Non-Hodgkin's Lymphoma

Question 1

Define Non-Hodgkin’s Lymphoma?

Answer 1

Lymphomas are malignancies of lymphoid cells originating in lymph nodes or other lymphoid tissues

Question 2

What do Non-Hodgkin’s Lymphoma consist of?

Answer 2

A diverse group consisting of:

• 85% B Cell
• 15% T Cell and NK cell forms

Question 3

What can Non-Hodgkin’s Lymphoma range from?

Answer 3

Stable indolent disease to aggressive disease

Question 4

What is the aetiology of Non-Hodgkin’s Lymphoma?

Answer 4

Complex process involving the accumulation of multiple genetic lesions
The changes in the genome in certain lymphoma subtypes have been associated with the introduction of foreign genes via oncogenic viruses (e.g. EBV and Burkitt’s Lymphoma)

Question 5

What are some of the other risk factors of Non-Hodgkin’s Lymphoma?

Answer 5

Radiotherapy 
Immunosuppressive agents 
Chemotherapy 
HIV, HBV, HCV
Connective tissue disease (e.g. SLE)

Question 6

What is the epidemiology of Non-Hodgkin’s Lymphoma?

Answer 6

Incidence increases with age
More common in males
More common in the Western World

Question 7

What are the presenting symptoms of Non-Hodgkin’s Lymphoma?

Answer 7

Painless Enlarging Mass (in neck, axilla or groin)
Systemic Symptoms (occurs less frequently than in hodgkin’s)
Symptoms related to organ involvement

Question 8

What are the Systemic Symptoms in Non-Hodgkin’s Lymphoma?

Answer 8

Fever
Night Sweats
Weight Loss > 10% body weight
Symptoms of hypercalcaemia

Question 9

What are the Symptoms related to organ involvement in Non-Hodgkin’s Lymphoma?

Answer 9

Extranodal disease is more common in Non-Hodgkin's Lymphoma than Hodgkin's Lymphoma 
Skin rashes 
Headache 
Sore throat 
Abdominal Discomfort 
Testicular Swelling

Question 10

What are the signs of Non-Hodgkin’s Lymphoma?

Answer 10

Painless Firm Rubbery Lymphadenopathy
Skin Rashes 
Abdominal mass 
Hepatosplenomegaly
Signs of Bone Marrow Involvement

Question 11

What are the skin rashes in Non-Hodgkin’s Lymphoma?

Answer 11

Mycosis Fungoides - looks like a fungal infection but is in fact a cutaneous T-Cell lymphoma

Question 12

What are the signs of Bone Marrow Involvement in Non-Hodgkin’s Lymphoma?

Answer 12

Anaemia
Infections
Purpura

Question 13

What investigations would you do for Non-Hodgkin’s Lymphoma?

Answer 13

Bloods 
Blood Film
Bone Marrow Aspiration and Biopsy 
Imaging 
Lymph Node Biopsy
Staging

Question 14

What bloods would you do for Non-Hodgkin’s Lymphoma and what would you see?

Answer 14

FBC:

• Anaemia
• Neutropaenia
• Thrombocytopaenia

High ESR and CRP
Calcium may be raised
HIV,HBV and HCV serology

Question 15

What would you see on a Blood Film in Non-Hodgkin’s Lymphoma?

Answer 15

Lymphoma cells may be visible in some patients

Question 16

What imaging would you do for Non-Hodgkin’s Lymphoma?

Answer 16

CXR
CT
PET

Question 17

Why would you do a Lymph Node Biopsy in Non-Hodgkin’s Lymphoma?

Answer 17

Allows histopathological evaluation
Immunophenotyping
Cytogenetics

Question 18

What staging would you do for Non-Hodgkin’s Lymphoma?

Answer 18

Ann-Arbor