Non- Hodgkin’s Lymphoma

Question 1

What is the main distinction between Hodgkin’s Lymphoma (HL) and Non-Hodgkin’s Lymphoma (NHL)?

Answer 1

The presence of Reed-Sternberg cells distinguishes HL from NHL.

Question 2

What happens if Reed-Sternberg cells are present?

Answer 2

The diagnosis of Hodgkin’s Lymphoma (HL) is made.

Question 3

How are lymphomas classified?

Answer 3

All lymphomas other than HL are classified under the Non-Hodgkin’s Lymphoma (NHL) category.

Question 4

Where can Non-Hodgkin’s Lymphoma occur?

Answer 4

NHL can occur anywhere the lymph fluid travels, including lymph nodes and extranodal sites.

Question 5

How does Non-Hodgkin’s Lymphoma spread?

Answer 5

NHL spreads randomly and can involve multiple sites.

Question 6

What factors influence the prognosis of Non-Hodgkin’s Lymphoma?

Answer 6

The prognosis of NHL depends on specific histologies.

Question 7

What is the demographic predominance of Non-Hodgkin’s Lymphoma?

Answer 7

NHL predominantly affects white males aged 65-74 years.

Question 8

Who is more likely to develop NHL?

Answer 8

People with immune system deficiencies, autoimmune diseases, and chronic infections are more likely to develop NHL.

For example, patients with immunosuppression who are awaiting organ or bone marrow transplants are at an increased risk.

Question 9

Which viruses or diseases increase the risk of NHL?

Answer 9

AIDS, Burkitt’s Lymphoma (EBV), Hepatitis C, T-lymphotropic virus type 1 (HTLV-1), and certain bacteria like Helicobacter pylori increase the risk.

Question 10

How does occupational exposure relate to NHL risk?

Answer 10

Overexposure to certain chemicals, most often occupation-related, increases risks.

Question 11

What are the symptoms of NHL?

Answer 11

Symptoms mimic those for HL: enlarged lymph nodes, night sweats, weight loss, fever, and itching.

Question 12

Where does NHL typically occur?

Answer 12

NL occurs in lymph nodes but is also found in a wide variety of locations in the body.

Question 13

What is the most common site for extranodal involvement in NHL?

Answer 13

The most common site for extranodal involvement is the gastrointestinal (GI) system, more specifically the stomach.

Question 14

What are other common sites for NHL involvement?

Answer 14

Other common sites include: Waldeyer’s ring, skin, bone marrow, sinuses, thyroid, large vessels, CNS, and genitourinary system (GU).

Question 15

What imaging studies are helpful in assessing NHL?

Answer 15

X-ray, CT, PET, MRI, and US are helpful in the assessment of the extent of disease and in the initial stage.

Question 16

What abnormalities may be present in lab studies for NHL?

Answer 16

Lactic acid dehydrogenase and calcium levels may be abnormal.

Question 17

What types of biopsies are used for NHL diagnosis?

Answer 17

Lymph node and bone marrow biopsy are used for NHL diagnosis.

Question 18

What are the two main groups of NHL?

Answer 18

The two main groups are B Cell Lymphomas and T Cell Lymphomas.

Question 19

What percentage of NHLs are B Cell Lymphomas?

Answer 19

B Cell Lymphomas account for 85% of NHLs.

Question 20

What are examples of B Cell Lymphomas?

Answer 20

Examples include diffuse large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma, and Burkitt lymphomas.

Question 21

What types of T Cell Lymphomas exist?

Answer 21

Types include peripheral T-cell lymphoma, cutaneous T-cell lymphoma

Question 22

NHL can either be _____ or ______.

Answer 22

Indolent

Aggressive

Question 23

What are the indolent NHLs?

Answer 23

Nodular and follicular

Question 24

What staging system is most often used for NHL?

Answer 24

The Ann Arbor staging system is most often used for NHL.

Question 25

What is other staging system is used for grading NHL?

Answer 25

The Revised European American Lymphoma Classification (REAL) is used for grading NHL.

Question 26

What are the grades of NHL?

Answer 26

NHL is graded as Low grade, Intermediate Grade, and High Grade.

Question 27

What characterizes low grade NHL?

Answer 27

Indolent, slow growing cancers are low grade but tend to recur more over time.

Question 28

What characterizes high grade NHL?

Answer 28

Aggressive tumors are referred to as high grade and grow at a much faster rate.

Question 29

Can aggressive tumor cells be curable?

Answer 29

Although aggressive tumor cells multiply more quickly than indolent lymphomas, they are often just as curable.

Question 30

What is the treatment of choice for NHL?

Answer 30

Chemotherapy CHOP

Question 31

What does the CHOP regimen consist of?

Answer 31

Cyclophosphamide, doxorubicin, vincristine, prednisone

Question 32

How can indolent NHL in stages I or II be treated?

Answer 32

With radiation alone

Question 33

What is the purpose of immunotherapy with rituximab?

Answer 33

To boost the immune system into fighting off cancer cells

Question 34

Who can benefit from a stem cell transplant?

Answer 34

Patients with advanced or recurrent disease

Question 35

What is the treatment approach for aggressive lymphomas?

Answer 35

Chemo and radiation combined

Question 36

What is included in radiation therapy treatment for NHL?

Answer 36

The involved site along with the related drainage nodal clusters nearby.

Question 37

What is the typical dose for radiation therapy in NHL?

Answer 37

Treatment fields are treated to a dose of 35-45 Gy.

Question 38

What is testicular shielding used for?

Answer 38

Testicular shielding may be used in the treatment of pelvic and abdominal lymph nodes to preserve fertility in males.

Question 39

What procedure can females undergo to protect their ovaries during treatment?

Answer 39

Females can have an oophoroplexy done to move the ovaries out of the area of treatment.

Question 40

How does prognosis differ between men and women with NHL?

Answer 40

Men have a slightly worse prognosis than women.

Question 41

What is the prognosis for children diagnosed with NHL?

Answer 41

Children generally have a good prognosis with this disease.

Question 42

What is the cure rate for early-stage NHL?

Answer 42

With early-stage disease, there is a 90% cure rate.

Question 43

What is more dependent on histology, NHL or Hodgkin lymphoma?

Answer 43

Prognosis for NHL is more dependent on histology than is Hodgkin lymphoma.

Question 44

What characterizes indolent lymphoma?

Answer 44

An indolent lymphoma is slow-growing and causes little problems at the time of diagnosis.

Question 45

What is the median survival time for indolent lymphoma?

Answer 45

The median survival time is from 10 to 20 years, depending on advancement.

Question 46

What is the overall 5-year survival rate for aggressive NHL?

Answer 46

Aggressive NHL has an overall 5-year survival rate of 60%.

Question 47

When is the risk of relapse highest for both indolent and aggressive NHL?

Answer 47

The risk of relapse is the highest after the first 2 years of treatment.