Non-hodgkins lymphoma

Question 1

What is NHL?

Answer 1

basically every other lymphoma that doesn’t have Reed-Sternberg cells (i.e. not Hodgkins)

Question 2

Which is more common NHL or HL?

Answer 2

NHL

Question 3

What age is typically affected?

Answer 3

elderly

Question 4

What cells are affected the most?

Answer 4

B cell

Question 5

What is the main function of B cells?

Answer 5

bind to an antigen

differentiate into plasma cells that make antibodies

Question 6

What are the causes ?

Answer 6

immunodeficiency 
EBV
Human T-lymphocytotrophic virus 1 (HTLV-1)
H. Pylori
HIV

Question 7

What are the sx?

Answer 7

1. Painless lymphadenopathy - non-tender, rubbery, asymmetrical
2. B sx
3. Extranodal disease

Question 8

What are the features of extra nodal disease?

Answer 8

1. GASTRIC- dyspepsia, dysphagia, WL, abdo pain
2. BM - pancytopenia, bone pain
3. skin - lesions - patches or raised plaques

Question 9

What investigations would you do?

Answer 9

1. FBC - thrombocytopenia, pancytopenia, lymphocytosis (CLL)
2. Blood smear
3. Excisional LN biopsy
4. BM biopsy - staging
5. LFTs and LDH elevated

Question 10

How would you assess staging?

Answer 10

CT chest abdomen and pelvis

Question 11

What does LDH used for?

Answer 11

marker of cell turnover - prognosis

Question 12

What system is used to stage?

Describe it

Answer 12

Ann Arbour
Stage 1 - 1 node affected
Stage 2 - more than one node on the same side of the diaphragm
Stage 3 - one node on either side of diaphragm
Stage 4 - extra nodal involvement e.g. spleen

Question 13

What are type A and type B

Answer 13

A - no B sx

B - presence of B sx

Question 14

What are the differences between low grade and high grade lymphomas?

Answer 14

low grade - indolent, incurable, widely disseminated

high grade - more aggressive but often curable

Question 15

Give an example of high grade lymphoma

Answer 15

burkitt lymphoma

diffuse B cell lymphoma

Question 16

How can low grade lymphoma be managed?

Answer 16

if no sx, none may b needed
radiotherapy in localised
chlorambucil in diffuse
Remission w - interferon alpha or rituximab

Question 17

What is the treatment of high grade lymphoma?

Answer 17

R-CHOP 
Rituximab 
Cyclophosphamide
Hydroxydaunorubicin
Vincristine (Oncovin)
Prednisolone

Question 18

What can be given to help treat neutropenia?

Answer 18

Granulocyte colony-stimulating factors - filgrastim

Question 19

How might you be able to differentiate between NHL and HL clinically?

Answer 19

NHL - B sx occur later + extra nodal disease much more common
HL - alcohol induced pain in the node