HL & NHL

Question 1

S&S HL

Answer 1

Enlarged painless mass-usually in the neck and s/c region

33% of patients will have B symptoms
–.unexplained fevers & wt loss, drenching night sweats,

Question 2

S&S of NHL

Answer 2

Enlarged lymph nodes in the cervical region (70%)
-groin and axilla

B-Symptoms 10-15%

Question 3

Most commonly involved with NHL S&S

Answer 3

GI tract (MC)--> epigastric discomfort
Waldeyer's ring--> sore throat

Question 4

Epi/Eti HL

Answer 4

usually diagnosed before 40
1st peak–>25-30
2nd peak–>75-80

Rare in children <10yrs

No defined risk factors

Question 5

Epi/Eti NHL

Answer 5

1.5:1 male
occurs in older people 80-84

immunosuppressed

Question 6

Pathology HL

Answer 6

Always arises in lymph nodes, typically derived from B cells
predictable due to the presence of Reed-Sternberg cells

2 groups

1. Nodular lymphocyte predominant HL (not classical) most favourable
2. Classical HL 4 subtypes
   a) Nodular Sclerosing (most common)
   b) Mixed Cellularity
   c) Lymphocyte Rich (Favourable of all CHL)
   d) Lymphocyte depleted

Question 7

Pathology NHL

Answer 7

1) diffuse 60%
- B or T cell
- more aggressive
- increase involvement in bone marrow and waldeyer’s ring

2. Follicular 40%
   - B Cell origin
   - Low grade and slow growing
   - usually appear below diaphragm

Question 8

Acute side effects

Answer 8

Radiation pneumonitis–> 6-12 weeks after mantle
radiation pericarditis
shingles

Question 9

Secondary Malignancy for HL & NHL

Answer 9

Breast, lung, GI

Question 10

Disease Management HL

Answer 10

Staging sx–>Laparotomy
sx is used for biopsy and debulk

chemo: standard tx! ABVD w/ or w/out RT

Stage I&II: chemo ABVD alone or w/ chemo
Stage III&IV: ABVD and RT for recurrence

Question 11

Dose HL

Answer 11

2000-3000 for non-bulky

2000-3600 for bulky

Question 12

Disease Management NHL

Answer 12

Stage I&II Diffuse lg B cell: R-CHOP followed by RT
-30-35/150-200

Stage III&IV: RCHOP only

Stage I&II low grade follicular (indolent)
-20-30/10-20fx

Stage II&IV:

• Stage III–> observation until symptoms (no cure)
• chemo and immunotherapy
• 35-45–> TBI + BMT

NHL is radiosensitve but has limited success due to high probability of spread to other LN or organs

Question 13

Classic Mantle Field (HL)

Answer 13

Supradiaphragmatic LN
Sup: mandible Inf: T10
Shielded–> Head of humorous, lungs, larynx, occipital regions, spinal cord and heart

Question 14

Classic inverted Y field (HL)

Answer 14

Sub-diaphragmatic (disease inferior to diaphragm)

treating the Pelvic, common iliac, inguinal and PA nodes

Question 15

Classic total nodal radiation (HL)

Answer 15

All lymphatics treated
Mantle + inverted Y
APPA 6-15MV

Question 16

NHL Treatment technique

Answer 16

Whole abdomen RT
A) initially (in 2 weeks) APPA border: dome of diaphragm to top of iliac 1500/150

B) secondary (in 2 weeks) upper abdomen is treated using lateral fields.
Ant border: ant abd wall Post: ant to kidneys 1500/150

C) Boost (in 2 weeks) Wide PA node field. APPA 1500/150

Total dose 45/6-7 weeks