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6. Cancer > Lymphomas > Flashcards

Lymphomas Flashcards

1
Q

What are lymphomas?

A

Malignancies of the lymphoid system and hence may arise at any site where lymphoid tissue is present

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2
Q

At what ages is Hodgkin’s lymphoma most prevalent?

A

16-65

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3
Q

What are risk factors for Hodgkin’s lymphoma?

A

Epstein-Barr virus infection

Smoking, HIV

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4
Q

What cancer is Epstein-Barr virus linked to?

A

Hodgkin’s lymphoma; up to 40% of patients with HL have increased EBV antibody titres

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5
Q

What is the most common lymphoma?

A

Non-HL

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6
Q

What is the clinical presentation of Hodgkin’s lymphoma

A

The commonest presentation of HL is painless cervical lymphadenopathy, commonly described in examination as ‘rubbery’

Signs and symptoms of Hodgkin’s lymphoma may include:

  • Persistent fatigue
  • Fever
  • Night sweats
  • Unexplained weight loss
  • Severe itching
  • Increased sensitivity to the effects of alcohol or pain in your lymph nodes after drinking alcohol
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7
Q

How is Hodgkin’s lymphoma classified?

A
  1. Classical Hodgkin’s lymphoma (cHL) (hallmark Reed-Sternberg cell)
  2. Nodular lymphocyte-predominant HL (NLPHL) (popcorn cells)
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8
Q

What cancer type has Reed-Sternberg cells?

A

Classical Hodgkin’s lymphoma (cHL)

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9
Q

What investigations would you do for Hodgkin’s lymphoma?

A
  1. FBC: The degree of any anaemia, leukocytosis and lymphopenia are prognostic indicators
  2. ESR: an ESR of greater than 70 carries an unfavourable prognosis
  3. LFT
  4. Lymph node biopsy
  5. CXR
  6. CT for staging
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10
Q

What is the most common type of Hodgkin’s lymphoma?

A

Nodular sclerosis classical Hodgkin’s lymphoma

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11
Q

How would you manage Hodgkin’s lymphoma?

A

Cardiac and pulmonary function tests are mandatory

  1. Early disease: chemo + radio
  2. Advanced disease: extended chemo
  3. After relapse: high dose chemo + stem cell transplant
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12
Q

What is the risk of chemotherapy in Hodgkin’s lymphoma?

A

Leukaemia

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13
Q

What is the prognosis for Hodgkin’s lymphoma?

A

With modern treatment strategies, 80-90% of patients achieve permanent remission and can be considered cured[

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14
Q

What is non-Hodgkin’s lymphoma?

A

Non-Hodgkin’s lymphomas (NHLs) are an heterogeneous group of lymphoproliferative malignancies with differing patterns of behaviour and responses to treatment. There is a much greater predilection to disseminate to extranodal sites than in Hodgkin’s lymphoma. The prognosis depends on the histological type, stage and treatment.

They can be divided into two prognostic groups:
1. Low-grade: relatively good prognosis, with median survival as long as 10 years. However, they are usually not curable in advanced clinical stages.

  1. High-grade: shorter natural history but a significant number of these patients can be cured with intensive combination chemotherapy regimens.
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15
Q

How would you classify non-Hodgkin’s lymphoma?

A
  1. Precursor B-cell neoplasms: precursor B-lymphoblastic lymphoma.
  2. Mature (peripheral) B-cell neoplasms (including Burkitt’s)
  3. Precursor T-cell neoplasms: precursor T-lymphoblastic lymphoma.
  4. Mature (peripheral) T-cell neoplasms:
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16
Q

What is the median age of presentation for non-Hodgkin’s lymphoma?

A

50 and over

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17
Q

What are the most common types of non-Hodgkin’s lymphoma?

A

Diffuse large B-cell lymphoma and follicular lymphoma

18
Q

What are the risk factors for non-Hodgkin’s lymphoma?

A

Chromosomal translocations and molecular rearrangements.

