms, less than 3 sites of
nodal involvement, and no markedly abnormal
lab results?

A

early favorable HL

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53
Q

True or false: HL that is advanced can still be considered favorable with stage III or IV and 3 or fewer risk factors.

A

True

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54
Q

____________ _______________ has stage III or IV and 4 or more risk factors.

A

Advanced unfavorable

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55
Q

HL is one of the most __________ types of cancer. The primary treatment modality is __________.

A

Treatable

chemotherapy

56
Q

What is the Chemotherapy treatment for Stage I and II HL?

A

4 cycles of ABVD

57
Q

What is ABVD

A

chemotherapy treatment for Stage I and II HL

adriamycin

bleomycin

vincristine

dacarbazine

58
Q

What is the risk factor of adriamycin>

A

risk factor of heart disease

59
Q

Radiation may be given in adjuvant to chemotherapy in stage I and II of HL to treat _____________.

A

subclinical or residual

60
Q

When might a patient in early stages of HL be treated with EBRT alone?

A

If the patient experiences adverse reactions to chemotherapy

61
Q

Patients diagnosed with stage III or IV HL with bulky
disease or with B symptoms are treated with a
______________________.

A

chemotherapy regimen and adjuvant radiation
therapy

62
Q

Radiation therapy might be used for __________ in Stage III and IV of HL.

A

palliation

63
Q

What is salvage therapy?

A

Use of chemotherapy after the disease has reoccurred in an area already treated with radiation therapy.

64
Q

In HL, where is radiation most often delivered?

A

neck

chest

axilla

paraaortic lymph nodes

spleen

pelvic lymph nodes (sometimes)

65
Q

What is TNI?

A

Total Nodal Irradiation

includes radiation to the upper nodes and lower nodes

66
Q

Upper nodes are irradiated via a ________ AP/PA.

A

mantle field

67
Q

Describe Mantle Field AP/PA TNI.

A

Treatment fields to the neck, chest, and axilla

Nodes are in wire blue frame

Lungs, occipital, and head of humerus are blocked

68
Q

Lower nodes are irradiated via an _____________ AP/PA.

A

inverted “Y”

69
Q

Describe an Inverted “Y” AP/PA field.

A

Pelvic and paraaortic fields are treated together

nodes are in red wire frame

part of the kidney, bladder, and rectum are blocked

70
Q

Upper and Lower Node fields can be treated separately, but when they are treated altogether, they form the _______ ______ _________ _________.

A

total nodal radiation therapy (TNI)

71
Q

What energy is used to treat HL tumors?

A

6-10 MV photons

72
Q

What is the initial tumor dose for mantle radiation therapy of HL tumors?

A

20-30 Gy to mantle field at 1.8-2.0 Gy/fraction

73
Q

What is the boost dose for an HL tumor treatment?

A

35-44 Gy at 1.8 to 2.0 Gy/fraction

74
Q

Recent studies have shown that patients who are receiving chemotherapy
and radiation may be treated to a lesser dose up to _________ Gy with the same
results and less toxicity.

A

20

75
Q

Lowering radiation dose for young HL patients is beneficial to:

A

preserve fertility

prevent second malignancies caused from the initial treatment

76
Q

The treatment procedure for pediatric cases is much like that for adults,
but much more emphasis is spent on minimizing lower doses for
chemotherapy and radiation therapy to prevent toxicities and
interruption in the __________ _____________.

A

growth process

77
Q

Overall survival rate of HL is _______ per the National Cancer Institute’s
Surveillance, Epidemiology, and End Results Program.

A

86.6%

78
Q

What is the main distinction between HL and NHL?

A

presence of Reed- Sternberg cells

79
Q

Where can NHL occur?

A

anywhere the lymph fluid travels

lymph nodes

extranodal

80
Q

What is the spread pattern of Non Hodgkin’s lymphoma?

A

random

81
Q

What is the sex/racial epidemiology of NHL?

A

white male predominance

82
Q

What is the age epidemiology of NHL:

A

most common in 65-74 years of age

83
Q

What is the geographic epidemiology of NHL?

A

more common in the US, Canada, and Europe

less common in Asian countries

84
Q

What are the risk factors of NHL?

A

Immunocompromised

Virus/disease

Occupational exposure (chemicals)

Ionizing radiation exposure

85
Q

Patients with ______________ who are awaiting organ or bone marrow transplants are at an increased risk of NHL.

A

immunosuppression

86
Q

What Viruses and diseases are associated with NHL?

A

AIDS

Burkitt’s Lymphoma (EBV)

Hepatitis C

T lymphotropic virus type 1 (HTLV-1)

Helicobacter pylori bacteria

87
Q

What are the signs/symptoms for NHL?

A

enlarged lymph nodes

night sweats

weight loss

fever

itching

88
Q

What is the most common site for extra nodal involvement in NHL?

A

the GI system, specifically the stomach

89
Q

What are common sites for extra nodal involvement for NHL?

A

Waldeyer’s ring

Skin

Bone Marrow

Sinuses

Thyroid

CNS

Genitourinary system (GU)

90
Q

What may suggest NHL in a history/physical exam?

A

knowledge of occupational risks and background

91
Q

What imaging is used for NHL?

A

X-ray

CT

PET

MRI

US

92
Q

Among X-ray, CT, PET, MRI, and US imaging of NHL, which are useful in the assessment of the extent of the disease and initial stages?

