Non hodgkins lymphoma Flashcards

1
Q

Why imporatnt get diagnosis correct

A

Each subtype has different optimal treatment

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1
Q

What are non hodgkins lymphomas

A

Malignant proliferation of lymphocytes derived from B cells
Remainder occuring form T cells or NK cells
6th ost common cancer in YK

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2
Q

NHL vs HL

A

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

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3
Q

Infections increasing risk of NHL

A

HIV - burkitts or diffuse large B cell
HTLV-I - T cell leukaemia
EBV - burkitt
H.pylori - MALT lymphoma
Hep C

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4
Q

Risks for NHL

A

Infection
Immunosupression esp post transplatn
AI disease - RA, SLE, sjrogens, coeliac, hashimotos thyroiditis

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5
Q

What gene is ass with follicular lymphoma

A

BCL12 translocation

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6
Q

What gene is ass with bukitt lymphoma

A

MYC transloaction

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7
Q

What type of NHL is most aggressive and hoe common is it

A

Diffuse large B cell lymphoma
30-58% of all NHL

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8
Q

What is most common indolent NHL

A

Follicular lymphoma
35% of all NHL

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9
Q

Most common lymph noes in NHL adenopathy

A

Cervical, axillary, inguinal, femoral
Extranodal aslo common

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10
Q

Most common effected extra nodal sites NHL

A

GI tract - esp stomach
Skin
Bone marrow -> cytopneia

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11
Q

Symptoms due to mass effect from enlarging lymph nodes

A

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

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12
Q

NHL features

A

Lymphadenopathy
Compression symptoms from above
GI tract, skin or bone marrow affected
B sympmots = worse prognosis

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13
Q

What is mycosis fungoides

A

Skin lesions incl eczematous reaction -> plaques, tumours, fungating ulcers and erythroderma extremely itchy

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14
Q

Features of NHL severe

A

mediastinal mass, superior vena cava syndrome and meningeal disease with cranial nerve palsies

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15
Q

Features of adult T cell leukaemia lmphoma

A

fulminating clinical course with skin infiltrates, lymphadenopathy, hepatosplenomegaly, and leukaemia
May have hyperalcemia

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16
Q

Features of anaplastic large cell lymphoma

A

rapidly progressive skin lesions, adenopathy, and visceral lesions

17
Q

Features of burkitts lymphoma

A

Large abdo mass
Bowel obstruction

18
Q

Initial investigations NHL

A

Bloods - FBC, U+Es, LFTs, LDH,, viral screening, B2 microglobulin
CXR
MRI brain and spinal cord if neuro symotos

19
Q

What look for on CXR w NHL

A

Mediastinal adenopathy
Pleural or pericardial effusions and parenchymal involvement

20
Q

Diagnostic tests for NHL

A

If lesion palpable, excisional biopsy preferred
Lesion ling or abdomen - core needle biopsy
Immunophenotyping - FISH for MYC -> burkitts lymphoma - BL2 or 6

21
Q

Painless lymphadenopathy differntatisl

A

EBV - IM
Toxoplasmosis
CMV
Primary HIV
Leukaemia
HL

22
Q

Peripheral lymphocytosis differntiasl

A

Leukaemia
EBV
Duncan syndrome - X linked lymphoproliferative syndrome

23
Q

Staging NHL

A

Lugano classification - same as HL
I - one node affected
IV - systemic/extranodal - not local to one organ

24
Q

Criteria for urgent referral NHL

A

Persistent (>6 weeks) lymphadenopathy
One or more lymph nodes >2 cm in diameter
Rapidly increasing lymphadenopathy
Generalised lymphadenopathy
Persistent and unexplained splenomegaly

25
Q

Vaccines receive w NHL

A

Pneumococcal polyvalent, Influenza
Men C, H.influenzae
esp treatment and asplenia or splenic dysfunction

26
Q

What can reduce the duration of chemo induced neutropenia

A

Recombinant granulocyte colony stimulating factor - rhG-CSF
Stimulates neutrophil production

27
Q

Options for indolent NHL

A

Local radiotheraoy w IIA localised follicular
Watchful eait if asymtpomatci
Rituximab with or without chemo
Combo chemo
Palliative radio

28
Q

Aggressive NHL treatment opetions

A

R-CHOP = Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone
Radiation therapy
Bone marrow or stem cell transplantation

29
Q

If HIV positive what treatment give

A

Combo chemo an HAART
porphylaxis against PCP

30
Q

What patients are at high risk of CNS involvement

A

Lymphoma involved in bone marrow
Testis
Nasal or paranasal sinuses
Orbits
Bone
Peripheral blood

31
Q

What do if high risk CNS involevement NHL

A

CNS prophylaxis - intrathecal methrotrexate or cytarabine

32
Q

What subtype is intitally responsive but ofetn relapses after chemo

A

Mantle cell lymphoma

33
Q

General chemo used in NHL

A

R-CHOP
FCR - fludarabine, cyclophosphamide, rituximab
CVP, MCP, CHVPi (late stage follicular)
Methotrexate - Primary CNS

34
Q

What need to do w treatment of gastric MALT lymphoma

A

H pylori eradication therapy
THEN progress to chemo or gastric radio
can watch and wait

35
Q

CVP chemo combo

A

Cyclophosphamide, vincristine and prednisolone

36
Q

RCHOP

A

Rituximab Cyclophosphamide, doxorubicin, vincristine and prednisolone

37
Q

MCP drugs

A

Mitoxantrone, chlorambucil and prednisolone

38
Q

CHVPi drugs

A

Cyclophosphamide, doxorubicin, etoposide, prednisolone and interferon-α

39
Q

Complications of disease

A

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

40
Q

What can cause neuro symptoms NHL

A

primary CNS lymphoma, lymphomatous meningitis, or vertebral metastases

41
Q
A