Non-Hodgkin's Lymphoma

Question 1

Define NHL

Answer 1

• Malignant tumours of lymphoid tissue NOT involving reed-Sternberg cells
• Does not have to have lymph node involvement e.g. mucous-associated lymphoma tissue (MALT)
• 70% B cell
• 30% T cell

Question 2

What is the aetiology of NHL?

Answer 2

• Age
• Slight male preference
• Burkitt’s lymphoma common in Africa
• Viruses: EBV, herpes simplex virus
• Immunosuppression - HIV/AIDS
• H.pylori = gastric MALT lymphoma

Question 3

What are the clinical features of NHL?

Answer 3

• Superficial lymphadenopathy – painless
• B symptoms: fever, sweats, anorexia, weight loss
• Extranodal presentation (25%)– e.g. compression symptoms; GI tract, testes, brain, thyroid, skin.
• Hepatosplenomegaly.
• Pancytopaenia – anaemia, infections, failed clotting

Question 4

What are the investigations for NHL?

Answer 4

SAME AS HL PLUS

Bone marrow aspiration and trephine
-Trephine - procedure to bore into bone (very painful)

Immunophenotyping
-Distinguish B and T tumours – this can be done on blood, marrow or nodal material

• Uric acid – high = aggressive ==> renal failure
• Immunoglobulin tests – check if it is IgG or IgM influence treatment
• HIV testing – may be appropriate if certain risk factors are present

Question 5

What is the general management options for NHL?

Answer 5

1. watchful waiting,
2. single-agent or multi-agent chemotherapy
3. regional or extended radiotherapy.