A

All

92
Q
A
93
Q

What Lab studies are done for NHL?

A

CBC (complete blood cell count)

Serum chemistry studies (liver function)

Serum beta-2 macroglobulin level may be elevated

HIV serology

Human T-cell lymphotropic virus-1 serology

Lactic acid dehydrogenase and calcium levels may be abnormal

94
Q

What kind of biopsies are done for NHL?

A

Lymph node and bone marrow

95
Q

anemia, thrombocytopenia, leukopenia, lymphocytosis, or
thrombocytosis may be a sign of ________.

A

NHL

96
Q

What are the two subcategories of NHL?

A

B cell NHL

T cell NHL

97
Q

What are the four subcategories of B cell NHL?

A

Diffuse large B-cell lymphoma

follicular lymphoma

Mantle cell lymphoma

Burkitt lymphoma

98
Q

What are the two subcategories of T cell NHL?

A

Peripheral T cell lymphoma

Cutaneous T cell lymphoma

99
Q

What types of NHL are considered indolent?

A

Nodular

Follicular

100
Q

What staging system is used for NHL?

A

Ann Arbor staging system

101
Q

What is unique about the Ann Arbor staging system for NHL?

A

Includes involvement of:

Waldeyer’s ring

thymus

spleen

appendix

Peyer’s patches of the small intestines

102
Q

In Staging of NHL, what is REAL?

A

The Revised European American Classification

103
Q

What are the various grades for NHL?

A

Low grade

intermediate grade

high grade

104
Q

__________, slow growing NHLs are low grade but tend to be more aggressive and recur over time.

A

Indolent

105
Q

__________ NHL tumors are referred to as high grade and grow at a much faster rate.

A

aggressive

106
Q

True or false: aggressive and indolent tumors are equally curable.

A

True

107
Q

NHL tumors metastasize through __________ spread.

A

hematogenous

108
Q

What is the treatment of choice for NHL?

A

chemotherapy

109
Q

What is the chemotherapy plan used for NHL?

A

CHOP

110
Q

What is CHOP chemotherapy?

A

Cyclophosphamide

doxorubicin

vincristine

prednisone

111
Q

Indolent NHL in states _____ or ______ can be treated with radiation alone.

A

I or II

112
Q

What immunotherapy agent is used to boost the immune system into fighting off cancer cells?

A

rituximab

113
Q

NHL patients with advanced or recurrent disease from aggressive chemotherapy and radiation therapy followed by a bone marrow transplant are candidates for:

A

stem cell transplant

114
Q

Aggressive NHLs are treated with ____________ and _____________ combined.

A

chemo

radiation

115
Q

For NHL, radiation therapy is used _________ or in ___________ with chemotherapy.

A

adjuvantly

combination

116
Q

true or false: NHL is less likely to emerge in various locations of the lymphatic system along with or in addition to
extranodal sites.

A

False. more likely.

117
Q

In NHL radiation treatments, , the involved site is included along with the related___________ clusters nearby.

A

drainage nodal

118
Q

NHL treatment fields are treated to a dose of ________.

A

35-45 Gy.

119
Q

What are two special considerations of NHL radiation treatments?

A

Proper dental care

custom mouth guards

120
Q

What organs commonly need to be blocked in NHL treatments to avoid late effects?

A

Lungs

Heart

Spinal Cord

Larynx

humeral heads

121
Q

In the treatment of pelvic and abdominal lymph nodes in NHL radiation therapy treatment, _____________ shielding is used to preserve fertility in males.

A

testicular

122
Q

For pelvic and abdominal NHL radiation treatments, sperm count should return to normal within ______ years.

A

2

123
Q

What is the purpose of oophorplexy in females undergoing radiation therapy for NHL?

A

to move the ovaries out of the area of treatment

124
Q

NHL treatments utilize daily ______ images to verify accuracy and prevent healthy tissue from being irradiated.

A

kv

125
Q

What are the acute treatment side effects of NHL?

A

nausea/vommitting
(Phenergan)

Erythema (Skin Cream)

Dysphagia (Magic Mouthwash)

Fatigue

Alopecia

Esophagitis

Altered taste

Dry cough

Diarrhea

126
Q

What are the chronic side effects of NHL Radiation therapy treatment?

A

fibrosis

pneumonitis

edema

L’hermittle’s syndrome

thyroid conditions

leukemia

127
Q

What is the most important prognosis factor of NHL?

A

stage of disease at the time of diagnosis

128
Q

True or false: in NHL, men have slightly better prognosis than women.

A

false

129
Q

Children have a ___________ prognosis with NHL.

A

generally good

130
Q

With early stage disease of NHL, there is a ________ cure rate.

A

90%

131
Q

Prognosis for NHL is more dependent on _________ than is HL.

A

histology

132
Q

___________ NHL has a median survival time of 10-20 years depending on advancement.

A

indolent

133
Q

____________ NHL has an overall 5 year survival rate of _______%.

A

aggressive

60

134
Q

The risk of relapse for indolent and aggressive NHL is highest after _____________ of treatment.

A

the first two years

135
Q

Treatment above the diaphragm are _______ fields.

A

mantle

136
Q

Treatment below the diaphragm are _______ fields.

A

inverted Y

Radiation Therapy (26 decks)

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