Week 20 - fatigue and neck lumps Flashcards
What are the 2 lineages of hematopoiesis ?
myeloid and lymphoid
What is haematopoiesis ?
the process which all mature blood cells are produced from the haematopoietic stem cell
Where does haematopoiesis occur ?
In the bone marrow
Name the blood cells that originate from the myeloid linage ?
- neutrophils
- basophils
- eosinophils
- macrophages (monocytes)
- thrombocytes (platelets)
- erythrocytes (RBCs)
- mast cells
Name the blood cells that originate from the lymphoid linage ?
- T lymphocytes
- B lymphocytes
- natural killer cells
- plasma cells
What does it suggest when ‘blast’ cells are found in the peripheral blood/circulation ?
a haematological malignancy
Where are ‘blast’ cells normally found?
in the bone marrow in small quantities
What are ‘blast’ cells ?
the immature form of a cell
What structures make up the lymphatic system ?
- lymph nodes
- lymphatic vessels
- bone marrow + thymus (organs where immune cells develop)
- spleen
- organs where immune cells are stored/collect
What renal conditions can cause fever and tiredness?
urinary infections
What cardiac conditions can cause fever and tiredness?
- pericarditis
- infective endocarditis
What endocrine conditions can cause fever and tiredness?
- hypo/hyperthyroidism
- diabetes
What neuro conditions can cause fever and tiredness?
- meningitis
What resp conditions can cause fever and tiredness?
- pneumonia
- covid
- TB
What gastro conditions can cause fever and tiredness?
- cholangitis
- diverticulitis
What are ‘coryzal symptoms’ ?
symptoms of upper respiratory tract infection …
- runny nose
- sneezing
- nasal stuffiness
- sore throat
- cough
etc
What are the ‘B symptoms’ ?
- fever
- weight loss (>10% body weight)
- drenching night sweats
What is another name for glandular fever ?
infectious mononucleosis or “mono”
Epstein-barr virus causes this
What are B symptoms signs of ?
haematological cancer = lymphoma
What do malignant nodes usually feel like ?
hard, painless and tethered to surrounding structures
What could be some differentials for hilar lymphadenopathy on CXR ?
- lymphoma
- sarcoidosis
- TB
- metastatic spread
What is the best type of biopsy for diagnosing lymphoma ? why ?
complete lymph node excision because the cells are far clearer this way and therefore needle biopsy has a risk of false negative
What are the types of lymphoma ?
- Hodgkin lymphoma
- Non-Hodgkin lymphoma (there are several types of this)
What is the most common type of lymphoma …
a) hodgkin lymphoma ?
b) non-hodgkin lymphoma ?
Non-Hodgkin lymphoma
What is the difference between lymphoma and leukaemia ?
lymphoma = originates in lymph nodes or spleen and spreads through lymphatic system
leukaemia = originates in bone marrow and spreads through the blood stream
What are the hallmark tumour cells of Hodgkin lymphoma seen on biopsy called ?
Reed-Sternberg cells
What are Reed-Sternnerg cells and what do they indicate ?
large, abnormal lymphocytes with more than one nucleus
their presence indicates hodgkin lymphoma
When staging lymphoma, what do the letters A and B mean ?
the numbers indicate spread of the cancer through the lymphatic system but the letters A/B refer to whether or not the patient presented with B symptoms
eg. someone who did have B symptoms would be a stage 1B/2B/3B/4B and someone who didn’t would be stage 1A/2A/3A/4A
What is the name of the A/B staging system in lymphoma ?
Ann Arbor system
Are lymph nodes in the neck usually palpable ?
No
unless in children, they often can be!
In terms of shape, what should a healthy lymph node be most similar to…
a) a football ?
b) a rugby ball ?
rugby ball
they’re quite a similar shape to kidneys!
What size lymph node is clinically relevant in lymphadenopathy?
> 1cm in adults
2cm in kids
What are the 2 causes of lymphadenopathy ?
- inflammatory (most common)
- malignancy
What are the most common inflammatory causes of cervical lymphadenopathy?
- bacterial/viral infection to scalp, tonsils, teeth, ear etc
- TB
- HIV
Which bacteria is the most common cause of inflammatory cervical lymphadenopathy ?
streptococcus A
Which virus is the most common cause of inflammatory cervical lymphadenopathy ?
adenovirus
Which types of cancer are most commonly the cause of metastasis to the neck nodes ?
