Non-Hodgkins Lymphoma

Question 1

Describe two ways in which Non-Hodgkins lymphomas can be classified

Answer 1

Affecting B or T-cells

high grade or low grade.

Question 2

Risk factors for the development of non-hodgkins lymphoma

Answer 2

Elderly
Caucasians
Viral Inf e.g. EBV
FHx
Chemical agents (pesticides, solvents)
Hx chemo/radiotherapy
Immunodeficiency (transplant, HIV, diabetes mellitus)
Autoimmune disease (SLE, Sjogren’s, coeliac disease)

Question 3

Symptoms of Non-Hodgkins lymphoma

Answer 3

• Painless lymphadenopathy
• B symptoms

Extranodal Disease:
- gastric:
>dyspepsia
>dysphagia
>weight loss
>abdominal pain

bone marrow:
>pancytopenia
>bone pain

other: lungs, skin, CNS

Question 4

Differentiating Hodgkins and Non-hodgkins

Answer 4

alcohol-induced pain = HODGKINS

‘B’ symptoms =
earlier in HODGKINS
later in NON-Hodgkin’s

Extra-nodal disease = more common in NON-Hodgkin’s

Question 5

Investigations used to diagnose Non-Hodgkins lymphoma

Answer 5

Node biopsy
CT CAP
HIV test
FBC - anaemia
LDH

Other investigations can be ordered as the clinical picture indicates (LFT’s if liver metastasis suspected, PET CT or bone marrow biopsy to look for bone involvement, LP if neurological symptoms)

Question 6

investigations to look for extra nodal disease in NHL

Answer 6

LFTs for ?liver mets

PET CT or bone marrow biopsy to look for bone involvement

LP if neuro symptoms

Question 7

Ann Arbor staging

Answer 7

Stage 1 - One node affected
Stage 2 - >1 node affected on the same side of the diaphragm
Stage 3 - Nodes affected on both sides of the diaphragm
Stage 4 - Extra-nodal involvement e.g. Spleen, bone marrow or CNS

A - no systemic symptoms
B - presence of B symptoms

Question 8

General management of NHL

Answer 8

Either:
- watchful waiting
- chemotherapy
- radiotherapy

All patients will receive flu/pneumococcal vaccines

Patients with neutropenia may require antibiotic prophylaxis

Question 9

Complications of NHL

Answer 9

Bone marrow infiltration
=> anaemia/ neutropenia/ thrombocytopenia

SVC obstruction

Metastasis

Spinal cord compression

Question 10

Does high or low grade NHL have a better prognosis?

Answer 10

Low-grade non-Hodgkin’s lymphoma has a better prognosis

High-grade non-Hodgkin’s lymphoma has a worse prognosis but a higher cure rate