Haematology - lymphoma Flashcards
What is lymphoma?
A group of cancers that affect the lymphocytes inside the lymphatic system
What is the presentation of lymphoma?
Lymphadenopathy is the key symptom
May be in neck, axilla or inguinal region
Classically the LNs are not tender and feel rubbery
Some patients will experience pain in the LNs when they drink with alcohol
Other symptoms can include: Fatigue Itching Cough Shortness of breath Abdominal pain Recurrent infections
What are the B symptoms of lymphoma?
Fever
Weight loss
Night sweats
Investigations to do in suspected lymphoma
Lymph node biopsy is the key diagnostic test.
Lactate dehydrogenase (LDH) is a blood test that is often raised in Hodgkin’s lymphoma but is not specific and can be raised in other cancers and many non-cancerous diseases.
CT, MRI and PET scans can be used for diagnosing and staging lymphoma and other tumours.
What is the key finding of Hodgkin’s lymphoma on biopsy?
The Reed-Sternberg cell is the key finding from lymph node biopsy in patients with Hodgkin’s lymphoma.
They are abnormally large B cells that have multiple nuclei that have nucleoli inside them.
This can give them the appearance of the face of an owl with large eyes.
What are the two main categories of lymphoma?
Hodgkin’s lymphoma
Non-Hodgkin’s lymphoma
Epidemiology of Hodgkin’s lymphoma
Bimodal distribution with peaks at 20 and 75 years
1/5 lymphomas are this type
Risk factors for Hodgkin’s lymphoma
HIV
Epstein-Barr Virus
Autoimmune conditions such as rheumatoid arthritis and sarcoidosis
Family history
What is the staging system for lymphoma?
Ann Arbor staging
Stage 1: Confined to one region of lymph nodes.
Stage 2: In more than one region but on the same side of the diaphragm (either above or below).
Stage 3: Affects lymph nodes both above and below the diaphragm.
Stage 4: Widespread involvement including non-lymphatic organs such as the lungs or liver.
Management of Hodgkin’s lymphoma
Chemotherapy and radiotherapy with aim to cure
Usually successfully cures the disease
Risks of chemotherapy and radiotherapy for lymphoma
Chemotherapy creates a risk of leukaemia and infertility.
Radiotherapy creates a risk of cancer, damage to tissues and hypothyroidism.
What are some examples of non-Hodgkin’s lymphoma?
Burkitt lymphoma is associated with Epstein-Barr virus, malaria and HIV.
MALT lymphoma affects the mucosa-associated lymphoid tissue, usually around the stomach. It is associated with H. pylori infection.
Diffuse large B cell lymphoma often presents as a rapidly growing painless mass in patients over 65 years.
Risk factors for non-Hodgkin’s lymphoma
HIV
Epstein-Barr Virus
H. pylori (MALT lymphoma)
Hepatitis B or C infection
Exposure to pesticides and a specific chemical called trichloroethylene used in several industrial processes
Family history
Management of non-Hodgkin’s lymphoma
Combination of treatments depending on the type and staging of lymphoma
Watchful waiting Chemotherapy Monoclonal antibodies such as rituximab Radiotherapy Stem cell transplantation
