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Oncology > Non-Hodgkin's lymphoma > Flashcards

Non-Hodgkin's lymphoma Flashcards

1
Q

what is it?

A

cancer of lymph organs with non reed-sternberg cells

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2
Q

origin

A

B cells, NK cells or T cells

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3
Q

how many subtypes?

A

60

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4
Q

what are the most common origins?

A

B cell

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5
Q

who is most affected?

A

males
prevalence increases with age
most diagnosed after 55 - 80-84 are most commonly affected group
but one of the more common cancers in younger people

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6
Q

presentation

A

depends on type and grade

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7
Q

general clinical features

A 
lymphadenopathy
fever 
night sweats
weight loss 
pruritus 
splenomegaly
hepatomegaly 
ranges from dermatological conditions to bowel obstruction to SVC obstruction
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8
Q

high grade and aggressive symptoms

A 
rapidly enlarging mass
malaise 
weight loss 
fevers 
night sweats
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9
Q

low grade symptoms

A

gradual lymphadenopathy
malaise
marrow involvement signs

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10
Q

extra-nodal lymphoma

A

primary CNS, cutaneous and GI tract lymphomas

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11
Q

primary CNS lymphoma

A 
neurological features 
headache 
confusion 
seizures 
coma
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12
Q

primary cutaneous lymphoma

A

rashes
plaques
ulcers
mycosis fungoides = cutaneous T cell lymphoma

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13
Q

primary GI tract lymphoma

A

abdominal pain
nausea
obstruction
haemorrhage

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14
Q

oncological emergencies

A 
superior vena cava obstruction 
cord compression
hypercalcaemia
tumour lysis syndrome 
neutropenic sepsis
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15
Q

investigations

A 
excision biopsy
FBC
U&Es
LFTs
ESR
bone profile
LDH
uric acid
HIV
Hep B
Hep C
CXR
CT
PET CT
MRI
USS
bone scan 
bone marrow aspirate and biopsy 
lumbar puncture 
fluorescence in situ hybridisation
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16
Q

excision biopsy

A

fine needle aspiration is not appropriate and core biopsy is inferior to excisional biopsy

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17
Q

CT

A

of neck, chest, abdomen and pelvis to assess and identify enlarged nodes, liver, spleen and soft tissue masses

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18
Q

what is PET CT for?

A

staging and assessing treatment response

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19
Q

what is MRI used for?

A

brain when suspicion of leptomeningeal infiltration or mass lesions

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20
Q

what is USS for?

A

testicles to identify testicular lymphoma

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21
Q

when is lumbar puncture done?

A

if suspected CNS disease
cytology
flow cytometry

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22
Q

what is fluorescence in situ hybridisation for?

A

to identify MYC rearrangement in high grade B cell lymphoma

if found further testing to identify BCL2 and BCL6 rearrangements and immunoglobulin partner arranged

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23
Q

what is the staging?

A

Lugano

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24
Q

Lugano staging

A

describes anatomical distribution of disease
important for prognostic and therapeutic importance
modified by presence or absence of B symptoms, extranodal involvement and bulky disease

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25
Q

what are the categories in Lugano staging?

A

limited
stage II bulky disease
advanced

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26
Q

limited disease stages

A

I and II

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27
Q

stage II bulky disease

A

stage II with bulky disease

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28
Q

what is bulky disease

A

disease >10cm

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29
Q

advanced disease stages

A

Stage III and IV

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30
Q

stage I

A

1 node or group of adjacent nodes, single extra-nodal lesion without nodal involvement

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31
Q

stage II

A

2 or more nodal groups on same side of diaphragm

stage I or II by nodal extent with limited contiguous extra-nodal involvement

32
Q

stage III

A

nodes on both sides of diaphragm, nodes above diaphragm with spleen involvement

33
Q

stage IV

A

additional non-contiguous extra-lymphatic involvement

34
Q

treatment

A

chemotherapy

35
Q

chemotherapy

A

R-CHOP

36
Q

R-CHOP

A 
Rituximab
Cyclophosphamide 
Doxorubicin 
Vincristine 
Prednisolone
37
Q

Rituximab

A

monoclonal antibody with activity against CD20 which is on surface of B cells

38
Q

side effects of Rituximab

A

infusion reactions
hepatitis B reactivation
mucocutaneous reactions
progressive multifocal leukoencephalopathy

