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BREAST CANCER > LYMPHORETICULAR CANCERS > Flashcards

LYMPHORETICULAR CANCERS Flashcards

1
Q

What is the etiology of Hodgkin’s lymphoma?

A

No known main cause of HL, only some factors

-Epstein-Barr virus may play a role in some cases as its genome is present in Reed-Sternberg cells DNA

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2
Q

What is the epidemiology of Hodgkin’s lymphoma?

A
  • F
  • 50% of cases Affect < 40 yrs old, but rare < 10 yrs, median age 38
  • more common in developed countries than in non-developed countries
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3
Q

What is the main characteristic of Hodgkin’s lymphoma that distinguish it from lymphomas and leukemias?

A

-presence of Reed-Sternberg cells, which are giant connective tissue cell with 1 or 2 large nuclei

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4
Q

What are the prognostic factors of Hodgkin’s lymphoma?

A

-stage of Hodgkin’s lymphoma has the greatest effect on prognosis
-Gender, as male prognosis is worse and more common. It also defines the choice of treatment as can cause toxicities to reproductive system
-Youth is a favorable prognostic factor
-extend of disease
-B symptoms
-number of sites involved
-

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5
Q

What are the organs involved in Hodgkin’s lymphoma?

A

-Waldeyer’s ring
-Thymus
-Spleen
-
-

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6
Q

What are the function of the thymus and the spleen?

A

Thymus consists of thymocytes, lymphocytes remaining inactive, and dv

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7
Q

What is the most common clinical presentation of Hodgkin’s lymphoma?

A

-Painless mass near neck or supraclavicular region
-Mediastinal mass on chest X-ray commonly above the diaphragm
-B symptoms:
Unexplained fevers
Drenching night sweats
Weight loss 10% in 6 months
Pruritis, severe itching
Alcohol induced pain

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8
Q

What are the diagnostic and detection tools for Hodgkin’s lymphoma?

A
  • complete history
  • physical examination
  • CBC
  • liver tests
  • thyroid function tests
  • chest x-ray
  • CT
  • MRI
  • PET/CT
  • bone marrow biopsy (5% of cases)
  • liver biopsy
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9
Q

What is the most common histopathology for Hodgkin’s lymphoma?

A

There is 2 categories:
-nodular lymphocyte predominant Hodgkin’s lymphoma (NLPHL)

-classic Hodgkin’s lymphoma (CHL)
Lymphocyte rich Hodgkin’s lymphoma (LRHL)
Nodular sclerosing Hodgkin’s lymphoma (NSHL)
Mixed cellularity Hodgkin’s lymphoma (MCHL)
Lymphocyte depleted Hodgkin’s lymphoma (LDGL)

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10
Q

What are the characteristics of NLPHL?

A

.

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11
Q

What are the characteristics of CHL?

A

.

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12
Q

What are the characteristics of LRHL?

A

.

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13
Q

What are the characteristics of NSHL?

A

.

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14
Q

What are the characteristics of MCHL?

A

.

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15
Q

What are the characteristics of LDHL?

A

.

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16
Q

Whats is the staging system for Hodgkin’s lymphoma?

A

The Ann Arbor staging system is used.

17
Q

What are the routes of spread of Hodgkin’s lymphoma?

A

It has a predictable pattern and in 90% of patients have a contiguous spread.
The cancer spreading to the adjacent nodes or region.
Spread to viscera occurs after adjacent lymph nodes, followed by the spread to the spleen in late stages.

Liver and bone marrow risk increased with splenic involvement.

Hodgkin’s can also spread to lung and skeletal system.

18
Q

What are the treatment techniques for Hodgkin’s lymphoma stage 1 and 2?

A

Stage 1 and 2:
Before 1960s
Total nodal irradiation, Dose: 35 to 44 Gy using 6 MV photons
ANT and POST supra diaphragmatic mantle field + sub diaphragmatic field
Treated with a break to let the patient to recover from side effects of radiation treatment.
extended field irradiation
ANT and POST supra diaphragmatic mantle field + sub diaphragmatic field + Inverted Y
+ Chemotherapy used as salvage therapy in case of recurrence

Today’s treatment of choice:
Chemotherapy because Radiation for younger than 40< is not good due to its risk of second solid malignancy in the lung, GI tract and breast.

Chemotherapy Regimen: ABVD (Adriamycin, Bleomycin, Vincristine and Dacarbazine)
+/- Radiation Therapy (30-36 Gy = involved-field irradiation, as the minimum field size used.

19
Q

What are the treatment techniques for Hodgkin’s lymphoma stage 3 and 4?

A

Stages 3A, 3B and 4
treated with Chemotherapy +/- Radiation Therapy (which lowers local relapse, debatable)
So only Stage 3 with bulky disease recommended Chemotherapy + Radiation
Stage 4 Chemotherapy only

Chemotherapy Regimen ABVD (Adriamycin, Bleomycin, Vincristine, Dacabazine)

20
Q

What are lymph nodes involved in a Mantle field?

