Non-hodgkins lymphoma Flashcards
Differences between HL and NHL
AGE
Bimodal 15-30 and 50 yrs in H
Increaseswith age, median age being 50. Low grade NHL is 55-60
Gender difference
M;F =5;1 IN H
M;F=7;1 IN NHL
Hodgkins lymphoma
More in males
rises in adolescence peaks in 3rd decade
Stages difference
stages 1 and 2 at presentation in H
stages 3 and 4 at presentation in NHL
b symptons and signs
25-40% in H
15% in NHL
direction of spread difference
predictable axial spread in H
Random spread in NHL
Leukemic phase
rare in H
Common in NHL
ORIGIN DIFFERENCE
MAjority originate from nodal region -H
80% nodal and 20% extranodal NHL
Trochlear, mesenteric, pharyngeal nodes
Rarely involves these areas-H
Occasional involvement-NHL
mediastinum involvement
50% involvement-H
20% NHL
Lymph node involvement
subdiaphragmatic LN. gENERALISED ln AND EXTRA LYMPHATIC DX LATER-H
Widespread LN involvemenr- NHL
Bone marrow involvement
less than 10% in H
70% in NHL
Spread
Contiguous-H
Non contiguous- NHL
GIT AND LIVER INVOLVEMENT
Rare-H
COMMON-NHL
Superior vena cava obstruction
Common-NHL
Non common- H
CAUSES OF NHL
EBV
HTLV 1
immunosuppression
First implicated virus
EBV
What type of infection by EBV is associated with lymphomas
Latent
Type 1 EBV latency causes
burkitts lymphoma
Type 2 EBV latency causes
hodgkins dx
nasopharyngeal ca
Type 3 EBV latency causes
HIV LYMPHOMA
Classification of NHL
Indolent NHL
B cell lymphomas
T cell lymphomas
Examples of B cell lymphomas
Diffuse large B cell lymphomas Follicular lymphoma Mantle cell lymphoma Marginal zone lymphomma Burkitts lymphoma Lymphoplasmacytic lymphoma
Example of T cell lymphoma
Cutaneous T cell lymphoma
Angioimmunoblastic T cell lymphoma
Anaplastic large cell lymphoma
Enteropathy type t cell lymphoma
Investigations in NHL
Investigation of waldeyers group of LN
Bone biopsy
is staging laparatomy justifies in NHL
no
Symptom status B meaning
unexplained fever
Drenching night weats
weight loss greater than 10%
Bulk
Mediastinal mass greater than 1/10 the max diameter of the chest
Recommendations for clinical imaging
size - >1.5 Spleen- physical exam,Chest X rat, CT Lymph angiography to identify abnormal LN Gallium scan MRI
Clinical features of NHL
Lymphadenopathy-widespread
Hepatosplenomegaly
Fever, night sweats, weight loss
Systemic symptoms and signs
due to involvement of particular organs like GIT, lungs, CNS
Can cause delay in diagnosis and can decrease survival
Less frequent symptoms
abdominal pain fatigue painful adenopathy malaise dysphagia cough bone pain edema pruritus
Burkitts lymphoma presents with
extranodal dx in the jaw in africa
in GIT and intraabdominal sites in the west
Lymphoblastic lymphoma symptoms
Thymic mass
Systemic symptoms
Bone marrow failure
In advanced NHL about half obtain
Complete remission
the rest obtain useful dx control
Those who have complete remission
Relapse in 5 yrs
Front line therapy being studied
Fludarabine and 2 chloro deoxyadenosine
Management of treatment failures
Repeat previous combination after a long period of remission
Quick relapse after chlorambucil; give CHOP/fludarabine
Valuable in 2/3 of patients heavily pretreated
Fludarabine, mitoxantrone, dexamethasone