39
Q

Cyclophosphamide

A

alkylating agent
inhibits DNA synthesis through cross linking
carcinogenic tendencies
linked to development of malignancies - transitional cell carcinoma of bladder

40
Q

side effects of cyclophosphamide

A

bone marrow suppression

infertility

41
Q

doxorubicin

A

anthracycline

inhibits topoisomerase II leading to inhibition of DNA and RNA synthesis

42
Q

side effects of doxorubicin

A

cardiomyopathy
myelosuppression
skin reactions

43
Q

vincristine

A

inhibits microtubule formation by binding to tubulin

44
Q

side effects of vincristine

A

peripheral neuropathy

bladder atony

45
Q

prednisolone

A

glucocorticoid steroid

46
Q

side effects of prednisolone

A

typical of steroids

47
Q

types of non-Hodgkin’s lymphoma

A

Burkitt’s lymphoma
Follicular lymphoma
Diffuse large B cell lymphoma

48
Q

Diffuse large B cell lymphoma

A

most common form
more common in men
present at younger age in people of black ethnicity

49
Q

presentation of diffuse large B cell lymphoma

A

rapidly enlarging mass in neck, abdomen or mediastinum
B symptoms
extranodal disease - GI tract

50
Q

disease of mediastinum

A

may lead to SVC obstruction

51
Q

bony destruction

A

may lead to cord compression

52
Q

treatment for limited diffuse large B cell disease

A

R-CHOP chemotherapy

or combined modality therapy

53
Q

combined modality therapy

A

chemoimmunotherapy and radiotherapy

54
Q

treatment for advanced diffuse large B cell disease

A

R-CHOP or EPOCH-R

55
Q

treatment for recurrent diffuse large B cell disease

A

autologous haematopoietic cell transplant

56
Q

follicular lymphoma

A

second most common

57
Q

presentation of follicular lymphoma

A

gradual lymphadenopathy - may come and go

B symptoms

58
Q

genetics in follicular lymphoma

A

85% have 14:18 translocation

59
Q

prognosis assessment for follicular lymphoma

A

Follicular Lymphoma International Prognostic Index

60
Q

Treatment for follicular lymphoma

A

depends on stage at diagnosis

61
Q

treatment for early stage follicular lymphoma

A

local radiotherapy

62
Q

treatment for stage II + follicular lymphoma

A

depends on whether patient is symptomatic or not

63
Q

treatment for stage II+ symptomatic follicular lymphoma

A

chemoimmunotherapy = Rituximab and chemo, e.g. R-CHOP

64
Q

treatment for stage II+ asymptomatic follicular lymphoma

A

immunotherapy with Rituximab

65
Q

cure rate for follicular lymphoma

A

uncommon in those with stage II-IV disease

relapse is frequent

66
Q

what is Burkitt’s lymphoma?

A

high grade rapidly proliferating B cell lymphoma

67
Q

how common is Burkitt’s lymphoma?

A

uncommon
more common in males
commonly affects children

68
Q

types of Burkitt’s lymphoma

A

endemic
sporadic
immunodeficiency

69
Q

endemic Burkitt’s lymphoma

A

strongly associated with EBV and follows distribution of malaria

70
Q

sporadic Burkitt’s lymphoma

A

less associated with EBV

seen in Europe and North America

71
Q

immunodeficiency Burkitt’s lymphoma

A

associated with AIDs or conditions/medications causing immunosuppression

72
Q

genetics of Burkitt’s lymphoma

A

caused by mutation in c-myc proto-oncogene

translocation between chromosomes 8 and 14

73
Q

presentation of endemic Burkitt’s lymphoma

A

rapidly enlarging tumour in child’s jaw or enlarged neck/abdominal lymph nodes/masses

74
Q

presentation of sporadic Burkitt’s lymphoma

A

abdominal symptoms with ileocaecal valve affected causing bowel obstruction

75
Q

how to manage Burkitt’s lymphoma?

A

depends on patient’s health, wishes and disease type

highly chemosensitive

76
Q

1st line treatment for Burkitt’s lymphoma

A

immunochemotherapy

77
Q

risks of Burkitt’s lymphoma treatment

A

tumour lysis syndrome due to rapid tumour breakdown on initiation of treatment
prophylaxis is needed

Oncology (5 decks)

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