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Cancer Care- Blood Results > Non- Hodgkin's Lymphoma > Flashcards

Non- Hodgkin's Lymphoma Flashcards

1
Q

What is Non- Hodgkin’s Lymphoma?

A
  • Lymphoma which does not have Reed- Sternberg cells
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2
Q

How does Non-Hodgkin’s Lymphoma affect the body?

A
  • Lymphoma means that your WBC divide abnormally
  • The cells start to divide before they are fully mature
  • This means the cells are unable to fight infection
  • The abnormal WBC collect in lymph nodes, bone marrow and spleen
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3
Q

Where does non- Hodgkin’s Lymphoma occur in the body?

A
  • NHL starts in the lymph nodes
  • It is commonly found in the neck, liver and spleen
  • It can be found in the stomach, small bowel, bones, brains, testicles, skin and eye
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4
Q

What are the two types of NHL?

A
  • B-cell Lymphoma
  • T- cell Lymphoma
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5
Q

How common is NHL?

A
  • 4 out of 100 cancers diagnosed are NHL
  • 6th most common type of cancer in adults
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6
Q

Who get NHL?

A
  • Common in older people
  • 75 and over
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7
Q

What are the symptoms of NHL?

A
  • Painless Swellings in neck, armpit and groin
  • B symptoms
  • enlarged tonsils
  • lump in your tummy (enlarged spleen/ liver)
  • breathlessness (lymphoma affecting nodes in your chest
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8
Q

What are the symptoms of NHL in the bone marrow?

A
  • Anaemia, tiredness and breathlessness ( low RBC)
  • infections (low WBC)
  • bleeding problems, heavy periods and nosebleeds ( low platelets)
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9
Q

What are the symptoms of Lymphoma in the brain?

A
  • Headaches
  • Difficulty thinking
  • Changes in Personality
  • Epileptic fits (seizures)
  • Confusion
  • Coma
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10
Q

What are the risks of Non- Hodgkin Lymphoma?

A
  • Age ( typically 75 and over)
  • Weakened immune system ( HIV/AIDS/ anaemia/ SLE/ Sjogren’s Syndrome)
  • Infections ( H-pylori/ HIV/ T cell lymphoma virus 1/ EBV/ Hepatitis)
  • Family History of NHL
  • Previous cancer and treatment
  • Coeliac Disease ( enteropathy- associated T-cell Lymphoma)
  • Breast Implant Associated Anaplastic Large Cell Lymphoma
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11
Q

What are the different types of NHL?

A
  • Diffuse Large B cell Lymphoma
  • Follicular Lymphoma
  • Burkitt’s Lymphoma
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12
Q

What is Diffuse Large B cell Lymphoma and how does it present?

A
  • Accounts for around 30% of NHL
  • Presents with rapidly enlarging mass - neck, abdo, mediastinum
  • disease may lead to SVCO
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13
Q

What is Follicular Lymphoma?

A
  • 2nd most common NHL
  • Presents with gradually worsening painless lymphadenopathy
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14
Q

What is Burkitt’s Lymphoma?

A
  • high grade, rapidly proliferating
  • B-cell NHL commonly affects children
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15
Q

What is the staging for Non-hodgkin’s Lymphoma?

A
  • It is the same as Hodgkin’s Lymphoma
  • Lugano classification
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16
Q

What are the low grade Non-Hodgkin Lymphoma?

A
  • Follicular Lymphoma
  • Mantle cell Lymphoma
  • Marginal Zone Lymphoma (MALT lymphoma, Nodal Marginal Zone Lymphoma, Splenic marginal zone lymphoma)
  • Small Lymphocytic Lymphoma ( also known as CLL)
  • Lymphoplasmacytic Lymphoma (Waldenstrom’s macroglobulinaemia)
  • Skin Lymphoma ( cutaneous B cell/ T cell lymphoma)
17
Q

What are the high grade Non- Hodgkin’s Lymphoma?

A
  • Diffuse large B cell Lymphoma
  • Burkitt Lymphoma
  • Peripheral T cell Lymphoma
  • Lymphoblastic lymphoma
  • Blastic NK cell lymphoma
  • Enteropathy associated T cell lymphoma
18
Q

What are the symptoms of Primary Cutaneous Lymphoma?

A
  • Rashes
  • Plaques
  • Ulcers
  • Mycosis fungoides (cutaneous T-cell Lymphoma)
19
Q

What are the symptoms of Primary GI tract Lymphoma?

A
  • Abdominal Pain
  • Nausea
  • Obstruction
  • Haemorrhage
20
Q

What is the gold standard investigation for Non-Hodgkin’s Lymphoma?

A
  • Excision biopsy
21
Q

What bloods are required for Non-Hodgkin’s Lymphoma?

A
  • FBC
  • U+E
  • LFTs
  • ESR
  • LDH
  • Uric Acid
  • HIV, Hep B, Hep C
22
Q

What imaging is required for Non-Hodgkin Lymphoma?

A
  • Chest X-ray
  • CT neck, abdomen, chest and pelvis (to identify enlarged lymph nodes)
  • PET CT (staging and assessment of treatment response to lymphomas)
  • MRI brain (particularly with leptomeningeal infiltration/ mass lesions are suspected)
  • Testicular USS (identify testicular lymphoma)
  • Bone Scan
23
Q

What additional investigations are required?

A
  • Bone marrow aspirate and biopsy
  • Lumbar Puncture ( in patients with suspected CNS disease)
  • FISH
24
Q

What is the chemotherapy regime for Non-Hodgkin’s Lymphoma?

A

R-CHOP
- Rituximab ( monoclonal antibody against CD20 - which is found on B cells)
- Cyclophosphamide ( an alkylating agent which inhibits DNA synthesis through cross linking DNA)
- Doxorubicin (inhibits topoisomerase II)
- Vincristine (inhibits microtubule formation by binding to tubulin)
- Prednisolone (glucocorticoid steroid)

25
Q

What immunotherapy treatment would you have for Non-hodgkin’s Lymphoma?

A
  • CAR T-Cell Therapy
  • T cells are taken from your blood (apheresis)
  • The T cells are genetically changed so they are able to recognise + target specific proteins on the cancer cells
  • These changed T cells can grow and multiply in the lab
  • You receive a dose of chemotherapy which lowers your number of T cells and prepares your body for CAR T-cells
  • Once there are enough cells you have a drip containing these cells back into your bloodstream
  • CAR T-cells can then recognise and attack the cancer cells
26
Q

What are the side effects of the Immunotherapy?

A
  • Allergic reaction
  • Cytokine- release syndrome
  • Side effects affecting the brain
  • Increased risk of infection
  • Tumour Lysis Syndrome
27
Q

What is Cytokine- Release syndrome?

A
  • cytokines are a group of proteins that play an important role in boosting the immune system
  • CAR T-cell therapy stimulates the immune system into making large amounts of cytokines
  • Symptoms: Fever, Dizziness due to low BP, Difficulty breathing
28
Q

What is the reversible treatment for cytokine release syndrome?

A
  • Tocilizumab
29
Q

What are CAR T-Cells designed to recognise?

A
  • CD-19 protein/ antigen which is found on the surface of most B cells

Cancer Care- Blood Results (27 decks)

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