OnlineMedEd: Hematology Oncology - "Lymphoma"

Question 1

What kind of lymphadenopathy is suggestive of lymphoma?

Answer 1

• Non-tender
• Immobile
• Persisting longer than 2 weeks

Question 2

Describe the type of biopsy needed to diagnose lymphoma.

Answer 2

Excisional biopsy with staining for cytoarchitectural changes

Fine-needle aspiration is not sufficient.

Question 3

List the four possible outcomes of lymph node biopsy.

Answer 3

• Metastatic cancer
• Primary cancer (i.e., lymphoma)
• Infectious (so do a Gram stain, AFB, and fungal)
• Idiopathic

Question 4

Review the old and new ways of staging lymphoma.

Answer 4

Old: go in this order until definitive results are acquired

1) Chest x-ray
2) CT chest/abdomen/pelvis
3) Bone marrow biopsy

New:
1) Do a PET-CT because CXRs aren’t sensitive

Question 5

Explain the staging system for lymphoma.

Answer 5

I) One lymph node
II) Two or more nodes on the same side of the diaphragm
III) Two or more nodes on opposite sides of the diaphragm
IV) Metastatic to other organs

Question 6

Which is the “good” lymphoma?

Answer 6

Hodgkin’s (cure rate of greater than 80%)

Non-Hodgkin’s usually goes away for a few years but returns.

(“HOdgkin’s is HOpeful! Non-Hodgkin’s Never goes away.”)

Question 7

Why does non-Hodgkin’s lymphoma have a worse outcome?

Answer 7

• It lacks B symptoms so presents at a later stage.

* It spreads hematogenously (whereas HL spreads contiguously).

Question 8

What are two pieces of clinical history unique to Hodgkin’s lymphoma?

Answer 8

• Pel-Epstein fevers (cyclical fevers)

* LAD that becomes tender with alcohol ingestion

Question 9

Review the chemotherapies used for Hodgkin’s and non-Hodgkin’s lymphomas.

Answer 9

Hodgkin’s: ABVD

• Adriamycin (trade name for doxorubicin)
• Bleomycin
• Vinblastine
• Dacarbazine

Non-Hodgkin’s: R-CDVP

• Rituximab
• Cyclophosphamide
• Doxorubicin
• Vinblastine
• Prednisone