Non-Hodgkin's Lymphoma

Question 1

What is the hallmark of non hodgkin’s lymphoma?

Answer 1

All lymphomas without reed sternberg cells

Question 2

What are the causes of Non hodgkins L?

Answer 2

1) Immunodeficiency (drugs, HIV)
2) H pylori
3) toxins
4) congenital

Question 3

How do patients with non hodgkins L present?

Answer 3

1) 75% have superficial lymphadenopathy
2) 25% have extranodal disease:
- Skin (Sezary syndrome - diffusely red, itchy, thickened, scaly skin)
- Oropharynx ( sore throat, obstructed breathing)
- Gastric MALT causes by Hpylore —> fever sweats
- Small bowel lymphomas–> diarrhoea, vomiting, abdo pain, weightloss
- pancytopenia (anaemia, infection, bleeding)

Question 4

What tests are done for non hodgkin’s lymphoma?

Answer 4

BLOODs:

• FBC
• U&E
• LFT
• raised LDH (lactate –> poor prognosis, shows increased cell turnover)

MARROW and NODE biopsy

CYTOLOGY of effusion

Lumbar puncture if CNS signs

Question 5

What is the incidence of non hodgkins lymphoma?

Answer 5

1 in 10,000

Question 6

What is the management of low grade non hodgkin lymphomas?

Answer 6

Low grad lymphomas are often indolent (causing little pain), often incurable and widely disseminated.

If symptomeless then no treatement may be needed

If localised then radiotherapy

Question 7

What is the management of high grade non hodgkin lymphoma?

Answer 7

High grade NHL are aggressive but often curable.
rapidly enlarging lymph nodes with systemic symptoms.

treated with rituximab and prednisolone.

Question 8

What makes survival and prognosis of non hodgkin lymphoma poor?

Answer 8

• AGE 65+
• systemic symptoms
• bulky disease (large abdo mass)
• raised LDH (lactate)
• Disseminated disease

5 yr survival rates:

• High grade = 30%
• low grade = 50%

Question 9

a raised LDH level indicated poor prognosis for non-hodgkins lymphoma - why?

Answer 9

LDH = lactate

raised lactate = increased cell turnover.