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Malignant haematology > Hodgkins lymphoma > Flashcards

Hodgkins lymphoma Flashcards

(44 cards)

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1
Q

History of lymphadenopathy

A

Duration
pAInful
changing
B symptoms
Immunosupression
Risk - HIV.TB
Cat contacts - cat scratch fever
Travel history

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2
Q

What is hodgkins lymphoma

A

Proliferation of B lymphocytes -> lymphadenopathy
Spleen and/or bone marrow can be effected

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3
Q

Physcial exam of nodes

A

Size, shape, surface, mobility, consistency
Exam of other lymph node areas
Check skin for brusing
Neuro exam if indicated eg headahces

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4
Q

Do you see changes in FBC w lymphoma

A

No - normally doesnt infiltrate bon marrow unless advanced disease

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5
Q

Referral criteria for lymphoma

A

Any patient >1cm for 6 weeks or more
Generalised lymphadenopathy eg two or more contigious areas
Supraclavicular nodes concerning

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6
Q

Initial investigation hodgkins lymphoma

A

FBC, U+Es, LFTs, ESR, LDH
Immunoglobulins (paraprotein ass)
Viral screen - HIV, hep B, EBV -

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7
Q

Why do viral screen

A

increased risk of developing lymphoma and also reactivation in chemo

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8
Q

LDH why can signla cancer

A

(non specific if high cell turnover)

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9
Q

Why do CXR in lymphoma

A

Widened mediastinum need other scans

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10
Q

What is diagnostic investigation of lymphoma

A

Biopsy of lymph node
Core biopsies via US or CT often adequate
If cant above then surgical excision biopsy

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11
Q

What cell is classical feature of hodgkins lympomha

A

Reed steinberg cell - owl eyes on film

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12
Q

What stain use in lymphoma

A

CD20 - marks B cells

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13
Q

Imaging for Staging of lymphoma

A

CT neck, chest, abdo and pelvis
PET required for some subtypes
MRI brain and spine for CNS lymphoma

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14
Q

What does PET scan show

A

Increased glycolytic acitivity of malignant tissues

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15
Q

How stage lymphoma

A

Ann arbor staing - above or below diaphragm

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16
Q

Stages of lymphoma

A

A - no B cell symtpoms, B = present
I - 1 nodal site one side of diaphragem
II - 2 nodal sites same side of diaphragm
III - if disease crosses diaphragm in nodal sites
IV - extranodal

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17
Q

What is high grade vs low grade lymphomas

A

Treat high grade
Watch and wait low grade

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18
Q

What type of lymphoma is hodgkins

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A

High grade - needs treatment

19
Q

Age distribution in hodgkins lymphoma

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A

Bimodal - teenagers and young adults and then old adults

20
Q

How often do bloods in tumour lysis syndrome

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A

Twice daily bloods

21
Q

Prognosis w hodgkins lymphoma

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A

V good - 5 year survival 80-90% if early
40-80% if later stages

22
Q

Peak incidence hodgkins lymphoma

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A

20-30 years
BIMODAL DISTRIBUTION tho

23
Q

Multifactorial causes of hodgkins lymphoma

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A

EBV infection
Immunosupression - organ transplant, immunosupression, HIV
AI conditions - RA, SLE, sarcoidosis
Familial- same sex siblings 10 x more likely develop

24
Q

What are reed steinberg cells

Study These Flashcards
A

Histological feature hodgkins lymphoma - post germinal B lymphocytes transfomation intended for apoptosis but escape and unchecked proliferation
EBV prevents cytotoxic T cell detection
EBNA1 nad LMP1 proteins contribute
Cytokines and chemokines from inflam cells inhibit Th1 response -> immunosupress and prolif B lymphocytes by IL13
HLA class I ihibtis CD8 antigen presnetation

25
Hodgkin lymphoma types
Classical Nodular lymphocyte predominant HL
26
Features of nodular lymphocyte-predominant hodgkins lymphoma
More common in males Not ass w EBV absence of RS cells - characterised by LP popcorn cells Peripheral adenopathy presents Affects mesenteric lymph nodes
27
Subtypes of classical HL
Nodular sclerosing Mixed cellularity - EBV Lymphocyte-rich - older age group Lymphocyte -depeleted - EBV
28
Subtype w worst prognosis
Lymphocyte depleted more common w HIV/EBV
29
Lymhpadenopathy in HL
Painless ASymmetrical Cervical nodes or mediastinal involvement Usually upper body Spreads continuously Spleen, axillary, abdominal, hilar, inguino-femoral Alxohol induced pain?
30
Classical features of hodgkins lymphoma
B-symtpoms 30% - fever night sweats, weight loss Pruritis Abdo pain if lymphadenopathy Rare: Clinical hepatosplenomegaly Bone marrow involvement Pel-ebstein fever
31
2 week wait vs urgent referral for HL
2 week wait in adults w unexplained lymphadenopathy considering ass symptoms CHILDREN - URGENT 48 HRS REFERRAL
32
Significance of A/B, E, S and X staging HL
A/B = presence B cell symptoms or not E = extranodal S = spleen X = bulky disease/large tumour mass
33
When is a mediastinal mass bulky and in need of radiotherapy
>1/3 mediastinal mass ratio
34
When can do regular monitoring in HL
Stage III/IV nodular lymphocyte predominant hodgkins lymphoma Unless rpaid progression or symptomatic then RCHOP
35
Treatment for stageI/II calssical HL
Chemo then radiotherapy Chemo - ABVD (BEACOPP if unfavourable)
36
When is chemo alone used in HL
NOn bulky HL <1/3 mediastinal mass ration Stage III/IV classical
37
When is radiotherapy alone used HL
Stage I/II nodular lymphcyte predom HL
38
ABVD chemotherapy drugs
Doxorubicin, bleomycin, vinblastine, dacrabazine
39
BEACOPP chrmo drugs and risk
Bleomycin, etoposie, doxorubicin, cyclophosphamide, vincristine, procabazine, prednisolone Risk of secondary leukaemia higher
40
Treatment for relapsed or refractory HL
Chemo then autologous Stem cell transplant Immunotherapeutic agents eg brentixumab vedotin, nivolumab Pembrolizumab
41
Treatment related complications HL
Myelosupression -> infection, bleeding Cardiotoxicity (anthracycline) Secondary malignancies esp AML, NHL, solid tumours eg breast and lung cancer
42
Complications disease progression HL
Hyperviscosity syndrome SVC syndrome Lymph node compression of organs or structures eg trachea, oesophagus Liver failure, bone marrow failure = end stage
43
Prognositc factors HL stage I/II
B symptoms Extra nodal High ESR
44
Prognositc factors HL stage III/IV
Male >45 yrs Lymphopenia Low Hb Low albumin, high ESR

Malignant haematology (16 decks)

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