Lymphomas - Hodgkin's Lymphoma Flashcards
What is the definition of lymphoma?
Malignancies of the lymphoid system and hence may arise at any site where lymphoid tissue is present, including:
- Lymphadenopathy
- Extranodal
- Bone marrow
What are the main types of lymphoma?
- Hodgkin’s lymphoma
- Non-hodgkin’s lymphoma
What age group does Hodgkin’s Lymphoma normally occur in?
Bimodal age curve (Between ages 16 and 65):
- 15-35y - first peak
- 2nd peak later in life
What are the main lymphoid tissues?
- Lymph glands
- Adenoids
- Palatine tonsils
- Thymus
- Spleen
- Liver
What does Hodgkin’s lymphoma have an asscoiation with?
EBV - up to 40% have increased EBV antibody titres at the time of diagnosis and EBV DNA has been demonstrated in tissue from patients with HL
What are the subclassifications of Hodgkin’s Lymphoma?
- Classical Hodgkin’s lymphoma (cHL) - 90-95% of cases
- Nodular lymphocyte predominant HL (NLPHL)
What are the characteristic cells found in classical Hodgkin’s Lymphoma?
Reed-Sternberg Cells
What are the characteristic cells found in Nodular lymphocyte predominant HL?
Popcorn Cells
What are the following?
Reed-Sternberg Cells - malignant binucleate cells
What are the main groups of causes of cervical lymphadenopathy?
- Infection
- Autoimmune disease
- Drug reactions
- Primary malignancy
- Secondary Malignancy
- Miscellaneous
Why can Hodgkin’s Lymphoma produce an inflammatory picture on FBC?
Reed-Sternberg cells produce cytokines, which attracts inflammatory cells and creates an inflammatory environment
What are acute infections which can cause cervical lymphadenopathy?
- Pyogenic infections
- EBV
- CMV
- Cat Scratch fever
- Infected Eczema
What are chronic infections that can cause cervical lymphadenopathy?
- TB
- Syphilis
- HIV
What are autoimmune causes of cervical lymphadenopathy?
- Rheumatoid Arthritis
- Sarcoidosis
What can increase the risk of someone developing Hodgkin’s Lymphoma?
- Affected sibling
- EBV
- SLE
- Post-transplantation
- Obesity
What drug reactions can cause cervical lymphadenopathy?
Phenytoin
What primary malignancies can cause cervical lymphadenopathy?
- Hodgkin’s Lymphoma
- Non-Hodgkin’s Lymphoma
- CLL
- ALL
What secondary malignancies can cause cervical lymphadenopathy?
- Thyoid
- Laryngeal
- Lung
- Melanoma
- Breast
- Stomach
- Nasopharyngeal/Oropharyngeal
What mnemonic can you use to help you remember groups of causes for lymphadenopathy in general?
- Malignancy
- Infection
- Autoimmune
- Miscellaneous
- Iatrogenic
What are miscellaneous causes of cervical lymphadenopathy?
- Kawasaki disease
- Sarcoidosis
What are symptoms of Hodgkin’s Lymphoma?
- Swellings
- Fever
- Weight loss
- Night Sweats
- Pruritis
- Lethargy
What is characteristic of the swellings seen in Hodgkin’s Lymphoma?
- Painless
- Non-Tender
- Rubbery
- Superficial
Where does lymphadenopathy most commonly occur in Hodgkin’s Lymphoma?
- Cervical
- Axilla
- Inguinal nodes
What are signs of Hodgkin’s Lymphoma?
- Lymphadenopathy
- Cachexia
- Anaemia
- Splenomegaly
- Hepatomegaly
Why might someone with Hodgkin’s Lymphoma present with a cough?
Mediastinal lymphadenopathy
What can happen if someone with Hodgkin’s Lymphoma drinks alcohol?
Alcohol-induced lymph node pain
What is Pel-Ebstein fever?
Cyclical fever with long periods of normal or low temperature
How would you investigate if you suspected Hodgkin’s Lymphoma?
Investigations for diagnosis
- Bloods - FBC, Blood Film, ESR
- CXR
- CT Chest, Abdo, pelvis, neck
- PET +/- Bone Scan
- Fine Needle Aspiration - core biopsy
Why would you do a CXR when investigating suspected Lymphoma?
Look for mediastinal widening
What investigations would you do to prepare for treating lymphoma?
- Bloods - LFTs, U+E’s, Serum Biochemistry, Urate, LDH
- Virology - HIV, HBV, HCV
- Consider Cardiorespiratory Function Testing
- Consider Fertility testing
Why would you do a serum urate in someone with lymphoma?
Serum uric acid is helpful, particularly in those lymphomas in which there is risk of tumour lysis syndrome
Why is Serum LDH raised in Hodgkin’s lymphoma?
It is released during cell turnover
How would you manage someone with Hodgkin’s Lymphoma?
Based on staging
- Stage IA + IIA - radiotherapy and short courses of chemo
- Other Staging - longer courses of chemo
In relapsed disease
- High-dose chemo + Stem cell transplant
What chemotherapeutic regimen is most commonly used in Hodgkin’s Lymphoma?
ABVD
- Adreomycin (doxorubicin)
- Bleomycin
- Vinblastine
- Dacarbazine
2-4 cycles of ABVD in early/low risk disease + radiotherapy
6-8 cycles of ABVD in advanced disease + radiotherapy
What percentage of those treated with ‘ABVD’ are cured?
Approximately 80%
What staging system is used to stage Hodgkin’s Lymphoma?
Ann Arbor System
What would class as a stage I hodgkin’s lymphoma?
Confined to a single lymph node
What would class as Stage II hodgkin’s lymphoma?
Involvement of two or more nodal areas on the same side of the diaphragm
What would class as stage III Hodgkin’s Lymphoma?
Involvement of nodes on both sides of the diaphragm
What would class as stage IV Hodgkin’s Lymphoma?
Spread beyond the lymph nodes - e.g. liver, bone
What are complications of treatment of Hodgkin’s Lymphoma?
- Second malignancy - lung, breast, melanoma, sarcoma, stomach, thyroid
- Ischaemic heart disease
- Hypothyroidism
- Lung fibrosis
- Peipheral neuropathy
What are side effects to chemotherapy?
- Myelosuppression
- Nausea
- Alopecia
- Infection
- AML
- Non-hodgkin’s Lymphoma
- Infertility
What are emergency presentations that can occur in Hodgkin’s lymphoma?
- Infection
- SVC obstruction
What are features of SVC obstruction?
- Increased JVP
- Sensation of fullness in the head
- Dyspnoea
- Blackouts
- Facial Oedema
When staging hodgkin’s Lymphoma, what do A and B stand for?
- A - no systemic symptoms
- B - presence of b symptoms
What are B symptoms?
- Weight loss > 10% in last 6 months
- Unexplained fever > 38oC
- Neight sweats (needing change of clothes)
- Pruritis
What classification of Classcial hodgkin’s lymphoma has a poor prognosis?
Lymphocyte deplete classical hodgkin’s lymphoma
