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Heme > Lymphomas > Flashcards

Lymphomas Flashcards

1
Q

How do lymphomas begin?

A

by the “malignant transformation” of a lymphocyte in the lymphatic system

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2
Q

What is the cause of follicular lymphoma?

A

overexpression of BCL-2 (gene that blocks programmed cell death)

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3
Q

Where does it start?
Lymphoma
Leukemia

A

Lymphoma- starts in the lymph nodes or lymphatic system

Leukemia- tumor or cancer of blood cells or bone marrow

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4
Q

MOA
Lymphoma
Leukemia

A

Lymphoma invades other organs by unnecessary and uncontrollable growth of a lymphoid tissue

Leukemia produces abnormal white blood cells which inhibits the function of the immune system and platelet function

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5
Q

How does each present?
Lymphoma
Leukemia

A

Lymphomas- present with signs of swollen lymph nodes in the neck, armpits, or groin which are frequently painful

Leukemia-have sx typical of other cancers and may have no early telling symptoms, especially if chronic

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6
Q 
Hodgkin Lymphoma
Incidence
characterized by
who gets this (incidence)
How does it spread? (orderly vs. not)
Involves what cells
A

Incidence- 1% of cancers, 11% of lymphomas

characterized by- Reed-sternberg cells

who gets this (incidence)-bimodal, young adults and elderly

How does it spread? (orderly vs. not)- Orderly

Involves what cells- abnormal B cells

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7
Q

Types of HL

A 
Nodular sclerosis (60-75%) **predominant
Mixed cellularity (5-15%)
Lymphocyte rich (5%)
Lymphocyte depletion (5%)
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8
Q 
Non-Hodgkin Lymphoma
Incidence
characterized by
who gets this (incidence)
How does it spread? (orderly vs. not)
Involves what cells
A

Incidence- 4% cancers, 89% lymphomas

characterized by- Nothing special. This just includes anything without the Reed-Sternberg cells.

who gets this (incidence)- adults, ~60yo

How does it spread? (orderly vs. not)- Disorderly fashion

Involves what cells- abnormal B cells (most common) or T cells

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9
Q

Types of Non-hodgkin lymphoma

A

Over 60 different types

Indolent
-follicular lymphoma
-MALT lymphoma
Agressive
-diffuse large B-cell lymphoma
-AIDS-associated lymphoma
-Burkitt's lymphoma
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10
Q

Symptoms of HL

A
  • Painless enlargement of lymph nodes, slow growth usually
  • swelling from edema
  • SOB, fatigue
  • weight loss, muscle weakness
  • Pel-Ebstein fever (very variable fever), night sweats
  • Increased susceptibility to infections
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11
Q

Symptoms of NHL

A
  • RAPID, painless enlargement of lymph nodes
  • progressive swelling of legs, swelling of face
  • pale skin or dark, itchy patches of skin
  • difficulty breathing, chest pain
  • pleural effusion, causing persistent cough
  • bloating, cramping, diarrhea (MALT)
  • abd pain or distention, constipation
  • fever, weight loss
  • increased susceptibility to infections
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12
Q

What is the Ann Arbor system used for?

A

Staging of lymphoma

  • classifies tumors into categories based on where the tumor is present
  • useful in determining specific treatments, prognosis
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13
Q

Diagnostic testing for lymphomas

A
  • CXR
  • CT scans*
  • Bone marrow aspiration/biopsy*
  • PET scan
  • Gallium scan
  • MRI
  • Lumbar puncture
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14
Q

Ann Arbor Staging System
staging and site involvement
sub staging and description

A

Stage 1- single LN region or extralymp organ or site
Stage 2- Cancer in 2 or more groups of LN on same side of diaphragm
Stage 3- Caner in groups of LN both above and below diaphragm
Stage 4- Cancer has spread to one or more organ or tissure site

A- No systemic symptoms present at dx
B- fever, night sweats, weight loss
E (extranodal)-cancer in an area or organ other than LN
S (spleen)- Cancer spread present in the spleen

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15
Q

When is Grading used?

