Lymphomas Flashcards
What is Lymphoma?
Lymphomas are cancers that begin by the “malignant transformation” of a lymphocyte in the lymphatic system
Many lymphomas are known to be due to specific genetic mutations
Follicular lymphoma due to overexpression of BCL-2 (gene that blocks programmed cell death)
Multipotential myeloid cells differentiate into
red cells basophils
neutrophils monocytes
eosinophils platelets
Multipotential lymphocytic cells differentiate into
T lymphocytes
B lymphocytes
Natural Killer Cells
Stage 1 of Lymphoma(Ann Arbor Staging System)
Single LN region or extra lymphatic organ or site
Stage 2 of Lymphoma(Ann Arbor Staging System)
Cancer in 2 or more LN groups on the SAME side of the diaphragm
Stage 3 of Lymphoma(Ann Arbor Staging System)
Cancer in groups on BOTH sides of both above and below the diaphragm
Stage 4 of Lymphoma(Ann Arbor Staging System)
Cancer has spread to one or more organ or tissues
Sub-stages of Lymphoma A
No systemic symptoms present at diagnosis (B-Symptoms absent)
Sub-stages of Lymphoma B
B-symptoms are present (fever, night sweats, weight loss)
Sub-stages of Lymphoma E
Cancer in an area or organ other than LN or spread to tissues outside the lymphatic system
Sub-stages of Lymphoma S
Cancer spread present in the spleen
Grading Low
slow growing, incurable. Follicular, small lymphocytic, Waldenstrom’s
Grading Intermediate
rapid growing, potentially curable.
Diffuse large B cell, mantle cell, anapestic large (T cell) NHL
Grading High
fastest growing, potentially curable.
Burkitt’s lymphoma, lymphoblastic lymphoma
Grading Indolent
Grow very slowly, need little or no treatment until symptoms appear. Tend to reoccur after treatment
Grading Aggressive
Grow quickly, symptomatic and treatment required immediately. Can be treated with intense chemotherapy.
Hodgkin’s Lymphoma Clinical Features
Asymptomatic lymphadenopathy (70%)
Splenomegaly
Systemic symptoms: B symptoms – fever, pruritus, night sweats
Non-specific: alcohol induced pain in nodes, nephrotic syndrome
Disease spread in contiguity with lymphatic system
NON-HODGKIN’S LYMPHOMA
Malignant proliferation of lymphoid cells of progenitor or mature B/T cells
Most common hematological cancer
85 % of all NHL are B-cell lymphomas
Distinguished from HL by proliferation of only malignant B-cells (rarely, T-cells)
Lymphoma Take home points
To diagnose lymphoma, a lymph node biopsy is required
Hodgkin’s is distinguished from non-Hodgkin’s lymphoma by the presence of Reed-Sternberg cells
Classical presentation of HL: painless, non-tender, firm, rubbery enlargement of superficial LN, most often in cervical nodes.
NHL associated conditions: Immunodeficiency (e.g. HIV), Autoimmune disease (e.g. SLE), infections (e.g. EBV)
Tx of HL depends on stage; treatment of NHL depends on histological sub-type