9 - Haematological Malignancies (2)

Question 1

What are the two lymphoma subtypes and which is more common?

Answer 1

Hodgkin lymphoma

Non-Hodgkin lymphoma (More common)

Question 2

What is the most common type of indolent lymphoma and the most common type of aggressive lymphoma?

Answer 2

Indolent - Follicular lymphoma

Aggressive - Diffuse large B cell (DLBC) lymphoma

Question 3

What are the symptoms, diagnosis and treatment methods for Hodgkin lymphoma?

Answer 3

• Painless lymphadenopathy (common), B cell symptoms: fever, weight loss, night sweats (25%)
• Lymph node biopsy (Reed-Sternberg cells), Immunohistochemistry (subtype), PET-CT (stage)
• Chemo (early disease), combination chemo ABVD (late disease), bone marrow transplant (relapsed disease)

Question 4

What are the symptoms, diagnosis and treatment methods for follicular lymphoma (NHL) and is it aggressive or indolent?

Answer 4

• Asymptomatic or generalised lymphadenopathy
• Lymph node biopsy
• Watch and wait if asymptomatic if necessary chemo + immunotherapy
• Indolent

Question 5

What are the symptoms, diagnosis and treatment methods for diffuse large B-cell lymphoma (NHL) and is it aggressive or indolent?

Answer 5

• Rapidly enlarging mass, usually nodal but may be extranodal
• Biopsy, immunohistochemistry and PET-CT
• R-CHOP Chemo, radiotherapy and bone marrow transplant in relapse
• Aggressive

Question 6

What are the symptoms, diagnosis and treatment methods for Extranodal NHL?

Answer 6

• Extranodal mass, B cell symptoms
• Biopsy, various imaging techniques depending on site
• Depends on site, including: chemo, immunotherapy, targeted antibiotics

Question 7

What are three examples of extranodal NHLs and their characteristics?

Answer 7

MALT lymphoma - such as in the stomach, caused by Helicobacter pylori

T-lymphoblastic lymphoma - thymic mass

Cutaneous T-cell lymphoma (Mycosis Fungoides) - progression: itchy patches -> plaques -> tumour -> erythroderma

Question 8

What are the symptoms, diagnosis and treatment methods for multiple myeloma?

Answer 8

• Lytic bone lesions (bone pain, fractures), paraproteinemia (kidney damage) plasmacytosis (high plasma cells in marrow)
• FBC, urine test (protein in urine), bone marrow biopsy, X-rays and MRI (lytic lesions)
• Chemotherapy, immunomodulators, bone marrow transplant