A

in NHL

-describes how quickly how quickly cancer is growing

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16
Q

Grading

grade and description

A

Low- slow growing, incurable (follicular, waldenstroms)
Intermediate- rapid growing, potentially curable
High-fastest growing, potentially curable (Burkitt’s lymphoma)

can also use
Indolent-grow very slowly, need little or no treatment until sx appear. tend to recur after treatment
Aggressive-grow quickly, symptomatic and tx required immediately, can be treated with intense chemo

17
Q

Risk factors for HL

A
  • h/o mononucleosis increases risk of young-adult HL

- sibling dx w/HL

18
Q

Risk factors for NHL

A
  • Toxic compounds in atmosphere
  • EBV after organ transplant
  • h. pylori can cause MALT lymphoma
  • other viruses such as Hep C
  • Genetic predisposition
19
Q

Risk factors for both HL and NHL

A
  • HIV
  • AIDS
  • HTLV (human T-cell virus)
  • Suppressed immune function
  • S. japan, caribbean, S. America, Africa
20
Q

Clinical features of HL

A
  • Asymptomatic lymphadenopathy (70%)
  • Splenomegaly
  • systemic symptoms: B symptoms- fever, puritis, night sweats
  • Non-specific: alcohol induced pain in nodes, nephrotic syndrome
  • disease spread in contiguity with lymph system
21
Q

What would the results of a HL CBC be?

A

anemia, eosinophilia, leukocytosis, platelets increased the decreased in advanced disease

22
Q

What would you order for HL (labs and diagnostic)?

A
  • CBC
  • LFT, ESR, LDH
  • CXR, CT
  • Cardiac function assessment
  • excisional lymph biopsy confirms dx
  • bone marrow bx (if B sx present)
23
Q

Stage is often more important than the type for prognosis. True or false

A

True

24
Q

What do the Reed-Sternberg cells look like and what disease might they be present in?

A

“Owl eyes” and HL

25
Q

HL treatment methods

A
  • surgery
  • radiation
  • chemo
  • biotherapy
  • peripheral blood stem cell transplant (PBSCT)
26
Q

Treatment HL
Stage 1-2
Stage 3-4
Relapse after tx

A

Stage 1-2: chemo followed by XRT
Stage 3-4:Chemo wiith XRT for bulky disease
Relapse after tx: high dose chemo, bone marrow transplant, -PET to follow up tx response

27
Q

HL treatment complications

A
  • cardiac disease and hypothyroidism post XRT
  • Pulmonary disease
  • Infertility (2ndary to damage)
  • secondary malignancy
28
Q

What is the most common hematological cancer?

A

Non-hodgkin’s lymphoma (malignant proliferation of lymphoid cells of progenitor or mature b/t cells)

-distinguished from HL by proliferation of only malignant B-cell

29
Q

Types of NHL neoplasms

A

B-cell

  • Precoursor
  • Mature (Hairy cell leukemia)

T-cell

  • Precoursor
  • Mature
30
Q

Adult risk factors of NHL

A
  • being older, male
  • autoimmune disease
  • HIV/AIDS
  • other viruses
  • h. pylori
  • long term use of immunosuppressant drugs
  • pesticides
  • past treatment for hodgkin’s lymphoma or with radiation
31
Q

NHL Clinical features

A
  • Painless superficial LAD
  • widespread disease
  • constitutional symptoms uncommon
  • cytopenia (anemia, neutro, thrombocytopenia) with bone marrow involvement
  • abdominal signs: hepatosplenmegaly, retropertoneal and mesenteric involvement
  • sore throat and obstructive apnea
  • CNS involvement in HIV pts
32
Q

What is essential for diagnosing NHL?

A

lymph node bx

33
Q

What is the diagnostic process for NHL

A
  • Biospy**
  • CBC (normocytic, normochromic anemia, autoimmune hemolytic anemia, thrombocytopenia, neutropenia)
  • Uric acid (elevated), LDH- poor prognosis, LFTs abnormal)
  • CXR, CT chest, abdomen, pelvis
  • gallium scan (monitor response to tx)
34
Q

NHL Tx

A
  • follow up frequently
  • CD20 (Rituximab) (new biotherapy)
  • autologous or allogeneic transplantation
  • totaly nodal irradiation

-everyone gets chemo. Burkitt lymphoma is 90% chemo.

35
Q

NHL
complications
prognosis

A

complications

  • hypersplenism
  • infection
  • autoimmune hemolytic anemia and thrombocytopenia
  • vascular obstructions
  • tumor lysis syndrome (aggressive lymphoma)

Prognosis
-diffuse B cell lymphoma… 5 year survival (25-73%)

36
Q

Which virus is a member of the herpes family, infects B cells and epithelial cells of the oropharynx, and causes a positive heterophil rxn?

A

EBV

37
Q

What disease would you suspect if you saw a histologic section with numerous mfgs that have a “starry sky” appearance?

A

Burkitt lymphoma

38
Q

NHL associated conditions

A 
immunodeficiency (HIV)
autoimmune disease (SLE)
infections (EBV)

Heme (13 decks)

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