Non hodgkins lymphoma Flashcards
Why imporatnt get diagnosis correct
Each subtype has different optimal treatment
What are non hodgkins lymphomas
Malignant proliferation of lymphocytes derived from B cells
Remainder occuring form T cells or NK cells
6th ost common cancer in YK
NHL vs HL
NHL - B/T cells at various maturation stages, increases with age, non contigious spread, extra nodal disease common, systemic symptoms uncommon, AI disorders, organ transplant etc , lymphadenopathy anywahere
HL - RS cells mature B cells, bimodal age, contigious spread upper body lymhp nodes, extranodal uncommon , systemic symptoms common
Infections increasing risk of NHL
HIV - burkitts or diffuse large B cell
HTLV-I - T cell leukaemia
EBV - burkitt
H.pylori - MALT lymphoma
Hep C
Risks for NHL
Infection
Immunosupression esp post transplatn
AI disease - RA, SLE, sjrogens, coeliac, hashimotos thyroiditis
What gene is ass with follicular lymphoma
BCL12 translocation
What gene is ass with bukitt lymphoma
MYC transloaction
What type of NHL is most aggressive and hoe common is it
Diffuse large B cell lymphoma
30-58% of all NHL
What is most common indolent NHL
Follicular lymphoma
35% of all NHL
Most common lymph noes in NHL adenopathy
Cervical, axillary, inguinal, femoral
Extranodal aslo common
Most common effected extra nodal sites NHL
GI tract - esp stomach
Skin
Bone marrow -> cytopneia
Symptoms due to mass effect from enlarging lymph nodes
SVC syndrome
External biliary tree compression - jaundice
Ureter compression - hydronephrosis
Bowel obstruction
Vomitting and constiaption
Impaired lymph drainage - chylous pleural or peritoneal fluid or lymphoedema of lower limbs
NHL features
Lymphadenopathy
Compression symptoms from above
GI tract, skin or bone marrow affected
B sympmots = worse prognosis
What is mycosis fungoides
Skin lesions incl eczematous reaction -> plaques, tumours, fungating ulcers and erythroderma extremely itchy
Features of NHL severe
mediastinal mass, superior vena cava syndrome and meningeal disease with cranial nerve palsies
Features of adult T cell leukaemia lmphoma
fulminating clinical course with skin infiltrates, lymphadenopathy, hepatosplenomegaly, and leukaemia
May have hyperalcemia
Features of anaplastic large cell lymphoma
rapidly progressive skin lesions, adenopathy, and visceral lesions
Features of burkitts lymphoma
Large abdo mass
Bowel obstruction
Initial investigations NHL
Bloods - FBC, U+Es, LFTs, LDH,, viral screening, B2 microglobulin
CXR
MRI brain and spinal cord if neuro symotos
What look for on CXR w NHL
Mediastinal adenopathy
Pleural or pericardial effusions and parenchymal involvement
Diagnostic tests for NHL
If lesion palpable, excisional biopsy preferred
Lesion ling or abdomen - core needle biopsy
Immunophenotyping - FISH for MYC -> burkitts lymphoma - BL2 or 6
Painless lymphadenopathy differntatisl
EBV - IM
Toxoplasmosis
CMV
Primary HIV
Leukaemia
HL
Peripheral lymphocytosis differntiasl
Leukaemia
EBV
Duncan syndrome - X linked lymphoproliferative syndrome
Staging NHL
Lugano classification - same as HL
I - one node affected
IV - systemic/extranodal - not local to one organ
Criteria for urgent referral NHL
Persistent (>6 weeks) lymphadenopathy
One or more lymph nodes >2 cm in diameter
Rapidly increasing lymphadenopathy
Generalised lymphadenopathy
Persistent and unexplained splenomegaly
Vaccines receive w NHL
Pneumococcal polyvalent, Influenza
Men C, H.influenzae
esp treatment and asplenia or splenic dysfunction
What can reduce the duration of chemo induced neutropenia
Recombinant granulocyte colony stimulating factor - rhG-CSF
Stimulates neutrophil production
Options for indolent NHL
Local radiotheraoy w IIA localised follicular
Watchful eait if asymtpomatci
Rituximab with or without chemo
Combo chemo
Palliative radio
Aggressive NHL treatment opetions
R-CHOP = Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone
Radiation therapy
Bone marrow or stem cell transplantation
If HIV positive what treatment give
Combo chemo an HAART
porphylaxis against PCP
What patients are at high risk of CNS involvement
Lymphoma involved in bone marrow
Testis
Nasal or paranasal sinuses
Orbits
Bone
Peripheral blood
What do if high risk CNS involevement NHL
CNS prophylaxis - intrathecal methrotrexate or cytarabine
What subtype is intitally responsive but ofetn relapses after chemo
Mantle cell lymphoma
General chemo used in NHL
R-CHOP
FCR - fludarabine, cyclophosphamide, rituximab
CVP, MCP, CHVPi (late stage follicular)
Methotrexate - Primary CNS
What need to do w treatment of gastric MALT lymphoma
H pylori eradication therapy
THEN progress to chemo or gastric radio
can watch and wait
CVP chemo combo
Cyclophosphamide, vincristine and prednisolone
RCHOP
Rituximab Cyclophosphamide, doxorubicin, vincristine and prednisolone
MCP drugs
Mitoxantrone, chlorambucil and prednisolone
CHVPi drugs
Cyclophosphamide, doxorubicin, etoposide, prednisolone and interferon-α
Complications of disease
Neutropenia, TP, anaemia - bone marrow infiltration
Bleeding - TP, DIC or direct vascular infiltrate
Large pericardial effusion or arrhythmias - cardiac mets
Resp -pleural effusion or parenchymal lesions
SVC obstriction
Neuro problems
Gi obstruction, perf, bleed
Pain
What can cause neuro symptoms NHL
primary CNS lymphoma, lymphomatous meningitis, or vertebral metastases
