Lymphomas Flashcards
What are lymphomas?
This is a group of cancers that affect the lymphocytes inside thelymphatic system; these cancerous cells proliferate within thelymph nodes and cause the lymph nodes to become abnormally large (lymphadenopathy)
What are the 2 main classifications of lymphoma?
Hodgkin’s lymphoma
Non-Hodgkin’s lymphoma
How are lymphomas classified?
They are classified by the presence or absence of Reed-Sternberg cells (Hodgkins has these cells)
What is Hodgkin’s lymphoma?
A group of lymphomas caused by the proliferation of lymphocytes
They account for around 1/5th of all lymphomas
Describe the age distribution of Hodgkin’s lymphoma
There is abimodal age distribution with peaks around aged 20 and 75 years
What are some risk factors of Hodgkin’s lymphoma?
- Immunosuppression (e.g. HIV, inherited immunodeficiency states)
- Autoimmune disorders (e.g. rheumatoid arthritis, sarcoidosis)
- EBV
- Family history
What are the 2 main categories of Hodgkin lymphoma?
Classical
Nodular lymphocyte predominant
What is first line management of Hodgkin lymphoma?
Multi-agent chemotherapy
What chemotherapy agents are use din Hodgkin’s lymphoma?
ABVD:
- Adriamycin
- Bleomycin
- Vinblastine
- Dacarbazine
What is a possible risk factor of bleomycin?
Can cause pneumonitis
What are some risks of long-term chemotherapy in Hodgkin’s lymphoma?
Secondary cancers
Cardiovascular disease
Infertility
What is Non-Hodgkin’s lymphoma?
This is a group of lymphomas classified by the lack of Reed-Sternberg cells
This is the most common type of lymphoma
What are some risk factors for non-Hodgkin lymphoma?
- Infections (E.g. HIV, EBV, H. pylori)
- Hepatitis B or C infection
- Exposure to pesticides
- Exposure to trichloroethylene(used in several industrial processes)
- Family history
What are the 2 main classes of non-Hodgkin lymphoma?
B-cell lymphoma
T-cell lymphoma
What are some notable forms of non-Hodgkin lymphoma?
- Burkitt lymphoma
- MALT lymphoma
- Diffuse large B cell lymphoma
- Mantle cell lymphoma
- Marginal zone lymphoma
How does treatment differ between different grades of non-Hodgkin lymphoma?
Low grade B-cell NHL is a slow growing cancer, so chemotherapy cant cure it, as chemotherapy targets rapid proliferation and division, meaning it is incurable but manageable
High grade B-cell NHL is curable with chemotherapy, but effects the patient a lot due to its fast growing and highly aggressive nature
What are the main 2 first line treatment options in NHL?
- Multi-agent chemotherapy ± radiotherapy
- Monoclonal antibody therapy + chemotherapy
What chemotherapy agents are used in the treatment of NHL?
R-CHOP:
- Rituximab
- Cyclophosphamide
- Hydroxydaunorubicin (Doxorubicin)
- Oncovin®(Vincristine)
- Prednisolone
What is the purpose of steroids in the treatment of NHL?
They have a large effect on lymphocytes and are usually used in suspected lymphoma, prior to return of results (Take biopsy first however to avoid distorting results)
What is an example of a monoclonal antibody used in the treatment of NHL?
Rituximab (CD20 antibody used in B-cell lymphoma)
What are some viruses associated with Burkitt’s lymphoma formation?
EBV
Malaria
HIV
How do viruses cause Burkitt’s lymphoma?
Viral infection can cause DNA damage and thus genomic instability
How do MALT lymphomas affect the body
MALT lymphoma affects themucosa-associated lymphoid tissue, usually around thestomach - associated withH. pylori infection
How do diffuse large B-cell lymphomas usually present?
Rapidly growing painless mass in patients over 65 years
What are some symptoms of lymphoma?
- Lymphadenopathy
- Night sweats
- Weight loss
- Itch without a rash
- Alcohol induced pain (In regions of lymphadenopathy)
- Fatigue
How will lymph nodes usually feel in lymphoma?
Tender and rubbery
What are some tests used in lymphoma?
serum LDH
Lymph node biopsy with staining
CT, MRI and PET
ESR and Hb
How will LDH be affected in Hodgkin’s lymphoma?
It will be raised (Also raised in a number of diseases)
What will lymph node biopsy and staining show in Hodgkin’s lymphoma?
Reed-Sternberg cells (Abnormally large B-cells with multiple nuclei, containing nucleoli)
What staging system is used for Hodgkin’s lymphoma?
Ann-Arbor system (Stages I - IV)
