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Adult and Ped Test 7 > Lymphoma > Flashcards

Lymphoma Flashcards

1
Q

what is lymphoma?

A

It is a cancer of certain types of white blood cells. these cells circulate throughout the body in the blood stream and in the lymphatic system which part of the body’s immune system.

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2
Q

Is hodgkin’s or non-hodgkin’s more common? what is their age distributions?

A

non-hodgkin’s is more common. increases with incidence as you age. hodgkin’s is less common, and it is bimodal age distribution (early 20s and then 65-80s)

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3
Q

What causes hodgkin’s lymphoma?

A

unknown, maybe thought to be EBV and it is increased in people with immunodeficient states

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4
Q

What causes non-hodgkin’s lymphoma?

A

Risk factors include previous radiation, chemo, immuosupressive tx or conditions. Agricultural pesticides, viral infections (HIV, Hep B&C, EBV–> Burkitts, H.Pylori–> MALT), autoimmune disease (RA, SLE), family history.

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5
Q

H. Pylori can cause what type of NH lymphoma?

A

MALT, which can be cured by a regimen of PPI, and 2 antibiotics.

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6
Q

what is the most common type of NH lymphoma?

A

diffuse large B cell

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7
Q

What HL histological type is most common?

A

nodular sclerosis

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8
Q

What NHL type of cell is the most common?

A

B cell and most express CD20. T cell is less common and usually a lower survival rate.

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9
Q

What are the physical findings for HL?

A
  1. painless mass (tendency to arise in a single node, usually cervical or supraclavicular node)
  2. Mediastinal mass found on CXR
  3. B symptoms (fever, unexplained weight loss of 10% of BW over last 6 months, drenching night sweats)
  4. pruritis
  5. pain after alcohol ingestion in lymph node
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10
Q

What are the physical finding for NHL?

A
  1. B symptoms (fever, weight loss, drenching night sweats)
  2. painless lympadenopathy
  3. Type specific:
    -Indolent lymphomas: slow growing, hepatomegaly, splenomegaly
    - GI lymphoma: anorexia, n/v, early safety, fullness
    -CNS lymphoma: HA, lethargy, seizures
    (sometimes you will see skin rash, itching, alcohol pain,fatigue)
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11
Q

Do the symptoms of NHL and HL tend to be the same?

A

Yes, they tend to present the same way.

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12
Q

What is the mainstay for evaluation of lymphoma?

A

Excisional lymph node biopsy. (FNA is NOT acceptable)

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13
Q

What lab work will you want to get for HL?

A

CBC with diff: could be normal
ESR: elevated in active disease
Immunophenotyping: Reed Sternberg Cells
Histological type: 4 types, most common is nodular sclerosis

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14
Q

What lab work will you want to get NHL?

A
  1. CBC with diff: could be normal, but later you may see anemia, leukopenia, pancytopenia, etc
  2. CMP: could see abnormal LFT levels
  3. Serum LD: elevated LD indicates poor prognosis
  4. ESR: elevated
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15
Q

What other diagnostics (besides labs) may you want to order for lymphoma?

A
  1. CXR: looking for mediastinal mass
  2. CT Scan: staging, get info on nodes
  3. Bone marrow biopsy: staging purposes
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16
Q

What staging system does lymphoma use?

A

Ann Arbor System I-IV

17
Q

What could be a differential for lymphoma?

A

CMV/Mono, the other type of Lymphoma (either reed stern berg cells or no reedsternberg cells), Sarcodosis, TB, Cancer

18
Q

describe low grade NHL (indolent) lymphoma:

A

stage: rarely limited, usually extensive. It is felt to be incurable. most transform to intermediate or high-grade survival <1 year. Tend to have splenomegaly, and cytopenia. It is hard to treat this because treatment is based on active dividing cells, and these cells divide too slowly for treatment.

19
Q

Describe Follicular B-Cell Lymphoma

A

2nd most common NHL. It usually affects middle aged. There is typically bone marrow involvement, and most are B cell types and CD20 positive. The cytogenetic abnormality t(14;18).

20
Q

Describe some of the grading follicular lymphoma:

A

grade 1: 0-5 centroblasts, small cleaved.
grade 2: 6-15 centroblasts, mixed small and large
grade 3: >15 centroblasts, large

21
Q

What is prognostic index used for follicular lymphoma grading?

A 
FLIPI
uses N, LASH
nodal ()
L (LDH)
Age (60)
Stage (1/2 or 3/4)
H( hemoglobin low or high, 12)
22
Q

What is an example of low grade NHL?

A

follicular B-cell lymphoma t(14:18)

23
Q

describe intermediate to high grade NHL :

A

it is aggressive. more sensitive to chemo, higher response rates is treatment. most relapses will occur within 2years, so look for them at that point. usually exhibit B symptoms.

24
Q

What is an example of high grade NHL?

A

diffuse large b-cell lymphoma

25
Q

Describe Diffuse large b-cell lymphoma:

A

median age is 64, tend to spread to other sites. cytogenetic abnormality is t(3:22). symptomatic at diagnosis is common.

26
Q

What is the staging system for B-Cell?

A

APLES
p= performance status
e= extranodal sites

27
Q

What is mantle cell lymphoma?

A

accounts for 6% of lymphomas. very rare, but very aggressive. usually affects older men. GI tract is typically involved so you want to do a colonscopy at diagnosis. Cytogenetic abnormality is t(11:14).

28
Q

What should be included in the INITIAL WORKUP for mantle cell?

A

colonoscopy

29
Q

What is peripheral T-Cell lymphoma?

A

Poor prognosis, very rare but usually presents with skin lesions called mycosis lymbodies

30
Q

What is the treatment for HL?

A

Chemotherapy is first line

31
Q

What is the treatment for NHL?

A

indolent lymphomas: irradiation, but it is considered incurable. MALT: can be treated with antibiotics and a PPI. Diffuse large B-cell lymphoma: short course immunochemotherapy. Mantle cell lymphoma = intensive immunochemothrapy including stem cell transplantation. Primary CNS: high dose Iv methotrexate. High grade lymphomas= intense, cyclic chemotherapy and intrathecal chemotherapy at CNS…BASICALLY GIVE CHEMO AND RADIATION

32
Q

When is wait and watch appropriate?

A

asymptomatic low grade (indolent). Regular routine physician visits ever 2-3 months, with lab and CT scans. However, if patient becomes symptomatic then treatment measures need to be considered.

Adult and Ped Test 7 (18 decks)

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