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Haematology > Non-Hodgkin's Lymphoma > Flashcards

Non-Hodgkin's Lymphoma Flashcards

1
Q

What is NHL?

A

Malignant tumours of lymphoid tissue that do not contain Reed-Sternberg cells

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2
Q

What percentage are B cell in origin and what percentage T cell?

A

70% are B cell in origin

30% T cell

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3
Q

Is it the most common haematopoietic malignancy?

A

Yes

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4
Q

What does the incidence increase with?

A

Age

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5
Q

What is the median age of presentation?

A

55-75

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6
Q

Do all the conditions involve lymph nodes?

A 
No - extranodal generating lymphoma including mucosa-associated lymphoid tissue e.g gastric MALT
Spleen
BM
Thymus 
Oropharynx
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7
Q

Is there a slight male or female predominance?

A

Male

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8
Q

What risk factors are there?

A

Elderly, Caucasians
History of viral infection specifically EBV
FH
Certain chemical agents - pesticides, solvents
History of chemotherapy or radiotherapy
Immunodeficiency- transplant, HIV, DM
Autoimmune disorders- SLE, Sjogrens, coeliac, RA..

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9
Q

How can NHL be classified?

A

Low grade - B cell or T cell

High grade - B cell or T cell

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10
Q

Is HL or NHL more common?

A

NHL

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11
Q

What symptoms and signs are associated?

A

Superficial, painless, rubbery lymphadenopathy
B symptoms - weight loss, fever, night sweats
Constitutional symptoms - lethargy, pruritis
Extranodal involvement:
GI - abdominal pain, dyspepsia, constipation or diarrhoea
Oropharynx (Waldeyer’s ring) - dysphagia, obstructed breathing
BM - fatigue, bleeding and bruising, recurrent infections, bone pain
Lungs - SOB, cough
Skin - red patches or scaly lumps under skin
CNS - headaches, seizures, weakness/numbness

Hepatosplenomegaly

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12
Q

Do B symptoms typically occur earlier in HL or NHL?

A

Earlier in HL

B symptoms in NHL suggest disseminated disease

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13
Q

Is extra nodal disease more common in NHL or HL?

A

Much more common in NHL

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14
Q

What lymph nodes are typically affected?

A

Cervical
Axillary
Inguinal

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15
Q

What is the diagnostic investigation of choice?

A

Excisional node biopsy NOT FNA

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16
Q

What imaging is needed?

A

CTCAP to assess staging

17
Q

What tests should be done?

A

FBC and blood film
U&E
Uric acid - some aggressive NHLs can cause high levels
LFTs - if liver mets expected
ESR - prognostic indicator
LDH - a marker for cell turnover, useful as a prognostic indicator

Bone marrow aspiration and trephine are routine
HIV test - this is a RF for NHL
LP if CNS involvement

18
Q

What staging system is most commonly used?

A

Ann Arbor

19
Q

Describe low grade lymphomas

A

Indolent, often incurable and widely disseminated
Follow a replacing and remitting course
Median survival = 10 years
Accounts for 45% of cases

20
Q

How can B and T tumours be distinguished?

A

Immunophenotyping- dome on blood, marrow or nodal material

21
Q

What types of low grade lymphoma are there?

A

Follicular lymphoma
Marginal zone / MALT
Lymphocytic lymphoma - closely related to CLL
Hairy cell leukaemia

22
Q

Describe high grade lymphoma

A

More aggressive
More likely to be cured
Often rapidly enlarging lymphadenopathy with systemic symptoms
80% will initially respond to treatment

23
Q

What types of aggressive NHLs are there?

A

Diffuse large B cell = most common
Burkitt’s lymphoma
Lymphoblastic lymphoma
Mantle cell

24
Q

Describe Burkitt’s lymphoma

A 
Commonly seen in West Africa
Childhood disease 
Highly aggressive 
Associated with jaw lymphadenopathy 
Associated with EBV
25
Q

What is the link between Burkitt’s lymphoma and malaria?

A

Malaria thought to reduce resistance to EBV, allowing the virus to take hold

26
Q

How is low grade type treated?

A

Depends on sub type present
If symptomless - likely no treatment given and monitored
RT may be curative if localised disease
Chlorambucil (chemotherapy) can be used if diffuse

Remisssion may be maintained with alpha interferon or rituximab

27
Q

How is high grade lymphoma treated?

A 
Chemotherapy regime: R-CHOP 
Rituximab 
Cyclophosphamide 
Hydroxydaunorubicin 
Vincristine (Oncovin) 
Prednisolone
28
Q

What can be given to help neutropenia?

A

GCSF

29
Q

What suggests poor prognosis?

A

Over 60
Bulky disease e.g abdominal mass > 10cm
Raised LDH
Disseminated disease

30
Q

Rituximab kills what cells?

A

CD20+

31
Q

Some lymphomas can produce IgM leading to what?

A

Hyperviscosity syndrome - IgM is the biggest gamma globulin

Autoimmune cytopenias e.g AIHA

32
Q

Some lymphomas produce very few gammaglobulins. What does this lead to?

A

Infections

Haematology (16 decks)

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