NHL and Hodgkin Lymphoma Flashcards
what is Hodgkin Lymphoma?
malignant proliferation of B cells in the LN
what is non-Hodgkin Lymphoma?
malignant proliferation of lymphoid cells (progenitor or mature B or T cells) in LN or extranodal areas
the two subtypes of hodgkin lymphoma are
- Classical HL
- Nodular lymphocyte predominant HL
3 common aggressive subtypes of non-hodgkin lymphoma include
- diffuse B cell lymphoma
- Burkitt’s lymphoma
- mantle cell lymphoma
3 examples of indolent non-hodgkin lymphoma include
- follicular lymphoma
- marginal zona lymphoma (MALT)
- lymphoplasmacytic lymphoma (Waldenstrom)
____-______ cells are pathognomonic for classical HL
Reed-Sternberg
large, mutlinucleated cell w/ two mirror-image nuclei (owl eyes) within a reactive cellular background
B-symptoms are classically found in _____ and include ____, _____, and _________
lymphomas
fever, drenching night sweats, and loss of >10% of body weight over 6M
compare the epi for hodgkin lymphoma to non-hodgkin lymphoma
incidence: NHL > HL
poor prognosis: NHL > HL (bc HL is localized vs NHL can be diffuse)
overall: males > females
HL = bimodal age distribution (20-40 and then 55+)
NHL: >50Y
RF for non-hodgkin lymphoma
- EBV ➔ Burkitt’s lymphoma ➔ masses in African children jaws
- viruses like HTLV-1 (bc CLL can transform into NHL)
- Richter’s transformation
- autoimmune conditions (RA, SLE)
- H. pylori infection ➔ esp for MALT NHL subtypes
- environmental exposures: pesticides, lead, asbestos
- prev chemo or radiation
RF for hodgkin lymphoma
- EBV
- immunocompromised state (HIV, organ transplant) ➔ makes sense bc this is a cancer where B cells are non functional
- autoimmune diseases (RA) ➔ as your immune system is already dysfunctional and attacking self-cells
- family history of HL
pathophys of Hodgkin lymphoma
- genetic mutation within the lymphocyte
- improper cell division resulting in the formation of Reed-Sternberg cells
- Reed-Sternberg cells release cytokines and attract inflammatory mediators within the LN
- growth of these atypical cells within the LN w/a reactive “WBCs” background ➔ make up the bulk of the tumour in the LN
- these tumors/RS accumulations can then spread to adjacent areas (lymph tissue or LN)
pathophys of general non-hodgkin lymphoma
- genetic mutation resulting in the proliferation of nonfunctional B/T or NK cells
- accumulate in lymphoid tissue ➔ LN, MALT, spleen
- can spread to any lymphoid tissue no matter where it starts ➔ can metastasize to extra nodal tissues
B symptoms are more common in ______ lymphoma than ____________ lyphoma
hodgkin lymphoma
non-hodgkin lymphoma
what key s/s would be present in hodgkin lymphoma
- contiguous LAD ➔ typically above hte diaphragm
- alcohol induced painful LAD
- chronic pruritus
- Pel-Ebstein fever: cyclic fevers that rise and fall every 1-2 weeks
mass effect of large mediastinal LN ➔ dyspnea, chest pain, SVC syndrome
what key s/s would be present in non-hodgkin lymphoma? indolent vs aggressive
in indolent
- waxing and waning of LAD
in aggressive
extranodal involvement
- GI: N/V, anorexia, abdo pain, constipation, GI hemorrhage, obstruction
- CNS: headache, lethargy, seizures, paralysis, spinal cord compression
- skin: pruritis
- BM: pancytopenia, and bone pain
- mediastinal involvement: persistent cough, chest pain, SVC syndrome
- CNS
how to dx hodgkin and non-hodgkin lymphoma?
definitive dx:
- LN biopsy w/ flow cytometry and histological analysis
what ix would you do to work up a lymphoma?
Bloodwork
- CBC with diff ➔ may see pancytopenia
- LDH ➔ correlates with the bulk of disease
- kidney function and lytes
- liver function
Imaging
- can complete U/S, CXR, CT CAP or PET to help assess LAD extent and disease spread/extranodal involvement in NHL
Procedures
In NHL – evaluate potential extranodal involvement
- LP for CSF analysis ➔ look for atypical cells
- endoscopy ➔ biopsy and visualization for potential GI involvement
- BM aspiration and biopsy
how to treat hodgkin lymphoma?
ABVD regimen + local radiation
- antitumour abx
- MT inhibitor (vinca alkaloid)
- alkylating agent
consider local resection if not spread – refer to surg onc
consider autologous stem cell transplant or clinical trials
how to tx non-hodgkin lymphoma
indolent - watchful waiting +/- regional radiation
R-CHOP for aggressive
- immunotherapy – rituximab
- antimetabolite
- antitumour abx
- MT inhibitor
- steroid
consider CNS prophylaxis w/ intrathecal mxt
consider autologous stem cell transplant for recurrent or refractory cases
what cx are we considered with for lymphomas?
- infertility post tx
- chemotherapy toxicities - heart
- secondary leukemia bc of the alkylating agents (AML or myelodysplastic syndrome)
- secondary cancers – most common is lung cancer
