Lymphomas

Question 1

What is a lymphoma?

Answer 1

Solid tumours of lymphatic system
Most lymphatic accumulation in lymph nodes

Question 2

Presentation of lymphomas

Answer 2

B symptoms:
Fever
Night sweats
Unintentional weight loss
+ lymphadenopathy

Question 3

What are the 2 types of lymphoma?

Answer 3

Hodgekins and non hodgekins

Question 4

Hodgekins lymphoma
Ages?
Associated with?
Contagious?

Answer 4

Bimodal age distribution: teens & elderly (2 peaks)

EBV (aka glandular fever)

Contagious spread - from one node to another & keeps going

Question 5

Symptoms of Hodgekins

Answer 5

B symptoms +
Painless rubbery lymphadenopathy (localized)
(Painful after drinking alcohol)

Question 6

Diagnosis of Hodgekins
Tests and results?

Answer 6

Reed sternberg positive (DIAGNOSTIC)

(A subtype of Hodgekins - Nodular lymphocyte predominant Hodgekin’s; produces popcorn cells, a variant of RS)

High LDH (Lactate dehydrogenase)

Low Hb, High ESR (shows inflammation)

Question 7

What does LDH measure?

Answer 7

enzyme used to make energy so increase = tissue damage

Question 8

What is used to check the severity of the lymphoma?

Answer 8

ANN HARBOUR STAGING 1-4 USED FOR HODGEKINS + NON HODGEKINS

Question 9

Describe Ann harbour staging?

Answer 9

1. Single lymph node\
2. > 2 lymph nodes on same diaphragm side
3. lymph nodes on both diaphragm sides
4. Extra nodal organ spread

A = No B symptoms
B = B symptoms present

Question 10

Treatment for Hodgekins

Answer 10

ABVD, Chemotherapy
Adriamycin
Bleomycin
Vinblastine
Dacarbazine

Question 11

Side effects of chemotherapy

Answer 11

alopecia, n+v, myelosuppression, BM failure, infection

Question 12

Side effects of drugs A and B

Answer 12

A = cardiotoxicity
B = Pulmonary fibrosis

Question 13

What is Febrile Neutropenia?
Patients symptoms?
Treatment?

Answer 13

Massive risk in patients who had recent dose of chemo (or on carbimazole)

Fever (38+), tachy, sweats, rigours, tachypnoea

Immediate broad spectrum Abx (eg. Amoxicillin + fluoroquinolone)

Question 14

What is non Hodgekins lymphoma?

Answer 14

Tumour derived from lymphocytes

Question 15

What are the 3 types of NHL?

Answer 15

Follicular - low grade
Diffuse large B cell - High grade (aggressive)
Burkitts - very high grade (highly aggressive)

Question 16

What is follicular caused by?

Answer 16

t(14:18)

Question 17

which is the most common type?

Answer 17

Diffuse large B cell
80%

Question 18

What is Burkitts linked to?

Answer 18

Link to EBV, often causes Jaw massive lymphadenopathy in children

Question 19

Symptoms of NHL?

Answer 19

more varied as many subtypes but B symptoms + painless rubbery lymphadenopathy (not affected by alcohol)

Question 20

Diagnosis of NHL?
Tests and results?

Answer 20

Lymph node biopsy - DIAGNOSTIC
no RS/popcorn cells
Confirms NHL subtype (eg. Burkitt’s = ‘starry sky’ biopsy)

Question 21

What other important tests are done?

Answer 21

CT, MRI chest, abdo, pelvis for staging
ANN ARBOUR STAGING 1-4

Question 22

Treatment for NHL?

Answer 22

R-CHOP
Rituximab
Cyclophosphamide
Hydroxydaunorubicin
Oncovin = brand name (vincristine)
Prednisolone

Question 23

What is rituximab?

Answer 23

Monoclonal Ab - targets CD20 on B cell