Hodgkin's Lymphoma Flashcards
What is lymphoma?
Malignant proliferations of lymphocytes These accumulate in the lymph nodes causing lymphadenopathy but may also be found in the peripheral blood and infiltrate organs.
What is characteristic of Hodgkin’s lymphoma?
Reed-Sternberg cells Mirrim image nuclei
What are risk factors for Hodgkin’s lymphoma?
Occurs in 5-24 year olds and elderly
Affected sibling
EBV infection
SLE
Post-transplantation
What are clinical features of Hodgkin’s lymphoma?
Asymptomatic lymphadenopathy: Enlarged, non-tender, rubbery superficial lymph nodes - cervical
Cough, haemoptysis, dyspnoea
B symptoms: Fever Weight loss Night sweats
Pruritis
Lethargy
Alcohol induced lymph node pain
Mediastinal lymph nodes can cause bronchial obstruction of SVCO
What are types of Hodgkin’s lymphoma? Which has worst prognosis?
Nodular sclerosing - 70%, good prognosis
Mixed cellularity - 25%, good prognosis
Lymphocyte rich - 5%, good prognosis
Lymphocyte depleted - <1%, poor prognosis
What are investigations for Hodgkin’s lymphoma?
Lymph node excision biopsy
Image-guided needle biopsy, laparotomy or mediastinoscopy may be needed
Bloods: FBC - anaemia
Film - Reed-Sternberg
ESR
LFT
LDH - raised due to increased cell turnover
Urate
Calcium
Imaging: CXR CT/PET of CAP
What is staging of Hodgkin’s lymphoma? What are B symptoms
Ann-Arbor staging
I - Single lymph node region
II - 2 or more lymph node regions on same side of diaphragm
III - Involvement of lymph node regions on both sides of diaphragm
IV - Invovlement beyond lymph nodes - liver or bone marrow Each stage is either
A - no systemic symptoms or
B - presence of B symptoms:
Weight loss >10% in last 6 months
Unexplained fever > 38
Night sweats needing change of clothes
What is Mx of Hodgkin’s lymphoma?
Radiotherapy + chemotherapy
Adriamycin Bleomycin Vinblastine Dacarbazine
In relapsed disease - high dose chemotherapy with autologous stem cell transplantation
