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CSB092 > Lymphomas > Flashcards

Lymphomas Flashcards

1
Q

What is lymphoma?

A
  • malignant tumours of lymphoid origin which can arise anywhere lymphoid tissue is present
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2
Q

What are the two classifications of lymphomas?

A
  • Hodgkin’s lymphoma

- Non-Hodgkin’s lymphoma

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3
Q

What is the epidemiology of lymphomas?

A
  • more common in males

- age-dependent which varies with type

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4
Q

What is the lymphatic system?

A
  • systemic network of various tissues, glands, organs and ducts
    e. g. lymph nodes, bone marrow, spleen, liver
  • produces, stores and transports lymph
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5
Q

What is lymph?

A
  • a portion of blood plasma separated from interstitial fluid
  • contains waste from cell
  • travels one-way toward the subclavian veins to be returned to the venous system
  • lymph nodes treat and filter harmful entities
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6
Q

What are the similarities between HL and NHL?

A
  • lymphocyte origin
  • painless swelling of LNs
  • can occur anywhere in the body but most frequently occur in LNs
  • General symptoms of weight loss, fevers, night sweats
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7
Q

What is the orgin of HL?

A
  • arise mostly from b-cells
  • reed-sternberg cells
  • distinct under light micro (enlarged, multi or bi-loaded nucleus)
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8
Q

What characterises HL?

A
  • reed-sternberg cells
  • two age groups (15-40; 55+)
  • more often in upper body
  • usually contiguous nodes
  • rarely extra-nodal
  • distinct type
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9
Q

What characterises NHL?

A
  • risk increases with age (60+)
  • no site predominance
  • widely disseminated node groups
  • common extra-nodal involvement (90% stage 3 or 4 include bone marrow involvement)
  • more then 30 types
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10
Q

What is the aetiology of HL?

A
  • genetic
  • familial (siblings especially identical twins)
  • socioeconomic status-higher
  • environmental
  • infections EBV, glandular fever, HIV
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11
Q

What are the histological subtypes of HL?

A
  • lymphocyte predominant
  • nodular sclerosis
  • mixed cellularity
  • lymphocyte depleted
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12
Q

What are the signs and symptoms of HL?

A
  • lymphadenopathy (cervical and sup’clav, mediastinal)
  • splenomegaly/abdo mass
  • spread to contiguous nodes
  • alcohol induced pain
  • chest pain
  • bronchial obstruction
  • SVC obstrucion
    SYSTEMIC
  • pruritus
  • fatigue
  • bone pain
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13
Q

Where does HL metasesis extranodally to?

A
  • liver (20%)
  • bone marrow (10%)
  • bone (7%)
  • lung (5%)
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14
Q

What is used to diagnose HL and NHL?

A
  • biopsy
  • physical exam
  • full medical history
  • chest x-ray/CT
  • CT abdomen, pelvis
  • FBC
  • bone marrow biopsy
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15
Q

What is the staging of HL and NHL?

A
  • stage 1: single lymph node group
  • stage 2: multiple LNs on same side of diaphragm
  • stage 3: multiple LNs on both sides of diaphragm
  • stage 4: mutliple extranodal sites of Lns and extranodal disease
  • stage 5: bulk>10cm
    A/B
  • B symptoms: weight loss>10%, fever, drenching night sweats
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16
Q

What is the clinical management of HL?

A
  • dependent on stage
  • RT (highly radiosensitive)
  • chemo
  • combined modality
17
Q

What is the clinical management of stage IA and IIA for HL?

A
  1. extended or involved field RT, salvage chemo

2. Extended field RT then 6 cycles of chemo

18
Q

What is the clinical management of stage IIIA for HL?

A
  • may apply TNI; however chemo alone is effective
  • Chemo: Adriamycin, Bleomycin,
    Vinblastine, & Dacarbazine
19
Q

What is the clinical management of stage IIB, IIIB, IVB for HL?

A

CHEMO ABVD

  • adriamycin
  • bleomycin
  • vinblasine
  • dacarbazine
20
Q

What is the RT fields used from HL?

A
  • involved field: involved nodal group only
  • extended field: mantle or inverted-Y
  • total nodal irradiation (TNI): mantle + inverted-Y
21
Q

What is the patient positioning for RT of HL?

A
  • supine (or prone)
  • arms by side
  • handy on hips
  • elbows flexed and supported mantle board
  • vac bags
  • lung shields
22
Q

What is the RT dose for HL? (extended field following chemo)

A
  • 35Gy in 20#

- 40Gy in25#

23
Q

What is the RT dose for HL? (involved field)

A

early stage: 20Gy in 10f

advanced stage/post chemo: 30Gy in 15f

24
Q

What is the RT dose for HL? (palliative/post relapse)

A
  • 20GY in 5#
  • 30Gy in 10#
  • 8Gy in 1#
25
Q

What is the RT acute side effects for HL?

A

size of volume:

  • blood count
  • fatigue (blood count)

location of volume:

  • nausea, vomitting, diarrhoea
  • alopecia
  • erythema
26
Q

What is the RT late side effects for HL?

A
  • malignancy
  • cardiac sequelae
  • thyroid dysfunction
  • radiation pneumonitis
  • gonadal effects
27
Q

What are some consideration of side effects for paediatrics?

A
  • skeletal effects
  • stertility
  • many psychological
28
Q

What is the aetiology of NHL?

A
  • viral infection (EBV, HIV, Hep C)
  • immunodeficiency (AIDS, transplant patients, coaeliac disease)
  • environmental (peticide exposure)
29
Q

What are the classifications of NHL?

A

B CELL

  • low grade: follicular
  • high grade: burkitts lymphoma

T-CELL

  • low grade: mycosis fungoides
  • high grade: large cell
30
Q

What are the signs and symptoms of NHL?

A
  • lymphadenopthy neck

- presenting symptoms may be due to compression

31
Q

What is the common clinical management for an eldery with folicular lymphoma?

A
  • watch and wait
32
Q

What is the clinical management for stage I and II NHL?

A
  • extended field RT
33
Q

What is the clinical management for recurrent NHL?

A
  • RT to chase the spread

- chemo + RT not as effective

34
Q

What are the clinical management options for NHL?

A
  • watchful waiting
  • chemotherapy
  • MAB therapy (monoclonal antibody)
  • RT
  • steroid therapy
  • peripheral blood stem cell transplant
35
Q

What are the common treatments for cutaneous T-cell NHL (mycosis fungoides)

A
  • topical treatment (steroid creams; nitrogen mustard)

- widespread disease - psoralens and UV light or total body electrons

36
Q

What is the RT dose of Stage I, IE, II, IIE NHL?

A

24-30Gy in 12-15f

37
Q

What is the RT dose post chemo for NHL?

A

30Gy in 15f

38
Q

What is the palliative RT dose for NHL?

A
  • 20Gy in 5f
  • 30Gy in 10f
  • 4Gy in 2f
39
Q

What is the dose for splenic irradiation?

A

10-12Gy in 0.5-1.5Gy/f up to 3f/week

CSB092 (9 decks)

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