Viral infections

Environmental factors such as pesticides, solvents, preservatives

Congenital and acquired immunodeficiency states.

19
Q

How does non-Hodgkin’s lymphoma present?

A

Painless, slowly progressive peripheral lymphadenopathy
Fatigue, weakness, fever, night sweats, weight loss
Splenomegaly, hepatomegaly

20
Q

What are the investigations for non-Hodgkin’s lymphoma?

A

FBC: anaemia and thrombocytopenia and neutropenia
Renal function and electrolytes: obstructive nephropathy, hypercalcaemia.
CXR: mediastinal adenopathy
CT scans

21
Q

How is non-Hodgkin’s lymphoma staged?

A

The Ann Arbor staging system is the most commonly used

22
Q

How is non-Hodgkin’s lymphoma managed?

A

Options include watchful waiting, single-agent or multi-agent chemotherapy and regional or extended radiotherapy.

23
Q

What is the prognosis for non-Hodgkin’s lymphoma?

A

Low-grade NHL types have a relatively good prognosis, with median survival as long as 10 years; however, they are usually not curable when advanced.

24
Q

What is the cellular origin of most non-Hodgkin’s lymphoma?

A
  • 80% are B-cell origin

- 20% are T-cell origin

25
Q

Which is more fatal, Hodgkin’s or non Hodgkin’s lymphoma?

A

Non-Hodgkins

26
Q

When does follicular lymphoma present?

A

Middle to late in life

27
Q

How does follicular lymphoma present?

A

Painless lymphadenopathy

28
Q

How do you diagnose follicular lymphoma?

A

Percutaneous needle biopsy may reveal transformation to diffuse large B-cell lymphoma

Bone marrow infiltration is common

29
Q

How do you manage stage 1 and 2 follicular lymphoma?

A

Field radiotherapy

30
Q

How do you manage stage 3 and 4 follicular lymphoma?

A

Rituximab, in combination with another chemotherapeutic agent

31
Q

How does Diffuse large B-cell lymphoma (DLBCL) present?

A

The majority of patients present with painless lymphadenopathy, clinically at one or several sites.

Intra-abdominal disease presents with bowel symptoms due to compression or infiltration of the gastrointestinal tract

32
Q

How would you manage Diffuse large B-cell non-Hodgkin’s lymphoma?

A

Rituximab with chemotherapy

33
Q

What is the median age of onset for Diffuse large B-cell non-Hodgkin’s lymphoma?

A

70 years

34
Q

Where does follicular lymphoma originate?

A

The cancer originates from the uncontrolled division of specific types of B-cells known as centrocytes and centroblasts

35
Q

What is Burkitt’s lymphoma?

A

Burkitt lymphoma is a cancer of the lymphatic system, particularly B lymphocytes found in the germinal center

36
Q

What causes Burkitt lymphoma?

A

EBV

c-myc translocation

37
Q

What is key about the differentation time for Burkitt lymphoma?

A

This is the most rapidly proliferating lymphoma

The commonest childhood malignancy worldwide

38
Q

What is the most common presentation for Burkitt lymphoma?

A

Rapidly growing jaw tumour in a young child

Otherwise, the next commonest is an abdominal mass often associated with bone marrow involvement

39
Q

What places can be used for a bone marrow puncture?

A
  1. Sternum
  2. Anterior iliac crest
  3. Posterior iliac crest (common)
  4. Tibia
40
Q

What two products can you get from a bone marrow puncture?

A
  1. Aspirate

2. Trephine

41
Q

What is trephine used for?

A

Staging of cancer

Classic Hodgkin lymphoma can be evaluated on a core biopsy. Core biopsy is more useful than an aspirate in assessing amyloid deposition and for staging metastatic malignancies to the bone. Core biopsy is essential in initial staging of many pediatric non-hematopoietic malignancies, such as rhabdomyosarcoma, neuroblastoma, PNETs, and Ewing sarcoma

6. Cancer (15 decks)

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