Staging and investigation

Question 1

Describe stage 1

Answer 1

One node or group of adjacent nodes

1E: single extra-lymphatic site in absence of nodal involvement

A: no B symptoms
B: presence of B symptoms
(Bulky) if >10cm hodgkins, >7.5cm DLBCL, >6cm follicular

Question 2

What are classed as B symptoms?

Answer 2

Fever >38 deg
Drenching night sweats
>10%weight loss

Question 3

What is classed as bulky disease in
A) Hodgkin’s lymphoma
B) DLBCL
C) follicular lymphoma

Answer 3

A) >10cm
B) >7.5cm
C) >6cm

Question 4

Describe stage II disease

Answer 4

2 or more nodal groups on the same side of the diaphragm

Question 5

Describe stage IIE disease?

Answer 5

Contiguous extra lymphatic extension from a nodal site with or without involvement of other LN regions on the same side of the diaphragm

Question 6

What is stage III disease?

Answer 6

Nodes on both sides of the diaphragm or above the diaphragm with spleen involvement

Stage III (I) ; involvement of spleen or splenic, hilar, coeliac or portal nodes

Stage III (II); involvement of paraaortic, iliac, inguinal or mesenteric nodes

Question 7

Describe stage IV

Answer 7

Diffuse or disseminated involvement of one or more extranodal organ beyond that designated E, with or without LN involvement

(Designated E if can fit in an irradiation field)

Question 8

What stage groups can an addition designation of ‘E’ be added?

Answer 8

Stage I and II

Question 9

What does a designation of ‘B’ mean within the staging system?

Answer 9

Presence of B symptoms

Question 10

A 30yo patient presents with a 3 month history of painless enlarged left cervical lymph nodes. What investigations should be performed if lymphoma is suspected?

Answer 10

1. History and examination to include LN examination and presence of B symptoms
2. Bloods - FBC incl film, bone profile, renal and liver function, ESR, LDH, paraprotein, b2 microglobulin, serum electrophoresis, HIV and hepatitis serology
3. CT neck to pelvis with oral and IV contrast
4. Core or excisional biopsy
5. PET/CT If high grade or stage 1 low grade lymphoma confirmed;
6. Brain MRI & CSF if neurological symptoms
7. Low grade: bone marrow aspirate

Question 11

Would CD30 and CD 15 positivity with negative CD45 and CD20 be consistent with classical or nodular lymphocyte predominant HL?

Answer 11

Classical.

Nodular lymphocyte predominant HL is associated with CD30 and CD15 negativity and CD20 and CD45 positive. (Therefore respond to rituximab)

Question 12

Why is it important to check hepatitis B status in pts due to receive rituximab?

Answer 12

Can get reactivation with treatment