- larynx/pharynx/mouth squamous carcinoma (mucosal membranes)
- thyroid cancer
- salivary gland cancer
- skin cancer (squamous, melanoma)
How do you investigate for cervical lymphadenopathy?
- head/neck exam (baso thyroid exam)
- endoscopy
- imaging (USS, CT, MRI, PET)
- biopsy
What are some red flags in a history presenting with a neck lump that indicate cancer?
- unilateral pain, especially in the ear when swallowing
- persistent vocal hoarseness (>3 weeks)
- dysphasia (liquids or solids)
What are the risk factors for head/neck cancer ?
- smoking
- alcohol
- HPV
- cannabis
Which type of head/neck cancer does HPV increase risk of ?
tonsil cancer
What level of weight loss is a significant B sign for lymphoma ?
> 10% of weight lost in the last 3 months
How does a PETCT scan hep in diagnosis of malignancies ?
metabolically active cells take up more of the contrast so shows spread of malignancy
a malignant node will be brighter than any other reactive node due to larger uptake of contrast
What does stage 1 lymphoma mean ?
There is 1 lymph node area affected
What does stage 2 lymphoma mean ?
2 lymph node areas involved on the same side of the diaphragm
What does stage 3 lymphoma mean ?
lymph node areas affected on both sides of the diaphragm (above and below)
What does stage 4 lymphoma mean ?
Involvement from extra-nodal tissues eg bone marrow, liver, spleen, lungs
What are the causes of hodgkin lymphoma ?
vast majority have no clear cause
otherwise some rare cases of…
- strong familial link
- previous Epstein barr virus infection
- person with reduced immunity
What is the treatment for hodgkin’s lymphoma ?
chemo therapy
What is the prognosis for hodgkin’s lymphoma ?
> 80% are cured and relapse after 5 years is rare
What is the most common type of non-hodgkin lymphoma (NHL) ?
Diffuse Large B cell lymphoma
How is LDH linked to lymphoma?
a high LDH blood test suggests a rapid growth and a poor prognosis for non-hodgkin’s lymphoma patients
LDH = lactate dehydrogenase
How is Diffuse Large B cell lymphoma treated ?
chemotherapy combined with immunotherapy
What can be a bad side effect/ complication of chemotherapy ?
neutropenic sepsis
What is the prognosis of Diffuse Large B Cell lymphoma (NHL) ?
50% of patients are cured and relapse is rare after 5 years
(NHL = non-hodgkin’s lymphoma)
What is the second most common type of non/hodgkin’s lymphoma (NHL) ?
follicular NHL
Is follicular non-hodgkin’s lymphoma painful ?
No! it is often painless and therefore not diagnosed for a while
What is the prognosis of follicular non-hodgkin’s lymphoma ?
- responds well to treatment but is “incurable”
- recurrent relapses
- 50% of patients will survive 10yrs post diagnosis
How is follicular non-hodgkin’s lymphoma treated ?
chemo or radiotherapy
Are the majority of non-hodgkin lymphomas …
a) T cell lymphomas ?
b) B cell lymphomas ?
B cell lymphomas = vast majority
Where are T cell lymphomas predominantly found ?
in the skin, can look similar to eczema or psoriasis
What type of common examination is important to do for a patient presenting with lymphadenopathy ?
abdo exam for hepato-splenomegaly
because the liver and spleen are part of the reticulo-endothelial system
What are the 2 main subgroups of non hodgkin lymphoma ?
- low grade = slow growth
- high grade = rapid growth
Which subgroup of non hodgkin lymphomas are more likely to be cured…
a) high-grade?
b) low grade?
high grade (rapid growing ones)
Who needs to be present in an MDT discussing a patient with lymphoma ?
- a haematologist
- a clinical oncologist to give advice on radiotherapy
- a radiologist to interpret scans
- a specialist histopathologist to review biopsy
- a specialist nurse
What advice is given to women of child bearing age when going through standard ABVD chemo for lymphoma ?
- fertility will remain intact
- periods may be disrupted during treatment
- don’t get pregnant during/6 months after treatment
- delay pregnancy until 2 years post diagnosis if possible as this is the most likely period for recurrence
What are some long term/late side effects of treatment for hodgkin’s lymphoma ?
depending on treatment, patients should know there’s a risk of
- second cancers
- cardiac issues
- hormonal issues
especially if they do not stop smoking
