Lymphomas Flashcards
What is lymphoma?
- malignant tumours of lymphoid origin which can arise anywhere lymphoid tissue is present
What are the two classifications of lymphomas?
- Hodgkin’s lymphoma
- Non-Hodgkin’s lymphoma
What is the epidemiology of lymphomas?
- more common in males
- age-dependent which varies with type
What is the lymphatic system?
- systemic network of various tissues, glands, organs and ducts
e. g. lymph nodes, bone marrow, spleen, liver - produces, stores and transports lymph
What is lymph?
- a portion of blood plasma separated from interstitial fluid
- contains waste from cell
- travels one-way toward the subclavian veins to be returned to the venous system
- lymph nodes treat and filter harmful entities
What are the similarities between HL and NHL?
- lymphocyte origin
- painless swelling of LNs
- can occur anywhere in the body but most frequently occur in LNs
- General symptoms of weight loss, fevers, night sweats
What is the orgin of HL?
- arise mostly from b-cells
- reed-sternberg cells
- distinct under light micro (enlarged, multi or bi-loaded nucleus)
What characterises HL?
- reed-sternberg cells
- two age groups (15-40; 55+)
- more often in upper body
- usually contiguous nodes
- rarely extra-nodal
- distinct type
What characterises NHL?
- risk increases with age (60+)
- no site predominance
- widely disseminated node groups
- common extra-nodal involvement (90% stage 3 or 4 include bone marrow involvement)
- more then 30 types
What is the aetiology of HL?
- genetic
- familial (siblings especially identical twins)
- socioeconomic status-higher
- environmental
- infections EBV, glandular fever, HIV
What are the histological subtypes of HL?
- lymphocyte predominant
- nodular sclerosis
- mixed cellularity
- lymphocyte depleted
What are the signs and symptoms of HL?
- lymphadenopathy (cervical and sup’clav, mediastinal)
- splenomegaly/abdo mass
- spread to contiguous nodes
- alcohol induced pain
- chest pain
- bronchial obstruction
- SVC obstrucion
SYSTEMIC - pruritus
- fatigue
- bone pain
Where does HL metasesis extranodally to?
- liver (20%)
- bone marrow (10%)
- bone (7%)
- lung (5%)
What is used to diagnose HL and NHL?
- biopsy
- physical exam
- full medical history
- chest x-ray/CT
- CT abdomen, pelvis
- FBC
- bone marrow biopsy
What is the staging of HL and NHL?
- stage 1: single lymph node group
- stage 2: multiple LNs on same side of diaphragm
- stage 3: multiple LNs on both sides of diaphragm
- stage 4: mutliple extranodal sites of Lns and extranodal disease
- stage 5: bulk>10cm
A/B - B symptoms: weight loss>10%, fever, drenching night sweats
What is the clinical management of HL?
- dependent on stage
- RT (highly radiosensitive)
- chemo
- combined modality
What is the clinical management of stage IA and IIA for HL?
- extended or involved field RT, salvage chemo
2. Extended field RT then 6 cycles of chemo
What is the clinical management of stage IIIA for HL?
- may apply TNI; however chemo alone is effective
- Chemo: Adriamycin, Bleomycin,
Vinblastine, & Dacarbazine
What is the clinical management of stage IIB, IIIB, IVB for HL?
CHEMO ABVD
- adriamycin
- bleomycin
- vinblasine
- dacarbazine
What is the RT fields used from HL?
- involved field: involved nodal group only
- extended field: mantle or inverted-Y
- total nodal irradiation (TNI): mantle + inverted-Y
What is the patient positioning for RT of HL?
- supine (or prone)
- arms by side
- handy on hips
- elbows flexed and supported mantle board
- vac bags
- lung shields
What is the RT dose for HL? (extended field following chemo)
- 35Gy in 20#
- 40Gy in25#
What is the RT dose for HL? (involved field)
early stage: 20Gy in 10f
advanced stage/post chemo: 30Gy in 15f
What is the RT dose for HL? (palliative/post relapse)
- 20GY in 5#
- 30Gy in 10#
- 8Gy in 1#
What is the RT acute side effects for HL?
size of volume:
- blood count
- fatigue (blood count)
location of volume:
- nausea, vomitting, diarrhoea
- alopecia
- erythema
What is the RT late side effects for HL?
- malignancy
- cardiac sequelae
- thyroid dysfunction
- radiation pneumonitis
- gonadal effects
What are some consideration of side effects for paediatrics?
- skeletal effects
- stertility
- many psychological
What is the aetiology of NHL?
- viral infection (EBV, HIV, Hep C)
- immunodeficiency (AIDS, transplant patients, coaeliac disease)
- environmental (peticide exposure)
What are the classifications of NHL?
B CELL
- low grade: follicular
- high grade: burkitts lymphoma
T-CELL
- low grade: mycosis fungoides
- high grade: large cell
What are the signs and symptoms of NHL?
- lymphadenopthy neck
- presenting symptoms may be due to compression
What is the common clinical management for an eldery with folicular lymphoma?
- watch and wait
What is the clinical management for stage I and II NHL?
- extended field RT
What is the clinical management for recurrent NHL?
- RT to chase the spread
- chemo + RT not as effective
What are the clinical management options for NHL?
- watchful waiting
- chemotherapy
- MAB therapy (monoclonal antibody)
- RT
- steroid therapy
- peripheral blood stem cell transplant
What are the common treatments for cutaneous T-cell NHL (mycosis fungoides)
- topical treatment (steroid creams; nitrogen mustard)
- widespread disease - psoralens and UV light or total body electrons
What is the RT dose of Stage I, IE, II, IIE NHL?
24-30Gy in 12-15f
What is the RT dose post chemo for NHL?
30Gy in 15f
What is the palliative RT dose for NHL?
- 20Gy in 5f
- 30Gy in 10f
- 4Gy in 2f
What is the dose for splenic irradiation?
10-12Gy in 0.5-1.5Gy/f up to 3f/week