A

Mantle field includes these lymph nodes:

  • submandibular
  • occipital
  • cervical
  • supraclavicular
  • infraclavicular
  • axillary
  • hilar
  • mediastinal

Position of treatment:

  • Supine
  • Akimbo
  • Chin extended to prevent mouth exposure
21
Q

What are the Mantle field limits?

A 
Remember there's a ANT and POST mantle field.
ANT: 
superior border is the inferior part of mandible
inferior border is T10
Lateral border includes axillary nodes
POST: 
superior border includes occipital nodes
inferior border is T10
Lateral border includes axillary nodes

Shielding blocks to:

  • healthy lung on ANT and POST although some lung must be treated at mediastinal and hilar
  • Humeral heads to be blocked to prevent future bone destruction
  • Larynx must be shielded on ANT
  • spinal cord must be shielded on POST, starting at 40Gy unless otherwise indicated
22
Q

What are the lymph nodes involved in a sub diaphragmatic field?

A
  • Para-aortic nodes

- Spleen or splenic pedicle

23
Q

What are the subdiaphragmatic field limits?

A

Superior border is defined with the mantle inferior border as a gap is used to avoid overdosing to spinal cord.
Inferior border is L4-L5

Shielding blocks:

  • liver
  • kidneys
  • bone marrow
  • reproductive organs

Oophorexy, ovaries clipped behind uterus, reduces risk of infertility
A midline block of 10 HVL can be used to shield gonads. No special shielding for males.

24
Q

What are the lymph nodes involved in a total-nodal irradiation field?

A

Mantle field + subdiaphragmatic + Inverted Y field
Inverted Y field includes these lymph nodes:
-retroperitoneal
-common iliac
-inguinal

25
Q

What is the treatment regimen for Pediatric cases of Hodgkin’s lymphoma?

A
  • Chemotherapy + Radiation
  • MOPP/ABVD + Involved-field radiation 15-25 cGy
  • reduced cytoxic chemotherapy drugs and smaller volumes of radiation
26
Q

What are the side effects of radiation treatment for Hodgkin’s lymphoma?

A

Acute side effects are dependent on fields size. Para-aortic and mantle fields

  • Fatigue
  • Occipital alopecia
  • Skin erythema
  • Esophagitis
  • Altered taste
  • Transient dysphagia
  • Dry cough
  • Nausea
  • Occasional vomiting
  • Diarrhea (rare)

Chronic side effects depend on treatment technique, dose and irradiated volumes. Mantle-field

  • Mild radiation pneumonitis (after 6-12 weeks after tx)
  • Hypothyroidism (33% of cases)
  • Herpes zoster
  • Transient xerostomia
  • Increased dental caries
  • Radiation Carditis (s previously.

*MOPP, not ABVD chemotherapy causes sterility in men.

27
Q

What are the 5-year survival rates for Hodgkin’s lymphoma?

A

.

28
Q

What are the main differences of non-Hodgkin;s lymphoma vs Hodgkin’s lymphoma?

A

NHL:

  • primarily in older patient
  • median age 67 yrs
  • can originate in lymph node or extranodal tissue.
  • spreads RANDOMLY, no predictable pattern of spread
  • multiple sites often involved, extra nodal lesions very common
  • the prognosis is strongly dependent on specific histology
  • NHL encompasses a wide variety of diseases.
29
Q

What is the epidemiology of NHL?

A
  • slight M > F predominance
  • median age is 67 yrs, 50% of NHL patients are >60 yrs
  • peek in 80-84 yrs
  • Lymphoma is 3rd most common childhood malignancy (10% of childhood cancers)
  • NHL accounts for 66% of all child lymphoma
30
Q

What is the etiology of NHL?

A
  • IMMUNOSUPPRESSION
  • Exposure to particular infectious agents
  • reduced immune function
  • Burkitt’s lymphoma is caused by EBV
  • T cell leukemia/lymphoma is associated with T cell leukemia/lymphoma virus (HTLV-1)
  • AIDS increases by 165% the risk of NHL 3.5 yrs after AIDS diagnosis.
  • heart and kidney transplant increases risk for NHL.
  • ionizing radiation increases risk of developing lymphomas.
  • Chemotherapy increases risk of developing NHL (20x for MOPP regimen for HL patients)
  • phenytoin used to control seizures
  • herbicides in agricultural workers
  • solvents and vinyl chloride for industrial workers
  • recreational drug use
  • trans-unsaturated fats high diet intake in women
31
Q

What are the clinical presentation for NHL?

A

similar to HL:

  • enlarged lymph nodes
  • fever
  • night sweats
  • fatigue
  • itching

BREAST CANCER (9 decks)

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