Non-Hodgkin's Lymphoma

Question 1

Non-Hodgkin’s Lymphoma General

Answer 1

-Much greater predeliction to disseminate to extra nodal sites than in Hodgkins
Two prognostic groups
-Low grade: good prognosis, not as curable in advanced stages
-High grade: shorter natural history but significant number can be cured with intensive chemo

Question 2

Non-Hodgkin’s Lymphoma Classification

Answer 2

• Precursor B-cell neoplasms
• Mature B-cell neoplasms (high grade and low grade)
• Precursor T-cell neoplasms
• Mature T-cell neoplasms (high grade and low grade)

Question 3

Non-Hodgkin’s Lymphoma Epidemiology

Answer 3

• 5x more common than Hodgkin’s
• Presentation >50
• Some in children
• Two most common types are diffuse large B cell (DLBCL) and follicular

Question 4

Non-Hodgkin’s Lymphoma RFs

Answer 4

Genetics, viruses (EBV…), environmental factors, autoimmune, H.pylori and MALT

Question 5

Non-Hodgkin’s Lymphoma Presentation

Answer 5

Low grade

• Painless, slowly progressive, peripheral lymphadenopathy
• Splenomegaly, hepatomegaly
• Extranodal involvement and systemic symptoms or not common until advanced stages
• Bone most common site of extra nodal spread

Intermediate and high grade

• Most present with rapidly growing bulky lymphadenopathy
• Systemic symptoms and extranodal involvement are more common
• Hepatomegaly, splenomegaly
• Obstructive hydronephrosis due to retroperitoneal lymphadenopathy is common

Question 6

Non-Hodgkin’s Lymphoma Differentials

Answer 6

• Hodgkin’s
• Acute or chronic lymphoma
• Metastatic malignant disease
• Lymphadenopathy

Question 7

Non-Hodgkin’s Lymphoma Ix

Answer 7

• FBC- anaemia from marrow infiltration or haemolytic anaemia, thrombocytopenia and neutropenia
• U/Es, (obstructive nephropathy)
• Serology: HIV, HTLV-1, hepatitis C.
• CXR mediastinal
• Biopsy
• CT
• Bone scans
• Scrotal USS

Question 8

Non-Hodgkin’s Staging

Answer 8

-Ann Arbor

Question 9

Non-Hodgkin’s Management

Answer 9

• Vary due to heterogeneous nature
• Watchful waiting, single-agent or multi-agent chemotherapy R-CHOP-21
• Vaccinations

Question 10

Non-Hodgkin’s Complications

Answer 10

• Neutropenia, anaemia, thrombocytopenia (secondary to bone marrow inflitration)
• Metastatic problems e.g. CVS, respiratory system, SVCO…

Question 11

Non-Hodgkin’s Prognosis

Answer 11

• Low-grade NHL types have good prognosis with median survival 10 years, usually not curable when advanced
• Intermediate-grade and high-grade lymphomas are more aggressive but more responsive to chemotherapy