Lymphomas

Question 1

What are B symptoms?

Answer 1

Weight loss (>10% of body weight)
Fever (>38C)
Night sweats

Question 2

How is lymphoma diagnosed?

Answer 2

Excisional lymph node biopsy

Fine needle aspirate is not appropriate for diagnosing lymphoproliferative disorders

Question 3

What is pathognomonic for Hodgkin’s lymphoma on peripheral blood film?

Answer 3

Reed Sternberg Cells (owl’s eyes)

Question 4

What virus is Hodgkin’s lymphoma associated with?

Answer 4

Epstein-Barr virus (EBV)

Question 5

At what age does Hodgkin’s lymphoma present?

Answer 5

Bi-modal distribution

20’s and 50’s

Question 6

How does Hodgkin’s lymphoma usually present?

Answer 6

Asymptomatic lymphadenopathy in 1 LN region (often cervical), contiguous spread

LNs are painless/non-tender, rubbery

Question 7

What is the prognosis for Hodgkin’s lymphoma?

Answer 7

Very good, treatable and curable disease

Question 8

What type of cells does Hodgkin’s Lymphoma arise from?

Answer 8

B lymphocytes

Question 9

What types of cells do non-Hodgkin’s Lymphomas arise from?

Answer 9

B or T lymphocytes

Question 10

How do non-Hodgkin’s lymphomas tend to present in general?

Answer 10

WIDESPREAD, painless, non-tender lymphadenopathy

Unlike Hodgkin’s lymphoma, which arises from one lymph node region and spreads contiguously

Question 11

What are the 3 main histological variants of Non-Hodgkin’s lymphomas?

Answer 11

Indolent (follicular)
Aggressive (diffuse, large B-cell)
Highly aggressive (Burkitt's)

Question 12

What are typical of lymph nodes in indolent/follicular non-Hodgkin’s lymphomas?

Answer 12

Slow growing, wax and wane

Question 13

What is the prognosis of indolent (follicular) non-Hodgkin’s lymphoma?

Answer 13

If stage I or II, radiotherapy with curative intent

Incurable if stage III or IV, radiotherapy for symptom control

Question 14

What is the prognosis of intermediate/aggressive (diffuse large B cell) non-hodgkin’s lymphomas?

Answer 14

Short survival of months if untreated
Most patients symptomatic at time of presentation
Chemotherapy aimed at cure

Question 15

What is the prognosis of high grade/highly aggressive/Burkitt’s NHL?

Answer 15

Untreated survival time measured in weeks

Can be cured with aggressive inpatient chemotherapy

Question 16

How is a bone marrow aspirate/biopsy useful in staging lymphoma?

Answer 16

Bone marrow involvement = stage IV

Question 17

Risk factors for lymphoma?

Answer 17

Organ transplant
Viruses (HIV, Hep C, HTLV-1)
EBV (history of mononucleosis)
Bacterial infections (H. pylori)
Autoimmune (Sjogren's, Celiac, Crohn's)
Immunosuppression (MTX, anti-TNF)

Question 18

What is Ann Arbour Staging?

Answer 18

I: single LN region or extralymphatic organ/site
II: 2+ affected regions (LNs or extralymphatic site) on SAME SIDE of diaphragm
III: involvement of LNs and regions on both sides of diaphragm including 1 extralymphatic site or spleen involvement
IV: diffuse involvement of one ore more extralymphatic organs (e.g. bone marrow)

Question 19

When is observation/watchful waiting appropriate for lymphoma treatment?

Answer 19

Low grade lymphomas

Offer treatment only when necessary for symptom control

Question 20

How is chemotherapy used in lymphoma treatment?

Answer 20

Single agent for indolent lymphomas for symptom control

Multi-agent chemo for more aggressive lymphomas often with intent to cure

Question 21

How is radiation therapy used in lymphoma treatment

Answer 21

For localized disease either as standalone treatment or following chemotherapy

Can also be used in palliative setting for symptom control when chemotherapy has failed

Question 22

What is Rituximab?

Answer 22

Monoclonal antibodies against tumour cell surface antigens, leading to an immune mediated response against tumour cells